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SPECIAL FEATURE
Year : 2017  |  Volume : 9  |  Issue : 1  |  Page : 4-7

Restructuring of dental implant education in India


Department of Periodontics and Implantology, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India

Date of Web Publication30-Jun-2017

Correspondence Address:
Abhay P Kolte
Department of Periodontics and Implantology, VSPM Dental College and Research Centre, Digdoh Hills, Hingna Road, Nagpur - 440 019, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jicdro.jicdro_7_17

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   Abstract 

Various treatment modalities have been proposed and practiced over the years for comforting the functions of individuals with enhanced life expectancy leading to an aging population. These therapeutic modalities are directed toward providing masticatory apparatus to patients with atrophic edentulous ridges. After evolving over several years, clinicians have now been enabled to use dental implants and provide a functionally viable and esthetically pleasing masticatory apparatus to their patients. However, majority of the dentists lack the detailed knowledge, skills, and experience which are necessary and essential for a successful implant therapy. Various training programs have been conducted across the country with the motive to bridge the gap between the clinician and the therapy. However, the existing training programs and courses lack the detailed theoretical inputs and deliberations, which form the very basis for an implicative understanding of the therapeutic modality and thus do not offer desired outcomes many a times. The success of implant therapy depends not only merely in achieving osseointegration of the implant but also providing the esthetic and functional standards, which are in tune with the patient's expectation. Oral implantology cases can be briefly divided based on their complexity as either straightforward or complex placement and/or restoration of implant. To benefit the society at large, it is high time that training programs be proposed with differential skill upgradation with different avenues. The article proposes a few training avenues for the dental professionals which if taken up in the right perspective will restructure the education in oral implantology in our country. Such training avenues need to be brought under regulatory bodies such as the State Health Universities and Dental Council of India so as to achieve a desired standardization and uniformity.

Keywords: Complex therapy, curriculum, dental implants, education avenues


How to cite this article:
Kolte AP. Restructuring of dental implant education in India. J Int Clin Dent Res Organ 2017;9:4-7

How to cite this URL:
Kolte AP. Restructuring of dental implant education in India. J Int Clin Dent Res Organ [serial online] 2017 [cited 2017 Aug 23];9:4-7. Available from: http://www.jicdro.org/text.asp?2017/9/1/4/201438


   Restructuring of Dental Implant Education in India Top


The ever-expanding horizons of the dental profession have necessitated the introduction, adaptation, and acceptability of newer and better therapeutic modalities in clinical practices. Dental implant is one such therapeutic modality which has evolved over the years and enabled the clinicians into providing a functionally viable and esthetically pleasing masticatory apparatus to their patients. Therapeutic measures involving dental implants have improvised on the previously available treatment options overcoming their limitations and bettering on the masticatory efficiency as well.[1],[2] With these definite positives and increasing awareness among the clinicians and patients alike, there is an enhanced demand for dental implant therapeutics. An additional propagating factor has been the commercial interests of the manufacturing companies and distributors of dental implants.

The surge in dental implant therapeutics in our country has been evident in the past 20 years. The treatment modality which was thought to be almost a dream for most of the clinicians and considered to be reserved for specialist dental teams for the management of extremely atrophic edentulous ridges has now opened up and is being practiced on a much larger scale. This has been reflected in the dramatically growing number of dental implants being placed. With the increase in life expectancy across the world, an aging population points to huge numbers of additional candidates to be taken up for dental implant therapy, at least for the next several decades.[3],[4],[5]

In the current scenario, there are many general dental practitioners who have taken up into practicing implant therapy on account of being able to provide a better and advanced therapeutic option to their patients and which in turn would fetch a greater remuneration. The preliminary knowledge for such practitioners is provided by additional training courses in placement and restoration of dental implants in straightforward cases. It is assumed to be mandatory to acquire necessary training, knowledge, skills and competence in treatment planning, surgical placement, restoration, and maintenance of dental implants before performing such procedures. Individualized risk assessment should be undertaken to categorize clinical cases as straightforward, advanced and complicated, thereby matching the degree of difficulty of a given situation to the dentist's level of education, training, experience, and skills. Furthermore, the dental practitioners need to be aware of their limits in terms of adequate knowledge and technical skills in the management of advanced and complicated cases. Unfortunately, due to the lack of regulations, this remains a gray area and is attempted by many a clinicians which ultimately results into complications and/or suboptimal results for the patients.


   Training Avenues – current Perspectives Top


In the present scenario, there is no mandatory requirement of training as far as practicing implant therapy is concerned in our country. The general dental practitioner may opt for continuing professional development courses may be of a single day or two and commence with practicing this therapeutic modality. A few universities off late have ventured into the implant fellowship programs, which are affiliated to them. These training courses vary in duration from as less as 2 days to a maximum of 20 days and would result in the grant of a certificate.

