Does dynamic navigation assisted student training improve the accuracy of dental implant placement by postgraduate dental students: an in vitro study

OBJECTIVES

To assess the accuracy of implant placement in models and satisfaction in dynamic navigation assisted postgraduate dental students training.

METHODS

Postgraduate dental students who had at least one year of dental clinical practice with no experience in dental implant surgeries were included. Students were instructed to make treatment plans in the dynamic navigation system. Each student placed two maxillary right incisors, using freehand approach at first and then under dynamic navigation. The implant position was compared with treatment plan. Factors influencing the accuracy of implants placed under dynamic navigation were analyzed. Student acceptance towards the training and use of dynamic navigation was recorded using a questionnaire.

RESULTS

A total of 21 students placed 42 implants. For freehand implant placement, the median entry point deviation, apex point deviation, and implant axis deviation was 3.79 mm, 4.32 mm, and 10.08°. For dynamic guided implant placement, the median entry point deviation, apex point deviation, and implant axis deviation was 1.29 mm, 1.25 mm, and 4.89° (p < 0.001). The accuracy of dynamic guided implant was not influenced by student gender or familiarity with computer games. All students were satisfied with the training.

CONCLUSIONS

Dynamic navigation system assisted students in improving the accuracy of implant placement and was well accepted by students.

Introducing a novel educational training programme in dental implantology for pregraduate dental students

INTRODUCTION

This study aimed to determine whether implant surgery procedures can be implemented in the dental curriculum by designing novel courses for students. Additionally, this study assesses the perception of these courses and how they can be established in the future.

MATERIALS AND METHODS

Students from the third to fifth years participated in a programme consisting of 4 modules according to their academic year. The modules taught theoretical and practical content as well as clinical references. After participating, the students completed two questionnaires with research questions (RQ1 = evaluation of the relevance and effects; RQ2 = impact of modules 3 and 4) to evaluate the programme. The questionnaires consisted of 52 statements, each rated on a 6-point scale (1 'totally disagree' to 6 'totally agree'). Cronbach's alpha analysis was used, and median values, interquartile ranges and Pearson correlations (p-value) were statistically calculated.

RESULTS

In total, 94 students completed the questionnaires. Cronbach's alpha exceeded 0.7 for all constructs except for one (skills training). The highest evaluated median was 6, and the lowest was 4.75. Pearson correlations were significant (<0.05) for perceived importance/lectures, perceived importance/tutor performance, lectures/skills training, skills training/tutor performance and tutor performance/lectures. Seventeen analysed free comments expressed strong interest in implantology courses for the curriculum. 88% of the students wished for more practical exercises in dental implantology during the curriculum or suggested expanding the programme in the future.

CONCLUSION

The programme was highly accepted among dental students. The students wished for more practice in the future to perform supervised procedures on patients.

Knowledge and attitude in implant dentistry training courses amongst undergraduate dental students at Tehran University of Medical Sciences

INTRODUCTION

Due to the increase of implant treatments in daily practice, graduates should be well acquainted with appropriate diagnostic and therapeutic knowledge in implantology. This study sought to assess the knowledge and attitude of undergraduate students towards the benefits of their courses in the implant dentistry curriculum.

MATERIALS AND METHODS

This survey study was performed on all senior dental students at Pardis International Campus, School of Dentistry of Tehran University of Medical Sciences. Data collection was carried out through a questionnaire containing various items on knowledge and attitude. The validity and reliability of the questionnaire were already approved. Collected data were coded, entered in Microsoft Excel 2019, and analysed by t-test (α = .05).

RESULTS

Forty questionnaires were filled out by 28 female and 12 male students. Only 7.5% and 12.5% of students reported that they had adequate knowledge to conduct the surgical and prosthetic steps of dental implant treatment, respectively. The majority of students had a positive attitude towards the quality of theoretical education. However, less than 50% of them perceived the same about their practical education. No significant difference existed between male and female students regarding their responses to the knowledge and attitude questions (p = .458 and p = .288, respectively). Ninety percent of the students felt the need for further education regarding dental implant treatment in the undergraduate curriculum.

CONCLUSION

Despite the satisfaction of the theoretical knowledge, most senior students believed that they did not achieve adequate expertise to practice after graduation and were willing to receive further practical training in implantology.

CODA standard 2-24 h-"replacement of teeth" dilemma: Unintended consequences and proposed solutions

BACKGROUND

The Commission on Dental Accreditation (CODA) was established in 1975 with the goal of serving the public and the dental profession by developing and implementing standards that guide and maintain the quality of dental educational programs. These standards are defined broadly around competencies reflective of an evidence-based definition of general dentistry and that should be met by the new graduates to function as an entry level provider. Consequently, CODA "expects each school to develop specific competency definitions and assessment methods in the context of the broad scope of general dental practice". CODA Standard 2-24 h was implemented a decade ago to address concerns that dental schools are not sufficiently proactive in incorporating implant-related curricula and clinical competencies. When the standard was implemented, most patients already preferred dental implants over FPDs. This market trend, together with the prescriptive format of the standard, had the unintended consequence of creating pressure on programs that struggled to find enough patients who will chose FPDs as a treatment option.

