Implant surgery by undergraduate students: preliminary 1-year outcome

Background: The increasing demand for implant treatment requires that dentists are properly informed and trained. However, there is some concern that introducing implant surgery in the undergraduate program would encourage students to perform implant surgery beyond their level of skill. Aim: To evaluate benefits and clinical outcome of an educational undergraduate implant program, including surgery and prosthetics. Methods: All last term undergraduate students received theoretical and preclinical (pig cadaver) courses on the principles of implant surgery. Following careful examination and presurgical/prosthetic planning, the students placed one implant (NanoTite Tapered Certain) with an Encodeo`abutment (Biomet 3i, Palm Beach Gardens, FL, USA), by enlarge in a one-stage surgery. After 3–6 months the crown was restored on an individual abutment. Bone loss was measured on peri-apical radiographs, taken at baseline and 1 year. Patients and students scored a questionnaire, to rate their opinion on a Visual Analogue Scale, ranging from 0 (¼very negative) to 100 (¼very positive). Results: Twenty-one implants were placed (18 maxilla, 3 mandible) in 16 patients (3 male, 13 female), mean age 46 years (range 25–64). Four were light smokers ( < 10 cig/day). Four implants were submerged during healing and three were placed into extraction sockets. All implants reached 35–60Ncm stability. Compared with the planned implants, 52.4% of the placed implants had a different dimension. Overall, the students planned for a shorter implant. After 1 year, mean bone loss was 1.33mm (SD 0.50, range 0–2.10) and no failures had occurred. The patients’ reasons for choosing implant treatment were problems with esthetic appearance (13), eating (7), speaking (2) or broken provisional prosthesis (1). They were informed about implants by dentists (7), family or friends (3), the media (4) or the periodontist (2). They reported minimal postoperative pain (80.4/100), would definitely undergo the treatment again (90.4/100) and advise it to others (91.7%). Overall, students were very positive about the project, but realized that more additional training and education is necessary to perform implant surgery independently. Conclusions and clinical implications: Although the clinical outcome was good, the students realized that implant surgery can be complicated and additional training is needed. The fear for overconfidence seems to be limited. Overall, patients were pleased with the treatment and students thought it was a valuable contribution to their education

An analysis of the decision-making process for single implant treatment in general practice

Background: There is little information on the decision-making process for single implant treatment in general practice. Aim: To study the incidence of and the factors associated with the decision to perform single implant treatment after tooth extraction by general practitioners in a private, fee-for-service setting. Methods: One hundred practitioners with a general dental practice in Ghent were randomly selected from an official list received by the Belgian Social Security Institute. Clinicians were asked to fill in a study form for every single extraction they performed during an 8-week period. The study form related to the treatment decision as discussed with the patient and a number of patient- and clinician-related factors. The association of these factors with single implant treatment was evaluated using univariate tests and logistic regression. A decision-tree was also constructed with the predictors from the regression analysis as independent variables. Results: Ninety-four general dentists (52 males, 42 females; mean age 49; range 24–68)agreed to participate and extracted 1180 single teeth in an equal number of patients (50% males, 50% females; mean age 53; range 18–90). The main reasons for tooth loss were caries (48%) and periodontal disease (28%). At the time of extraction tooth replacement was deemed necessary in half of the patients and are movable partial denture was chosen in 55% of them. Similar frequencies were found for fixed partial denture (23%) and single implant treatment (21%). Although the vast majority of patient- and clinician-related factors showed a significant association with the latter on the basis of univariate tests, logistic regression only identified seven predictors. These included location of the extracted tooth, number of missing teeth, regular supportive care, bone loss at adjacent teeth, restoration level of adjacent teeth, gender of the clinician and dentists’ experience in implant prosthetics. The decision tree identified bone loss at adjacent teeth and number of missing teeth as the most important predictors for single implant treatment. Conclusions and clinical implications: If tooth replacement was deemed necessary at the time of extraction, a single implant was the treatment of choice in only one-fifth of the patients. Mainly oral factors had an impact on the decision-making process in contrast to patients’ background and medical factors. Dentists’ experience in implant prosthetics also showed a positive association with single implant treatment as opposed to dentists’ experience in implant surgery

