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Choosing an Implant Course

By Paul Stone, ADI Past President (2003-2005)

With so many dentists becoming involved in implant dentistry, 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.

In a policy statement on implant dentistry from the GDC we are reminded that “Dental professionals have an ethical responsibility to limit their scope of practice to what they are trained and competent to do.  Any dental professional who carries out work for which they are not trained and competent puts their registration at risk.”

The GDC document ‘Training Standards in Implant Dentistry’ published in 2008 by the FGDP (www.fgdp.org.uk) has been formally acknowledged by the GDC as “the authority on training standards for this procedure” and continues that “inserting dental implants is a surgical procedure which should only be carried out by dentists with suitable training.  This would normally involve a postgraduate training course in implant dentistry and an assessment of competence. Training can come from a variety of sources including university, Royal College or hospital-based programmes, as well as from courses run by commercial groups or individuals. The guidelines make clear the minimum training the GDC would expect dentists to have successfully completed before undertaking implants.  In a new policy statement the GDC has confirmed that it will refer to these guidelines when assessing complaints against dentists who have allegedly practiced implant dentistry beyond their competence.”

Probably the most important aspect and certainly the first consideration must be to look at the individuals own level of ability and experience in the areas of restorative and surgical dentistry. Having identified the strengths and weaknesses, many dentists would benefit from addressing these first, before moving onto implant training. This seldom occurs, but there can be little doubt that failing to have a good level of expertise in both areas will inevitably impact on the acquisition of further knowledge and skills in implant dentistry; all too often dentists attend implant courses with little or no experience in surgery and somehow expect to be trained in both basic surgical skills and implant surgery at the same time.  This is rarely successful.  I hope that we might begin to see more of a move to address improving the fundamental skills, before moving forward with further training, but this relies on the course organisers taking responsibility.  There is little doubt that by preparing in this way, substantially more benefit will be gained from 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’; the 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 many 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 and the general format is probably the more appropriate for basic training in implant dentistry.  A number of these courses are also linked to some form of clinical mentor-led training’ providing more of a comprehensive experience and more chance of gaining the range of skills necessary to enable the practice of 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 delegates from previous courses.

Many academic institutions also offer post-graduate training and these often culminate in a ‘qualification’ (either at ‘certificate’, diploma or MSc level). They can be either full-time or part-time over one, 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 assignment work, travel to and from the venue and the implications that this might have on both professional and family life.

The next issue (and again very important) is the content of the 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, 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 is made.  Clearly there are many different types of study available and whilst randomised controlled trials are our benchmark for evidence-based credibility, there are few of these in restorative dentistry, let alone in implant dentistry. Instead, much of the literature is based on short -term case reports, or on extended case studies, where as time progresses, 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 all 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 will need a more prolonged period of specific training to meet their needs.

Very few implant qualifications are registerable with the GDC, but it looks as though the majority of all these ‘additional’ qualifications might soon cease to be formally recognised by the Council as they endeavor to rationalize their role in the postgraduate qualifications awarded by other academic bodies.  It’s also important to recognise that some courses have virtually no practical content but are intended as research degrees.  Whilst any course can fall short of achieving the intended outcome, it is fair to say that achieving competence, let alone expertise depends as much on the individual as the course itself.

My own belief is that a ‘self-directed’ training programme, allowing for individual selection of the most suitable courses, followed by an assessment of competence by an independent body, would be appropriate for many clinicians.  This is now possible and the emphasis is upon the dentist obtaining the training necessary to comply with accepted guidelines, and to maintain records of their clinical activity for evaluation.  The ability to progress though implant training at ones own pace, in response to individual needs would seem very desirable and can accommodate the many different courses available.  The presence of accepted Training Standards together with an assessment by an independent examining body should mean that courses without their own examination are able to direct their curriculum and ‘learning outcomes towards the aspects appropriate to the delegate’s requirements for sitting an examination that assesses knowledge, skills and clinical competence.