The provision of dental implants to replace missing teeth requires coordination and integration of staff members involved in delivering this treatment. These members form a team, with each member having a direct or indirect role to play at different stages of the journey. Close integration of these roles contributes to a safe and effective outcome for the patient. This requires timely training of the team members about their role and how each role interfaces with each other to achieve predictable treatment outcomes.

The implant team can be considered to comprise six roles, with the patient at the core or center of the implant treatment. The clinician is responsible for treatment planning as well as the preparation and execution of treatment, along with input from the dental nurse or assistant and the hygienist. Dental technicians may work remotely, but they also play an important role in the preparation and execution of treatment, including construction of the prosthesis. The receptionist and practice manager form the front office staff, and together with the implant coordinator they complete the implant team by organizing the patient's treatment. Each member's role interlinks with others like a jigsaw, and effective communication amongst all team members is crucial to ensure the best outcome. The following slides will outline the basic responsibilities of each member of the implant team. As there is great variation amongst practice settings and types, these roles and responsibilities may vary. For example, in smaller teams, some members may play more than one role.

The clinician is the key decision maker in the implant treatment. Their duties include patient assessment and treatment planning, proposing treatment options to the patient, obtaining informed consent from the patient, and executing the agreed-upon treatment. The clinician is also responsible for ensuring that all members of the implant team have been trained to the required standards for their roles. Moreover, the clinician must provide team members with the information they need to support the patient's treatment. For example, the clinician must ensure that the type, lengths and diameters of the planned dental implants are recorded so that the dental nurse or any other responsible team member can order supplies as needed.

It is important to note that a clinician may work in a variety of practice settings, from sole practitioner to group practice to a multi-specialty center where a full scope of dental services are available. Therefore, the roles and responsibilities of the clinician may vary depending on the practice setting. When there is only one clinician involved in the placing and restoring of implants, their role in leading the team is more well defined. However, when more than one clinician undertakes a patient's treatment, they must work closely together to ensure the best outcome for the patient. Each treating clinician, irrespective of being an associate or assistant clinician, incurs a legal and ethical obligation to the patient. In a group or multi-specialty practice, one clinician, often the restoring dentist, must remain responsible for coordinating a particular patient's treatment. This is a legal as well as an ethical and practical need.

The dental nurse is known as the 'dental assistant' in some countries. The nurse or assistant is instrumental in ensuring that the implant treatment proceeds smoothly and safely. This is a multifaceted role requiring detailed knowledge and information about the implant treatment, as often patients or other team members approach them with queries about the planned treatment. Thus, a dental nurse makes specific contributions at all stages of the implant treatment sequence. If the nurse is not an integral part of the implant team at every stage, the procedure can be placed at risk and the patient's care compromised. The nurse or assistant makes specific contributions at all stages of the implant treatment sequence, with roles before, during, and after the implant treatment is completed. Learn about the responsibilities of the dental nurse by clicking on each time frame. When done, click on the 'next' button at the bottom right to proceed to the next slide. Before the procedure, the dental nurse checks equipment and materials and orders items if needed. The nurse also ensures that the planned implants, biomaterials, and laboratory work are present in the clinic. This means that the nurse has to be well-versed in the planned procedure and all required instruments and materials. The nurse is also responsible for setting up for the planned procedure. During treatment, the nurse prepares the patient for the procedure, ensures that the operating team follows agreed-upon protocols in regard to asepsis and biosafety, assists the clinician, and provides support and reassurance for the patient. After the procedure is over, the nurse supports the patient and provides postoperative instructions. The nurse is responsible for clearing up as well as for ensuring correct disposal of biohazardous materials. The nurse is also responsible for documenting the materials and kit used in the patient's record.

The hygienist plays a key role by working with the clinician to ensure that the patient attains a healthy tissue foundation for the planned implants, and then works with the patient to maintain peri-implant mucosal health once the implant therapy is complete. What are some of the specific tasks that comprise this role? Click on the boxes to find out. When done, click on the 'next' button at the bottom right. The hygienist should be involved in the patient's management from the outset so that they can build a rapport with the patient while highlighting the importance of a good home care regime. This includes educating the patient on plaque control methods and available oral hygiene aids. If necessary, the hygienist also provides treatment to stabilize the periodontal health prior to implant placement. During these patient encounters, the hygienist can identify potential challenges to plaque control and adequate oral hygiene, such as issues with dexterity. These concerns can then be passed on to the clinician. On occasion the implant treatment sequence may extend for a long period of time. In this case the hygienist may also provide interim care to ensure that the patient maintains optimal oral health. The hygienist's pretreatment involvement with the patient forms the basis of the posttreatment maintenance regime, which is implemented as soon as the implant treatment is completed. The hygienist demonstrates how to remove plaque around the implants and the prosthesis and provides ongoing maintenance care customized to the patient's needs. During these appointments the hygienist monitors the peri-implant mucosa and refers the patient to the clinician as needed.

