Implant dentistry in postgraduate university education. Present conditions, potential, limitations and future trends

Periodontists and oral surgeons' peri-implantitis-related education, knowledge, attitudes, and professional behavior: A national survey

OBJECTIVES

Each year, approximately 5 million dental implants are placed in the United States and one out of three patients is likely to experience peri-implantitis (PI). The objectives were to compare the PI-related education, knowledge, attitudes, and professional behavior of periodontists and oral maxillofacial surgeons (OMS), and to explore relationships between these constructs of interest.

METHODS

A total of 389 periodontists and 161 OMS responded to a web-based survey. Descriptive and inferential statistical analyses (independent sample t-tests, chi-square tests, and correlational analyses) were conducted.

RESULTS

On average, periodontists reported a higher percentage of time spent in residency on implant surgery (21.02% vs. 7.27%; p < 0.001), better education about PI (5-point scale with 1 = not at all well: means: 2.86 vs. 2.59; p < 0.001), and better knowledge of risk factors (4.07 vs. 3.86; p < 0.001) than OMS. Periodontists argued that oral hygiene-related treatment (4.45 vs. 4.22; p = 0.001) and regeneration-focused treatments such as guided tissue regeneration (3.62 vs. 3.20; p < 0.001) contributed more to successfully treating PI and used these treatments more in their practices (4.86 vs. 4.56; p < 0.001/3.06 vs. 2.68; p < 0.001) than OMS. They also considered PI as a more serious problem than OMS (4.55 vs. 3.80; p < 0.001). The better the respondents' PI-related knowledge was, the more they considered PI as a serious problem (r = 0.19; p < 0.001). The more cases they treated per month, the more they considered PI as a serious problem (r = 0.19; p < 0.001).

CONCLUSIONS

The results of the present study highlight the lack of standardization in the specialty training of periodontists and OMS. Best practice guidelines for the diagnosis and treatment of PI are needed to optimize graduate education about this important topic.

Efficacy of CAD/CAM technology in dental procedures performed by students: A systematic scoping review of randomized clinical trials

To assess the efficacy of computer-aided design/computer-aided manufacturing (CAD/CAM) in dental procedures performed by dental students.

METHODS

A systematic scoping review was performed. MeSH terms and keywords were specified to assess randomized clinical trials (RCTs) in all idioms.

RESULTS

Nine RCTs that include 520 students were selected. Two RCTs studied implant placement, and the rest of the trials explored implant impressions, intraoral scans, canal obturation, head positioning errors in panoramic images, deep caries and pulp exposure, diagnosis of temporomandibular disorders, and a tooth for restorations. Considering efficacy, variable results were found. The RCTs that explored implant impressions, deep caries and pulp exposure, and diagnosis of temporomandibular disorders showed better results when CAD/CAM technology was performed by students. Two RCTs that investigated implant placement presented contradictory outcomes; one showed better results when CAD/CAM systems were used while the other described similar results to conventional methods. The remaining RCTs did not find differences with conventional procedures. Considering the time spent during the procedures, two studies showed no differences between groups, while another indicated that the time spent was less for digital impressions (p < 0.001). A continuous decrease in scanning time was also perceived for all groups as skills in intraoral scanning augmented (p = 0.0005). Students indicated an interest in utilizing the CAD/CAM systems and recognized that their abilities were enhanced.

CONCLUSIONS

Considering the limitations of this review and the limited number of RCTs evaluated, students recognized that their skills improved using CAD/CAM systems; however, only in some specific procedures greater efficacy and less time spent were observed when this technology was used. Dental students also showed great interest in using these techniques.

Training of novice surgeons using dynamic computer assisted dental implant surgery: An exploratory randomized trial

BACKGROUND

Dynamic Computer Assisted Implant Surgery (CAIS) systems have been shown to improve accuracy of implant placement, thus training in the use of such systems is becoming increasingly important. There is a scarcity of research on how to implement dynamic CAIS training in the settings of postgraduate university education.

