Students Opinion of a Predoctoral Implant Training Program

Size: px

Start display at page:

Download "Students Opinion of a Predoctoral Implant Training Program"

Justina Bishop
5 years ago
Views:

1 Students Opinion of a Predoctoral Implant Training Program Hirofumi Kido, D.D.S., Ph.D.; Katsuki Yamamoto, D.D.S., Ph.D.; Kae Kakura, D.D.S., Ph.D.; Kenzo Morinaga, D.D.S., Ph.D.; Takashi Matsuura, D.D.S., Ph.D.; Tatsuaki Matsunaga, D.D.S., Ph.D.; Hiroshi Shimizu, D.D.S., Ph.D.; Yutaka Takahashi, D.D.S., Ph.D.; Hironobu Sato, D.D.S., Ph.D.; Masaro Matsuura, D.D.S., Ph.D. Abstract: Implant treatment today is highly predictable and provides valid restorative options for the completely or partially edentulous patient. In Japan, many dental care facilities have incorporated implant treatment, and such treatment is no longer rare. For predoctoral students, the educational environment related to implants is not always applicable in present clinical settings. In this article, we describe the implant training program developed at our university for predoctoral education, and we report the changes in student opinions regarding implant treatment by comparing pre- and post-training opinions. The newly developed models for implant training were effective in increasing student understanding that implant treatment is one prosthetic option for restoring missing teeth. In a survey of predoctoral students, responses indicating negative opinions toward implant treatment decreased after training, and responses indicating positive opinions increased. These findings indicated that this training was effective in deepening student understanding of implant treatment. Dr. Kido is Associate Professor, Section of Oral Implantology, Department of Oral Rehabilitation; Dr. Yamamoto is Lecturer, Section of Oral Implantology, Department of Oral Rehabilitation; Dr. Kakura is Research Associate, Section of Oral Implantology, Department of Oral Rehabilitation; Dr. Morinaga is Research Associate, Section of Oral Implantology, Department of Oral Rehabilitation; Dr. Matsuura is Associate Professor, Section of Fixed Prosthodonotics, Department of Oral Rehabilitation; Dr. Matsunaga is Lecturer, Orofacial Esthetic Medical Center; Dr. Shimizu is Associate Professor, Section of Removable Prosthodonotics, Department of Oral Rehabilitation; Dr. Takahashi is Professor, Section of Removable Prosthodonotics, Department of Oral Rehabilitation; Dr. Sato is Professor, Section of Fixed Prosthodontics, Department of Oral Rehabilitation; and Dr. Matsuura is Professor, Section of Oral Implantology, Department of Oral Rehabilitation all at the Fukuoka Dental College. Direct correspondence and requests for reprints to Dr. Hirofumi Kido, Section of Oral Implantology, Department of Oral Rehabilitation, Fukuoka Dental College, Tamura, Sawara-ku, Fukuoka, , Japan; phone; fax; hkido@college.fdcnet.ac.jp. Keywords: predoctoral education, implant treatment, hands-on training, student opinion survey Submitted for publication 4/17/09; accepted 7/12/09 Since the early 1990s, there have been reports on the need for incorporating implantology into dental education and educational methods for doing so. 1-8 According to these reports, implantology has been incorporated into dental education in many countries, but the approaches have varied and have not been standardized. Reports over the past decade have shown that many dental schools have incorporated implantology into their curricula; however, there is wide variation in their use of lectures and hands-on experience using models as well as the extent of practical clinical experience In a survey on implant education in fifty-six European dental schools conducted by Afsharzand et al., 14 the majority of the schools reported that the completion of implant courses was an essential part of predoctoral training, but these authors found that the predoctoral educational program in implantology differed greatly by school. After Maalhagh-Fard et al. began a predoctoral elective program in implantology at the University of Detroit Mercy School of Dentistry, they surveyed their graduates and found a strong positive correlation between participation in the program and the use of implant restorations in their practices after graduation. 17 Huebner also found that students learning about implant treatment in predoctoral education greatly affected their involvement in implant treatment after graduation. 18 Implant treatment today is highly predictable and provides valid restorative options for the completely or partially edentulous patient. In Japan, many dental care facilities have incorporated implant treatment, and such treatment is no longer rare. It is not unusual to see patients who received implant treatment from a recently graduated dentist in training or undergraduate students in clinical training. For predoctoral students, the educational environment related to implants is not always applicable in November 2009 Journal of Dental Education 1279

