Many dentists enrol on implant training programmes expecting to gain the additional skills and confidence to be able to place implants in their own practices. Unfortunately this expectation often goes unmet and many are left even less confident about placing implants than they were when they first started. This is not a fault inherent in the programme, but legitimate insecurities arise as a result of the realisation in the mind of the dentist of just how complex and multi factorial implant treatment can be.
A fundamental General Dental Council guideline related to implant dentistry requires that dentists undertake supervised clinical training by a suitably experienced supervising clinician. Also it is important that dentists undertaking clinical training have their competency assessed and formally recorded in the key areas of treatment planning, surgical and prosthodontic skills. A portfolio of the cases treated should be compiled as evidence of clinical competencies acquired.
There are a number of programmes, often run abroad, that offer the opportunity to place implants. While these programmes deliver surgical training they do not adequately cover patient selection, treatment planning and restoration expected by the GDC.
Even more importantly, how to identify and manage complications that can arise after implant placement are not addressed by such short programmes. Again this is not a criticism of these programmes, many of which are excellent, but given time constraints it is just not possible to provide full clinical training allowing the necessary time for reflection and assimilation.
A short one-shot programme offering only limited exposure to the surgical phase of implant treatment is insufficient to acquire all the competencies that dentists need for implant treatment. A new approach to mentored clinical training has been developed at The City of London Dental School which permits the dentist to follow the implant case from consent, treatment planning through to surgical placement and final restoration.
A unique feature of this clinical training programme is that consented patients are provided presenting a number of implant scenarios that expose the treating dentist to a variety of management and restorative challenges.
The programme has two parts:
Part one is Foundation in the Clinical Practice of Implant Dentistry. This course introduces the clinical principles of implantology and dentists get the opportunity to place implants on actual patients that have been selected to be straight forward. These cases
have predictable outcomes and do not present anatomical or restorative challenges beyond the dentist’s competency. In total five straightforward cases are provided that help the dentist to develop their surgical and restorative implant skills and competency. These cases normally entail placing up to two implants under direct supervision in regions of good bone volume or requiring only minimal bone grafting using synthetic materials. Dentists also get the chance to insert at least one immediate implant in the anterior region of the mouth. On completion of the foundation programme dentists may decide to defer progress to Part 2 and confidently treat further straightforward cases independently in their own practices.
Part 2 is Advanced Clinical Practice of Implant Dentistry. The advanced programme of supervision introduces autogenous bone grafting and closed sinus lifting and covers the rehabilitation and reconstruction of resorbed jaws where loss of alveolar bone height and buccolabial bone width combined with reduction in bone density or anatomy makes implant placement more challenging requiring the acquisition of advanced clinical competencies.
Five cases classified as advanced are provided. These cases are restoratively less predictable and extend the dentist’s skills and knowledge safely and ethically while building a portfolio of a range of cases.
Facilities and support
Training is delivered in a state of the art clinical facility dedicated to the provision of implant treatment offering a fully equipped implant suite. The supporting dental team are trained in implant dentistry allowing the dentist to concentrate on the learning experience without having to be concerned about clinical support and administration. The team has 10 years’ experience in training dentists in implant dentistry and can advise on equipment set up, maintenance and sterilisation. An onsite CBCT is essential for the planning of advanced cases and computerised scanners mean that delegates can virtually design their cases. Dentists are given the opportunity to operate a CT scan and taught how to evaluate and report the results.
Surgery assistant training
A successful dental implant treatment outcome is not solely reliant on the skills of the treating dentist, but also on the quality of the training of the dental surgery assistant. This is why it is essential to integrate the DSA into the training process as early as possible. Dentists are encouraged to bring their DSA with them during training so that they can become familiar with implant equipment, terminology and surgical techniques.
Assessment and feedback
Continuous assessment and feedback allows the dentist to extend themselves without being pushed beyond their clinical competency. Appraisal feedback sessions provide the opportunity for constructive dialogue with the mentor and help in identifying training needs. It is not a way for mentors to find fault with performance, but a medium through which strengths and areas for development can be identified. The mentor will identify the aspects of the procedures causing difficulty and discuss these advising on personal development plans and strategies, while undertaking assessment in treatment planning and implant therapy.
Diploma and MClinDent
Cases treated on these supervised programmes can be submitted for assessment on a number of diploma and MClinDent programmes. Such recognition of training further strengthens the dentists position professionally and standing with their patients.