Educational Objectives for the Provision of Dental Implant ...
Educational Objectives for the Provision of Dental Implant Therapy by Dentists 0 “advancing the value and excellence of general dentistry”
Educational Objectives for the Provisionof Dental Implant Therapy by DentistsINTRODUCTIONIn February 2009, the Academy of General Dentistry provide quality care through the provision of dental(AGD) created an Implantology Task Force (ITF) implant therapy.comprised of nine general practitioners with As a “prosthetic discipline with a surgicalsubstantial dental implant experience. component,” the placement of dental implants isThe purpose of the ITF was to review the current part of the practice of general dentists andstate of dental implant training in the United States specialists alike who have attained the appropriate 1and formulate guidelines. These guidelines would education.delineate the objectives that are recommended in Dentists performing the surgical placement of dentalcoursework for educating dentists about safe and implants should have an understanding of the finalappropriate dental implant therapy. prosthetic goal of each case and the variousVarious dental implant reference materials were elements of the restorative process.reviewed, and pertinent information gleaned from Dental implants provide support for restorationsthese sources aided in the construction of this that substitute for missing dentition. Dental implantdocument. therapy restores the patient’s function, form, andAdditionally, the observations and experiences of esthetics, as well as comfort and longevity, and hasthe members of the ITF, many of whom are become the tooth replacement methodology ofeducators in implant dentistry, were used to develop choice for many patients. Additionally, dentalthese training objectives. implant therapy facilitates the health and preservation of the remaining oral structures.It is not the purpose of these Educational Objectivesto define a curriculum for dental implant therapy. In anticipation of untoward circumstances that mayRather, these objectives are to be used as guidelines occur during the treatment process or after thefor educational providers to develop curricula that restorative phase has been completed, dentistswill adequately prepare dentists for providing safe should have attained the education necessary to beand appropriate dental implant therapy. familiar with interventions needed to manage those circumstances.There are a variety of educational outlets availableto provide dentists with the necessary training indental implant therapy. These outlets include, but GLOSSARYare not limited to, university-based sources, Autogenous grafthospital-based sources, dental organizations, Hard or soft tissue harvested from one or more sitesmanufacturer-sponsored courses, private and transplanted to another site or other sites in the 2individuals, and commercial training centers. same individual.All providers of dental implant continuing education CERP(CE) should be AGD PACE- or American Dental “Recognizing the need to offer its members and theAssociation (ADA) CERP-approved. dental community a way to select continuing education (CE) with confidence, to assist regulatoryDental implant therapy can be accomplished agencies and other organizations responsible forsuccessfully by all licensed dentists who have approving credit, and to promote the continuousreceived adequate training. No manufacturer, improvement of CE, the American Dental Associationuniversity, hospital, or provider of CE should limit Continuing Education Recognition Program (ADAany licensed dentist from having access to the CERP) was established in 1993. Through anspecific knowledge base or materials needed to application and review process, the ADA CERP 1
evaluates and recognizes institutions and DENTAL IMPLANT CASE TYPES6organizations that provide continuing education Current literature indicates that surgery may be 3(CE).” divided into two case types: straightforward andDental implant complex.A dental implant is an alloplastic material or device The type of case is not an absolute measure. Afterthat is surgically placed into or onto orofacial tissues completion of adequate coursework in dentaland used for anchorage, functional, therapeutic, implant therapy, the dentist should be able to assess 2and/or esthetic purposes. the case type and make treatment or referralDental implant prosthesis decisions accordingly.Syn: Dental implant restoration. “Any prosthesis Dental implant therapy, regardless of case type, may(fixed, removable, or maxillofacial) that utilizes be performed safely by an appropriately traineddental implants in part or whole for retention, dentist, and these case types are not determinative 2support, and stability.” of need for referral. 7Dental implant therapy The following attributes of straightforward andSyn: Implant dentistry, oral implantology. The field of complex cases are indicative but not singularlydentistry dealing with the diagnosis, surgical determinative of the respective case types, and areplacement, prosthetic reconstruction, and presented below by interpretation of and/or citation 2 6maintenance of dental implants. of current literature:Exogenous graft Straightforward case:Hard or soft tissue derived from outside the Perception of Case: The end prosthetic result and 2patient’s body. treatment protocols are readily understood.Familiarity Tooth Position: Adequate identifiable anatomical“A simplified knowledge for the purposes of landmarks exist to determine optimal tooth position.orientation and recognition of general principles.” 4 Dental Implant Surgery: The dental implant surgery procedure has minimal anatomical risks and can bePACE carried out without the need for significant hard or“The Academy of General Dentistry (AGD) Program soft tissue grafting.Approval for Continuing Education (PACE) was Occlusion: The teeth can be replaced withoutcreated to assist members of the AGD and the dental significant alteration to the patient’s existingprofession in identifying and participating in quality anatomic structures.continuing dental education (CDE). The programprovider approval mechanism is an evaluation of the Complex case:educational processes used in designing, planning, Perception of Case: The end prosthetic result andand implementing continuing education.” 