2 present clinical settings. Approaches toward implant education vary by country and university. In some cases, most students have not received systematic education in implant treatment. Dentists have often learned information and techniques on implants through vendor-led workshops and lectures providing little basic knowledge. A systematic curriculum is necessary in implant education for predoctoral students to postgraduate dentists. In particular, the educational environment needs to prepare predoctoral students for comprehensive understanding of implant treatment. Since 2003, our university has performed hands-on implant training for predoctoral students using models. The first training involved the placement of one type of implant body into a simple urethane model. The content of the training has been improved since We now use three types of distinctive implant bodies and a simulation model that we developed. All predoctoral students receive this training. The students also receive fifteen hours of lectures on basic information about implant treatment, conducted parallel to the practical training. In this article, we describe the implant training program developed at our university for predoctoral education, and we report the changes in student opinions regarding implant treatment by comparing pre- and post-training opinions. Materials and Methods Approximately 500 students received training in implants in the five-year period from 2004 to The newly developed simulation model for implant training was used. The training was conducted for fifth-year students on two consecutive days immediately before the start of clinical training. The clinical training of implantology for predoctoral students was conducted as part of restorative dentistry in hospital for approximately thirty days. This training included only chairside observation and assisting of instructors. Approximately ten students participated per training session, and one instructor supervised two to three students. The students placed implants in the model. In addition, they learned information and skills to explain to their patients the necessity of prosthetic treatment to restore missing teeth and their treatment options. All students completed the training process within the two-day training period. To examine student opinions on implant treatment, we conducted a survey of ninety-four students (fifty-three males and forty-one females) Table 1. Survey questions asked of predoctoral dental students regarding implant training 1. What do you think about learning the techniques of implant treatment? a. These techniques should be incorporated into student education after it becomes part of the national examination. b. These techniques should be taught after students learn the conventional dental treatment. c. These techniques need to be taught in lectures but not in basic practical training. d. These techniques need to be taught in lectures and in practical training. e. Other 2. Do you think you would incorporate implant treatment into your future practice? a. Yes, I will incorporate it. b. I would like to wait a little more before I incorporate it. c. Probably not. d. Other 3. Do you think implant treatment is more difficult compared with treatments using bridges and partial dentures? a. I do not think it is particularly more difficult technically. b. I think it is slightly more difficult. c. I think it is more difficult. d. I think it is much more difficult. e. Other 4. If your first mandibular molar were missing, how would you like to have it restored? a. With an implant b. With a bridge c. With a partial denture d. Other 1280 Journal of Dental Education Volume 73, Number 11

3 who received implant training in 2007 (Table 1). The surveys were conducted just before and after implant training. In the survey, the students were asked to respond affirmatively or negatively to the necessity of training and lectures on implants and to implant treatment. We compared the pre- and post-training responses. Statistical analysis was performed with SPSS ver J (SPSS, Chicago, IL, USA). Results A simulation model was developed specially for this practical training (NISSIN Dental Products Inc., Kyoto, Japan) (Figure 1). The edentulous area was changeable in this simulation model. The edentulous area for the implant training was composed of three layers: silicone rubber gingiva, cortical bone, and cancellous bone. The edentulous area can be changed to acrylic resin and used for training in removable partial denture fabrication. Thus, the students use the same model for training in implants and removable dentures. One type of tapered implant body (Replace Select Tapered, NobelBiocare Japan Inc., Tokyo, Japan) and two types of straight implant bodies (Replace Select Straight, NobelBiocare Japan Inc., Tokyo, Japan and GC Implant Re SETIO, GC Inc., Tokyo, Japan) were used in the implant training (Figure 2). The students learned the gingival incision method, flap reflection method, determination of site for implant body placement, preparation of an implant socket, placement of an implant body, and suturing (Figure 3). Next, the students learned methods for platform exposure, abutment connection, and impression making (Figure 4). The response rate on the survey was 100 percent. When the students were asked about the timing for learning implant treatment techniques, the number of students who responded as follows decreased approximately 38 percent after training: These techniques should be taught after students learn the conventional dental treatment. In contrast, the number of students who responded as follows doubled: These techniques should be incorporated into student education after it becomes a part of the national examination (Table 2). When the students were asked about whether or not implant treatment will be incorporated into their future practices, the number of students who responded as follows increased approximately 40 percent: I will incorporate it. On the other hand, the number of students who responded as follows decreased markedly: I would like to wait a little more before I incorporate it (Table 3). After the training, fewer students responded that they thought implant treatment was technically very difficult, and more students responded that they thought implant treatment was technically not very difficult (Table 4). Each student was also asked how Figure 1. A simulation model for predoctoral implant training November 2009 Journal of Dental Education 1281

