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
OMFS = Oral and maxillofacial surgery
Pe = Periodontology
Pr = Prosthodontics
R =Restorative dentistry
L = Lectures
CO - Clinical observation
D = Direct involvement in clinical treatment
this teaching is likely to be variable in
composition, emphasis and duration
because the departments involved vary
(Table 5). It is worth noting that under-
graduate teaching is likely to be limited
since the GDC has specifically stated that
dental implant treatment is beyond the
expected competence of graduates on
qualification.14
If trends in the UK and Eire follow
those in Europe and the USA, dental
graduates will encounter more patients
with dental implants. The long term
monitoring and maintenance of those
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
been shown that oral hygiene can be
problematical in the early stages of
implant maintenance15 but there is no
NHS funding for dental implant mainte-
nance by general dental practitioners.
The general practitioner who decides to
accept responsibility for implant moni-
toring and maintenance then faces the
difficulty of setting appropriate and rea-
sonable fees for the service.16 If the needs
of the patient are beyond the skills of the
dentist an appropriate referral must be
made.17 General practitioners could,
however, choose to implement a suitable
implant maintenance programme if they
have undergone appropriate training and
acquired adequate clinical experience.
However, this survey shows that formal
academic degree courses based on oral
implantology, or with a component of
oral implantology, are only available at
eight university centres at present. This is
surprising considering that current
guidelines specify that dental implant
training is a postgraduate subject.14 It is
also recognised that masters and doctoral
programmes may vary considerably in
their clinical training content.
Prospective students and general dental
practitioners may consider the level and
extent of implant training at a particular
dental school and hospital to be an
important factor in their choice of centre
for training. At the same time, the role
of formal graduate education in
674
Table 5 Undergraduate teaching in oral implantology at the
University Dental Schools of the UK and Eire.
Teaching by Level of teaching
R L
OMFS + R (Pe, Pr) L, CO
R L, CO, HO
R (Pe) L, CO
OMFS + R L, CO
OMFS + R L, CO
OMFS + R (Pr) L, CO
OMFS + R (Pe, Pr) L, CO
R L, CO
R L, CO
OMFS + R L, CO
R L, CO
R (Pr, Pe) L, CO
OMFS + R L, CO
R none
L, CO
determining the quality and quantity of
research in oral implantology should not
be underestimated, nor should its poten-
tial for supporting the research profile of
the institution.
To ensure that the results in this paper
were accurate, a copy was forwarded to
the dean of each institution for verifica-
tion. At the same time, permission was
sought to publish the results either in an
anonymous form, or with the institu-
tions named. Just three centres stated
they did not wish to consent to the results
being published in a paper that named
the institutions. Consequently, one aim
of this survey, namely to present infor-
mation to practitioners on where they
might seek further teaching and training
in oral implantology, could not be
achieved. Hopefully, all the institutions
will permit details of their teaching and
training programmes in oral implantol-
ogy to be published in the future.
It is hoped that the university dental
schools and hospitals will respond to
the increased use of oral implants by
further increasing the availability of both
academic and clinical training in oral
implantology at undergraduate postgrad-
uate and graduate levels. Rather encour-
agingly, eleven institutions indicated that
increased activity in implant training was
anticipated in the future. Formal training
pathways for the clinical discipline of
oral implantology have yet to be clearly
defined.
BRITISH DENTAL JOURNAL, VOLUME 187, NO. 12, DECEMBER 25 1999
Clinical experience in oral
impantology
none
none
none
(D: some students)
none
none
none
none
none
none
none
(D: some students)
(D: some students)
(D: some students)
The authors would like to extend their sincere gratitude
to the Deans and the Staff of the University Dental
Schools and Hospitals of the UK and Eire who kindly
replied to this questionnaire. Our thanks go to those
staff who provided us with additional information and
constructive comments. In addition, we would like to
thank the Institutions in permitting us to publish these
findings. Finally, we would like to thank Miss Sheena
Palmer, Unit of Oral Surgery, Turner Dental School, for
organising the distribution of this survey.
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P I. A 15-year study of osseointegrated
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2. Lekholm U, van Steenberghe D, Herrmann I,
Bolender C, Folmer T, Gunne J, Henry P,
Higuchi K, Laney W R, & Linden, B.
Osseointegrated implants in the treatment of
the partially edentulous jaws: a prospective 5-
year multicentre study. Int J Oral Maxillofac
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3. Albrektsson T, Zarb G A, Worthington P,
Eriksson A R. The long-term efficacy of
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