Predoctoral Dental Education
An Overview of U.S. Predoctoral Dental Implant Programs and Their Directors Christopher A. Barwacz, DDS; Gustavo Avila-Ortiz, DDS, MS, PhD; Veerasathpurush Allareddy, BDS, MBA, MHA, PhD, MMSc; Monelle Tamegnon, BS, MS; Kaitlin Hoogeveen, BS Abstract: The aim of this study was to provide an overview of current predoctoral implant programs in the United States, including curricular characteristics and clinical practices regarding implant therapy education and program directors’ characteristics. An electronic survey was sent to predoctoral implant program directors of all 64 accredited U.S. dental schools; 52 of the 60 eligible programs responded, for a response rate of 87%. The responding program directors were primarily affiliated with either prosthodontics departments (44%) or restorative dentistry departments (40%). Structurally, 80.8% of the responding schools integrate their implant programs into the third year of the curriculum. Clinical implant therapy exercises reported were simulation exercises without direct patient care (90.4% of responding schools) and direct patient care under supervision (94.2%). The most frequently taught restorative modalities are posterior single-tooth implant crown (96.2%), mandibular implant-retained overdenture (88.5%), and anterior implant-supported single crown (61.5%). A majority (74.5%) of responding programs utilize analog surgical guide planning, while 25.5% reported use of digital guided surgery planning software. All schools in the Northwest and 66.7% in the South Central regions utilize custom abutments as the primary abutment design, while a majority of schools in the North Central (62.5%), Northeast (53.8%), Southwest (66.7%), and Southeast (80%) regions use stock abutments (p=0.02). Regional differences were significant with regard to fixation modality, with all the Northwest programs using screw retention and 90% of Southeast and 87.5% of North Central programs using cement retention (p=0.002). This study demonstrated that while institutions share program director and curricular similarities, clinical practices and modalities vary significantly by region. Dr. Barwacz is Assistant Professor, Craniofacial Clinical Research Center, The University of Iowa College of Dentistry and Dental Clinics; Dr. Avila-Ortiz is Assistant Professor, Department of Periodontics, The University of Iowa College of Dentistry and Dental Clinics; Dr. Allareddy is Associate Professor, Department of Orthodontics, The University of Iowa College of Dentistry and Dental Clinics; Ms. Tamegnon is Graduate Student, Department of Biostatistics, The University of Iowa College of Public Health; and Ms. Hoogeveen is Predoctoral Student Researcher, The University of Iowa College of Dentistry and Dental Clinics. Direct correspondence to Dr. Christopher A. Barwacz, The University of Iowa College of Dentistry and Dental Clinics, Craniofacial Clinical Research Center, W425 Dental Science Building, Iowa City, IA 52242-1010; 319-384-3002;
[email protected]. Keywords: dental education, dental implants, implantology, prosthodontics, curriculum Submitted for publication 6/13/14; accepted 7/28/14
I
mplant therapy, and the prevalence with which it is employed in modern dental practice, has progressed significantly since its early adoption; as a result, it has gained widespread acceptance and adoption as a tooth replacement strategy for partial or complete edentulism by both clinicians and patients.1-3 This maturation can be attributed to the high success rates generally observed in oral implantology,4-7 the demonstrable improvement of patient quality of life measures as a result of treatment,8-10 the long-term cost-effectiveness when compared to other prosthetic options,11-14 and the relatively low complication rates15 when compared with other transcortical orthopedic devices.16,17 To address an increase in patient demand for implant therapy, both
March 2015 ■ Journal of Dental Education
European18 and U.S. academic dental institutions and their representative organizations19 have recognized the need for increased inclusion of implant therapy at the predoctoral level, where education in singletooth implant and implant overdenture restorative therapies is feasible.20,21 In the past two decades, an increasing majority of U.S. and European academic institutions have established dedicated predoctoral dental implant programs in an effort to prepare general dentists for the provision of routine dental implant restorative therapy. While dental implant therapy has been conducted for over four decades, its incorporation into predoctoral dental curricula has been markedly conservative when compared with other treatment
265
modalities and technological advancements. In 1974, 33% of U.S. dental schools reported including implant therapy in their predoctoral curricula;22 this coverage grew to 84% by 2002.23 At the outset, such an increase in implant education appears substantial, yet recent national evaluations of graduating predoctoral dental students have found significant perceptions of deficiency with regard to students’ implant education and acquisition of proficient clinical skills upon graduation. The two most commonly cited student perceptions are that there is inadequate time (39% of respondents) in the predoctoral curriculum to master implant concepts and thus they feel a lack of preparedness (43%) with regard to perceived proficiency in providing routine implant therapy.24,25 While there has been a decline in the percentage of graduating