Educational Pathways in Implant Dentistry in the UK

Abstract

Over the last few years, the dental implant industry has been expanding steadily, despite the depth of the recession. It has been estimated that currently 200,000 dental implants are placed in the UK. Further expansion is predicted as the economic output improves in the UK, which could see the doubling of the demand. This increase in demand will bring a rapid growth in the number of dentists wanting to offer dental implant treatment. This will undoubtedly increase the postgraduate demand on education and training in this field of dentistry. Delivering treatment While complex dental implant therapy requires treatment by teams of highly experienced dentists and specialists working in hospitals or referral clinics, routine treatment is carried out by appropriately trained practitioners working in general dental practices. Unpublished research has shown that most dental practitioners place 20-50 implants per annum, while a small number of referral dentists place 200-400 yearly. Only a very small number of dentists, who limit their practices to implant dentistry, place more than 500 dental implants annually. These dentists possess different qualifications and experiences in implant dentistry. However, good quality postgraduate courses are being offered in the UK, including six to seven university-based courses and a highly structured diploma course offered by the Faculty of General Dental Practitioners UK (FGDP). The core training in implant dentistry requires the acquisition of oral surgical and prosthodontic knowledge, which is taught by a wide variety of courses currently offered in the UK, as several sources have shown (Sanz and Saphira, 2009; Donos et al, 2009; Mattheos et al, 2009; Koole et al, 2014; Ucer et al, 2014). The problem is that most of these courses differ substantially in duration, their aims and objectives, and the quality of education. Nor are they regulated or validated. There is, therefore, a distinct lack of standardisation in dental implant education in the UK and Europe in general.

Full text

Over the last few years, the dental implant
industry has been expanding steadily,
despite the depth of the recession. It has
been estimated that currently 200,000
dental implants are placed in the UK.
Further expansion is predicted as the
economic output improves in the UK, which
could see the doubling of the demand.
This increase in demand will bring a
rapid growth in the number of dentists
wanting to offer dental implant treatment.
This will undoubtedly increase the
postgraduate demand on education and
training in this field of dentistry.
Delivering treatment
While complex dental implant therapy
requires treatment by teams of highly
experienced dentists and specialists working
in hospitals or referral clinics, routine
treatment is carried out by appropriately
trained practitioners working in general
dental practices.
Unpublished research has shown that
most dental practitioners place 20-50
implants per annum, while a small number
of referral dentists place 200-400 yearly.
Only a very small number of dentists,
who limit their practices to implant
dentistry, place more than 500 dental
implants annually. These dentists possess
different qualifications and experiences in
implant dentistry.
However, good quality postgraduate
courses are being offered in the UK,
including six to seven university-based
courses and a highly structured diploma
course offered by the Faculty of General
Dental Practitioners UK (FGDP).
The core training in implant dentistry
requires the acquisition of oral surgical and
prosthodontic knowledge, which is taught
by a wide variety of courses currently offered
in the UK, as several sources have shown
(Sanz and Saphira, 2009; Donos et al, 2009;
Mattheos et al, 2009; Koole et al, 2014; Ucer
et al, 2014).
The problem is that most of these courses
differ substantially in duration, their aims
and objectives, and the quality of education.
Nor are they regulated or validated. There is,
therefore, a distinct lack of standardisation
in dental implant education in the UK and
Europe in general.
IMPLANT ESSENTIALS
Cemal Ucer BDS MSc PhD is the clinical lead of
the diploma/MSc in dental implantology at the
University of Salford and runs a referral practice at
Oaklands Hospital, also in Salford. He is the past
president of the ADI.
Education pathways
There are currently three different training
pathways available to dentists wishing to
practise implant dentistry in the UK:
• Follow CPD training courses, ranging in
duration from a few days to a year. These
courses are delivered by a wide variety of
providers, ranging from the universities to
so-called ‘expert’ clinicians. Unfortunately,
most of these courses are not educationally
structured and do not offer tangible
outcomes such as a recognised qualification
or transferrable credits
• Attending a university postgraduate degree
course dedicated to implant dentistry (such
as postgraduate certificates or diplomas, or
MSc and PhD courses)
• Completing specialist training in a related
field of dentistry (eg, periodontology, oral
surgery or prosthodontics) (Ucer et al,
2014).
Currently, it would appear that only a
very limited number of implant dentistry
courses offer accreditation of postgraduate
training by a national organisation or a
university, as sources have shown (Koole et
al, 2014; Ucer et al, 2014).
Sadly, the lack of regulation when it
comes to postgraduate training in the UK
affects the educational quality of the courses
available to dentists.
IDT
May 2014 33
Educational
pathways
What path should you follow?
Cemal Ucer
discusses the various postgraduate training choices in implant dentistry

