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Professional collaboration for enhanced patient management

Crawford Bain reflects on his forthcoming talk at the ADI Team Congress 2022

There is approximately 40 years of evidence demonstrating high success rates for dental implants. However, complications and failures still happen. It is, therefore, crucial that the dental team work with their patients to mitigate the risks. This requires patients to understand their own responsibilities with regards to optimising oral hygiene and attending regular review appointments. Patient management can often be one of the most difficult aspects of delivering and maintaining successful treatment outcomes in dental implantology.

This is an area that Crawford Bain has lectured extensively on around the world. He is a Specialist in Periodontology, Prosthodontics and Restorative Dentistry, having spent 40 years in specialist practice in Canada, the USA, Scotland and Dubai. He was, until recently, Professor of Periodontology and Director of Postgraduate Periodontics at the Hamdan Bin Mohammed College of Dental Medicine in Dubai. He says:

“There are virtually no absolute contraindications for dental implants, but we are aware of certain risk factors that can influence success rates. For example, failure rates among smokers used to be three times greater than in non-smokers. That doesn’t mean smokers cannot have dental implants, but it is vital that they understand the risks if they decide to proceed.”

Patient understanding is crucial for informed consent and realistic patient expectations. Crawford outlines what can make some patients difficult to manage from the start:

“We need to remember that patients seeking dental implants have already lost or will soon loose 32 teeth. In most cases, their attitude to oral hygiene is not ideal, which presents a challenge. That’s why treatment plans should always include details of the maintenance phase so that patients are made aware of their responsibilities from the outset. 

“There are several other warning signs that the whole dental team can look out for to identify patients likely to be particularly challenging. Those only interested in a major aesthetic improvement, rather than a functional one, could be problematic. Dental implants are not a replacement for teeth; they are a replacement for no teeth. Patients need to appreciate this and if not, they may be more suited to dentures that can deliver a more predictable aesthetic outcome. The other patients to be wary of are those who are more confident than you about what you can achieve. If they ‘know’ that you can get them the perfect result, even when you don’t know how you’ll do it, their expectations are likely to be beyond anything you could deliver. The Mayo Clinic puts it very well – ‘anticipate improvement, not perfection’.

“Finally, be cautious of the person with a tight deadline, such as an upcoming wedding or party. If you have 12-18 months before the big event, that provides time for proper healing and management of any complications. Where you have only a few months, you cannot guarantee results in time.”

Crawford will be exploring this topic in detail during his session at the ADI Team Congress 2022. He will address dental hygienists and therapists, commenting: 

“I will review the current evidence to provide an update on which patients are actually considered compromised and at a higher risk of dental implant failure. I will also share my own 34 years’ experience of placing, restoring and maintaining dental implants and offer delegates some advice on how to manage unrealistic patient expectations.

“It would not be unusual for staff on the reception desk or a practice manager to speak to a patient for longer than perhaps a dentist would – they could get a better sense of the patient’s personality outside the clinical setting. A dental hygienist might also see the patient 2-3 times a year, so they will have a good idea about the patient’s oral hygiene compliance and attendance. Where there are any warning signs that the patient may expect too much from dental implant treatment, these concerns need to be communicated with the dentist. From here, the team can work together to encourage improvement in oral health or attitude from the patient before proceeding with dental implants. A collaborative approach to managing the patient’s expectations will deliver much more effective results. 

“If proceeding with dental implants, it is important for all team members to document every patient conversation and to monitor them closely. If an appointment is missed, attempts to contact the patient must be recorded. It can be easy to ‘lose’ a patient in the system, but every opportunity should be taken to avoid this, especially for previously difficult dental implant patients.

“Around 95% of patients are a delight to treat, but the other 5% give us 95% of our misery. If you can identify difficult patients before they receive dental implants and manage their expectations appropriately, the whole team will be much better off.” 

The ADI Team Congress 2022 will present an array of world-class speakers discussing various topics of interest to the entire dental team. To enjoy the generous early bird discounts, register for your place online today at

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