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EDUCATION

oral implantology teaching

A survey of oral implantology


teaching in the university dental
hospitals and schools of the
United Kingdom and Eire.
M P J Young,1* D H Carter,2 P Sloan,2 A A Quayle1,

Aim to provide an overview of the currently available academic teaching and clinical
training in oral implantology at the university dental schools and hospitals of the United In brief
Kingdom and Eire. ● The use of endosseous dental
Method A questionnaire was sent to the dean or director of dental studies and implants is increasing and general
forwarded to the respective units involved in the academic teaching and clinical training dental practitioners might be
of oral implantology. expected to maintain patients with
implants in everyday practice.
The setting was the university dental hospitals, and dental schools of the UK and Eire.
● However, currently there is no
Information was collected between July 1997 and March 1999. The main outcome funding for the maintenance of
measures were course availability, duration and emphasis for undergraduate and dental implants in NHS-funded,
postgraduate study in the clinical discipline of oral implantology. The units or general dental practice.
departments responsible for training and teaching were identified and formal degree ● Factors and guidelines pertinent to
courses were distinguished from non-degree courses. providing implant maintenance in
Results All institutions replied to the survey. All university dental schools provide general practice are presented.
undergraduate training in oral implantology in accordance with the guidelines provided ● The availability and nature of
by the General Dental Council. However, the courses vary with regard to the departments university-based teaching and
involved and the level of student participation. Thirteen centres provide informal training of oral implantology is
postgraduate training with the duration ranging from one to eighteen days. Just eight presented and includes
undergraduate, postgraduate and
centres provide formal academic graduate training based on oral implantology leading to
academic graduate study.
recognised degrees.
Conclusion All university dental schools provide undergraduate teaching in oral
implantology. Most centres also provide informal postgraduate training based on oral endosseus dental implants is expensive,
implantology. However, opportunities for academic graduate training, leading to compared with alternative treatments.
recognised qualifications in this subject, appear limited at present. In NHS hospital and university based
practice, patient dissatisfaction will be
identified by clinical audit with poten-
The efficacy of endosseous dental implants familiar with the general principles of tially serious implications for implant
has been demonstrated in edentulous appropriate case selection since oral service providers. Litigation may arise if
patients1 and partially dentate patients2 implantology now forms part of under- patients have costly private treatment
and appropriate criteria for implant suc- graduate teaching. Preliminary guidelines that they perceive as being unsatisfactory
cess have been defined.3 Consequently, for the use of endosseous implants have either in terms of aesthetics or function.
general practitioners are encountering been outlined4 and additional guidelines • The high expectations of the patient.
patients in everyday practice who have have been issued for the selection of appro- Patients are often referred for implant
undergone implant treatment and there is priate patients to receive dental implants treatment when non-implant treatments
an increasing requirement for the dentist within the NHS hospital services.5 Factors have failed and consequently their thera-
to be familiar both with the principles of influencing the need for these guidelines peutic expectations may be high. It has
the technique and implant maintenance. and appropriate training include: been shown that the emotional effects of
Recent graduates might be expected to be tooth loss upon a patient are significant
1Unit of Oral Surgery, 2Unit of Oral Pathology, • The elective nature of surgical oral even if they appear to be coping well with
Turner Dental School and Hospital, Higher implantology. Patients choose to dentures.6 The emotional effects of tooth
Cambridge Street, Manchester, M15 6FH. undergo implant treatment even though loss on patients undergoing compara-
* Correspondence to M P J Young.
REFEREED PAPER
non-surgical treatments are available. tively lengthy implant treatments might
received 13.07.98; accepted 04.08.99 • The high cost of implant therapy. be presumed to be even greater.
© British Dental Journal 1999; 187: 671–676 Prosthodontic treatment using • The long treatment times for

BRITISH DENTAL JOURNAL, VOLUME 187, NO. 12, DECEMBER 25 1999 671
EDUCATION
oral implantology teaching