The problem with the available training courses offered today is that most of them differ substantially in duration, their aims and objectives, course contents, and the quality of education. These courses are spread over a few days to a few modules and do not involve the necessary extensive clinical training for the participants. They often lack the detailed theoretical inputs and deliberations which form the very basis for an implicative understanding of the therapeutic modality. They are neither standardized nor are they regulated and validated. These courses are delivered by a wide variety of providers ranging from a few universities to the so-called “Expert Clinicians.” Unfortunately, these courses are not educationally structured and do not offer tangible outcomes such as a recognized qualification.

All the above anomalies point to the fact that, in our quest of propagating the science, we are producing mechanical experts in implantology. This sort of training may benefit a certain section of the population, but it would also increase the associated complications in implant therapy with dwindling success rates.[6],[7] At present, there is an urgent need for regulation of such training courses in terms of improving upon the duration, content, structure, and imparted clinical skills in such a way that they would provide the basic level knowledge to the practicing clinician. This will enable the course participants to identify the suitable cases, segregate them based on difficulty index, provide therapy to the ones at their levels of expertise, and refer the ones requiring advanced interventions.

It is high time that the Dental Council of India recognizes these ambiguities and steps into this arena with the sole intention of achieving uniformity and standardization of this specialty. If the current situation goes unchecked and unregulated, we ourselves will be responsible for causing a great disrepute to this advanced and excellent therapeutic science, which needs to be handled appropriately with due caution. With reference to the regulation of training avenues, the following facts are required to be considered before formulating such policy decisions.


   Oral Implantology - gaining an Insight Top


Oral implantology is a branch of dental science that aims to restore and maintain the oral function, appearance, and health of the patient through the placement of endosseous dental implants and associated fixed and/or removable prosthetic components. Dental implant therapeutics has three major components:

  1. Surgical - whereby the implants are placed into the alveolar foundations and are permitted to osseointegrate,
  2. Restorative - whereby the suprastructure is aligned with the osseointegrated implants, and
  3. Maintenance - whereby the functional dental implant is maintained in hygiene within the oral cavity.


The alignment of suprastructure and use in mastication is termed as loading of the implant. However, apart from these three components, there are numerous other factors that come into play both in planning as well as execution of the treatment. Thus, while oral implantology is not recognized as a separate specialty or super specialty, it is certainly a specialized field that requires cross-disciplinary understanding and skills. Although the literature suggests overall success rates of over 90% in dental implant therapeutics, in today's age, osseointegration alone is not necessarily a measure of success. We know that implants osseointegrate, but the real challenge lies in making this treatment successful by today's measure of esthetics and functional standards, which is in tune with the patient's expectations.[8],[9] Ensuring and achieving such success requires an in-depth knowledge and gradual attainment of skills that is based on clinical experience.

Furthermore, oral implantology encompasses a wide variety of techniques and procedures to be practiced in different situations. The clinical cases can be broadly divided in two levels of complexity (1) cases involving straightforward placement and/or restoration of dental implants and (2) cases involving complex placement and/or restoration of dental implants.


   Restructuring the Training Avenues Top


It is reasonable to assume that the complete spectrum of oral implantology cannot be taught within the current duration of UG curriculum and the short-term courses currently being conducted. To benefit the general public at large, it is proposed to have training programs as two separate avenues.

  1. The first avenue will comprise short-term courses on a modular basis with ten modules of 2/3 days duration for each of these modules spread over one complete year. This will enable the course conductors and faculties to deliberate on various issues of theoretical know-how and inculcate preliminary clinical skills among the course participants. These courses will also include implant placements by the course participants under the guidance and supervision of course conductors. These sort of courses need to be affiliated to respective state health universities. The educational quality, course contents, caliber of course providers, and pedagogical background of the educators will be ascertained by the regulatory bodies, and all the details will be monitored from time to time. Quality assurance features of such courses will adhere to predetermined learning objectives and achievable learning objectives. These will be evaluated at the completion by a theory, practical, and viva voce examination to be conducted by the respective state health universities


  2. Such courses can be conducted by private institutes other than implant manufacturing companies or by dental colleges recognized by the Dental Council of India and which will also grant an approval for such courses. The courses conducted by dental implant manufacturers tend to be biased toward a certain implant system. In this proposed institution-based course, the participants can experience many different implant systems and decide about the advantages and limitations of each based on their own experience. The course will be open for qualified dental graduates who possess a degree which is recognized by the Dental Council of India

  3. The second avenue should be to introduce a 5-year full-time dual degree course in the postgraduation courses of periodontics, oral and maxillofacial surgery, and prosthodontics. Candidates pursuing postgraduation in these specialties will have the option of seeking admission to postgraduate degrees in the basic specialty (3 years duration) and additional 2 years for postgraduation in implantology (2 years duration), thus making it a 3 + 2 years postgraduate dual degree course. As these three specialties are involved in one or the other aspects of implant therapeutics, the candidates will be in a position to master the skills that were not a part of their postgraduation in the additional 2 years. The additional 2 years can be utilized to acquire the necessary clinical skills to carry out advanced procedures such as sinus augmentations, zygomatic implants, nerve repositioning procedures, extraoral autogenous bone grafting, implant manufacturing process, computed tomography-guided surgical procedures, computer-aided design/computer-aided manufacturing-based prosthetics and rapid prototyping, advanced prosthetic procedures such as intraoral welding, and management of implant complications. The examination systems will be modified accordingly with two examinations, one at the completion of 3 years leading to a postgraduation in basic specialty and the second one at the end of 5 years leading to a postgraduate qualification in oral implantology


