Choosing an Implant Course

With so many dentists becoming involved in implant dentistry (over 1300 members in the Association of Dental Implantology alone), the emphasis must now shift to look at the quality of training and education available. The dental journals often have several advertisements for a variety of different courses, and we all receive flyers through the post from a number of commercially run events. For the inexperienced clinician, this presents a real dilemma, with very little guidance as to which type of course to choose. I posted a message on our ADI Committee forum asking what these experienced clinicians would advise as being important points to look for, and there was general agreement over the important aspects.

It's probably worth starting by looking at the individuals own level of ability and experience in the areas of restorative and surgical dentistry. Having identified the areas in need of attention, many dentists would benefit from addressing these aspects first, before moving onto implant training. This seldom seems to occur, but I suspect that we might see more of a move to address improving the fundamental skills, before moving forward with further training. There is little doubt that by preparing in this way, substantially more benefit will be gained from almost any further training course.

Implant dentistry is unavoidably linked with the implant industry due to the individual design features and subtle differences between different systems. Fortunately the main companies involved generally take their responsibility for basic system training seriously, with courses teaching the 'nuts and bolts' on offer throughout the year. The question is 'do they alone offer appropriate implant training?' Unfortunately at the moment, for many dentists, the answer must be 'no'; these shorter one and two-day courses can only really cover a small aspect of the subject, and to expect anything else would be wrong. For an already experienced implant clinician, such a course could be all that is required as a 'conversion' from one system to another. The majority however, would need to regard this as an introductory or foundation course, with a view to this leading on to other training. Times are changing, and we are now seeing some of the larger companies offering a range of courses in both this country and overseas. They vary from intensive 3 and 5-day events to more prolonged courses running often for one day a month over a year or more. The extended time period certainly gives a better opportunity to gain from the expertise of the tutors, and to address the deficiencies in the individuals own knowledge. Whilst each individual course is only as good as that actual event and the lecturers on it, the general format is probably the more appropriate for training in implant dentistry.

A number of experienced clinicians (and a few not so experienced) have established often highly regarded 'Independent' courses, usually following the 'one day a month for a year' model, and although they are distinct from a purely 'commercial' course, most will still need the support of one or more companies to provide the 'nuts and bolts' training component. Some of these clinicians also offer an intensive 3 or 5 day course usually for the more experienced. Once again, care needs to be taken by the prospective applicant to ensure that such a course will meet their individual training needs, and that the organising clinician is sufficiently experienced to be able to deliver the course objectives. Without doubt, one of the best ways of assessing this is by contacting one or two delegates from previous courses.

Many academic institutions also offer post-graduate training and these often culminate in a 'qualification' (often at MSc level). They can be either full-time or part-time over two or more years. This latter option allows the clinician to continue with some 'income generation' by maintaining their usual work, but obviously increases the time taken to complete the course. Many clinicians are surprised by the level of commitment expected by course supervisors both in the time involved, and with the amount of 'homework' required to satisfy the course requirements and to prepare for the next sessions. It is important that any potential applicant carefully considers the time involved to do justice to their selected training option. This should include not only the time spent in the 'classroom' but also the additional preparatory reading or essay work, travel to and from the venue and the implications that this might have on both professional and family life.

The next issue (and probably the most important) has to be the content of any course; what is actually taught to the delegates. The emphasis on 'evidence-based' clinical practice is now regarded as fundamental to the way we manage our patients. It is therefore important that any course of any length, presents scientific support for the claims being made. Delegates should continually be asking "show me the evidence," ensuring that reference to current and relevant literature be made. But there are many different types of literature available. Whilst randomised controlled trials are our benchmark for evidence-based credibility, there are very few of these in restorative dentistry, let alone in implant dentistry. Instead, much of the literature is based on individual or series case reports, or on extended time-based studies, where as time goes by, the results become less relevant due to continuing development by the implant companies. Rarely does a new 'innovation' have many months of clinical research supporting it before it reaches the marketplace. Never-the-less, a training programme that does not have its roots firmly in a literature-based environment should be treated with caution.

Finally, all the theory and literature have questionable value unless they are supported by a programme of practical, ongoing mentored support. The GDC has already let it be known that they regard mentoring as being very important in delivering appropriate training for many aspects of more advanced dentistry. A course that somehow integrates this with a structured, literature-based course is probably the best model of training for many clinicians, but not all will require this, and some might need a more prolonged period of specific training to meet their needs.

So far, very few implant courses and their subsequent qualifications are registerable with the GDC, and it's important to recognise that some others have virtually no practical content at all. For example, not all MSc implant courses have any intention of teaching the hands-on component to a high enough level to ensure competence in the subject; they are intended as research degrees. It is fair to say that any course can fall short of achieving this outcome, and that achieving competence, let alone expertise must depend on the individual as much as the course attended. My own belief is that a self-directed training programme with an assessment of competence by an independent body would be appropriate for many clinicians. The emphasis would be placed upon the dentist to obtain the training necessary to comply with accepted guidelines, and to maintain records of their clinical activity for evaluation. This is still just a personal view, but the idea seems to be well received by many colleagues. The ability to progress though implant training at ones own pace, in response to individual needs would seem a necessity. This proposal would compliment the many courses available. The presence of accepted clinical guidelines together with a curriculum from an independent examining body should mean that course organisers are able to direct their content towards certain aspects appropriate to the delegate's needs. I hope that in time we might see this approach to implant training, but in the meantime, an approach to choosing a course that has already been outlined above should help to ensure a reasonable quality of training.

Paul Stone