Key to table 1
University-based, post-graduate and graduate
OMFS = Oral maxillofacial surgery Table 1 courses in oral implantology. Nature of courses and clinical
R = Restorative dentistry groups responsible for impant teaching and training
Pe = Periodontology
Pr = Prosthodontics University
C = Conservative dentistry Dental Degree Course Non-degree Clinical Groups
Institution
1 No No Not applicable
implantology. The aesthetic and func-
2 No No Not applicable
tional expectations of the patient may
change, or even increase, during pro- 3 Yes Yes R
tracted treatment. It is important that 4 No Yes R (Pe)
the clinician can identify these possibili- 5 Yes Yes R
ties and discuss the implications with the 6 No Yes Details not provided
patient before treatment commences. 7 Yes Yes OMFS, R (C, Pr, Pe)
• The potential complications. So far, the 8 Yes No OMFS, R (Pr)
number of implant cases proceeding to 9 Yes Yes OMFS, R (Pe, Pr)
formal litigation appears to be low. 10 No Yes OMFS, R
However, irreversible anatomical dam- 11 No Yes R
age has been reported7,8 and re-treat-
12 Yes Yes OMFS, R (Pr)
ment may be complex, or impractical.
Compensation arising from litigation 13 Yes Yes OMFS, R
will affect both the cost and conditions 14 No Yes OMFS, R
of professional indemnity. 15 Yes Yes OMFS, R (Pe)
• The apparent variation in the level of 16 No Yes OMFS, R
scientific support for implant related
techniques and implant systems.
Many studies, cited in support of individ- and schools of the UK and Eire. In particu- units involved whilst others simply indi-
ual implant systems or implant techniques, lar, it aims to assess the undergraduate cated that restorative dentistry was involved
do not appear to meet accepted protocols teaching that dental students receive and in implant teaching.
for scientific review.9 More specifically, it both postgraduate and graduate training During the period of this survey, two
has recently been suggested that only one that is available for general practitioners. In institutions have been amalgamated. This
of the current implant systems possessed the context of this paper, the term ‘graduate paper presents details from the sixteen
scientific support for long-term success, degree’ is used to denote programmes lead- institutions, prior to this amalgamation.
when a review of manufacturer-supplied ing to a masters or doctoral degree offered Non-degree training in oral implantol-
literature was carried out.10 However, con- by the universities. In contrast, ‘postgradu- ogy for higher trainees within the NHS
cerns such as these are not restricted to ate’ education relates to programmes was not included in this survey.
implant dentistry.11 relating to higher clinical training and pro-
A survey of the availability of training in fessional development offered by the NHS Method
oral implantology in the UK and Eire was postgraduate dental deanery. Also, in this A questionnaire survey was forwarded to
reported in 1993.12 Our more recent survey survey, restorative dentistry was taken to the Dean, or Director of Dental Studies at
sets out to determine the currently available include periodontology, prosthodontics each of the listed University Dental Hos-
teaching and training in oral implantology and conservative dentistry. Certain institu- pitals and Schools and the Eastman Den-
provided by the university dental hospitals tions specified the precise departments or tal Institute. The information was
initially gathered between July 1997 and
September 1998. A copy of the results and
Further details of graduate degree courses. Units or a draft of this paper were then sent to the
Table 2 Departments involved in formal academic teaching in oral institutions for validation or amendment
impantology including degree details. of the data as necessary. All data were
University
finalised by March 1999.
Dental Clinical Group Qualification Graduates to date
Institution Results
All sixteen centres replied to the survey 13
3 R PhD Details not provided and the results are presented in Tables
5 R (Pe) MSc 6 1–5. Whilst all the institutions agreed to
7 OMFS + R (C, Pe, Pr) MSc, PhD 4
8 OMFS + R (Pr) MSc, PhD 3 Key to table 2
9 OMFS + R (Pe) MSc, M Clin Dent 4+
OMFS = Oral maxillofacial surgery
12 OMFS + R (Pr) PhD, MDentSci, MSc 11
R = Restorative dentistry
13 OMFS + R PhD, MSc Details not provided Pe = Periodontology
15 OMFS + R (Pe) M Med Sci 12 Pr = Prosthodontics
C = Conservative dentistry

672 BRITISH DENTAL JOURNAL, VOLUME 187, NO. 12, DECEMBER 25 1999
EDUCATION
oral implantology teaching

Table 3 University post-graduate, non-degree implant training


courses. Section 63 and other University-run courses.

