When is a dentist genuinely ready to start placing implants, and what is the biggest mistake new placers make?
Readiness is less about years in practice and more about having a solid foundation in surgical extraction, flap management, and reading a CBCT. A dentist who is comfortable with a surgical extraction and can visualize three-dimensional anatomy on a scan is in a much better position than one who has been in practice for 20 years but has avoided surgery. The most common mistake new placers make is choosing cases that are too difficult too early — a narrow ridge, a posterior maxilla with a low sinus, or a patient with significant bone loss. Starting with straightforward cases in the anterior mandible, where the anatomy is forgiving and the bone is dense, builds the muscle memory and confidence that carries over to harder cases later. Patience in case selection in the first 6 months pays dividends for the rest of a career.
How should a general dentist think about the decision to treat a periodontal case in-house versus referring to a specialist?
The honest answer is that most general dentists can safely manage a wider range of periodontal cases than they currently do — but the decision should always be driven by the complexity of the anatomy, not by the desire to keep the fee in-house. Cases involving furcation involvement beyond Class I, significant vertical bone loss, or patients with poorly controlled systemic conditions that affect healing are generally better managed by a periodontist. Where general dentists can add real value is in early-to-moderate disease: osseous resection in straightforward posterior sites, connective tissue grafting for isolated recession defects, and crown lengthening for restorative purposes. The key is having a clear referral threshold in your mind before you start — and communicating openly with the patient about why you are referring when you do.
What does the evidence actually say about socket preservation grafting — is it always worth doing after an extraction?
The evidence supports socket preservation as a meaningful intervention when implant placement is planned but will be delayed by 3 months or more, particularly in the aesthetic zone or in sites with thin buccal bone. In those situations, grafting demonstrably reduces the amount of ridge resorption that occurs during healing and can simplify the subsequent implant surgery. Where the evidence is less compelling is in the posterior mandible with thick buccal bone and no planned delay — in those cases, the socket often heals with adequate volume without grafting. The practical takeaway is to think about socket preservation as a site-specific decision: consider the anatomy, the planned timing of implant placement, and the aesthetic demands of the site, rather than applying it universally to every extraction.
