LETTER TO THE EDITOR

1575
other means of treating and replacing teeth. At their inception implants were largely a domain of 3 specialties, namely oral surgery, prosthodontics, and periodontics, and quite rightly so because the training imparted in these specialties was needed to render sound services for practicing implantation. Implant dentistry was limited to specialists and most general dentists stuck to their limits, but this sound and healthy practice did not remain so for a long time because there was overlapping of services. The application of services became muddled so that some general dentists currently provide full implantation services, prosthodontists are placing implants, and surgeons are restoring them. Some surgeons even provide implant maintenance instead of relying on the generalist. The fall out of this gradual shift in roles has led to a decline in the practice of specialist dentistry. The very identity of the specialist is at stake because almost anyone who has acquired technical knowhow for placing implants is doing so without any assessment of knowledge and skill of any kind. Currently, the trend is that one need not be a specialist in any eld to provide implantation services and one just needs to acquire a certain amount of training and a certain number of implants to be placed before one makes the self-assessment that one is ready to treat patients on ones own. Thus, a specialist practice like drilling bone for placing implants, xing a prosthesis, and regular maintenance of the device in the long run has gone to just one person who takes up the role of all the specialists together. Will it bring an end to specialization in dentistry? It may be too early to say but I think we should look into this matter with a positive intent. Many universities around the world are imparting knowledge for practicing implantation, but there is a lack of a denite curriculum the way it exists for the dental profession. Is it the goal of dental educators to create a general dentist to provide implantation services? If so, which ones? Is dentistry capable of addressing the issue of credentialing for specic procedures? Who is protecting the patient in this problematic environment? What needs to be established at this point is a denite set of rules and regulations that will guide the universities before handing over power to practice implantation dentistry. Dental specialties also need to dene their curriculum and plan for clinical practice vis--vis implant dentistry. MANISH BHAGANIA, MDS Manipal, Karnataka, India

References
1. Nussbaum ML, Laskin DM, Best AM: Closed versus open reduction of mandibular condylar fractures in adults: A meta-analysis. J Oral Maxillofac Surg 66:1087, 2008 2. Markiewicz MR, Arce K: Methodology standards in meta-analyses [letter]. J Oral Maxillofac Surg 67:235, 2009 3. Laskin DM, Best AM: In reply [letter]. J Oral Maxillofac Surg 67:236, 2009 4. Eckelt U, Schneider M, Erasmus F, et al: Open versus closed treatment of fractures of the mandibular condylar processA prospective randomized multi-centre study. J Craniomaxillofac Surg 34:306, 2006

doi:10.1016/j.joms.2009.03.004

IMPLANTOLOGY: IS IT THE END OF THE ROAD FOR DENTAL SPECIALTIES? To the Editor :Implantology is a rapidly expanding eld of interest among specialists and general dentists. With its various applications in the rehabilitation of patients who lose some or all teeth and associated structures, it is the standard dental treatment for replacement of missing teeth. The recent development of regenerative technology with implants shows good promise for the enhancement of this method of treatment. Computed tomographically guided implant placement for severely atrophic jaws is a recent advancement that decreases the difculties and morbidity usually associated with implant therapy. The ability to use implants has become broader and the results are more reliable than ever. All in all, the future of implant dentistry looks very bright and full of hope. However, this progress is coming at a price for the dental specialties. What is the greatest harm brought about by the practice of implantology? No, not the cost of research and training facilities; these are a necessary part of any developing science. In my view, the greatest and most terrible loss is in the form of how human resources in implant dentistry are being developed. Not just an increasing number of specialists are taking up the training to learn implants, but also a large number of general dentists are being drawn towards this lucrative eld. In both cases, the acquisition of general medical knowledge and efforts of the practitioner suffer. The powerful shift in the interest and dedication of specialists in favor of practicing implantology has caused a neglect of other formerly essential aspects of practice such as traumatology, care of the medically compromised patient, and tumor surgery. Conversely, general dentists are often ill prepared to manage the complex aspects of implant care and are neglecting

doi:10.1016/j.joms.2009.03.045