IMPLANT DENTISTRY EDUCATION - ADEA has consistently demonstrated commitment to dental implant education. In 1994 an annual elective program providing comprehensive didactic and clinical

IMPLANT DENTISTRY EDUCATION

C

ADEA BFACA MID YEAR MEETING OCT 9-12, 2013

C DINCER GURUN, DEPARTMENT OF RESTORATIVE

DENTISTRY, CHAIR

DENTAL IMPLANT EDUCATION IN U.S. DENTAL SCHOOLS

Dental implants have become a routine

treatment in this country due to the high success rate and predictability.

Students/residents are legally and ethically required to present dental implants as an option when developing treatment plans.


Incorporation of implant dentistry into pre-doctoral dental curriculum has steadily increased over the past years. 0

102030405060708090

1974 1989 1995 1997 2002

% Implant Dentistry Curriculum

Journal of Prosthodontics, Vol 14, No 1, 2005:pp 46-56


There has been a significant increase in pre-doctoral students having some clinical experience.

0102030405060708090

1990 2002

% ClinicalExperience

Journal of Prosthodontics, Vol 14, No 1, 2005:pp 46-56


97% of participated US Dental Schools offers didactic

%86 offers both didactic and clinical experience in restoring dental implants but did not include it as a graduation requirement.

(56 dental schools)

Journal of Dental Education, Vol 70, No 5, 2006:pp 580-88


Implant dentistry is commonly taught and clinical experiences are available for pre-doctoral students.

Pre-doctoral clinical experiences at that time were somewhat restricted to straightforward, uncomplicated cases involving single-tooth implants and implant-retained overdenture prostheses.

Generally, implant dentistry was taught by specialty faculty, rather than by the general dentistry faculty. Journal of Dental Education, Vol 70, No 5, 2006:pp 580-88

UDM Dental School

Teaching Activity

UDM Implant Restorative Curriculum

UDMSOD has consistently demonstrated commitment to dental implant education.

In 1994 an annual elective program providing comprehensive didactic and clinical training in implant dentistry was initiated for a select group of senior dental students.

Results of this 11 year program were published in Journal of Prosthodontics in 2008.

Maalhagh-Fard, A and Nimmo, A. Eleven-year Report on a Predoctoral Implant Dentistry Program. Journal of Prosthodont 2008 Jan 17(1) 64-68

UDM Implant Restorative Curriculum

The inclusion of implant therapy as standard of care was envisioned as a fundamental component of today’s graduating dentists.

Therefore, UDMSOD Department of Restorative Dentistry revised its curriculum in 2007 to provide an opportunity for all pre-doctoral students restoring dental implants as part of their clinical curriculum.

Curriculum and Instruction Methods

Presenter

Presentation Notes

Instead of creating a stand-alone implant course, the sophomore Removable Partial Denture Treatment Techniques course was successfully transformed into a multi-disciplinary track. The course was renamed as Partial Edentulism Treatment Techniques to focus on prosthetic treatment alternatives other than removable partial dentures.

Curriculum and Instruction Methods Evidence Based Foundational Knowledge and

Simulation Laboratory

Presenter

Presentation Notes

The final case scenario was replaced with a patient interested only in fixed prosthesis. As a result, a five-week hands-on implant dentistry module was introduced as the first element of their three year dental implant curriculum.

Treatment Planning

Mounting Diagnostic Models

Radiographs

Radiographs

No Lateral

Light Centric Contact

Diagnostic Wax-Up

Presenter

Presentation Notes

So want wax up for implant tooth to have: Light centric contact – means that when teeth bite together, opposing tooth only hits here and “minimally” No Lateral – means when teeth slide to the side this implant tooth does not contact – here “cuspid rise” is illustrated I.e. the teeth come apart as the opposing cuspids ride on one another. Module #2: Treatment Planning and Diagnostic Work-up Done by Residents (on their “own time”): - Create diagnostic wax up (single unit # 5) – Director, may elect to have students wax-up more than just #5

Preclinical Lab: Surgery (the surgical guide in implant placement)

Two Guides

Simulated Patient Model

(An exact duplicate of the other models &

represents the patient returning with healing collars)