Front office staff such as receptionists and practice managers are often overlooked as implant team members. Their role in meeting and greeting patients and putting them at ease is crucial to optimize the patient's experience in their implant journey. In fact, the patient may raise concerns with these team members in the first instance, and they often are able to appease the patient. Click on each position to learn more about the responsibilities of these staff positions. When done, click on the 'next' button at the bottom right. Receptionists are the patient's first point of contact in the implant clinic. As such, they are pivotal in easing any fears or concerns the patient may have about the treatment. The receptionist books and changes the patient's appointments and deals with any patient queries regarding their appointments. The practice manager is involved in the financial arrangements for the planned treatment. They handle patient concerns and complaints and, by being only indirectly involved with provision of treatment, often provide the patient with an independent voice at the time of concern. In doing so, the practice manager acts as an interface between the clinician and the patient.

Implant coordinators have an overarching role in the execution of implant treatment. Some implant coordinators are clinically trained, such as a dental nurse or assistant, and may therefore be able to undertake very detailed discussions with the patient. Regardless of the coordinator's background, it is the responsibility of the clinician to ensure that the coordinator has the in-depth knowledge, understanding, and clarity needed to discuss the planned treatment with the patient. However, even if the implant coordinator is highly knowledgeable, the ultimate responsibility for patient consent and detailed discussion about the treatment and its risks lies with the clinician. What are some specific tasks assigned to this staff member? Click on the box to find out. When done, click on the 'next' button at the bottom right. Implant coordinators generally act as the intermediary between the patient and the rest of the team. This interaction is often focused on the initial planning stages and involves discussion of the proposed treatment as well as the time, compliance, and commitment that will be required on the part of the patient. Implant coordinators also make themselves available to answer patient queries about the proposed treatment. During the active course of treatment, implant coordinators normally work closely with the clinician and in many situations will be the first point of contact for the patient. Coordinators follow up with the patient after treatment completion. They may also interface with implant company representatives when appropriate and advised by the clinician.

The dental technician fabricates the prosthesis, the end result of the implant treatment and one that the patient will see daily. The technician is therefore vital to a successful outcome. In the pretreatment phase they assist the clinician in developing the final planned implant positions via diagnostic wax-ups or set-ups, and by making radiographic and surgical templates. Technician involvement early in the planning process will help in minimizing any unforeseen issues, especially when patient expectations are high. Communication with the dental technician either verbally or through videos or photographs is key to optimizing the outcome. The technician may meet with the patient either independently or jointly with the clinician, usually for the purposes of shade matching. In more challenging cases, a joint face-to-face meeting can help to achieve a good end result. When a technician meets with a patient independently, they must ensure that any concerns are passed on to the clinician or implant team to avoid miscommunication or mishaps. It is important that the clinician retains ownership of any decision-making.

Implant Team Roles and Responsibilities, Key Learning Points: The clinician is the team leader and is responsible for ensuring that all team members are adequately trained for their roles. The dental nurse or assistant ensures the smooth delivery of treatment at all stages of implant therapy. The hygienist educates the patient on effective home care procedures and monitors for changes that indicate potential peri-implant problems. The front office staff have an important role in listening to the patient's concerns and putting them at ease. The implant treatment coordinator serves as an interface between clinician and patient regarding all aspects of the implant treatment. The technician should be involved in the implant treatment planning from the outset.

This arrow represents the patient's journey throughout implant treatment. Five milestones in this journey are marked by the circles: the initial patient visit; assessment and treatment planning; treatment proposal and patient consent; execution of implant treatment; and continuing care. Different team members participate in this journey at various milestones. Some are more closely involved, and others are more peripherally involved. These relationships will be depicted in the following slides. Regardless of the level of involvement, all team members should be aware of the end point of the journey.

