PROSTHETIC RECONSTRUCTIONS AND REFERRING IMPLANT SURVIVAL IN A POSTGRADUATE PROGRAM: A RETROSPECTIVE STUDY
placed prosthodontic graduate training curricula. As mentioned in the introduction many articles show clear trends that implant dentistry becomes integrated worldwide in the undergraduate training of dental students. Implant dentistry knowledge, however, is mostly a basic theoretical overview on implants. It appears that if the undergraduate students get in touch with implant dentistry they are more likely to incorporate implant treatment in their practice 34. A small survey restricted to a local area revealed that particularly male general practitioners felt the need to obtain training in implant dentistry 35. Today young dentists will meet patients who will ask for implant treatment 7 and who have already all kind of information on implants. In this respect, it seems important that in-depth knowledge is provided and the graduate students must achieve a good level of skills in well structured implant programs. A recent survey conducted in the States revealed that today many postgraduate prosthodontic curricula allow students to perform implant surgery in their advanced education program 36. The answers indicate that up to 50 % of students judged their implant-surgery skills on a level of good competence while others felt the need of more training to reach a better level of competence. One study showed that even a short but intense and closely supervised training of 4 sessions 3 days each may significantly improve surgical skills and as a result also implant survival 37. Postgraduate implant programs in University settings often underscore the multidisciplinary aspect of implant dentistry, as there are oral or maxillofacial surgery, prosthodontics and periodontology. With regard to implants, the specialty training programs subsequently focused on their own, specific knowledge and skills, and several specialists perform the implant treatment. Therefore, the comprehensive character of implant dentistry does not become sufficiently visible. In general, the intent of oral surgery is the removal of a pathological process and treatment of dental or oral diseases. Although implant placement is a surgical procedure, as well, its result is not the pathology but the prosthetic rehabilitation after tooth loss. The implant itself is a tool used to enable, improve and perform prosthetic treatment. Thus, implant dentistry must be prosthetically centered and driven, with regard to analysis, planning and the final outcome. Already in the nineties some authors emphasized the importance of prosthodontics training with regard to implant therapy 1, 2. The chewing function, phonetics and esthetics are the crucial aspects oft implant treatment. The term „ backward planning“ was created and this should become the standard in any implant treatment, particularly for full mouth rehabilitation. Accordingly, a comprehensive prosthetic training including implant placement and implant restoration appears to be the most effective approach to a broad understanding of the potential and limitations in implant rehabilitation.
The data of the present study show that the students were involved in the whole broad, therapeutic spectrum of implant dentistry, including the surgical and prosthodontic part as well as maintenance care. Thus, they reached full competence level of grade A( advanced) for surgery and prosthetics, while level C( complex) can be practiced under close supervision, particularly with regard to the surgical techniques. At the end of the training curriculum it is expected that the students are able to properly judge their own knowledge and skills and to adhere to strict patient selection criteria. Furthermore, the use of CAD / CAM technology for implant supported fixed and removable reconstructions helped to standardize the fabrication workflow and minimize inaccuracies due to manual errors. As reported in another investigation, the specific analysis revealed a predictable outcome of the implant reconstructions with improvements for the digital workflow 38. In the current competitive and fast developing market of implantology, which is often business driven, it becomes essential that high quality education and treatment is guaranteed. Therefore, theoretical knowledge and training of clinical skills must be an integral part of well-structured educational programs in comprehensive implant dentistry to reach the required competence and to maintain a high standard of care 39. The majority of articles on implant curricula deal with undergraduate education while information on specialty training for young dentists and general practitioners is somehow confusing and less clear. If implant teaching in University curricula is described, a variety of terms are applied, such as: undergraduate, predoctoral, graduate, postgraduate or residency and specialty training, advanced education or master program. It appears that there is no consensus and common use of these terms- except with regard to undergraduate education, which would clearly address the degree of training and specify the level competence. Furthermore, two universities recently reported on a predoctoral implant program where selected students placed a series of implants themselves. While the students highly benefited from this experience by improving their understanding of the connection between surgical implant placement and definitive prosthodontics reconstruction, their interest for a postgraduate implant program to improve theoretical and clinical skills became more intense 40. The placement of implants by undergraduate students as part of an implant program would require significant efforts in theoretical education, pre-clinical laboratory training and clinical treatment. However, it has been demonstrated that this approach may result in acceptable clinical outcomes, patient satisfaction and positive student perception 41.
232 STOMA. EDUJ( 2016) 3( 2)