Your Journey Through

Dental Implants
Designing a Better Way to do and
Enjoy Dentistry

By Colin Campbell

Specialist in Oral Surgery

BDS FDS RCS (Ed)

 It’s 1996.

It’s a wet, winter Saturday morning in Uttoxeter and I am a Senior House

Officer in Maxillofacial surgery in Derby, who has travelled out with my
consultant to assist in dental implant procedures in a private practice.

It’s a whole new world and I am staggered of what we’re doing and what is
possible.
Prior to that, for more than 2 years, I had been working in oral surgery and
oral medicine, and I would work for another year in oral and Maxillofacial
surgery assisting my consultant from time to time in the private practice he
would travel to at the weekends.

It was my first real introduction to

dental implants, after a very, very brief
2 or 3 lecture series at dental school in
the early 1990’s.

Dental implants weren’t here in the UK

yet, they were seen as a cult and an
outlier – how things have changed.

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 After my qualification from the
University of Glasgow in 1994 I worked
as a House Officer in perio, oral
medicine and oral surgery in Glasgow.
In 1995, I travelled to Nottingham to
work in Maxillofacial surgery, and a year
later travelled to Derby to work in
Maxillofacial surgery at a higher and
more advanced level.

I left my SHO job in 1997, finishing by assisting in a bimaxillary osteotomy

procedure, where my consultant said “you’ll miss this when you’re gone”. I
entered vocational training in 1997 with a lot of surgical experience and no
dental experience whatsoever, it was a baptism of fire.

During that time though, I carved out 30 minutes from 12:30pm-1pm on a

Monday to do oral surgery in the practice and go back to my roots. I had also
negotiated to continue to do a day case list at Derby Royal Infirmary on a
Tuesday morning, doing impacted canines and wisdom teeth etc. That
morning in Uttoxeter though had shown me if I wanted to do something in
practice where I could do the skills that I had learned, then dental implants
was likely to be it. I wanted to do oral surgery in practice, but knew that the
NHS fee scale was quite restrictive in that regard, and it was difficult to set up
a business around oral surgery.

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 By the time I
had left in 2008 I
had placed over
2,000 implants

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 I wanted to do dental implants and in 1998 I won a raffle at a Straumann
open evening and found myself at a 2-day surgical and restorative course in
Cambridge.

By the time I had left in 2008 I had placed over 2,000.

My journey was unconventional, all journeys at that stage were unconventional,

there was no pathway and there was no appropriate training.
Dental implants came from the hospital and Nobel Biocare (previously
Branimare) had cornered the hospital market in the UK, but these
procedures were seen as advanced surgical procedures usually carried out
by consultants who protected their private practice.

I placed my first implant in 1998 at a

large NHS practice in Ilkeston in
Derbyshire.

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 On the continent, it was different and
the ITI dental implant system had gone
into practices and not hospital. It was
much more restoratively lead, it was by
chance that I ended up picking that
system to start with in 1998.

Since then there has been much battle and debate about who should be
providing dental implants and the nature of the treatment; but there is no
question it is a restoratively driven specialty and the onset of guided surgery
and the introduction of digital planning has cemented that within the culture.

Sadly though, the 2-day course became the model for implant dentistry and many
people entered into implant dentistry having done 10-12 hours of training but very
little surgical experience.
Surgical aspects of implant dentistry cannot be underestimated and the
complications that can occur cannot be ignored.

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 Implants started to proliferate in dental practice in the UK in the 1990s but
much more through the early 2000s. In 2006, in Edinburgh castle at the ADI
congress, it looked like they had come of age, as Danny Buser presented a
brand new dental implant surface for the Straumann dental implant system.
From then on, it has become a battle ground of education and product with
noise and interruption everywhere; it seems difficult to make sense.

Planning to become involved in implant dentistry in your career is more than

career decision, it is a life decision.

It is not possible to be a weekend warrior anymore as it seems to be in many

other disciplines. The training pathway and the plan for development is one
which will take you through your career if you wish to be good.

The staggering fact is, that in statistics

carried out by the implant dental
companies themselves, over 90% of
people who attend a surgical implant
course are not placing implants 2 years
later. This shows how the battle for
education, and the poor quality of
prevision for training has impacted on
the confidence of the profession.

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 Other statistics show, that many
people who carry out implant
treatments place 15 or fewer
implants per year. This is simply
not enough to make the procedure
economically viable nor ethically
viable and things needs to change.

At The Campbell Academy we have always had the philosophy that dentists should be
trained to move towards 50 implants or more, or stop placing implants.