Preclinical Lab: Impression

Presenter

Presentation Notes

Modules #4: Prosthetic Lab, Part 1 - Impression Taking and Overdenture Pick-up Scheduled 1-2 weeks after module #3 Supplies include: - Impression Material – 3M - Triad or “other” light cured material to lute surgical guide to implant transfer – 3M - Cordless light curing machines – 3M - Lab Handpiece – optional** (may be used by resident prior to lab) - A large and small bur to relieve denture and drill vent hole** (may be done by resident prior to lab) - Pressure Paste (may be used by resident prior to lab) - Acrylic to pick up Ball and Cap housings PRIOR TO LAB: Residents “pours up/prepares” overdenture stone models with analogs and healing caps (see “Prior to Course Beginning…” at the top) TM – arranges to receive from Centerpulse, prosthetic kits (1 per 2 residents) and Typodont “simulated patient” models (1 per 2 residents) These models are acrylic replicas of “the patient” after Phase 2 surgery. (i.e. – missing #’s 5, 8, 14 & 15 replaced w/implants & w/healing abutments) TM – arranges to receive from Centerpulse, all remaining lab course items as “Paid For” by residents and / or Program (see items listed under Module #2 above) TM and Program Director conduct Prosthetic lab. TM may ask to do a short presentation on “benefits/features, etc of TSV” and the basic steps for making a “transfer impression”, using two techniques (3M Dental may provide impression and other materials for this lab as well as a brief overview regarding impression technique.) Impressions - open pickup – “using surgical guide and light cured material” (e.g. Triad – supplied by 3M) This exercise is done on the resident’s surgical model and the implant they previously placed in #5. § The “hole” in occlusal surface of surgical guide is enlarged to allow the transfer to protrude through it. Triad or light cured composite is applied around the transfer and onto the surgical guide. § It is then cured and the transfer, now attached to the surgical guide, is removed from the surgical model. § An implant analog is attached to the transfer. One of the previously poured “simulated patient pre-treatment”, partially edentulous maxilla models, is then “ground out” in the area of #5 and the “surgical guide impression transfer/analog assembly” is placed onto this cast § Stone is then added around the analog and allowed to set…etc., etc. (The “grinding out” of the model and the “setting” of the analog into a duplicate of the master cast will not be completed during this session. The time for it to be completed will be determined by the program director.) - “closed tray” - transfers from Prosthetic kits are placed on implant in “Typodont simulated patient model” and impression is made; analog and impression are assembled and place into impression and “soft tissue” material is added to impression. (Note: Model to be “poured-up” by resident on “own time”.) - “open tray – transfers are placed on model and impression may be taken or explained “Pick-up” ball cap attachments - TM and Program Director continue with Prosthetic lab and have residents “pick-up” ball cap attachments in clear acrylic dentures. The final finishing of the denture will be completed by the resident at a later time…as determined by the program director.

• Make an impression of #5 using a open tray” technique • Review technique for “closed tray” “impression

Preclinical Lab: Impression

Presenter

Presentation Notes

Surgical Models provided annually by Centerpulse. (an edentulous mandible surgical model is also provided) -surgery model is as if flaps have been reflected in the areas of implant surgery We’re going to place implant #5 - use radiograph and TSV or Spline implant template over radiograph to select implant length, diameter and consider anatomy (in this case maxillary sinus)….but plenty of room for 13mm implant (3.7mm diameter used in this lab)

Preclinical Lab: Soft Tissue Model

Presenter

Presentation Notes


Tapered Screw-Vent Implant

Preclinical Lab: Implant Components

Presenter

Presentation Notes


Making a Provisional Crown

Preclinical Lab: Provisional Crown

Presenter

Presentation Notes


Class Aug Sept Oct Nov Dec Jan Feb Mar April May June July

DS1

DS2

Restorative Curriculum Calendar

Introduction to Operative Dentistry

Aug 22 – Oct 17 (Simlab, 3-4 hr, M/W)

Dental Materials Aug 22 – Oct 10 (Class, 1 hr, W)

Dental Anatomy Aug 21 – Oct 18

(Class, 1.5 hr, T/TH)

Occlusion Oct 22 – Dec 10 (Simlab, 3-4 hr,

M/W)

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istm

as B

reak

D

ec 2

4 –

Jan

2

Direct Restorations (Amalgam/Composite)

Jan 7 – April 22 (Simlab, 3-4 hr, M/W)

Indirect Restorations (Single Crown, Inlay,

Onlay) April 24 – June 17

(Simlab, 3-4 hr, M/W)

Fixed Partial Prosthesis

Aug 20 – Oct 24 (Simlab, 3-4 hr, T/TH)

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as B

reak

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ec 2

4 –

Jan

2

Removable Partial

Prosthesiss Oct 29 – Dec 12 (Simlab, 3-4 hr,

T/TH)

Impl

ants

Ja

n 7

– Ja

n 23

(S

imla

b, 3

-4 h

r, T/

TH)

Conventional CD Jan 28 – April 3

(Simlab, 3-4 hr, T/TH)

Impl

ant C

D

Apr

il 8

– A

pril

10

(Sim

lab,

3-4

hr,

T/TH

)