The hygienist typically plays a role in the assessment and treatment planning by undertaking a full periodontal evaluation including probing charts. Prior to implant insertion, the hygienist performs preliminary treatment to stabilize periodontal health and provides oral hygiene instructions. During the continuing care phase, the hygienist provides the patient with the required instructions for cleaning around the implant-retained prosthesis and monitors the peri-implant mucosa.

As discussed previously, the dental technician may play a role in the treatment planning stage. For example, the technician may create a diagnostic wax-up and fabricate a radiographic template. The technician's primary role is to fabricate the final prosthesis (as well as the provisional prosthesis if indicated). Because the technician usually works remotely from the clinician, this role has been placed outside of the circles in the diagram. During the course of treatment, the technician will communicate with the clinician as well as the nurse or assistant and front office staff.

In this example of an implant journey, the patient presented with missing lateral incisors. With the aid of the nurse, the clinician planned the patient's treatment. The hygienist performed an initial periodontal assessment, and the technician contributed the diagnostic wax-up and radiographic templates. The clinician then finalized the treatment plan with the patient. The hygienist performed prophylaxis and gave the patient appropriate home care instructions. The clinician along with the nurse then undertook the surgical implant placement. This was followed by the prosthetic phase, in which the team communicated with the technician to produce the final crowns. The patient returned to the clinic at regular intervals so that the clinician and hygienist, with the aid of the nurse, could monitor the patient's prosthetic and peri-implant status. Under the direction of the clinician, the nurse played a key part in ensuring that all items needed for each appointment were available so that the journey progressed smoothly. The implant treatment coordinator pulled the different treatment steps together, working with the practice manager and receptionist to ensure that the patient was well informed and appointments booked to ensure a successful outcome. It is important to note that, regardless of the duration or complexity of the treatment journey, the points at which the patient interfaces with different team members - as well as the interactions amongst the team itself - remain the same. This enables a consistent and safe approach to the care of the patient. Team members should use an open and honest approach to care so that concerns can be dealt with effectively and optimally.

Team Member Contribution Throughout Patient Journey, Key Learning Points: All team members should be aware of the end point of the patient's implant journey. Communication amongst team members is important to achieving a successful outcome. The clinician and nurse participate in all stages of the patient's implant treatment. The hygienist has a role in patient assessment, oral hygiene and health during the active treatment phase, and continuing care. The dental technician is often involved in the planning stage and fabricates the prosthesis during the active treatment phase. The implant coordinator and front office staff are involved at various points throughout the patient's implant journey.

Smooth delivery of implant therapy requires a well-trained team. In their role as team leaders, the clinicians establish the training requirements for each staff member. Some of the required knowledge is generic core knowledge that applies to all team members. Everyone involved must have an overall understanding of the implant journey and an awareness of the required appointments and their timeline, from planning to surgical steps to provision of the prosthesis. This includes an understanding of the costs involved as well as information to be provided to the patient to ensure initial and ongoing consent. This core knowledge is supplemented by specific training that allows each individual to perform their role successfully. These training needs are outlined on the following slide.

The five roles that support the clinician are depicted here. What do these team members need to know to fulfill their responsibilities in the course of the implant journey? Click on each role to find out. It is important to note that these lists are by no means exhaustive. When done, click the 'Next' button at the bottom right to proceed to the next slide. The dental nurse or assistant needs education in surgical and prosthetic procedures and the related armamentarium, including the implant systems and biomaterials used by the clinician. The nurse must also be well trained in biosafety and infection control. It is helpful if the nurse is familiar with the risks associated with implant therapy as well as potential complications and their treatment. The nurse should also be trained in instructing the patient on postoperative care. The hygienist should have knowledge of implants, components and different types of prostheses as well as normal peri-implant anatomy. A hygienist should also be knowledgeable in current protocols for assessing implant parameters and the criteria for implant success. The hygienist should be trained in maintenance procedures and the use of the appropriate armamentarium. The clinician should also ensure that the hygienist is capable of providing patient education and prescribing self-care regimes. The implant coordinator often has a clinical background that forms the basis for much of their knowledge. If not, the coordinator will require training in all planned treatments and techniques so that they can answer patient queries as needed. Education in potential complications is also helpful. The clinician should ensure that the coordinator has knowledge of the consent process and required treatment documentation as well as the medicolegal implications of both. The receptionist and practice manager need to know what the implant treatment involves in terms of number, type, and length of appointments. They should also be familiar with complications so that they can schedule the patient accordingly if a complication does in fact arise. The clinician is not directly responsible for the training of the technician; however, it is the responsibility of the clinician to ensure that the technician is well versed in the implant system being used as well as the fabrication techniques of the planned provisional and final prostheses.