DISCUSSION

As a short term solution, we suggest a tooth replacement competency construct that has the potential to alleviate this burden. This solution incorporates principles of ethical decision making, patient-centered care, and evidence-based dentistry, without compromising educational aspects and competency development. For the longer term, we suggested to revise and rephrase the standard so that it will be clinically-centered rather than focused on technical tools that may evolve, change, or disappear as a result of technological progress and other market trends. This, in turn, will be conducive to fulfill the intent of Standard 2-24 to allow the schools to identify "competencies that will be included in the curriculum based on the school's goals, resources, accepted general practitioner responsibilities and other influencing factors."

Dentists' Attitudes Toward Dental Implant Maintenance in Thailand

INTRODUCTION

As implant therapy is a widely applied treatment modality, general dentists are in the frontline of maintaining health in patients with implants. It is however unknown to what extent general dentists are competent and feel prepared to deliver maintenance of implants to patients.

OBJECTIVES

The aim of this study was to investigate the attitudes and self-reported and objectively assessed competences of general dentists with maintenance of dental implants in patients.

METHODS

A questionnaire designed and validated for the purpose of the study, including attitudes and self-reported and objectively assessed competences, was distributed by means of an online platform.

RESULTS

Data from 429 questionnaires were included in the study. Half of the participants were 28 to 33 y old and 78% had been working <10 y. Seventy-eight percent believed that dental implant maintenance should be performed by general dentists, but only 51% were prepared to do this, citing obstacles such as insufficient knowledge and limitations of their working environment. The mean ± SD objectively assessed competence score was 8.97 ± 2.74 of 17. There were significant differences (P < 0.001, 1-way analysis of variance) in the scores among dentists who offered the full range of maintenance and management of complications (10.83 ± 2.45) with those willing to provide comprehensive oral examination and implant maintenance only (9.31 ± 2.73), those offering comprehensive examination but unwilling to conduct maintenance (8.22 ± 2.28), and those who refer all dental implant patients elsewhere (7.2 ± 2.66). Around half of the dentists believed that implants last for life.

CONCLUSIONS

While general dentists appeared to largely acknowledge the importance of providing implant maintenance care and present with positive attitudes, a large portion was unwilling to engage with maintenance of implants in patients and appeared to lack essential competences to this end. The main obstacles for providing implant maintenance care included insufficient knowledge and lack of a properly equipped clinical environment.

KNOWLEDGE TRANSFER STATEMENT

The results of this study can identify deficiencies in the currently available maintenance competences and schemes for patients with implants. These results can also help dental professionals, scientific bodies, and associations to design appropriate education and professional development strategies that can strengthen the confidence and competences of general dentists, thus offering better service to the public.

Evaluation of a dynamic navigation system for training students in dental implant placement

OBJECTIVE

Computer-guided simulation systems may offer a novel training approach in many surgical fields. This study aimed to compare dental students' learning progress in dental implants placement between a dynamic navigation system and a traditional training method using a simulation model.

METHODS

Senior dental students with no implant placement experience were randomly assigned to implant placement training using a dynamic navigation system or a traditional freehand protocol. After training, 3-dimensional (3D) deviation at implant platform, 3D deviation at implant apex, and deviation of implant axis between the planned and placed implant positions were measured using superimposed cone beam computed tomography scans.

RESULTS

Six students were trained in this study. Students showed significantly greater improvement in implant placement after training using the dynamic navigation system than after using the traditional freehand protocol. Overall deviation of implant axis (P < 0.001) and 3D apex deviation (P = 0.014) improved with training using the dynamic navigation system, but differences in 3D platform deviation (P = 0.513) were not statistically significant.

CONCLUSIONS

A dynamic navigation system may be a useful teaching tool in the early development of clinical skills in implant placement for the novice practitioners. Novice practitioners exhibited significant improvement in angulation deviation across implant placement attempts with dynamic navigation system training.

Dental implant maintenance teaching in Australia-A survey of education providers

INTRODUCTION

Implant treatments and peri-implant maintenance continue apace, while the evidence for implant maintenance and home hygiene continues to be developed. Information sources for dental practitioners and patients in peri-implant health maintenance and disease management are generally not known. This study investigated the implant maintenance topics taught, the discipline backgrounds of convenors and presenters and information delivery methods within implant dentistry teaching in Australia.

MATERIALS AND METHODS

An online survey was distributed to 56 convenors of implant dentistry and maintenance education programmes in Australia, garnering responses from 24 individuals which outlined 43 different education programmes.

RESULTS

Lectures were the main delivery method for implant maintenance information across the different course types. Peri-implant diagnostics were generally taught according to current literature recommendations, but coverage varied in topics where the evidence is yet to be established (eg home hygiene, professional maintenance and implant review). Some educators reported awareness of limitations in their programmes.

