BCDIS framework
Implant Case Complexity Tool
Classify a planned implant case against the BCDIS Implant Case Complexity framework — five levels, ICC I to ICC V, scored across six domains.
BCDIS independent guidance — established by the BCDIS Board. BCDIS ICC supplements existing guidance. It does not replace regulatory or professional obligations, and is not endorsed by any regulatory or professional body.
ICC Tool v1.0 · 12 September 2026
Classify a planned case
Seven groups of questions about the patient and the proposed treatment. Choosing an option moves you straight on.
Score what you have planned, not what might become necessary. Where the framework gives a range rather than a level, the tool shows you its words and asks you to record the level.
If something is not yet determined, say so. An undetermined domain produces classification incomplete rather than an artificially low score.
Nothing you enter is stored or sent anywhere. There is no account, no cookie, no saved answer and no patient identifier field — it all lives in this tab and is gone when you close it.
The principle the whole framework rests on
Case complexity describes the patient and proposed treatment. Competence describes the clinician. A qualification, case count or complexity label alone does not establish competence for every procedure within a category.
Why the College proposes this
Implant dentistry has no shortage of ways to describe a difficult case. What it lacks is a shared, written scale that a clinician, a mentor and a committee can all point at when they disagree about whether a particular plan is within someone's reach.
BCDIS ICC supplements existing professional guidance. It does not replace it.
The five levels
Each level carries an expected training position — where a clinician would ordinarily have reached before planning a case of that kind independently.
| Level | Indicative features | Expected training position |
|---|---|---|
| ICC I — Routine | Healed single or short-span site, adequate bone envelope, stable occlusion and periodontium, no augmentation. | Core independent case following assessed implant training. |
| ICC II — Routine Plus / Minor Augmentation | Minor contour deficiency managed with particulate graft and membrane; a stabilised risk modifier that does not change the plan. | Expected within a Level 11 pathway after supervised and assessed experience. |
| ICC III — Advanced | Immediate placement; augmentation to create the site; transcrestal sinus elevation; soft-tissue grafting; parafunction; selected immediate or early provisionalisation. | Only those ICC III procedures specifically taught, supervised and assessed — competence stays procedure-specific. |
| ICC IV — Complex | Compromised aesthetic socket; block, staged or vertical reconstruction; lateral-window sinus augmentation; full-arch reconstruction; partial extraction therapy; major occlusal alteration. | Post-diploma advanced development: structured training, mentorship and documented procedure-specific experience. |
| ICC V — Highly Complex / Extended Scope | Zygomatic, pterygoid or extramaxillary anchorage; severe-atrophy reconstruction; rescue of a failing full-arch system requiring extended scope. | Dedicated extended-scope training and substantial procedure-specific evidence. Not conferred by a general implant diploma. |
How the level is reached
The overall level is the highest material domain score. Beyond that, three rules do the work:
- Two or more domains scoring 3 do not escalate the case. They flag it for review at the next level, and the tool names the two domains responsible. The framework says review for, not escalates to, and the tool never silently escalates.
- A defining procedure sets a floor, whatever the domains score. Partial extraction therapy or a socket shield, and terminal dentition or a conventional fixed full arch, each set a floor of ICC IV. Any extended-scope procedure or anchorage produces ICC V.
- A suitability concern never raises the level. It sits outside the number entirely and stops the case reading as treatment-ready.
Missing information produces classification incomplete — never an artificially low score.
Clinician competence, recorded separately
Complexity and competence are assessed as two separate things and joined only at the end. Competence is recorded per procedure — never as a global label, and never by counting cases.
| Stage | What it records |
|---|---|
| A — Observed / knowledge | You have studied, observed or assisted with this specific procedure. |
| B — Mentored | You have performed it with a mentor or supervisor, or still require routine case-by-case support. |
| C — Assessed competent | Your competence in this specific procedure has been formally assessed using documented clinical or work-based evidence, and you can demonstrate repeated safe planning, execution, aftercare and complication recognition. |
| D — Independent experienced practitioner | You hold a longitudinal independent portfolio showing outcomes, maintenance and complication management for this procedure. |
| E — Mentor / advanced practitioner | You additionally have substantial procedure-specific experience and recognised ability to supervise and assess others. |
The two halves are written together as a single record — ICC III – C, for example. That record is specific to the procedures in the plan it was made for. ICC III – C for immediate posterior placement does not imply ICC III – C competence in connective-tissue grafting or ridge expansion.
