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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.

  • Q
    Q1. When placing implants or 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 placing the implant fixtures (or 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).

  • Q
    Q2. 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 (see Q3 below), 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.
  • Q
    Q3. I do not carry out sinus lifts via a direct external (Caldwell-Luc or similar) type of approach through the cortical plate, but I may occasionally place bone graft material under the mucosa via an internal “indirect” approach...
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    ...through an extraction socket or at the apical end of a pathway I have created to receive an implant fixture. The same might apply when it is necessary to use bone grafts to raise the nasal floor Are these “indirect” sinus wall augmentation  or “tenting” procedures count as “sinus lifts” under this category definition?  

    Yes they do. Any procedure which involves the sinus or its lining, and/or changes its anatomy in any way, is a “sinus lift” irrespective of the technique used. This applies whether or not the sinus lift was planned in advance to be part of the procedure. It is the fact of the sinus lift that matters. The same applies in the case of any procedure which alters the anatomy of the nasal floor, irrespective of whether an “open” (direct) or through-the-socket (“closed” or “indirect”) technique is used.

  • Q
    Q4. 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 Q5 and Q6 below).

  • Q
    Q5. 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 mist not exceed the stated level.

  • Q
    Q6. I am registered as a specialist oral surgeon. Do I need to be in the D4X category?
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    Not necessarily. If any of the conditions for inclusion in D4X apply to you, then you should be in that category. But if none of those conditions apply to you, then you should select whatever other category meets your needs and requirements.

© 2017 The Medical Protection Society Limited

DPL Australia Pty Ltd (“DPLA”) is registered in Australia with ABN 24 092 695 933. Dental Protection Limited (“DPL”) is registered in England (No. 2374160) and along with DPLA is part of the Medical Protection Society Limited (“MPS”) group of companies. MPS is registered in England (No. 36142). Both DPL and MPS have their registered office at Level 19, The Shard, 32 London Bridge Street, London, SE1 9SG. DPL serves and supports the dental members of MPS. All the benefits of MPS membership are discretionary, as set out in MPS’s Memorandum and Articles of Association. “Dental Protection member” in Australia means a non-indemnity dental member of MPS. Dental Protection members may hold membership independently or in conjunction with membership of the Australian Dental Association (W.A. Branch) Inc. (“ADA WA”).

Dental Protection members who hold membership independently need to apply for, and where applicable maintain, an individual Dental Indemnity Policy underwritten by MDA National Insurance Pty Ltd (“MDA”), ABN 56 058 271 417, AFS Licence No. 238073. DPLA is a Corporate Authorised Representative of MDA with CAR No. 326134. For such Dental Protection members, by agreement with MDA, DPLA provides point-of-contact member services, case management and colleague-to-colleague support.

Dental Protection members who are also ADA WA members need to apply for, and where applicable maintain, an individual Dental Indemnity Policy underwritten by MDA, which is available in accordance with the provisions of ADA WA membership.

None of ADA WA, DPL, DPLA and MPS are insurance companies. Dental Protection® is a registered trademark of MPS.