We believe this is a 5-year process for most practitioners which requires time,
finance and emotional investment, but the rewards for those who can are
fantastic and the practicing life is brilliant.

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 The Different Landscape
of Today

Things are very different now than when I started in 1998, over 20 years ago. In
my day, the GDC were unheard of and were someone you paid a small
amount of money to each year and stayed on the register unless you had
committed some horrible crime.

The CQC did not exist, and the weight of compliance that we see today was
none existent.

My early case notes in implant dentistry were laughable.

The threat of litigation was small, although did exist, but was sorted out easily
and straight forwardly by the defence unions in most cases. The commercial
pressure in implant dentistry was tiny, as there were very few people providing
the service, and very few companies involved. Those that were involved were
micro companies and their personal relationships
were fantastic. Nowadays there are more than
2,500 dental implant systems, at least on
the market, and not a day goes by
Evidence based dentistry has been where I see a different system or a
cast aside in the race for market different ‘innovation’ that I should be
share and Facebook and social media picking up.
teaching has become the norm
leading inexperienced and under
qualified practitioners into procedures
which are simply not appropriate
leading to the huge explosion of GDC
and litigation cases and the circle
seems to continue to grow.

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 What do I want to
achieve, in what
area and to what
stage do I want to
get to?

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 So, why would you enter into implant
dentistry now? Into a world that seems
dangerous, threatening and stressful, the
answer to that question is easy. If you
choose to be good and to make yourself
Nothing like this should be easy, and it the best practitioner you can be the
certainly is not, but the satisfaction and rewards will follow.
fulfilment developing into a competent and
capable implant practitioner must be one of
the best routes to take in dentistry in my opinion.

In setting out in your career, you would want to ask -

What do I want to achieve, in what area and to what stage do I want to get to?
If you wish to train as quickly as possible and as cheaply as possible, then there
are plenty of providers who will allow you the opportunity to do that, but ask
yourself the question, does this seem too good to be true? Because if it does it
usually is.

If you have already developed surgical skills you’re half way there. If you’re an
excellent restorative dentist, you’re the half that is half way there, but unless you
have both of these together you will struggle in implant dentistry and may
require the assistance of other people.

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 Remember the patients

It’s also important to remember you’re

treating patients, and that they will
assume that you have a level of
competency with which to provide the
treatment, which is completely
understandable.
Once you have decided which type of
practitioner you would like to be, and what you
would like to achieve you can start to draw your
personalised and bespoke road map towards the
goal that you wish to achieve.

At The Campbell Academy, we are very clear that we believe that for most
practitioners this will be a 5-year process, learning how to diagnose, plan, place and
manage straightforward dental implants before moving on to advanced cases and
ultimately complex cases.

We provide all the courses associated with this type of treatment in order to take
practitioners through a journey to placing 50 implants per year and beyond, which
is economically, emotionally and financially viable. The satisfaction of working
within a group of people who share the same philosophy and who discussed
implant dentistry on a regular basis over multiple platforms is one of the most
special things that the Academy has achieved. If you’re starting out in implant
dentistry and wish to be involved in a group of people such as that then this the
place for you.

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 Why 50 per year

In the old days, the specialist advisory committees of the Royal College of
Surgeons would recommend how many procedures trainees had to carry out
before they achieved competency. 50 was often the number that was associated
with surgical procedures, and 50 per year gives you the chance to place, practice
and reflect on your implant dentistry, together with developing your team. Aside
from that the indemnity fees for implant dentistry are sky rocketing and it’s simply
not financially viable at such a lower level.

Beneath that number, and heading towards 15 per year means that your dental
implant kit doesn’t come out once a month, the staff have no idea what they’re
doing and the practice has no systems in place to manage the implant patient
journey.

At the 50 per year level you can afford to attend dental implant conferences to get
better, you can do courses each year to improve and train your nurses, you can
invest in new pieces of kit and maintain the pieces of kit that you have and
develop systems associated with your implant
practice to make sure that it is safe and
improving at all times.

Below this level, you’re scratching

around as a hobby and this is not
something we believe that your
patients would want to know.

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 Why is it 5 years?
More and more dental implant courses
promise the earth in short period of
time as we head back to the weekend
warrior days. It’s not possible to pick up
straightforward implant dentistry from a
standing start in less that year, although
many courses purport to take delegates
from 0-60mph in the shortest possible
time.

You must provide cases, treat the cases and reflect upon them within a safe and
secure environment, this takes time.

Once you have secured straightforward implant dentistry you can work on your own
providing these cases and be mentored through advanced aesthetic and posterior
cases, ultimately moving on to complex cases as you provide the advanced cases.
This is not something that can be carried out in a matter of weeks or months, nor
can it be done on a crash course treating individuals who have paid money to have
implants screwed into their head in third world countries.