CONCLUSION

Implant dentistry education programmes in Australia vary widely in teaching implant maintenance, coverage of which should be current and evidence-based at all education levels. The structure of implant dentistry teaching at the continuing professional development level requires further development.

Exploring training dental implant placement using computer-guided implant navigation system for predoctoral students: A pilot study

INTRODUCTION

Recent computer-guided dynamic navigation systems promise a novel training approach for implant surgery. This study aimed to examine learning progress in placement of dental implants among dental students using dynamic navigation on a simulation model.

MATERIALS AND METHODS

Senior students with no implant placement experience were randomly assigned five implant placement attempts involving either three maxillary or four mandibular implants distributed in the anterior/posterior, and left/right segments. Implant placement was planned using a Navident Dynamic Guidance system. Surgical time was recorded. Horizontal, vertical and angulation discrepancies between the planned and placed implant positions were measured using superimposed CBCT scans. Data were analysed with repeated measures regression with Tukey's adjusted pairwise comparisons (α = 0.05).

RESULTS

Fourteen students participated, with a mean age of 26.1 years and equal males and females. Mean time for implant placement was associated with attempt number (P < 0.001), implant site (P = 0.010) and marginally related to gender (P = 0.061). Students had a significant reduction in time from their first attempt to their second (10.6 vs 7.6 minutes; adjusted P < 0.001) then plateaued. Overall 3D angulation (P < 0.001) and 2D vertical apex deviation (P = 0.014) improved with each attempt, but changes in lateral 2D (P = 0.513) and overall 3D apex deviations (P = 0.784) were not statistically significant. Implant sites were associated with lateral 2D, 2D vertical and overall 3D apex deviation (P < 0.001).

DISCUSSION

Males were marginally faster than females, had slightly lower overall 3D angulation, and reported higher proficiency with video games. Novice operators improved significantly in speed and angulation deviation within the first three attempts of placing implants using dynamic navigation.

CONCLUSION

Computer-aided dynamic implant navigation systems can improve implant surgical training in novice population.

A global perspective on implant education: Cluster analysis of the "first dental implant experience" of dentists from 84 nationalities

OBJECTIVES

The aim of this cross-sectional study was to explore the demographic and educational patterns related to the dentists' first implant dental experience.

MATERIAL AND METHODS

Participants of a Massive Open Online Course in implant dentistry who have placed and restored implants completed a 25-item online questionnaire investigating their pathway of education and assessing their experience with the "first implant placement." Exploratory analysis included hierarchical clustering using 9 demographic categorical factors.

RESULTS

A total of 1015 respondents from 84 countries formed 5 distinct clusters. Age and work experience were dominant clustering traits, decreasing from Cluster 1 to Cluster 5. Clusters 1 and 3 represented "senior" and "younger" general dental practitioners, respectively, whilst Clusters 2 and 4 represented post-graduate educated clinicians. Cluster 5 represented recent graduates. Asia, South America and Africa were over-represented in "younger" clusters. Time in practice was a significant determinant of attitudes, followed by completion of post-graduate education. There were significant differences in reported patterns of challenges and complications depending on dentists' time in practice, age and post-graduate education. Challenge in implant positioning was more frequently identified by "young post-graduate" educated dentists. Recent graduates reported having the fewest complications of all clusters. Obtaining implant education in University settings was most frequently recommended by clusters of dentists with post-graduate education.

CONCLUSIONS

Time in practice is a parameter to be considered when designing implant education. The absence of structured education and mentorship might lead to inability to properly assess treatment outcomes and identify complications. Quality-assured and practice-directed education is needed at a global level, to support in particular, recent graduates who now seem to engage with implant dentistry early in their career.

Dental Students' Exposure to Periodontal and Implant Placement Surgeries in U.S. Dental Schools

The aim of this study was to assess nationwide trends in the exposure of dental students to periodontal and implant surgical procedures and to evaluate the potential factors that influence these clinical experiences. A 19-item questionnaire was sent to all 64 directors of predoctoral periodontics in U.S. dental schools. In addition to gathering information on the percentage of students who perform surgical periodontics or implant placement procedures in each program, data on student research groups, periodontics residency programs, and periodontics faculty practices were collected. A total of 33 responses were received, for a response rate of 51.5%. Among the responding institutions, 97% and 45.5% allowed dental students to perform periodontal and dental implant placement surgeries, respectively, although only 26.4% and 15.2% of the dental class ended up performing periodontal and dental implant placement surgeries, respectively. Crown lengthening was the most commonly reported (84.8%) periodontal surgical procedure performed by dental students. A negative correlation was found between the presence of a periodontics residency program and dental students' placing dental implants, while the size of the residency program positively correlated with dental students' placing dental implants. Overall, a wide variation in the exposure of dental students to periodontal and dental implant placement surgical experiences was found. Future surveys should assess clinical procedures performed in other special-ties to gain a broader picture of the experience students are gaining in these areas.