The clinician with possible assistance from the practice manager will explore the training needs of the team members, both at an individual level and as a team. Often training needs are established via informal discussion or by observation. In addition to training to suit the treatment provided by the practice, there are also likely to be local jurisdictional training requirements that have to be met. The clinician should use a system of appraisal whereby the expectations of the role are discussed, current knowledge and skills are assessed, and specific training needs are established. These needs are then written into a personal development plan or PDP, which is owned by the team member. At the end of the process, a structured plan is agreed upon, including how and when the identified training needs will be met. A further duty of the clinician is to ensure that team training is up to date and maintained. The practice manager may assist in this effort.

Whilst the clinician will establish training needs, the team members should become part of the training development plan for the practice. The team members have a role in establishing their own learning needs, both as a group and as individuals. As a group, the team should ensure that generic training needs are aligned with job roles. The team should also highlight their group training needs using honest communication with the clinician as team leader or with the practice manager. Finally, all team members should be respectful of each other's roles.

Individual team members have a responsibility to engage proactively in establishing and fulfilling their own training needs. The personal development plan cycle is a structured framework in which individuals define and map their own educational needs and assess their own progress. The PDP cycle should be an integral part of each team role. Self-reflection and learning are the keys to personal enhancement and development and contribute to job satisfaction. Every team member should identify their own learning needs through self-evaluation. All members also have a responsibility to ensure they map these learning needs and that these harmonize and complement those of other team members. These needs should be communicated to the team leader or practice manager. Use of the PDP cycle will help the team member to gain confidence in discussing challenges and issues related to training, especially when expected tasks are beyond one's competence. Further information on the PDP cycle can be found in the ITI Academy Learning Module "Designing and Documenting Your Personal Development Plan".

Implant Team Training Needs, Key Learning Points: The implant team has shared as well as individual, role-specific training needs. Training needs are a joint responsibility between the clinician and team members. The clinician as the leader is responsible for establishing and implementing training. Team members are responsible for identifying and communicating their own learning needs using the personal development plan cycle. Team members should be confident to raise concerns about their own limitations.

Although access to training in dental implantology is plentiful for clinicians, the availability of formal implant courses for other members of the dental team is limited. Dental nurses or assistants are the intended audience for most of the courses on offer. However, not all of these courses are formally accredited. Thus this places the onus on the clinician - as leader of the team - to ensure that appropriate and customized training is implemented for the safety of the team and the patient. Initially, introductory training can be implemented through self-directed learning using resources such as books and journal articles. Self-directed learning can also be used to enhance and reinforce formal training courses. Another resource for staff training materials is the ITI Academy. The next slide gives an overview of how to access some of the available training. The training program followed by each team member will depend on their own development needs. Thus, before enrolling in any program or course it is important to ensure that its learning objectives align with the team member's own personal development plan.

Training for the team can be obtained in different ways and from different sources. The most appropriate means of training will depend on the specific practice setting and environment. This table shows some of the different venues for training. If access to other learning opportunities is limited, a team member can be trained on a one-to-one basis using mentoring, coaching, and on-the-job training. This often involves the stepwise 'tell-show-do' style of learning. In this strategy, the team member is given theoretical knowledge and information related to the skill being taught; then they are shown how to perform the skill and assisted in delivering it before being allowed to perform it independently. In implantology this is probably the most common way of learning, although shortcuts are often implemented in this stepwise approach. Training can also be obtained on a small-group basis. In this scenario, a member of the dental practice can train other team members on implant skills. Alternatively, a trainer from an outside organization or company can be hired to train the group. Accredited courses can be completed in person or online and can culminate in a certification in implant dentistry. Such courses are largely focused on dental nurses and assistants, with fewer courses available for technicians, receptionists, practice managers, and hygienists. Because implant dentistry is a clinical activity, the best courses are a combination of interactive discussion and simulated training.

Team Roles and Training in Implant Therapy, Module Summary: Safe and effective implant treatment is delivered through the use of a well-trained multi-professional team. Communication and integration amongst team members is critical to ensure the effective delivery of care for the patients throughout their implant treatment journey. The clinician who leads the team should ensure that the training needs of its members have been established and a plan for delivery of the training has been created. Team members have responsibility for their own lifelong learning utilizing self-reflective practice and a personal development plan.