University
Dental Course Duration Clinical Groups
Institution
3 Course run but details not provided Details not provided
4 2 days Details not provided
5 2 days Details not provided undergraduate teaching in oral implantol-
6 Course run but details not provided Details not provided ogy. In seven centres the teaching of
7 Course run but details not provided Details not provided undergraduate students was by both oral
3 days
and maxillofacial surgery and restorative
9 10-20
dentistry. In eight centres this teaching
10 2 days 20-27 was provided by Restorative Dentistry
11 1 day section 63 Details not provided
alone. Although all centres provided some
12 2 days section 63 training 6 undergraduate teaching the nature varied
13 2-3 days 24-30 with regard to the departments involved
14 1 day 20 and presumably the course content. All
15 18 days Details not provided dental schools provide undergraduate lec-
16 Course run but details not provided Details not provided tures, mostly supported by clinical obser-
vation of implant treatment. Direct
involvement of some undergraduates in
clinical implant treatment occurs at just
publication of the results, three institu- Predicted trend in implant training: (Table 4) four of the university dental schools.
tions requested that the data were pre- Eleven centres indicated that an increase
sented without the individual institutions in implant training was planned although Discussion
being named. Therefore, the results are it was considered difficult to provide At the present time, every university den-
presented with the institutions identified precise, or extensive, details for this sur- tal school provides undergraduate train-
by a randomised number from 1–16. vey. Just two institutions stated that they ing in oral implantology. This training is
had no plans to increase the teaching in likely to comprise basic familiarisation
Summary of Results oral implantology. with the principles of oral implantology
Formal Degree Courses: (Tables 1 and 2) and the factors that determine which
Eight of the sixteen centres provide for- Current undergraduate teaching: (Table 5) patients should be referred for consultant
mal academic training based on oral All the dental schools provide some advice. However, the precise nature of
implantology. The clinical academic
groups involved in this formal training
varied. In six centres teaching was carried
Table 4 Predicted trend in teaching and training in oral
out by both oral and maxillofacial surgery
implantology
and restorative dentistry, whilst in
two centres teaching was carried out by University
staff from restorative dentistry alone. At Dental Increase in training Clinical Groups
the time of this survey, the qualifications Institution
currently available for academic study
1 Yes Postgraduate courses planned
based on the clinical discipline of
oral implantology are Master of Science 2 Possibly Not known
(MSc), Master of Dental Science 3 Yes Details not provided
(MDent.Sci.), Master of Clinical Den- 4 Yes Increase in staff and postgraduate training
tistry (M. Clin.Dent.) and Doctor of Phi- 5 Yes Increase in postgraduate training
losophy (PhD). The number of graduates 6 Possibly Dependant on funding
who have qualified from each institution 7 Yes Increase in teaching and training
to-date ranged between two and twelve. 8 No Details not provided
9 Yes Degree course in implant dentistry planned
Non-degree, University based training: 10 Yes Small increase in training, funding dependent
(Table 3)
11 No Details not provided
Thirteen centres offer non-degree
implant courses for postgraduates rang- 12 Yes Not known
ing between one to eighteen days, in 13 Yes Specialist prosthodontic & periodontic courses
duration. These courses included sec- 14 Yes Details not provided
tion 63 courses and other ‘non-degree’ 15 Yes Confidential
postgraduate programmes run by the 16 Possibly Not known at present
universities.

BRITISH DENTAL JOURNAL, VOLUME 187, NO. 12, DECEMBER 25 1999 673
EDUCATION
oral implantology teaching

