The Building Blocks of Implant Success



Dr. Todd Engel is the founder of Engel Institute, a private teaching entity specializing in hands-on live-surgery implant training. A diplomate of the International Congress of Oral Implantologists, Dr. Engel maintains a private practice in Charlotte, North Carolina, treating complex restorative and implant cases.

In this interview, he speaks with us about his process of expanding from general dentistry into more implant cases, and advice for other dentists interested in doing the same.

Q: Dr. Engel, there are an increasing number of general dentists interested in incorporating more implant and oral surgery services into their practices. Obviously, each dentist’s journey is different, but could you share your process for embracing implant dentistry?

A: I believe that with any business – music, restaurants or medical professions – you have to move with the trends to stay relevant. This doesn’t mean leaving what you are good at, but enhancing your capabilities.

For me, the biggest trend, the fastest-growing category in all of dentistry, is dental implants.  As general practitioners, we have the “first touch” with our patients, essentially connecting them to the dental world. I see the general practitioners as the quarterbacks of dentistry. It is our job to call the play and offer various options to the patients. At that point, the patient can decide which play sounds best to them. From my personal standpoint, I felt that, in order to be a full-service operation, I needed to understand the biggest, boldest division of dentistry. The more I researched implant dentistry, the more I realized that it was something I was likely capable of doing – at least to a limited extent – in my practice.

I started by creating and maintaining a strong foundation in implant dentistry, cultivating the “know-how” and then growing and enhancing those abilities. I think of it like a song broken down to its basic elements: a good beat, good rhythm and good transitions. In our terms: a basic understanding of how I’ll approach the case, the patient options and who will provide the treatment. Once I had that down, I let my hands do more and experience more in the clinic, allowing this to pace my surgical growth.

Some general dentists won’t recommend implant procedures because they don’t subscribe to that philosophy or wouldn’t do it themselves. However, if our priority is the patient, then we need to be educated and render what is best in any given scenario. It is my goal to bring a deeper understanding of implant dentistry to the GPs because our patients deserve this level of care.

Q: It is a big jump from deciding to pursue implant dentistry to actually preparing yourself for the work of providing implant treatment. How did you go about educating yourself and equipping your practice in order to be successful?

A: Education can be challenging because this is a category of the profession that is growing and changing very quickly, and it is also a specialty that very few of us were exposed to in any major way in dental school. In my experience, again, the best thing to do is go back to basics. How did you learn to be a general dentist? Through didactic learning as well as time and repetition in the clinic. You certainly didn’t get the degree solely by sitting in the classroom; you worked on people. I felt that was a critical component in implant education. You can’t learn just by watching someone; the live component is critical.

In terms of equipment, I’ve always felt safe going to the leaders in the field, companies and people who I trust. I’ve always had that with KaVo, having used KaVo products over the last 15 years. It is a relationship where we meet in the middle: I provide the clinical knowledge and perform the treatment, and KaVo provides the technology and tools I can depend on. In many areas, technology is outpacing the knowledge of the general dentist because innovation happens that quickly. I’ve stressed to my students that they can’t just rely on technology, but also they must develop the skills. For example, we can’t just perform guided implant surgery without having the basic understanding of implant surgery, just because we feel it’s safe and predictable and will save us. I teach free-handed. I don’t want any dentist to go in with training wheels on, but rather, to know what it feels like to drill on the jaw, to do more than just hope the stent fits right.

Q: With technology moving so quickly, what do you think are the main things a dentist should expect from the manufacturers they work with?

A: Any time you’re entering into a relationship with a manufacturer – whether or not it pertains to implant dentistry – you should base that relationship on three things:

  1. The product, first and foremost
  2. The reputation of the company
  3. The people who work for that company.

As a general dentist, you have to be intentional about creating a good relationship with product people. They become partners in the success of your practice, allowing you to focus on dentistry instead of worrying about a hundred other things.

When it comes to smart product decisions, I find that travel can be a helpful metaphor. If you were visiting a country you’ve never been to before, what kind of hotel would you stay in? You can certainly go with a Travelocity special and end up in a hotel you’ve never heard of before. Me? I value brand security, where the name speaks to the quality and consistency of the experience. In dentistry, I consider KaVo equivalent to the Ritz Carlton.

Also important, I want the products to be user-friendly, something that doesn’t require a different or steeper learning curve than the competition. With handpieces, I look for durability, workmanship and reliability; when I’m in the surgical moment, I want to pick up my handpiece and know that it will function as it is supposed to. Other considerations: Comfort to you and the patient, weight, and the simplicity of surgical presets on the motor.

Q: Through the Engel Institute you are active in training other dentists looking to build their oral surgery skill set. What are common misperceptions or bad habits you regularly encounter and how do you correct them?

A: The very first thing I tell all my students is that they need to remember as beginners that their dental acumen is higher than their implant acumen. When you approach a crown, for example, your confidence is high because it is something you do all the time. Your implant acumen is not nearly the same because you didn’t get the extended training in dental school. So I warn them: This is a category of dentistry that is moving very rapidly. If you want to implement implant services in your practice, it requires nurturing. You have to be aware of your clinical ability and stay humble, but most of all … stay disciplined and fight the urge to take on cases that are outside your window of success.

People need to remember that as the quarterback, you are licensed to care for your patients and to also realize that the patient’s best care may not always belong in your hands; referrals are not a bad thing and are appropriate in many scenarios. All clinicians should have a blueprint in mind of the final outcome prior to the start, and also be mindful of what your capabilities are.

And, always act in the best interest of the patient, not yourself.

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