Dental Implants

The stance adopted by certain other indemnity providers in relation to implants leads to a regular stream of enquiries being made to our Membership department.

Implants are used not only in prosthodontics and restorative dentistry but also in orthodontics, where mini implants are sometimes used to provide anchorage. All the above forms of implants are covered by this position statement.

For subscription purposes, Dental Protection defines a dento-alveolar procedure as one which involves the intra-oral tissues, teeth and tooth-carrying bones i.e. mandible and maxilla only. Any implant placed and contained within these tissues - with or without bone grafting which is also contained within these tissues - is considered to be a dento-alveolar procedure and is generally included within our standard subscription rates.

There are three main exceptions to this, where additional subscriptions might apply: -

1. Where surgical dento-alveolar procedures (including, but not restricted to the placement of implants) are occupying more than 10 hours per week on average (more than 500 hours per subscription year), whether or not a member's total clinical activity exceeds this. Grade OMD applies (refer to subscription section of our website for the rate which currently applies). This cumulative threshold relates to all kinds of dento-alveolar surgery, including third molar removal, for example.

2. Where any part of the procedure or associated procedures (such as bone grafting) includes or extends to tissues other than those defined above, Dental Protection defines such procedures as "group 1 maxillofacial procedures". This includes any kind of sinus lift and/or bone harvesting from outside the dento-alveolar tissues.

The correct membership grade (and hence, subscription level) is then determined by the number of hours per year that the member is undertaking procedures of this nature. Refer to subscription section of our website for the rates which currently apply.

3. Where an individual dentist is felt to represent a particularly adverse risk for the mutual fund, by virtue of his/her own risk profile (involvement in implant dentistry might be one of many considerations within this evaluation), that member may be invited to join Dental Protection's Adverse Risk Member (ARM) programme.

Additional subscriptions are payable in one of 10 membership grades according to the assessed level of risk, and a structured and targeted risk management support programme is provided with the aim of reducing the risk and allowing the member to return to normal subscription grades wherever possible.

Dental Protection's view is that that this member-by-member approach is more equitable than simply loading the subscriptions of all dentists who are involved in implant dentistry, many of whom are extensively involved in these procedures with no problems.

Dental Protection's membership categories are continually under evaluation and the subscription rates are reviewed in April of each year.

Training
Dental Protection is not the arbiter of clinical opinion, nor of the adequacy of training courses in this or any other field. But as with all procedures, members should ensure that they are suitably trained and experienced before undertaking these procedures without supervision.

Dental Protection is currently considering the need for a specific membership grade for dentists whose only involvement in implant dentistry is within a formal, recognised training programme and under supervision. If there is any future change to our policy, it will be reflected in an updated version of this position statement in due course.

Placing implants outside the UK
When setting subscription rates, there is no cross-subsidy between medical and dental rates, nor between members working in different countries. Subscription rates in each country are set on expert actuarial advice and they aim to be fair and equitable across the whole membership. This position statement applies to the UK only. In some international jurisdictions where Dental Protection membership is available, a disproportionate share of the total case-related expenditure is incurred in connection with dental implants. In these countries (for example, Israel and some countries within the Caribbean region) additional subscription rates are payable by any clinicians who are involved in implant dentistry.

Last revised December 2006