The journey to replacing a missing tooth often leads to a crossroads: which type of dental professional should you see? The world of dentistry has many specialties, and for patients, the distinctions between them can be confusing. Two roles that are frequently mixed up are the general dentist and the orthodontist. When it comes to dental implants, a common question arises: who performs the procedure?
The short answer is that dental implants are performed by dentists with advanced training in surgery and restoration, not by orthodontists. However, the full picture is more nuanced. The success of a dental implant relies on the expertise of several dental professionals, each playing a distinct role. This guide will clarify the roles of different dental professionals, explain why orthodontists do not place implants, and describe the collaborative process that leads to a successful, lasting tooth replacement.
Who Performs Dental Implants An Orthodontist Or Dentist?
Understanding the Roles: Dentist vs. Orthodontist
The confusion often stems from a lack of clarity about what each professional does. Both are doctors of dental surgery (DDS) or dental medicine (DMD), but their post-graduate training paths diverge significantly.
The General Dentist
A general dentist is your primary care provider for oral health. They are trained in a wide range of procedures, from cleanings and fillings to crowns and extractions.
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Education: Four years of undergraduate study followed by four years of dental school.
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Scope of Practice: General dentists are licensed to perform a vast array of procedures. With additional training and experience, they can perform complex procedures, including the surgical placement of dental implants.
The Orthodontist
An orthodontist is a specialist in the alignment of teeth and jaws. Their focus is on correcting bites and straightening teeth using braces, clear aligners, and other appliances.
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Education: The same four years of dental school, followed by an additional two to three years of full-time residency in an accredited orthodontic specialty program.
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Scope of Practice: Their entire focus is on moving teeth. They do not perform surgery, place implants, fill cavities, or extract teeth. Their expertise lies in the mechanics of tooth movement and jaw development.
Who Actually Places the Dental Implant?
The surgical placement of a dental implant is a procedure that requires a specific set of skills and training. Several types of dentists are qualified to perform this surgery.
1. Oral and Maxillofacial Surgeons
These are the specialists most commonly associated with implant surgery.
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Their Training: After dental school, they complete a rigorous four-to-six-year hospital-based surgical residency. They are trained in all aspects of surgery of the mouth, face, and jaws, including complex bone grafting, treating facial trauma, and administering all levels of anesthesia.
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Their Role: They are the go-to experts for complex cases. If a patient has significant bone loss, requires extensive grafting, or has a complicated medical history, an oral surgeon is the safest and most skilled choice.
2. Periodontists
A periodontist is a specialist in the supporting structures of the teeth, namely the gums and the jawbone.
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Their Training: They complete an additional three years of training focusing on the prevention, diagnosis, and treatment of periodontal disease, and in the surgical placement of dental implants.
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Their Role: They are experts in the foundation of the mouth. If you have a history of gum disease, a periodontist is uniquely qualified to manage your soft tissue health and place your implant. They are masters of achieving a beautiful, aesthetic result for the gums surrounding the implant.
3. Prosthodontists
A prosthodontist is a specialist in restoring and replacing teeth.
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Their Training: They complete three additional years of training focused on complex dental restoration, including crowns, bridges, dentures, and implants.
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Their Role: While some prosthodontists surgically place implants, their primary expertise lies in the restoration phase—designing and fitting the artificial tooth (crown) that attaches to the implant. However, many are trained to perform both the surgical and restorative phases.
4. General Dentists with Advanced Training
An increasing number of general dentists are performing implant surgery.
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Their Training: While not specialists, these dentists have taken extensive continuing education courses, often hundreds of hours, in implant dentistry. They may have completed mini-residencies or earned fellowships from organizations like the International Congress of Oral Implantologists (ICOI).
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Their Role: For a straightforward case in a healthy patient, a highly trained general dentist can handle both the surgical placement and the final crown. This can be convenient and cost-effective for the patient.
The Orthodontist’s Role in the Implant Process
So, where does an orthodontist fit in? While they do not perform the implant surgery, they are often a crucial part of the team for patients who need both orthodontic treatment and implants.
1. Creating Space
If you are missing a tooth and the surrounding teeth have shifted into the gap, there may not be enough room to place a properly sized implant crown. An orthodontist uses braces or aligners to move the teeth back into their correct positions, opening up the ideal amount of space for the future implant.
2. Uprighting Tilted Teeth
Teeth adjacent to a missing space often tilt or drift. The orthodontist can upright these teeth, ensuring they are in a stable position and allowing the implant surgeon to place the implant at the perfect angle.
3. Managing Missing Teeth in Young Patients
For a child or teenager who loses a permanent tooth, an implant cannot be placed immediately. The jawbone is still growing, and an implant would fuse to the bone and not move with the jaw, leading to severe problems later in life. In these cases, an orthodontist will manage the space, often with a retainer or by incorporating a temporary replacement tooth into braces, until the patient is old enough (typically late teens or early twenties) for an implant.
A Typical Timeline for a Patient Needing Both Services
The collaboration between an orthodontist and an implant surgeon is common. Here is what that process might look like:
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Consultation with Dentist: You see your general dentist for a missing tooth. They refer you to an orthodontist.
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Orthodontic Phase: The orthodontist creates a treatment plan to move your teeth and open the correct space for the implant. This can take anywhere from 6 to 18 months.
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Consultation with Surgeon: When the orthodontic work is nearly complete, you see the oral surgeon or periodontist. They take a 3D X-ray (CBCT) to evaluate the bone.
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Implant Surgery: The surgeon places the titanium implant post. They may also perform a bone graft if needed.
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Healing Phase: You wait 3-6 months for the bone to fuse to the implant in a process called osseointegration.
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Final Restoration: Your general dentist or prosthodontist places the final abutment and crown on the implant.
Conclusion
To answer the initial question directly: an orthodontist does not perform dental implant surgery. Implants are surgically placed by oral surgeons, periodontists, or specially trained general dentists. The orthodontist’s role is one of preparation, using their expertise to align teeth and create the perfect environment for a successful implant. The best outcomes are achieved through a collaborative team approach, where each specialist contributes their unique skills to restore your smile.
FAQ
Q: Can my regular dentist do my dental implant?
A: Yes, many general dentists now offer implant placement. However, you should ask about their specific training and experience. Ask how many implants they have placed and what their success rate is. For complex cases, they may still refer you to a specialist.
Q: Why would I need to see an orthodontist before getting an implant?
A: If the teeth around the gap have shifted, tilted, or if the space is too small, an orthodontist is needed to realign the teeth and create the correct amount of space for a functional and aesthetic implant. Placing an implant in a space that is too small or at a bad angle can lead to failure.
Q: Is it better to see a specialist or a general dentist for an implant?
A: It depends on the complexity of your case. For a routine implant in a healthy patient with good bone, a skilled general dentist is a fine choice. For a case involving significant bone loss, a history of gum disease, or other medical concerns, an oral surgeon or periodontist is the safest and most predictable option.
Q: Does the orthodontist place the crown on top of the implant?
A: No. The crown (the visible tooth part) is fabricated and placed by a restorative dentist, which is usually your general dentist or a prosthodontist. The orthodontist’s job is done once the teeth are aligned and the space is ready.
Additional Resource
To learn more about the different dental specialties and what they do, visit the American Dental Association’s patient education site: https://www.mouthhealthy.org/