The framework deliberately avoids rigid numerical case-count thresholds as automatic licences to progress, and the tool never asks how many cases you have done.
Definitions awaiting Board ratification
These are real gaps in the source documents rather than settled positions. The tool behaves as described below, so the Board is ratifying something concrete.
Early placement, at about four to eight weeks
Early placement appears in the variable schema but has no scored row of its own. It is currently scored as a healed site. Should it carry ICC II in its own right?
Three or more domains scoring 3
The rule specifies two or more domains scoring 3 as a trigger for review. Is three or more automatically the next level — the ICC IV descriptor does say multiple interacting advanced modifiers — or still a review? Currently: review at two or more, never automatic.
Merging treatment extent with periodontal
The prose consensus keeps treatment extent and periodontal modifiers as separate domains; the published Visual Key merges them into one. This is not cosmetic. With both at 3, seven separate domains give two independent modifiers and trigger a review, while the merged six give one and trigger nothing. Currently: scored separately, merged as the higher of the two, and the count is taken on the merged six — the more conservative reading.
What "confidence" means in the output
Implemented as a completeness state — complete, provisional pending radiographic reconciliation, or incomplete — rather than a numeric or percentage confidence. A computed percentage would imply a precision the rule set does not have, and would be the single most quotable number on the page.
Partial extraction therapy and socket shields at ICC IV
Proposed rather than settled in the source documents. Currently implemented as a hard floor of ICC IV, because no domain question reaches it otherwise: a socket-shield case can score 3 on timing with every other domain at 1.
What makes a domain "material"
The rule is the highest material domain score, but no algorithmic test of materiality exists or could exist. The tool relies on the clinician choosing descriptors that reflect the plan as actually intended, and every screen carries the reminder to score what you have planned, not what might become necessary.
What is out of scope
The framework assumes a surgical plan. Restorative-only cases, maintenance and peri-implantitis management are out of scope, and the tool says so rather than scoring them at 1.
Safety and governance
- The classifier is decision support. It is not an autonomous determination of a dentist's legal scope or competence.
- The treating clinician remains responsible for diagnosis, treatment planning, referral and working within their competence.
- The tool displays which answers caused any escalation, with the source row each rule came from.
- Missing critical information produces classification incomplete, never an artificially low score.
- Radiographic or CBCT findings and clinical findings must be reconciled before a score is treated as definitive.
- A documented clinician override, with a written rationale, belongs wherever a classification is actually recorded and kept — this page stores nothing, so it offers none.
- The framework is version-controlled and periodically reviewed against GDC, CGDent/FGDP, ADI, ITI and emerging evidence.
- BCDIS ICC supplements existing professional guidance. It does not replace regulatory or professional obligations, and is not endorsed by any regulatory or professional body.
What this is checked against
The framework is reviewed against the General Dental Council's standards and its requirements for continuing professional development; the College of General Dentistry and FGDP Training Standards in Implant Dentistry; the ITI SAC classification of surgical and prosthodontic case difficulty; and the Association of Dental Implantology's published guidance. Citing them is a statement of what the framework is checked against — not a claim that any of them has endorsed it.
Classified the case. Now have the plan reviewed.
ICC tells you how demanding a case is. It cannot tell you whether your plan is the right one. ImplantCheck is the College’s own clinical case-submission platform: submit the plan and get structured expert review from BCDIS faculty — most useful at I C C level three and above, and for any case this tool has flagged for review.
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