Three types of implants for predoctoral training: GC Implant Re SETIO, GC Inc.

4 he or she would restore his or her first mandibular molar if it were missing. After the training, the students who responded with a bridge decreased approximately 40 percent, and those who responded with an implant increased approximately 30 percent (Table 5). Figure 2. Three types of implants for predoctoral training: GC Implant Re SETIO, GC Inc. (left); Replace Select Straight, NobelBiocare (middle); Replace Select Tapered, NobelBiocare (right) Discussion Our implant training is a required course for all predoctoral students and includes hands-on training using plastic models with artificial gingiva. This training involves gingival incision, flap reflection, preparation of an implant socket, implant body placement, suturing, secondary surgery, abutment connection, and impression making. The students placed implant bodies of three different types and gained an understanding that the process of implant surgery is not as complex as the students had assumed before the training. The models used in the training had an area of missing teeth that could be changed. These models can be used for implant placement training and training for partial denture fabrication. Therefore, the students can experience implant treatment as just one prosthetic option for restoring missing teeth. Our results indicated that negative responses on implant treatment decreased after implant training and positive responses increased. There were markedly more students after training who preferred to use implants if they had missing teeth and who wanted to incorporate implant treatment into their future practices. Therefore, this training was considered to be effective in motivating the students toward implant treatment. Figure 3. Implant placement procedure on a simulation model 1282 Journal of Dental Education Volume 73, Number 11

Figure 4. An implant analog connection procedure with an impression Table 2. Responses to the survey question What do you think about learning the techniques of implant treatment?

5 Figure 4. An implant analog connection procedure with an impression Table 2. Responses to the survey question What do you think about learning the techniques of implant treatment? by percentage of total respondents (n=94) A A A A A Chi-square value=5.05 No statistical difference of answer distribution between before and after hands-on training. A1: These techniques should be incorporated into student education after it becomes a part of the national examination. A2: These techniques should be taught after students learn the conventional dental treatment. A3: These techniques need to be taught in lectures but not in basic practical training. A4: These techniques need to be taught in lectures and in practical training. A5: Other Table 3. Responses to the survey question Do you think you would incorporate implant treatment into your future practice? by percentage of total respondents (n=94) A A A A Chi-square value=8.0 P<0.05: difference of answer distribution between before and after practice hands-on training A1: Yes, I will incorporate it. A2: I would like to wait a little more before I incorporate it. A3: Probably not. A4: Other November 2009 Journal of Dental Education 1283

