What's the difference between an implant placed by a periodontist versus a general dentist?

What "specialist surgical training" actually means

In South Africa, the route to placing implants for a specialist in periodontics and oral medicine is:

• Five years of undergraduate dentistry (the BChD).
• One year of community service.
• A single combined specialist degree — approximately four years of full-time postgraduate training (the MChD in Periodontics and Oral Medicine) — which includes implant surgery as a core component, performed under supervision in significant volumes during residency (University of Pretoria, MChD Periodontics and Oral Medicine).³
• Registration on the HPCSA specialist register.

The same is true of an oral and maxillofacial surgeon, whose specialist training is also surgical and includes implant placement as part of standard scope.

A general dentist who places implants will have done their five-year undergraduate dentistry plus additional postgraduate training, which can range from a weekend continuing-education course to a structured one- or two-year postgraduate diploma. The depth of training and the volume of cases supervised before independent practice varies very widely between general practitioners.

This does not mean that no general dentist should place implants. It means that the variance in skill and experience is much wider among general-dentist implant placers than among specialist implant placers, where there is a single recognised training pathway.

Which implant cases need a specialist?

The cases where the difference materially matters:

• Aesthetic-zone work (the front six upper teeth). Tiny errors in implant position become visible problems in the final smile. The soft-tissue contour around an aesthetic implant is at least as important as the implant itself, and managing it is core periodontal training.
• Insufficient bone. When the natural bone volume is inadequate for an implant, bone augmentation procedures (grafts, sinus lifts, ridge augmentation) are needed. These are surgical procedures within periodontal and OMFS scope.
• Multiple implants in a coordinated arch. Where four to six implants will support a fixed bridge or All-on-4 prosthesis, the implant positions must be planned together with the final prosthesis — a multi-implant case is not just several single-implant cases.
• Compromised bone quality (low density, history of radiotherapy, certain medications).
• Failing implants that need management or replacement. Peri-implantitis treatment is core periodontal scope.¹
• Patients with a history of periodontitis. Patients who have lost teeth to periodontitis carry a higher peri-implantitis risk; the placement and ongoing care benefit from periodontal expertise.

For these cases, the published consensus and the professional bodies on both sides of the Atlantic recommend specialist placement.²

Can a general dentist place a straightforward implant?

A "straightforward case" for implant placement is approximately:

• A single missing tooth (not in the front-tooth aesthetic zone).
• Site has been healed for at least three months after extraction.
• Adequate bone volume confirmed on CBCT scan; no grafting required.
• Adjacent teeth are healthy and there is no active periodontal disease.
• Adequate gum tissue.
• Patient is a non-smoker (or former smoker), in good general health, and motivated to maintain the implant.

For straightforward cases by this definition, a general dentist with substantive implant training, performing a meaningful number of placements per year, can produce excellent results. The difference between specialist and competent generalist for a straightforward single implant is marginal at the level of long-term survival.

How do I decide who should place my implant?

A reasonable approach:

1. At your consultation, ask who would be doing the placement, and what their training and case volume in implant surgery is.
2. Ask which system they use and why. Long-track-record systems matter for future serviceability.
3. Ask for a CBCT-based plan. If the case is being planned from a 2D x-ray alone, that's a red flag for anything beyond the simplest scenario.
4. Ask how peri-implantitis is detected and managed in their practice. A practitioner who places implants but does not have a clear management pathway for complications is half-equipped.
5. For complex cases, ask why specialist referral is not being recommended. A confident answer that addresses the specific complexity factors is reassuring; vagueness is not.

What we do at our practice

Implant placement at Blignaut · Kotze is performed by either Dr Leande Kotze or Dr Christa Blignaut — both are dual-trained specialists in periodontics and oral medicine, and implant surgery sits within the specialist scope each of them practises. Complex cases are discussed between both doctors before treatment begins. We place implants from major established systems with substantial long-term published evidence. We do not place implants without CBCT planning except for the simplest single-tooth cases where the clinical situation is unambiguous on conventional radiographs.

We work closely with referring general dentists and prosthodontists who restore the final crown or bridge. We send the final treatment summary back to the referring dentist and remain available for any peri-implant follow-up needed.

This article is general educational content. The right choice of practitioner for your case depends on the specifics of your case — bone, site, complexity, history. A consultation gives you the information to choose.