  4. These dual degree courses will enable the students to employ evidence-based decision making, thus enhancing their skills in tune with the current perspectives. The course duration will strengthen the ability to critically apprise and evaluate new products and techniques before implementing them in clinical practices. This is one of the requirements for safe and patient-centered treatment outcomes

  5. The third avenue should be through establishing oral implantology as a separate postgraduate specialty with a full-time duration of 3 years and which can be sought after graduation. The syllabus or curriculum should be directed at imparting basic theoretical knowledge and clinical skills in periodontics, oral and maxillofacial surgery, and prosthodontics along with the advanced procedures such as bone augmentation, guided bone regeneration, sinus augmentation approaches, and prosthetic rehabilitation in partially as well as fully edentulous arches with other therapeutic modalities. The postgraduate degree will be awarded on successful completion of research dissertation and the theory and practical/clinical examination which will be as per the pattern adopted in different postgraduate specialties


These departments will have teaching faculties from all the three basic specialties of periodontics, oral and maxillofacial surgery, and prosthodontics, the requirements of numbers being similar to the other specialties.


   Conclusion Top


Over the past few years, the dental implant industry has been expanding at a rapid pace despite the depth of recession seen in other sectors. The increase in demand will bring a manifold growth in the number of dental graduates wanting to offer dental implant therapeutics to their patients. This will undoubtedly increase the additional training and postgraduate demand in oral implantology, which will have to be necessarily addressed to, by the regulatory body, i.e., the Dental Council of India. It should not happen that an increase in demand of such additional training courses acts as money spinners for some, at the cost of the sacred science of oral implantology. This can only be prevented by ascertaining a proper restructuring of the avenues for education in oral implantology in our country.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Kapur KK, Garrett NR, Hamada MO, Roumanas ED, Freymiller E, Han T, et al. Randomized clinical trial comparing the efficacy of mandibular implant-supported overdentures and conventional dentures in diabetic patients. Part III: Comparisons of patient satisfaction. J Prosthet Dent 1999;82:416-27.  Back to cited text no. 1
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2.
Awad MA, Feine JS. Measuring patient satisfaction with mandibular prostheses. Community Dent Oral Epidemiol 1998;26:400-5.  Back to cited text no. 2
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3.
Murdock SH, Hoque MN. Current patterns and future trends in the population of the United States: Implications for dentistry and the dental profession in the twenty- first century. J Am Coll Dent 1998;65:29-35.  Back to cited text no. 3
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4.
Census 2000 Data on Aging. Available from: http://www.aoa.gov/prof/statistics/census2000/census2000.asp. [Last accessed on 2007 Jul 14].  Back to cited text no. 4
    
5.
Report of Expert Committee on Population Projections for India Up to 2001 – Register General of India, Minister of Planning and Programme Implementation. Government of India, New Delhi; 1998.  Back to cited text no. 5
    
6.
Lambert PM, Morris HF, Ochi S. Positive effect of surgical experience with implants on second-stage implant survival. J Oral Maxillofac Surg 1997;55 12 Suppl 5:12-8.  Back to cited text no. 6
    
7.
Smith LP, Ng M, Grubor D, Chandu A. Outcomes of dental implants placed in a surgical training programme. Aust Dent J 2009;54:361-7.  Back to cited text no. 7
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8.
Papaspyridakos P, Chen CJ, Singh M, Weber HP, Gallucci GO. Success criteria in implant dentistry: a systematic review. J Dent Res 2012;91:242-8.  Back to cited text no. 8
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9.
Al-Sabbagh M, Jenkins DW, de Leeuw R, Nihill P, Robinson FG, Thomas MV. Programmatic assessment of a university-based implant training program using patient-reported outcomes. J Dent Educ 2014;78:1534-41.  Back to cited text no. 9
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   Authors Top

Dr. Abhay P Kolte has done his Masters in Periodontology from the Government Dental College and Hospital, Nagpur, in 1996. Currently, he is working as Professor and Head, Department of Periodontology, VSPM Dental College and Research Centre, Nagpur. He has been co-coordinator for the implant fellowship course for the past few years, which is approved by Maharashtra University of Health Sciences, Nashik.

He has over sixty publications in national and international journals and has been an invited Keynote Speaker at various national and specialty conferences. He has authored the "Compendium of the Dental Research in India" published by Indian Dental Association, Head Office. He is member of editorial board for various national and international journals. He has worked extensively on various positions in the Indian Society of Periodontology and Indian Dental Association. Presently, he is Secretary-Indian Society of Periodontology and President (Elect) - Indian Dental Association, Maharashtra State Branch.




 

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