PURPOSE

To determine the effectiveness of two modes of CAIS training programs on motor skill acquisition of novice surgeons.

MATERIALS AND METHODS

Thirty-six postgraduate students without experience in dynamic CAIS systems were randomly assigned to a distributed training program (3 training sessions over 3 days) or a massed training (3 training sessions over the same day). A post-test involving the placement of one implant was conducted for both groups, 7 days after completion of the training. Surgical time and implant accuracy were recorded and analyzed, using independent t-tests, with 0.05 significant level.

RESULTS

Both groups reached the accuracy benchmarks expected by current standards in the use of CAIS. No significant differences with regards to accuracy were found between the groups, but a trend was documented favoring performance of distributed (mean difference-0.4, 95% confidence interval-0.7-0.1) in the accuracy at platform level. Distributed training students performed faster than massed for the third trial (mean difference-95.0, 95% confidence interval-178.8 to -11.2).

CONCLUSIONS

Novice students reached the accuracy benchmarks with the use of CAIS through both a massed and a distributed training program, while there was a strong but marginally not significant trend for higher accuracy in the distributed group. Students who received the training in the distributed format over the process of different days, performed faster. Trial registered in Thai Clinical Trials Registry: https://www.thaiclinicaltrials.org/show/TCTR20230109002. This clinical trial was not registered prior to participant recruitment and randomization.

Implant site development requirements in an advanced dental education program: A series of 290 implants

PURPOSE

Our purpose was to assess the frequency and impact of various site development procedures provided before, during, and after implant placement in an advanced dental education program.

METHODS

We evaluated all implant cases completed by two residents in each of three consecutive periodontics residency classes. Dependent variables included implant failure, complication occurrence, presence of radiographic bone loss, and need for tissue augmentation. We analyzed these outcomes against a panel of explanatory covariates.

RESULTS

Our study sample involved 370 site development procedures at 290 implant sites in 160 patients. Three factors exhibited statistically significant associations with need for tissue augmentation: alveolar ridge preservation (ARP) (odds ratio [OR] 0.28; 95% confidence interval [CI] 0.13, 0.57), immediate implant placement (IIP) (OR 0.21; 95% CI 0.10, 0.47), and implant submergence (OR 8.3; 95% CI 4.5, 15.3). Four factors predicted treatment complications: ARP (OR 6.1; 95% CI 1.3, 29.1), IIP (OR 6.1; 95% CI 1.06, 35.3), implant submergence (OR 5.3; 95% CI 1.1, 24.9), and mandibular arch (OR 31.3; 95% CI 1.9, 500). Anterior sites (OR 2.7; 95% CI 1.3, 5.8) were more likely to receive IIP.

CONCLUSIONS

In the evaluated sample, implant placement at a site exhibiting a favorable volume of native bone was rare. Seventy-eight percent of sites received hard tissue grafting during the treatment phase. The use of ARP or IIP at tooth extraction reduced subsequent tissue augmentation requirements. Education and training in ARP and other site development procedures may enhance the clinical practice and treatment outcomes of implant surgeons.

Innovative Trends in Implant Dentistry Training and Education: A Narrative Review

BACKGROUND

The field of implant dentistry education is rapidly evolving as new technologies permit innovative methods to teach the fundamentals of implant dentistry.

METHODS

Literature from the fields of active learning, blended learning, augmented reality, artificial intelligence, haptics, and mixed reality were reviewed and combined with the experience and opinions of expert authors. Both positive and negative aspects of the learning methods are presented.

RESULTS AND CONCLUSION

The fundamental objectives of teaching and learning remain unchanged, yet the opportunities to reach larger audiences and integrate their learning into active experiences are evolving due to the introduction of new teaching and learning methodologies. The ability to reach a global audience has never been more apparent. Nevertheless, as much as new technology can be alluring, each new method comes with unique limitations.