The national standards
A few years ago, the General Dental Council
(GDC) issued a statement on implant
dentistry, declaring: ‘A UK-qualified dentist
would not be expected to be competent
to practise implant dentistry without
undertaking structured postgraduate
training and assessment of competence.’
It endorsed
Training Standards in Implant
Dentistry
(TSID) guidelines (FGDP, 2012).
Developed by the GDC, FGDP(UK) and
the Royal Colleges in 2005, the
TSID
sets
out the postgraduate training requirements
for UK dentists in implant dentistry.
Most importantly, the GDC has declared
that it refers to the standards when assessing
patient complaints against dentists who,
allegedly, practise implant dentistry beyond
the limits of their competence.
The
TSID
also prescribes the learning
outcomes and standards that such training
courses in the United Kingdom should
provide. These standards have been
developed to ensure patient safety and
protection. Dental teams and providers
of training should use these guidelines to
ensure consistency in the acquisition of
knowledge and clinical skills for implant
dentistry procedures, and to ensure good
practice.
The guidelines also serve as a reference
point for the GDC when considering patient
complaints against dentists who have
allegedly practised implant dentistry without
the necessary competence.
Dos and don’ts
It is recommended that all members of the
dental team keep a detailed portfolio of their
training, the courses they have attended, all
mentoring they have received, and all the
implants they have placed and/or restored,
together with the outcomes.
Records should be audited annually. Such
portfolios could be used in any dispute as to
a dentist’s competence in implant dentistry,
including those brought before the GDC.
All dentists need to be appropriately
indemnified against medico-legal disputes
involving implants. The prosthodontic
team should be competent in managing
the occlusal scheme, including changes to
the vertical dimension and the position of
teeth, and how these changes interact with
the existing dentition (if present) and the
relationships in the jaw.
The placement of implants with complex
bone augmentation demands a high level of
surgical experience and significant ability to
care for such patients.
Dentists undertaking such treatment
should have been trained and assessed
by a suitably competent and experienced
mentor within an appropriately structured
programme – one that has enabled the
dentist to achieve a standard in these specific
techniques equivalent to trainees sitting a
specialist examination in oral surgery.
The requirements of the
TSID
(2012)
and the Association for Dental Education in
Europe’s (ADEE) pan-European consensus
guidelines (2014) in postgraduate education
in implant dentistry highlight the urgent
need for wider availability of highly
structured and recognised part-time CPD
postgraduate programmes.
Mentoring and qualifications
Learning clinical skills under the supervision
of a mentor is a requirement for dentists
wanting to provide implant treatment in the
UK, according to the
TSID
(2012) and the
GDC policy statement on implant dentistry
(2013). To address this need, a number of
organisations, including the Association
of Dental Implantology (ADI), ITI UK and
Ireland, and the FGDP(UK), have set up
mentor training programmes.
However, there is still no agreed
definition of what a mentor is. Well-
structured programmes to train and calibrate
mentors in implant dentistry are also absent.
There is a general consensus in Europe
that implant dentistry should be taught at
a postgraduate level, according to Mattheos
et al (2009) – either as part of an accredited
CPD programme or as a formal university
degree course.
A model that could facilitate different
educational pathways for the practising
dentist ranges from a continuing education
certificate to a full specialist training course
(see the box opposite: Training pathways in
implant dentistry) (Donos et al, 2009; Ucer
IMPLANT ESSENTIALS
et al, 2014). At present, the spectrum of
implant dentistry education includes courses
extending from a few days to three years of
full-time attendance.
Increasingly, the preference of most
dentists is obtaining formal university
qualifications rather than undergoing
unaccredited CPD training (Koole et al,
2014; Ucer et al, 2014).
Given that most qualified dentists are
in full-time employment, there is a strong
demand for part-time, rather than full-time,
postgraduate university degree programmes,
typically leading to an award of postgraduate
diploma, a masters degree or equivalent.
Courses available
The number of postgraduate degree
programmes dedicated to implant dentistry
has increased rapidly since the ADEE pan-
European consensus conference in Prague
(2008). The follow-up survey of the second
European Consensus Workshop (ADEE,
2013) identified that programmes ranging
from one to three years offer transferrable
European credits (ECTS) of up to 180
credits in implant dentistry, as shown by
Koole et al (2014).
Unfortunately, there still remains a
big diversity among university masters
programmes with regards to duration and
learning objectives, as well as the desired
outcomes. On one hand, it is possible to
gain an MSc in an implant dentistry degree,
but a one-year part-time study does not
involve clinical practice. On the other
hand, there are three-year full-time masters
programmes that offer rigorous clinical
experience (Koole et al, 2014).
Typically, the part-time postgraduate
degree programmes in implant dentistry
(postgraduate diploma and MScs) in the
UK involve two-year part-time study
for postgraduate diploma, and one-year
part-time for MSc dissertation module
(eg, UCLAN, Warwick, Salford, Cardiff,
Manchester, Edinburgh, Eastman Dental
Institute, Kings College, Leeds, Sheffield,
Bristol and the Peninsula).
IDT
May 2014 35
It is recommended that all members
of the dental team keep a detailed
portfolio of all the implants they have
placed and/or restored
Introductory lectures
Certificate in implant dentistry (entry level)
Postgraduate diploma in implant dentistry
Masters
Doctoral degrees
Specialist level training in related fields (eg, oral
surgery, periodontology, prosthodontics)
TRAINING PATHWAYS
IN IMPLANT DENTISTRY

