GENERAL DENTISTS, DENTAL SPECIALISTS, OR BOTH? A NARRATIVE REVIEW OF WHO SHOULD PERFORM SPECIALISED DENTAL PROCEDURES SUCH AS DENTAL IMPLANTS AND ORTHODONTIC TREATMENT

Objective: To appraise the evidence and regulatory context on whether specialised dental procedures, including dental implants, orthodontic treatment and complex endodontics, should be performed by general dentists, dental specialists or both. 
Methods: A narrative review was undertaken of peer-reviewed comparative studies, systematic reviews, and regulatory and workforce documents relating to provider training and treatment outcomes, with emphasis on the South African context. Findings were synthesised thematically. 
Results: Direct comparative evidence is limited, largely observational and heterogeneous. For dental implants, a meta-analysis found no significant difference in failure between specialists and non-specialists (odds ratio 1.24), but failure differed significantly when experience was defined by the number of implants placed (odds ratio 2.18), suggesting that procedural experience matters more than professional title. Single studies in orthodontics and endodontics reported better outcomes among specialists, although case selection and design limitations preclude causal conclusions. South African regulation permits general dentists to practise broadly without formal competence-based credentialing for advanced procedures, while specialists are few and concentrated in the largest urban provinces. 
Conclusion: Neither exclusive specialist provision nor unrestricted general practice is supported by the available evidence. A competence-based, risk-stratified, collaborative model is proposed in which general dentists with verified, structured training manage lower-complexity cases, and specialists manage complex cases and act as referral and mentoring partners. Formal scopes of practice, accredited training pathways, referral protocols and outcome audit are needed.