Key to table 5
Table 5 Undergraduate teaching in oral implantology at the
OMFS = Oral and maxillofacial surgery University Dental Schools of the UK and Eire.
Pe = Periodontology
Pr = Prosthodontics
R =Restorative dentistry
Teaching by Level of teaching Clinical experience in oral
L = Lectures
CO - Clinical observation impantology
D = Direct involvement in clinical treatment
R L none
OMFS + R (Pe, Pr) L, CO none
this teaching is likely to be variable in R L, CO, HO none
composition, emphasis and duration R (Pe) L, CO (D: some students)
because the departments involved vary OMFS + R L, CO none
(Table 5). It is worth noting that under- OMFS + R L, CO none
graduate teaching is likely to be limited
OMFS + R (Pr) L, CO none
since the GDC has specifically stated that
OMFS + R (Pe, Pr) L, CO none
dental implant treatment is beyond the
R L, CO none
expected competence of graduates on
R L, CO none
qualification.14
If trends in the UK and Eire follow OMFS + R L, CO none
those in Europe and the USA, dental R L, CO (D: some students)
graduates will encounter more patients R (Pr, Pe) L, CO (D: some students)
with dental implants. The long term OMFS + R L, CO (D: some students)
monitoring and maintenance of those R none
L, CO
implants may then fall, as a basic duty of
care, upon general dental practitioners.
At the same time, they will be required to
recognise associated pathologies. It has determining the quality and quantity of The authors would like to extend their sincere gratitude
been shown that oral hygiene can be research in oral implantology should not to the Deans and the Staff of the University Dental
Schools and Hospitals of the UK and Eire who kindly
problematical in the early stages of be underestimated, nor should its poten- replied to this questionnaire. Our thanks go to those
implant maintenance15 but there is no tial for supporting the research profile of staff who provided us with additional information and
NHS funding for dental implant mainte- the institution. constructive comments. In addition, we would like to
thank the Institutions in permitting us to publish these
nance by general dental practitioners. To ensure that the results in this paper findings. Finally, we would like to thank Miss Sheena
The general practitioner who decides to were accurate, a copy was forwarded to Palmer, Unit of Oral Surgery, Turner Dental School, for
accept responsibility for implant moni- the dean of each institution for verifica- organising the distribution of this survey.
toring and maintenance then faces the tion. At the same time, permission was 1. Adell R, Lekholm U, Rockler B, & Branemark
difficulty of setting appropriate and rea- sought to publish the results either in an P I. A 15-year study of osseointegrated
sonable fees for the service.16 If the needs anonymous form, or with the institu- implants in the treatment of the edentulous
jaw. Int J Oral Surg 1981; 10: 387-416.
of the patient are beyond the skills of the tions named. Just three centres stated 2. Lekholm U, van Steenberghe D, Herrmann I,
dentist an appropriate referral must be they did not wish to consent to the results Bolender C, Folmer T, Gunne J, Henry P,
made.17 General practitioners could, being published in a paper that named Higuchi K, Laney W R, & Linden, B.
however, choose to implement a suitable the institutions. Consequently, one aim Osseointegrated implants in the treatment of
the partially edentulous jaws: a prospective 5-
implant maintenance programme if they of this survey, namely to present infor- year multicentre study. Int J Oral Maxillofac
have undergone appropriate training and mation to practitioners on where they Implants 1994; 9:627-635.
acquired adequate clinical experience. might seek further teaching and training 3. Albrektsson T, Zarb G A, Worthington P,
Eriksson A R. The long-term efficacy of
However, this survey shows that formal in oral implantology, could not be currently used dental implants: a review and
academic degree courses based on oral achieved. Hopefully, all the institutions proposed criteria of success. Int J Oral
implantology, or with a component of will permit details of their teaching and Maxillofac Surg 1986; 1:11-25.
oral implantology, are only available at training programmes in oral implantol- 4. Guidelines on standards for the treatment of
patients using endosseous dental implants: A
eight university centres at present. This is ogy to be published in the future. supplement to the BDJ. British Association of
surprising considering that current It is hoped that the university dental Oral and Maxillofacial surgeons; British
guidelines specify that dental implant schools and hospitals will respond to Society for the Study of Prosthetic Dentistry.
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Prospective students and general dental uate and graduate levels. Rather encour- patients. Br Dent J 1998; 184: 90-93.
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674 BRITISH DENTAL JOURNAL, VOLUME 187, NO. 12, DECEMBER 25 1999
EDUCATION
oral implantology teaching

110 patients. Br J Oral Maxillofac Surg 1997; 35: lessons have we ignored? Br Dent J 1998; 184: 58-59 Complications and maintenance requirements
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