6 Table 4. Responses to the survey question Do you think implant treatment is more difficult compared with treatments using bridges and partial denture? by percentage of total respondents (n=94) A A A A A Chi-square value=12.1 P<0.05: difference of answer distribution between before and after hands-on training A1: I do not think it is particularly more difficult technically. A2: I think it is slightly more difficult. A3: I think it is more difficult. A4: I think it is much more difficult. A5: Other Table 5. Responses to the survey question If your first mandibular molar were missing, how would you like to have it restored? by percentage of total respondents (n=94) A A A A Chi-square value=5.05 P<0.5: difference of answer distribution between before and after hands-on training A1: With an implant A2: With a bridge A3: With a partial denture A4: Other Conclusions We can draw the following conclusions from our study: 1. The newly developed models for implant training were effective in increasing student understanding that implant treatment is one prosthetic option for restoring missing teeth. 2. The newly developed models for implant training were economical because they can be used for implant training and training for partial denture fabrication. 3. The results of the survey showed that negative responses on implant treatment decreased after training and positive responses increased. These findings indicated that this training was effective in deepening student understanding of implant treatment. Acknowledgments We would like to express our sincere gratitude to NobelBiocare Japan Inc. and GC Inc. for their support of implantology education at Fukuoka Dental College. REFERENCES 1. Weintraub AM, Seckinger R, Berthold P, Weintraub GS. Predoctoral implant dentistry programs in U.S. dental schools. J Prosthodont 1995;4(2): Seckinger RJ, Weintraub AM, Berthold P, Weintraub GS. The status of undergraduate implant education in dental schools outside the United States. Implant Dent 1995;4(2): Bell FA, Hendricson WD. A problem-based course in dental implantology. J Dent Educ 1993;57(9): Bell FA 3rd, Jones AA, Stewart KL. A clinical implant program in the predoctoral curriculum. J Dent Educ 1991;55(2): Journal of Dental Education Volume 73, Number 11

7 5. Schnitman PA. Education in implant dentistry. J Am Dent Assoc 1990;121(3): Simons AM, Bell FA, Beirne OR, McGlumphy EA. Undergraduate education in implant dentistry. Implant Dent 1995;4(1): Ismail JY. Predoctoral curriculum guidelines in implant dentistry. Int J Oral Implantol 1990;7(1): Seckinger RJ, Weintraub AM, Berthold P, Weintraub GS. The status of undergraduate implant education in dental schools outside the United States. Implant Dent 1995;4(2): Addy LD, Lynch CD, Locke M, Watts A, Gilmour AS. The teaching of implant dentistry in undergraduate dental schools in the United Kingdom and Ireland. Br Dent J 2008;205(11): Blum IR, O Sullivan DJ, Jagger DC. A survey of undergraduate education in dental implantology in UK dental schools. Eur J Dent Educ 2008;12(4): Kronstrom M, McGrath L, Chaytor D. Implant dentistry in the undergraduate dental education program at Dalhousie University. Part 1: clinical outcomes. Int J Prosthodont 2008;21(2): Petropoulos VC, Arbree NS, Tarnow D, Rethman M, Malmquist J, Valachovic R, et al. Teaching implant dentistry in the predoctoral curriculum: a report from the ADEA Implant Workshop s survey of deans. J Dent Educ 2006;70(5): Lim MV, Afsharzand Z, Rashedi B, Petropoulos VC. Predoctoral implant education in U.S. dental schools. J Prosthodont 2005;14(1): Afsharzand Z, Lim MV, Rashedi B, Petropoulos VC. Predoctoral implant dentistry curriculum survey: European dental schools. Eur J Dent Educ 2005;9(1): Klokkevold PR. Implant education in the dental curriculum. J Calif Dent Assoc 2001;29(11): Wilcox CW, Huebner GR, Mattson JS, Nilsson DE, Blankenau RJ. Placement and restoration of implants by predoctoral students: the Creighton experience. J Prosthodont 1997;6(1): Maalhagh-Fard A, Nimmo A, Lepczyk JW, Pink FE. Implant dentistry in predoctoral education: the elective approach. J Prosthodont 2002;11(3): Huebner GR. Evaluation of a predoctoral implant curriculum: does such a program influence graduates practice patterns? Int J Oral Maxillofac Implants 2002;17(4): November 2009 Journal of Dental Education 1285

Dental Student Perceptions of Predoctoral Implant Education and Plans for Providing Implant Treatment

Dental Student Perceptions of Predoctoral Implant Education and Plans for Providing Implant Treatment Judy Chia-Chun Yuan, D.D.S., M.S.; Linda M. Kaste, D.D.S., Ph.D.; Damian J. Lee, D.D.S., M.S.; Rand