5 treatment protocols cannot be readily determined without extensive diagnostic and planning techniques and may include multiple stages toDENTAL IMPLANT VARIATIONS achieve the desired outcome.Dentists involved in the practice of implant dentistry Tooth Position: Minimal identifiable anatomicalshould have a familiarity with the various dental landmarks require more extensive diagnosticimplants and dental implant restorations that are procedures to determine the optimal tooth positionpresently available, even though the dentists may be for esthetics and function.placing and/or restoring only one brand or modality. Dental Implant Surgery: The dental implant surgeryThis familiarity may aid in the recognition of a dental is a more challenging procedure with notableimplant device either clinically or radiographically anatomical risks and may require significant hard orand allow for maintenance protocols. Additionally, soft tissue grafting.familiarity with the various dental implants and Occlusion: A deterioration of the patient’s anatomicdental implant restorations will aid the dentist in structures requires significant treatment planning toexercising his or her professional judgment to treat adequately restore the occlusion.the patient or make an appropriate referral. 2
EDUCATIONAL OBJECTIVES d. An understanding of the clinical restorative procedures involved inEducational objectives for the straightforwardplacement of dental implants: straightforward dental implant- supported restorations.A dentist who intends to engage in the e. A recognition of technical andstraightforward placement of dental implants should cosmetic limitations of implanthave attained education that includes the dentistry.educational objectives listed below. The dentist 13. Long-term maintenance of dental implantsshould be familiar with the procedures involved in and dental implant restorations.the assessment, planning, placement, restoration, 14. Proper documentation of all clinical 6and maintenance of dental implants. activity. 6 1. Anatomy of the maxilla and mandible. 15. Assessment of the occlusion and its 2. Pathological processes that occur in the relevance in relation to the proposed 8 maxilla and mandible. treatment and longevity of the prosthesis. 3. Healing processes that occur following 16. Interventions and approaches to manage surgery and how to manage postoperative potential complications. untoward circumstances. 4. Diagnostic imaging of the mandible and Additional guidelines for complex dental implant therapy:6 maxilla, and how to interpret the findings from these examinations. Experience in the straightforward placement and/or 5. Clinical assessment of a patient’s suitability restoration is a prerequisite for complex dental for dental implants and the medical implant therapy. conditions that could preclude a patient A dentist should have attained an adequate level of from dental implant therapy or complicate surgical experience and the ability to provide follow- surgery. up care to patients who require the placement of 6. Infection control and aseptic techniques as dental implants with hard and soft tissue applied to dental implant surgery. augmentation. 7. Techniques involved in harvesting autogenous bone from oral sites for Before complex placement is attempted, a dentist augmentation during dental implant also should have attained the knowledge of the placement. prosthetics necessary for the substantial occlusal 8. The use of exogenous bone, bone alterations that are often needed in restoring and substitutes, and/or soft tissue for maintaining complex cases. augmentation in the placement of dental As dentists advance through the developmental implants. stages of skill acquisition, it would be advantageous 9. The use of appropriate pharmaceutical for them to seek the assistance and guidance of agents in relation to implant dentistry. more experienced dentists to serve as mentors. 10. The dental implant options available and their indications and contraindications. 11. Patient informed consent and how to DISCLAIMERS obtain it prior to dental implant placement. Dental implant therapy may be performed safely by 12. Clinical and laboratory protocols for dental an appropriately trained dentist. These Educational implant therapy, including: Objectives are not intended to limit the training or a. An understanding of the clinical practice of dentists in dental implant therapy, nor techniques for conventional dental are they intended to make any representations implant restorative procedures. regarding the qualifications or abilities of any b. An understanding of the pre- individual dentist or dental specialty. surgical laboratory procedures and The AGD expressly disclaims any and all liability techniques used to provide dental arising out of or in any way related to the use, implant therapy. transmission, reliance, or interpretation of these c. An understanding of the laboratory Educational Objectives or any part thereof. techniques used to construct implant-supported prostheses. 3
REFERENCES1. Zablotsky M. The periodontal approach to implant dentistry. J Calif Dent Assoc 1991 December;19(12):39-43.2. Jalbout Z, Tabourian G, eds. Glossary of implant dentistry II. Upper Montclair, NJ: The International Congress of Oral Implantologists (ICOI):2008.3. ADA Continuing education recognition program (ADA CERP). Available at: http://www.ada.org/prof/ed/ce/cerp/index.asp. Revised April 2008.4. American Academy of Implant Dentistry. Standards for the advanced education programs in implant dentistry. Revised February 2007.5. AGD PACE Guidelines. Available at: http://www.agd.org/files/education/pace/guide lines.pdf. Revised January 2009.6. Faculty of General Dental Practice (UK), The Royal College of Surgeons of England. Training standards in implant dentistry for general dental practitioners. Available at: www.fgdp.org.uk/pdf/training_stds_imp_dent_ guide_2008.pdf. Accessed November 2008.7. Academy of General Dentistry. General guidelines for referring dental patients to specialists and other settings for care. Revised July 2007.8. Academy of Osseointegration; Committee for the Development of Dental Implant Guidelines; American Academy of Periodontology, Iacono VJ, Cochran SE, Eckert MR, Wheeler SL. Guidelines for the provision of dental implants. Int J Oral Maxillofac Implants 2008 May- Jun;23(3):471-473. ®The AAID’s Guidelines for MaxiCourses (2008) alsoserved as a resource for this document.Respectfully submitted by:John P. DiPonziano, DDS, MAGD (Chair)Russell A. Baer, DDSWalter C. Chitwood, Jr., DDSRichard W. Dycus, DDS, MAGDLeonard R. Machi, DDS, FAGDEmile Martin, DDS, MAGDRichard J. Ringrose, DDS, MAGDBerry Stahl, DMDRoger D. Winland, DDS, MS, MAGDStaff Support:Daniel Buksa, JD,Associate Executive Director, Public AffairsSrini Varadarajan, Esq.,Director, Dental Care Advocacy 4