Basic Restorative Sciences Module

Partial Edentulism

Module

Diseased Tooth Module

Complete Edentulism

Module

Presenter

Presentation Notes

A number of years ago, As we were looking into improving and streamlining our restorative curriculum we looked into what kind of knowledge and skills should a graduate have in the near future

Three Year Curriculum In Implant Dentistry

DS2 • Didactic Training • Simulation Lab

DS3 • Advanced Course in Fixed Prosthodontics • Clinical Cases

DS4 • Oral and Maxillofacial Implants • Clinical Cases

Didactic Teaching

Sections: History Biology

Biomaterials Biomechanics

Patient Selection Diagnosis & Treatment Planning

Surgery Prosthetics

Maintenance

+ DS4 Summer Term Implant Course

DS4 Summer Term Implant Course

Advanced Didactic Lectures and Cases Evidence Based Critical Assessment Project Hands-on

Implant Dentistry Is Restoratively Driven…

UDMSOD IMPLANT PROTOCOL OUTLINE PATIENT QUALIFICATIONS and TRIAGE SCREENING APPOINTMENT and COMPLEXITY CRITERIA PATIENT ASSIGNMENT TO UNDERGRADUATE OR GRADUATE

PROGRAMS FURTHER DATA COLLECTION TREATMENT PLANNING AND SUPERVISION COMMUNICATION PROTOCOL FOR TREATMENT SEQUENCE PATIENT MANAGEMENT AND LONG TERM MAINTENANCE QA EDUCATIONAL GOALS

Our Clinical Policies

CASE I

Failing post and core restoration Periapical infection Short crown/root ratio Inadequate ferrule Atraumatic extraction with bone augmentation AEGD/Perio combination team for single tooth implant treatment

CASE II

Sectioned 6-unit FPD Unsatisfactory existing

interim RPD, unrestorable abutments with root caries

Patient does not want to have a Mandibular CD

Prefers to have minimum number of implants due to the financial concerns

Undergrad /O.S. team for two implant retained overdenture.

CASE III

Fractured FPD abutment/non-restorable

Multiple implants No canine guidance Block graft required AEGD/Oral Surgery

combo team for two single implants

Allowing Every DS3-DS4 Student to Treat Uncomplicated Cases

PROCEDURE CHECK-LIST/ASSESSMENT

PROGRESS

Having students exposed to implant dentistry earlier at their second year enabled us to provide the necessary patient care to the community.

A clinical implant care protocol, online implant clinic manual and a triage system were developed to streamline pre-doctoral cases.

Single tooth implant fees were modified to the level of a three unit fixed partial denture.

PROGRESS

The real growing part of the implant program has been the clinical education on direct patient care.

Since 2007 the number of pre-doctoral cases increased approximately 15 times.

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GRAPH #1 Implants restored in DDS program

# of implants restored by students perAcademic Year

0

100

200

300

400

GRAPH #2 Implants Placed Per YEAR

Total # of implants placed at UDMSODper Academic Year

IMPLANT EDUCATION TEACHING AWARD

ADEA recognizes an institution and dental educator team that has demonstrated a commitment to excellence and innovation in the field of implant dentistry education.

NEW CHALLENGE

New CODA standards’ competency in replacement of teeth with dental implants

Dental schools may need to diversify this competency assessment to include multiple mechanisms such as simulations or OSCEs as well as patient-centered clinical evaluation.

Moghadam, M. et al, JDE, Apr 1, 2012, vol 76 no 4 437-442

CODA CLINICAL STANDARDS

2-23 At a minimum, graduates must be competent in providing oral health care within the scope of general dentistry, as defined by the school, including:

h. replacement of teeth including fixed, removable and dental implant prosthodontic therapies

Commission on Dental Accreditation. Accreditation standards for dental educational programs. Chicago: American Dental Association, 2010.

Student Experience

Simulation Models

CLINICAL COMPETENCIES AT UDM Replacement of missing teeth with removable and

fixed prosthesis. Students in DS4 year are expected to take at least

one clinical competency by offering fixed partial denture or implant to their patients.

Majority of our students receive a clinical exposure in treating patients with implant retained posterior crowns. Current DS4 students are allowed to demonstrate competency on simulated models that are custom designed using our implant competency forms.

Dental Schools Need to Consider: Patient Pool Implant Company Support Faculty Training Case Selection Patient Fees Fair Distribution of Cases Alumni Relations Competency Methodology Financial Resources Administrative and IT Support Student Concerns

Thank You…

Documents

IMPLANT DENTISTRY EDUCATION - ADEA has consistently demonstrated commitment to dental implant education. In 1994 an annual elective program providing comprehensive didactic and clinical