I was watching a fascinating series on television about the

pioneers of surgery a while ago and was amazed at the

discussions on the development of transplant surgery.

What soon became clear was that the pioneers of transplant surgery were willing to take risks on the outcomes of treatment to learn, and eventually provide a form of care that now benefits so many people. Many of the early patients would have died without this care, so the overall risk to them of having the treatment was limited, perhaps even justified.

But I am not sure such surgical experimentation would be allowed in today’s ethical and medico-legal climate. We now have to take things very carefully, step by step, which makes mewonder where the next medical leap will come from.

In the field of periodontal therapy this issue brings a dilemma. As patients demand more exotic treatments from us our skill levels must be such that we know what treatments are available and can deliver them.

Clearly we do not want to make mistakes but often one of the most effective ways to learn something is by doing it – in the knowledge that if we do make any mistakes we can learn from them. Yet in our growing culture of blame and subsequent litigation we dare not make mistakes, even honest human ones.

So how else do we learn and therefore progress in the field of clinical excellence and innovation? How do we learn the clinical and surgical skills necessary to perform periodontal therapies and implant surgery in a risk-free way? I think the answer is slowly and under guidance from people who know what they are doing.

The first step is to gain a full understanding of the scientific and clinical principles underpinning any therapy. By learning about and understanding the biological principles, classifications and natural history of periodontal diseases we can develop and institute appropriate treatment plans.

By understanding the theory and then developing the clinical skills we can then provide treatments based on those underlying principles. It will also allow us to identify suitable cases for referral.

But we must still be able to accept minor – hopefully reversible – mistakes occasionally and learn from them. Above all, we must all be professional and carry out only those procedures that are within our competence.

We must push the boundaries of our skill levels and

competence bit by bit. We may not make immediate leaps

forward but we will be developing skills slowly and safely that will ultimately benefit patients while keeping our

credibility intact.