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 The mentoring questions?

It’s our belief at The Campbell Academy that without mentoring it’s impossible
to secure your knowledge and practice the techniques that you have learned
from implant dentistry training. We ensure that all delegates have access to
mentors in one form or another, and at an appropriate level to them to ensure
that the practical teaching that they receive, the group discussions that they
undertake and the surgical training that they’re given can be cemented in their
own practice and environment moving forwards for as long as they need.
Mentoring is essential, and the correct type of mentor and the correct
personality for individual delegates is invaluable. I’ve been involved in
mentoring for years (decades) and the thing that always falls apart in
mentoring is finance. It’s really crucial to get that sorted at the start, we assist
delegates to do that with practitioners so that it is reasonable and fair to both
parties. Mentoring becomes a lifelong friendship, and it’s wonderful to see
mentees ‘grow up’ and become colleagues, where you can discuss cases,
woes and difficulties. One of the reasons we got into
dentistry in the first place was because we’re
social animals who want to work with
people – that was right for me anyway.

The chance to work with senior

colleagues who had just become
colleagues over time is such a
wonderful privilege and one that we
have all learned from, and have reaped
the benefits for years and years;
mentoring is critical.

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 The dangers of Instagram
education
Great, formal, interactive education is
undermined by Instagram education. It is
also effected by the perception that
online and digital education is a
substitute for all. Really good online
education (and I include social media
postings in this) are an enhancement
and an adjunct to formal teaching and
hands-on clinical work. It’s hard to learn from photographs on
Facebook what you might learn in a group of
12 people who are honest and open with each
other. The internet allowed us to stop travelling so
much and to sit at home at night watching Game of Thrones scrolling through
dental pictures. That is perhaps not the way to bring a new system into your
clinical environment. The more toxic thing is that people aren’t always truthful on
social media (or ever truthful) which leads you to believe that you’re working at a
lower level that everyone else, which is wrong. The antidote to the culture which
thinks that you can learn implant dentistry on social media is to sink deep into a
tribe and a culture of people who want to continue to learn and to share the
highs and the lows with each other throughout the journey for the rest of their
careers.

That is what The Campbell Academy tribe does, that is what happens when we
meet up.

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 I wish I had known
to take more time
over the
restorative
planning aspects
at the start.

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 Things I wish I knew before I
started

Before I started in 1998 these are some of the things I wish I had known.

1. Implant dentistry is unpredictable

2. Complications in implant dentistry are common and serious

3. Lots of people in implant dentistry don’t tell the truth

4. Lots of companies in implant dentistry don’t tell the truth

5. Collect numbers obsessively

6. Evidence based healthcare is the way. If it’s not evidence based its homeopathy

7. Many companies will protect their balance sheet and their patency before they will
protect patients

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 For me, it took at least five years from
that first rainy morning in Uttoxeter until
the early 2000’s when I felt I had
become at least competent in the
diagnostics and initial planning of
straightforward implant cases.

I’ve watched with dismay as many people have tried to jump that hurdle in a year
or less
despite the fact that when I started out in implant dentistry I was already a
fellow of the Royal College of Surgeons of Edinburgh with three years of
maxillofacial surgery behind me.

I wish I had known to take more time over the restorative planning aspects at
the start, and I wish I had never lost my first 10 year’s worth of numbers in my
practice where I was an associate; it was taken over by Integrated Dental
Holdings and the computer was thrown away!

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 Questions you must ask before
you start

Before you start in implant training you must ask the following questions:
1. Where do I want to be in five years?

2. What type of practitioner do I want people to think that I am?

3. Why am I going into implant dentistry in the first place?

4. Am I a surgeon?

5. Am I a restorative dentist?

6. Do I want to practice in isolation or do I want to practice in a group of people who

will learn and grow with me as I move forwards?

7. Which system am I going to be taught, because the intangible damage of

changing systems is a real thing

8. Do I want to be rich or do I want to be good?

(Starting out by trying to be rich will not lead you to becoming good. But starting
out trying to be good will often lead to you also becoming rich)

9. Do I want implant dentistry to add to my practice and my practicing life and

increase my enjoyment of dentistry in the future?

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 Colin Campbell and the The Campbell Academy has provided implant dentistry
education in one form or another since the early 2000s. Literally hundreds of people
have been taught by the people in the Academy on an ethical and honest basis to
become good, caring and professional implant practitioners.

www.campbellacademy.co.uk | 0115 982 3919 | info@campbellacademy.co.uk

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