[Criterion assessment system of the actual level of expertise of dental professionals practicing implant dentistry]

The aim of the study was to develop criterion assessment system of the actual level of expertise of dental professionals practicing Implant dentistry. The study comprised fifteen dental experts aged from 35 to 47 years with the average 15 years clinical experience. For evaluation of the clinical portfolio of the dentists we developed 10 reference points and to ensure unification of the assessment approach we organised consensus methodical conference for our expert group. Scores were applied by parity of reasoning with point-rating system applied in continuing education programs of Medical University. Assessment of 43 clinical portfolios with short term and long term results of implant supported restorations was performed. Treatment was provided with the use of Nobel Biocare implants and prosthodontic rehabilitation was achieved with the use of CAD/CAM 'Procera' technology. The study showed that dentists who practice implant dentistry from 1 to 7 years have good manual skills and clinical expertise sufficient for achieving positive treatment outcome. At the same time in general their actual diagnostic skills are not sufficient, they misapply additional diagnostic methods, do not perform risk analysis of potential clinical complications that leads to shifting responsibilities on the patients in case of complications emergence. Methods of Computer Assisted Design are widely popular during all stages of rehabilitation (diagnostic, surgical stent, final prosthesis framework). Actual level of expertise of dental professionals doesn't depend on sex distribution. Males and females who practice implant dentistry have similar levels of clinical expertise.

A global perspective on implant education: Cluster analysis of the "first dental implant experience" of dentists from 84 nationalities

OBJECTIVES

The aim of this cross-sectional study was to explore the demographic and educational patterns related to the dentists' first implant dental experience.

MATERIAL AND METHODS

Participants of a Massive Open Online Course in implant dentistry who have placed and restored implants completed a 25-item online questionnaire investigating their pathway of education and assessing their experience with the "first implant placement." Exploratory analysis included hierarchical clustering using 9 demographic categorical factors.

RESULTS

A total of 1015 respondents from 84 countries formed 5 distinct clusters. Age and work experience were dominant clustering traits, decreasing from Cluster 1 to Cluster 5. Clusters 1 and 3 represented "senior" and "younger" general dental practitioners, respectively, whilst Clusters 2 and 4 represented post-graduate educated clinicians. Cluster 5 represented recent graduates. Asia, South America and Africa were over-represented in "younger" clusters. Time in practice was a significant determinant of attitudes, followed by completion of post-graduate education. There were significant differences in reported patterns of challenges and complications depending on dentists' time in practice, age and post-graduate education. Challenge in implant positioning was more frequently identified by "young post-graduate" educated dentists. Recent graduates reported having the fewest complications of all clusters. Obtaining implant education in University settings was most frequently recommended by clusters of dentists with post-graduate education.

CONCLUSIONS

Time in practice is a parameter to be considered when designing implant education. The absence of structured education and mentorship might lead to inability to properly assess treatment outcomes and identify complications. Quality-assured and practice-directed education is needed at a global level, to support in particular, recent graduates who now seem to engage with implant dentistry early in their career.

Dental Students' Perceptions of Digital and Conventional Impression Techniques: A Randomized Controlled Trial

The aim of this randomized controlled trial was to analyze inexperienced dental students' perceptions of the difficulty and applicability of digital and conventional implant impressions and their preferences including performance. Fifty undergraduate dental students at a dental school in Switzerland were randomly divided into two groups (2×25). Group A first took digital impressions in a standardized phantom model and then conventional impressions, while the procedures were reversed for Group B. Participants were asked to complete a VAS questionnaire (0-100) on the level of difficulty and applicability (user/patient-friendliness) of both techniques. They were asked which technique they preferred and perceived to be more efficient. A quotient of "effective scan time per software-recorded time" (TRIOS) was calculated as an objective quality indicator for intraoral optical scanning (IOS). The majority of students perceived IOS as easier than the conventional technique. Most (72%) preferred the digital approach using IOS to take the implant impression to the conventional method (12%) or had no preference (12%). Although total work was similar for males and females, the TRIOS quotient indicated that male students tended to use their time more efficiently. In this study, dental students with no clinical experience were very capable of acquiring digital tools, indicating that digital impression techniques can be included early in the dental curriculum to help them catch up with ongoing development in computer-assisted technologies used in oral rehabilitation.

