Frequently Asked Questions for D4X Category
It has become apparent that there is confusion regarding the qualifying criteria for category D4X.
We have prepared these FAQs to avoid the risk that members might have selected an inappropriate category. This can result in paying an insufficient rate for the true scope, nature and extent of their clinical practice, which in turn can mean that the MDANI Dental Indemnity Insurance Policy may not respond if a claim were to be made.
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Q1. I surgically place implants, which category do I require?
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If the surgical placement of implants takes up less than 10% of your total clinical time and the conditions of the D4X category do not apply to you, the correct category for you is D4I.
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Q2. I prosthetically restore implants that have been placed by another practitioner, what category is appropriate?
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If you do not undertake the surgical aspect of implant placement, you do not require D4I or D4X (providing you do not need this through one of the other criteria), you should select the category which best meets your needs and requirements.
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Q3. When undertaking the surgical extraction of third molars, the time I spend on this specific stage is in each case only a small fraction of the total appointment time(s)...
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..When calculating whether I fall above or below the stated time threshold of 500 hours in the year to which the policy relates, is it OK to include only the time I am actually extracting the third molars or should I be including the total time I spend with the patient?
The total time spent – including any associated consultation, case assessment and treatment planning, communication (including consent) and review - should be the basis of the calculation. This is because the time threshold is intended to be an approximate indication of the overall extent of the clinician’s activity involving these procedures, which carry greater risks than many other types of procedure.
Claims and other challenges can arise from any aspect of the treatment and are not limited to the actual placing of the implant fixtures or sinus lift/bone grafting (or the actual removal of the third molars).
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Q4. I often use bone grafts when carrying out treatment that includes implants. How does that affect the category that I should be in?
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Placing bone grafts is included within any of the normal categories, and the nature of the grafting material is not in itself a factor. The normal categories include harvesting autogenous bone (ie, from the same patient) as long as the donor site is within the mandible or maxilla, and/or the use of freeze dried, cadaver or synthetic bone materials (such as Bio-Oss). However, members are advised to read our briefing document on this subject.
However, if such a bone graft is used in association with a sinus lift, then category D4X applies.
The harvesting of autogenous bone from other sites beyond the mandible or maxilla (eg, rib or iliac crest) is a maxillofacial procedure and is not covered by our any of normal practitioner categories, nor by D4X. The appropriate oral and maxillofacial category applies.
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Q5. I am a periodontal specialist. I seem to remember that under the previous definition, D4X did not apply to anyone registered as a periodontal specialist. Is that still the case?
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The previous category definition covered all forms of dento-alveolar surgery, but periodontal surgery was specifically excluded. It was the type of surgery undertaken, not the training or qualifications of the clinician, that was the determining factor. The new category wording makes it much clearer that it is only the two higher risk surgical procedures (implant placement and third molar removal) that are covered by the D4X category. If you are carrying out either of these procedures and any of the specified conditions apply (eg, the time thresholds), you need to be in category D4X irrespective of whether you are a general practitioner or a specialist (but see Q6 and Q7 below).
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Q6. I am registered as a specialist in oral and maxillofacial surgery. Am I affected by category D4X?
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No you are not. You should refer to the specific categories for oral and maxillofacial surgeons, and select the one that meets your requirements. In any of these categories, you are covered for sinus lifts, and bone harvesting from outside the mandible and maxilla. Surgical removal of third molars and/or implant placement can occupy any proportion of the total time you work although if you choose a part time category, obviously your total working hours must not exceed the stated level.
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Q7. I am registered as a specialist oral surgeon. Do I need to be in the D4I or D4X category?
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Not necessarily. If any of the conditions for inclusion in D4I or D4X apply to you, then you should be in that category. But if none of those conditions apply to you, then you should select the category which best meets your needs and requirements.
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Q8. I am a registered Specialist but don’t do any extended procedures such as implants, surgical removal of wisdom teeth or sinus lifts. Am I covered under the D4 category?
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If you are a Specialist other than an Orthodontist or Oral Maxillofacial Surgeon and don’t undertake any of the extended procedures covered under D4I or D4X you should select the DSP4 category which is for all registered Specialists (other than Orthodontists and Oral Maxillofacial Surgeons). Please refer to our Practice Category Guide for more information.