Facilitating dental student reflections : using mentor groups to discuss clinical experiences and personal development

Despite the consensus on the importance of reflection for dental professionals, a lack of understanding remains about how students and clinicians should develop their ability to reflect. The aim of this study was to investigate dental students’ and mentors’ perceptions of mentor groups as an instructional method to facilitate students’ reflection in terms of the strategy’s learning potential, role of the mentor, group dynamics, and feasibility. At Ghent University in Belgium, third- and fourth-year dental students were encouraged to reflect on their clinical experiences and personal development in three reflective mentor sessions. No preparation or reports afterwards were required; students needed only to participate in the sessions. Sessions were guided by trained mentors to establish a safe environment, frame clinical discussions, and stimulate reflection. Students’ and mentors’ perceptions of the experience were assessed with a 17-statement questionnaire with response options on a five-point Likert scale (1=totally disagree to 5=totally agree). A total of 50 students and eight mentors completed the questionnaire (response rates 81% and 89%, respectively). Both students and mentors had neutral to positive perceptions concerning the learning potential, role of the mentor, group dynamics, and feasibility. The mean ideal total time for sessions in a year was 99 minutes (third-year students), 111 minutes (fourth-year students), and 147 minutes (mentors). Reported reflective topics related to patient management, frustrations, and practice of dentistry. Overall mean appreciation for the experience ranged from 14.50 to 15.14 on the 20-point scale. These findings about students’ and mentors’ positive perceptions of the experience suggest that mentor groups may be a potentially valuable strategy to promote dental students’ reflection

Above 15-year follow-up of single machined Brånemark implants

Background: Since the late 1980s dental implants have been used in the indication of single-tooth replacement. Aim: The aim of this study was to evaluate the radiographical and clinical outcome of single-machined Bra°nemark implants with at least 15 years of follow-up. Methods: Fifty-one patients who received 63 single implants between 1987 and 1994 were randomly selected. In this patient group three implants failed (4.8%), leaving 60 implants to be clinically investigated. Mean interproximal probing depth, bleeding and plaque index were measured around each implant. Peri-apical radiographs were compared for marginal bone level between baseline (¼within 6 months after abutment connection) and 2–4 years, 5–8 years and 15–22 years of follow-up. Mean interproximal bone level was measured from the implant shoulder as a reference point. Overall changes in marginal bone level were analyzed with the Friedman test and 2-by-2 comparison between time points was evaluated with the Wilcoxon signed ranks test. Results: The group consisted of 29 males and 22 females with a mean age of 24 years (range 14.7–57.4) at implant placement. Mean follow-up time was 18.5 years (range 15–22). Mean probing depth was 3.9 _ 1.27mm (range 2–10.3). Bleeding and plaque indices were 1.2 _ 0.81 and 0.2 _ 0.48, respectively. Mean bone level after 15–22 years was 1.7 _ 0.88mm (range _0.8 to 5). There was no correlation found between radiographic bone level and probing depth. The Friedman test indicated a statistically significant change in marginal bone level between time points (P < 0.05). Wilcoxon signed ranks test showed a statistically significant difference between baseline and all other time points. After 2–4 years no statistically significant differences could be found. All but one implants (98.3%) were within the currently accepted success criteria corresponding to a maximum accepted bone loss of 4.3mm after 15 years. If one accepts a mean bone level of 2.1mm from the implant shoulder (¼2nd thread), 81.7% of the implants are successful. If a mean interproximal probing depth of 5mm is accepted, 91.7% of the implants are successful. If both these criteria are combined, 76.7% are successful. Conclusions and clinical implications: The machined Bra°nemark implant used as a single-tooth replacement is a predictable solution with high clinical survival and success rates. In general, a steady state bone level can be expected over decades. New criteria for long-term implant success should be determined