Using discussion groups as a strategy for postgraduate implant dentistry students to reflect

INTRODUCTION

More than undergraduates, postgraduate students have the day-to-day clinical experience to reflect upon. Nevertheless, reflection in postgraduate dental education is less well studied. Hence, the purpose was to investigate the attitude towards reflection and the content of reflections in postgraduate implant dentistry education in the UK and Belgium.

MATERIALS AND METHODS

To investigate the attitude towards reflection, a questionnaire was administered to the 10 postgraduates at UCL Eastman Dental Institute (EDI) and 6 postgraduates at Ghent University (UGent). Additionally, students were invited to attend two reflective sessions (60-90 minutes). The sessions' audio recordings were transcribed and analysed using a thematic approach.

RESULTS

In total, 16 postgraduate implant dentistry students participated. Although the majority reported prior experience with reflection, there was variation in the provided definitions of reflection. EDI students agreed with reflection being beneficial for professional development/clinical reasoning and were positive about discussing clinical experiences in groups, but were divided about individual/group reflections. Their UGent counterparts were more indecisive (=neutral), but were positive about discussing clinical experiences. Thematic analysis identified recurring themes as individual learning process, learning and clinical experiences, attitude towards implant dentistry and course programme. EDI postgraduates' reflections focussed on specific clinical situations, while UGent postgraduates' reflections described general considerations.

CONCLUSION

Although students/professionals often report to reflect, it is not clear whether/how they actually reflect, due to the all-purpose word reflection has become. A strategy, using group discussions along with supervision/guidance in how to reflect, demonstrated to expand clinical reasoning into reflections about postgraduate students' clinical actions and professional growth.

Developing implant dentistry education in Europe: the continuum from undergraduate to postgraduate education and continuing professional development

INTRODUCTION

Implant dentistry is a treatment modality which has mainstream clinical practice of comprehensive care, which however is not adequately represented in the undergraduate dental curricula. A consensus workshop organised by ADEE in 2008, set the benchmarks for the knowledge and competences a modern dental practitioner must possess with regard to implant dentistry, as well as defined undergraduate and postgraduate pathways for the acquisition of these competences. Today, 5 years later, there exist several challenges for the implementation of these benchmarks in both undergraduate curricula but also post-graduation educational pathways.

METHODS

A consensus workshop was organised by ADEE, bringing together 48 opinion leaders, including academic teachers of all disciplines related to implant dentistry, specialists, representatives of relevant scientific and professional associations, as well as industry delegates. The objectives of the workshop were to evaluate the existing scientific literature, reported experience and best practices in order to identify potential and limitations for the implementation of implant dentistry in the undergraduate curriculum, as well produce recommendations for the optimal educational structures for postgraduate programmes and continuing professional development.

RESULTS

The scientific committee conducted two European-wide questionnaire surveys to better document the current state of education in implant dentistry. Upon completion of the surveys, reviewers were appointed to produce three scientific review papers, identifying current achievements and future challenges. Finally, during the 3 days of the workshop, all the evidence was reviewed and the main conclusions and recommendations that were adopted by all participants are reported in the present Consensus Paper.

CONCLUSIONS

Implementation of implant dentistry in the undergraduate curriculum has improved significantly, but still lags behind the benchmarks set in 2008 and the diversity between institutions remains big. At the post-graduation level, there is currently a wide diversity of courses and pathways towards competences related to implant dentistry and there is at present a great need for quality assurance, as well as standardisation and transparency of the learning outcomes.