University teaching of implant dentistry: guidelines for education of dental undergraduate students and general dental practitioners. An Australian consensus document#

The rapid growth of knowledge in conjunction with scientific and technological advances in the last three decades has imposed important challenges in the training of all oral healthcare professionals. With the global trend of the population growing older and retaining their dentition,1–4 there is an increasing demand for therapies and services aimed not only to assure oral and general health, but also to improve quality of life by enhancing function and aesthetics. Treatment with dental implants has developed significantly during the past two decades. A critical body of research evidence has accumulated, enhancing clinicians’ ability to safely and effectively provide implant dentistry procedures to a larger portion of the population and with increased predictability.5–7 As a result, a major increase in the number of implant treatments performed each year is occurring worldwide, with Australia being one of the rapidly growing markets.8 Implant dentistry is increasingly applied in general dental practice. Although there remains a range of implant procedures that are provided by specialists, it is clear that implant dentistry related procedures will occupy a significant part of the modern general dental practice in the near future. Existing guidelines in undergraduate dental education worldwide have little reference to the competencies and skills required within implant dentistry by dental graduates. In addition, general dental practitioners seeking the development of advanced competencies in relation to implant dentistry have only limited possibilities for university driven education. The Australian Consensus Workshop on Implant Dentistry University Education was organized and supported by a grant from the Australian Learning and Teaching Council (ALTC). This interdisciplinary consensus workshop included leading academics actively involved in the teaching of implant dentistry from all Australian dental schools offering such an education. While building on the work already produced by Australian and international bodies,9,10 the consensus workshop aimed to: • produce up-to-date, comprehensive consensus guidelines for the learning outcomes desired for Australian undergraduate education, reflecting the educational environment, as well as the specific healthcare needs of the Australian population; • describe the competencies needed and the educational structures which universities can develop in order to provide quality education for general practitioners who want to safely and effectively introduce implant dentistry procedures in their practice. Two position papers were brought to discussion during the workshop: one concerning the undergraduate dental curriculum, and a second addressing issues related to the education of currently practising general dentists. The statements that follow are organized in these two directions and represent consensus statements as adopted by all academic participants of the workshop. Further details of the rationale and background of these statements can be found in the respective position papers. The role we expect of the general dentist will direct the competencies recommended for the undergraduate curriculum to achieve. The group recommends the following competencies as the desired outcomes of undergraduate dental education within implant dentistry. The Australian dental graduate must be competent at : • Assessing patients’ suitability for dental implants by collecting and evaluating all necessary information from the patients’ medical history, dental history, social and psychological history, including patients’ needs and values. • Assessing predictability and risk profile of implant treatment on the individual patient – by conducting and evaluating all relevant clinical, radiographic and laboratory examinations to assess local anatomical factors governing the predictability of treatment with oral implants; – by determining an evidence based risk profile of the patient based on a comprehensive analysis of systemic, behavioural, psychosocial and local anatomical factors, including each patient’s functional and aesthetic requirements for potential implant treatment. • Presenting a treatment plan by designing an evidence based treatment plan, including options with dental implants and referral if needed. • Participating in a multidisciplinary management team This team might include general dentists, specialists, radiologists, oral health therapists/hygienist and laboratory technicians. The Australian dental graduate must have knowledge of: • all referral requirements when sending patients for imaging and radiographic examinations. The Australian dental graduate must be competent at: • applying the appropriate infection control strategies. The Australian dental graduate must have knowledge of: • principles and techniques for the placement of dental implants • basic equipment and instruments necessary for the placement of dental implants. The Australian dental graduate must be familiar with: • complex surgical procedures • approaches to bone and soft tissue management. The Australian dental graduate must be competent at: • applying the appropriate infection control strategies • selecting, designing and delivering temporary/provisional restorations in relation to straightforward implant therapy • designing and delivering implant-supported single unit FDPs in the non-aesthetic zone and implant-retained mandibular RDPs. The Australian dental graduate must be familiar with: • complex prosthodontic principles and procedures. The Australian dental graduate must be competent at: • planning and executing comprehensive maintenance protocols, based on the best available evidence and the needs and risk profile of individual patients. The Australian dental graduate must be competent at: • diagnosing diseases affecting the peri-implant tissues, identifying their aetiology, pathogenesis, progression and risk factors • diagnosing technical complications • treating peri-implant mucositis. The Australian dental graduate must have knowledge of: • therapeutic approaches for treatment peri-implantitis • management of technical complications. The Australian dental graduate must be familiar with: • management of complex biological and technical complications. Only a few practitioners will undertake full-time specialist education, while the vast majority of general practitioners will seek the acquisition of certain knowledge and competencies that were not included in their undergraduate education in order to expand the array of treatments that they offer to their patients. There is a clear role for universities in providing structured postgraduate pathways that facilitate the continuing professional development of general dental practitioners in the area of implant dentistry.10,11 • Universities should play the leading role in the facilitation of evidence based education in implant dentistry for the general dental practitioner. • University programmes should ensure that the level of competency reached allows safe practice of implant related procedures. • Programmes should place a strong emphasis on diagnosis, treatment planning and case selection with an understanding that implant dentistry is predominantly restorative-driven. • Programmes should consider the unique educational requirements of the general dental practitioner including the need for innovative program delivery. • Implant dentistry educational pathways can be divided into four levels of training (Table 1). • University programmes developed for the general dental practitioner should provide competencies up to the level of advanced surgical and/or prosthodontic treatment (Level 3). • Programmes providing competencies up to the level of complex surgical and/or prosthodontic treatment (Level 4) are provided in specialist education. • It is recommended that programmes be designed to allow incremental learning to take place within the bounds of the clinical competence of the individual. • It is recommended that universities develop a series of objective entry criteria tailored to the specific programme. • Programmes should be adequately resourced and be subject to routine university governance. • Mentorship is highly recommended and clinical supervision is essential in combination with a structured program of study. • Programmes must provide candidates with sufficient clinical experience to obtain competency at the level of complexity prescribed for the programme. • It is recommended that award programmes incorporate a component of research methodology to allow critical appraisal of scientific literature. • A sufficient level of clinical competence must be achieved prior to progressing to the next level. • A clearly defined process of formative and summative assessment is required to determine progression and graduation of candidates. • The involvement of external examiners for assessment of candidates is recommended. • It is recommended that external peer review of the programme and its outcomes be implemented. The Australian Consensus Workshop on Implant Dentistry was an initiative supported by a Competitive Leadership Grant by the Australian Learning and Teaching Council. We are also grateful to our partners Astratech Dental, Biomet 3i, Henry Schein-Halas/Southern Implants, Nobel Biocare and Straumann, whose generous contribution allowed for the maximum impact of this initiative.