Some universities have set up flexible
blended learning postgraduate programmes
that can enrol both regional and remote/
overseas students. This is commonly made
possible by combining a modular blended
learning structure of theoretical courses,
with clinical training offered in collaboration
with regional training centres/clinics or
accredited mentors (Koole et al, 2014).
Training programme structures
At present, there is an urgent need for
improving the structure and content of CPD
programmes (both formal university courses
and non-degree CPD courses) in implant
dentistry, including strengthening the quality
assurance, encouraging standardisation and
making learning outcomes clearer (Ucer et
al, 2014).
The necessary skills and competencies
that should be targeted by undergraduate
and postgraduate education in implant
dentistry have already been determined
by the first ADEE workshop on university
education in implant dentistry (Donos et al,
2009).
Following this, the second pan-European
consensus meeting organised by ADEE
(2013) recommended the development of
a structured and accredited CPD system
in implant dentistry with clearly defined
educational objectives mapped against these
specific levels of competence (Ucer et al,
2014).
Training programmes in implant
dentistry, whether they lead to a university
qualification or result in non-degree CPD
training, should incorporate the following
quality assurance features (Ucer et al, 2014):
• They should enable clinicians to gain new
clinical skills, which they should be able to
readily apply to the treatment of patients in
their practices. Initially, this should be at a
straightforward complexity level of implant
treatment
• CPD in implant dentistry should enable
clinicians to employ evidence-based
decision-making processes, by enhancing
their skills and keeping their knowledge
current
• CPD in implant dentistry should
strengthen the clinician’s ability to critically
appraise and evaluate new products and
techniques before using them in their
clinical practice. This ensures safe and
patient-centred treatment outcomes (FGDP,
2012; Ucer et al, 2014)
• CPD in implant dentistry should be highly
structured and include quality assurance
features, such as predetermined learning
objectives and achievable learning outcomes
• CPD in implant dentistry should be
delivered by educators of adequate
qualifications and pedagogical experience
(Ucer et al, 2014). The learning outcomes
of CPD should be assessed as part of each
activity (Ucer et al, 2014; Mattheos et al,
2009) and, ideally, the courses should be
accredited by a national or international
organisation
• CPD in implant dentistry should include a
workplace-based clinical skills development
component with an emphasis on a needs-
driven reflective learning activity (Ucer
IDT
May 2014 37
et al, 2014; Mattheos et al, 2009). It is
recommended that such activities are
documented using structured portfolios
(PDPs), with an appropriate input through
formative assessment by the mentor
• It is desirable that CPD in implant
dentistry is available to all members of the
dental team engaged in the provision of
implant dentistry: dentists, dental nurses,
hygienists and dental technicians
• It is desirable that industrial partners focus
their CPD input to product training, which
may include basic science (Ucer et al, 2014).
Advice for the future
In the absence of recognised qualifications
or accredited formal training programmes
in implant dentistry, dentists who wish
to receive training in this field would be
advised to carry out thorough appraisal of
the structure and content of the available
CPD courses. This way, they are able to
select one that best suits their identified
learning needs.
In order to maximise the clinical benefits
to the patients, and to satisfy possible future
regulatory demands, the prospective learner
is strongly advised to enquire about the
following: the educational quality of the
course, calibre of the course providers, the
pedagogical background of the educators,
and whether or not the course is accredited
by a competent national or international
body (Swiss College of Dental Medicine,
2004; European Commission; Adam, 2007),
such as a university (European Commission,
2007).
IDT
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IMPLANT ESSENTIALS