students reporting inadequate time since 2001 (when more than 50% reported this perception26), the percentage reporting a perceived lack of preparedness has remained steady. Such data should not be taken lightly, as it has been demonstrated that graduates who not only have formal didactic implant education (lectures, seminars, case series reviews) but also actively participate in preclinical laboratory27 and clinical management of implant patients in predoctoral programs overwhelmingly restore greater numbers of implants, refer more patients to surgical specialists, and continue to broaden their education in implant dentistry once in practice, as compared with graduates of predoctoral programs lacking a formal implant curriculum.28,29 Acknowledging these challenges, previous surveys have sought to evaluate the prevalence of implant education at U.S. dental schools from the 1970s to the early to mid-2000s, as well as student perceptions of preparedness for providing implant therapy upon graduation. The most recent report on predoctoral implant education trends was by Lim et al.,23 but the data acquired in their study are now over 12 years old. In the face of new technological advances and faculty turnover due to retirement, their data require updating and further clarification to remain relevant. In addition, there has been a paucity of research to determine the structure and specifics of implant therapy education at the predoctoral level across U.S. dental schools. The aim of our study was therefore to provide an overview of current predoctoral implant programs in the United States, including curricular characteristics and clinical practices regarding implant therapy and program directors’ characteristics.
266
Methods This study was approved by the University of Iowa Institutional Review Board (#201307759). Predoctoral implant program directors were identified for each of the 64 accredited dental schools as listed on the American Dental Association’s DDS/ DMD programs webpage.30 The appropriate contacts were subsequently researched on each institution’s webpage. Contact was made via email to verify the individual’s position as predoctoral implant program director. As a result of these preliminary contacts, four recently established schools (Midwestern University College of Dental Medicine-Illinois, University of New England College of Dental Medicine, East Carolina University School of Dental Medicine, and University of Utah School of Dentistry) responded that their predoctoral implant programs had not yet been formally developed, leaving 60 as the final number of institutions eligible to participate in the study. A draft of a survey instrument was developed to determine the predoctoral implant programs’ educational practices in the areas of diagnosis and treatment planning and restorative techniques, as well as the program directors’ characteristics and perceptions of their programs’ effectiveness in preparing students to provide implant therapy upon graduation. After feedback from two senior faculty members at The University of Iowa College of Dentistry and Dental Clinics, the survey was finalized (the full survey instrument is available from the corresponding author). The electronic survey tool Qualtrics (Provo, UT, USA) was used to create a digital version of the survey and record data from the respondents. The survey was divided into three sections. The first section (15 questions) asked for information about the predoctoral implant program directors, in order to ascertain whether training, years of experience, and tenure as program director influenced their perceptions of student preparedness. The second section (12 questions) focused on the predoctoral implant program’s educational methods in relation to diagnosis, treatment planning, and restorative modalities primarily taught. The third section (two questions) requested the program directors’ subjective perceptions of student preparedness, as well as what educational components they perceived most beneficial in preparing students to provide implant therapy after graduation.
Journal of Dental Education ■ Volume 79, Number 3
A letter detailing the objective of the study as well as a link to complete the survey via Qualtrics was emailed to each predoctoral implant program director on August 12, 2013. If a survey response or email was not received from the institution, a follow-up email was sent every three to four weeks until November 5, 2013, for up to four reminders. If no response was obtained after these attempts, the institution was considered to be a nonrespondent. Recipients of the emails were able to opt out by responding to any of the messages indicating they did not wish to be contacted or by simply not completing the survey. Additionally, respondents had the option to selectively answer some or all of the survey once they began. Any request not to be contacted again was respected by the research team, and no further attempt at contact was made. The data were exported to SPSS version 22.0 software (IBM Corp., Research Triangle Park, NC, USA) for analysis. Simple descriptive statistics (frequency distributions and pie charts) were used to summarize the data. Region of implant program location was one of the independent variables of interests. Responses of the implant program directors were the outcome (dependent) variables. Association between responding program directors and geographic regions was examined by global chi-square tests. All statistical tests were two-sided, and a p-value of
