Statement of the Academy of Prosthodontics of South Africa (APSA) concerning Implant Dentistry

Posted by: on September 21, 2012 in Featured 

The recent introduction of implant dentistry as a dental therapeutic option, and the rapid evolution of its technology and knowledge base, has meant that the requirements for the education and training required of clinicians before venturing into this field have not been developed adequately at undergraduate and non-specialist post-graduate levels. APSA is aware that current resource constraints limit the undergraduate training in implant dentistry, and do not equip the dental graduate to deal effectively with all patient needs; the practising dentist therefore has to obtain post-graduate education and training by attending short courses, none of which enjoy official accreditation, even though they may meet some of the requirements specified below.

The Academy has noted with concern the increasing incidence of reports of actual and perceived unsatisfactory outcomes of implant related procedures. It cannot escape the conclusion that in many instances these outcomes are related to inadequate education, training and experience on the part of the attending clinician. In an attempt to address the problem, APSA has developed this document as a guideline for the education and training of practitioners wishing to practise implant dentistry.

In the event of a dispute arising regarding the outcome of implant therapy, proof of compliance with these guidelines could serve to support the requirements of training and competence in the discipline of implant dentistry. Verification of compliance can be obtained in many ways, the obvious ones being certification by an accredited training institution, preferably after assessment.

The Academy is also of the opinion that, since the purpose of implant therapy is the rehabilitation of the occlusion, surgery should only follow after thorough assessment of all relevant factors.

Education and training requirements

There is a relationship between the complexity of the surgical procedures and those of the prosthodontic procedures; for example, the final prosthodontic reconstruction of the augmented mandible may be the same as that for the non-augmented mandible but the initial assessment and management of the patient requiring augmentation while healing is in progress requires additional expertise. Similarly, soft tissue augmentation in the aesthetic zone requires special attention. APSA is of the opinion that the potential for surgical and prosthodontic complications are so closely related that levels of complexity should guide the training in the surgical as well as the prosthodontic aspects of implant dentistry.

In 1999 the Swiss Society for Oral Implantology suggested a surgical classification of implant sites with or without bone deficiencies, as per Table 1.

Table 1

In addition, an on-line assessment tool for determining the complexity of implant procedures has also been developed by the ITI Group (Table 2). This assessment rates both prosthodontic and surgical procedures in terms of difficulty as Straightforward or Advanced or Complex. These classifications serve as useful tools to determine levels of training required.

Table 2

Obtaining training at each level will enable the clinician to operate at that level. APSA is of the opinion that attending lectures and demonstrations, even in a skills laboratory, does not fulfil the necessary requirements, and holds the view that only those courses developed under the auspices of the academic training institutions should be considered valid.

APSA therefore proposes the following:

1. It is recommended that education and training in implant dentistry at the undergraduate level should at least allow students to gain experience in the treatment (i.e. diagnosis, planning, placement, restoration and maintenance) of a single implant in a non-aesthetic zone.
Ideally, APSA would like to see a situation where teaching at undergraduate level encompasses those aspects at the Simple or Straightforward level as per the tables above but accepts that at this time resource constraints make this unlikely.

2. For a general dental practitioner to undertake treatment at the Simple or Straightforward level, additional postgraduate education and training is required, and this should only be under the auspices of any of the four dental schools. Such courses should be assessed, and could lead, for example, to a Post-graduate Diploma in Implant Dentistry.

3. As soon as these courses (as per 1 and 2) are available, courses for the surgical aspects of the Simple or Straightforward level should be incorporated into the national curriculum for the specialty course in Prosthodontics.
These courses should also be made available for those Prosthodontists who wish to undertake the placement of implants at this level.

4. At present, treatment under the Advanced and Complex levels should be limited to the specialist groups involved in implant dentistry, namely Prosthodontics, Oral Medicine and Periodontics (OMP), and Maxillo-Facial and Oral Surgery (MFOS).

5. However, APSA is aware that there are specialists from these groups who may wish to undertake all aspects of implant dentistry, including those currently outside the scope of their practice, and at different levels, and provision should be made for this by the creation of sub-specialties in implant dentistry in each of the specialist areas. Hence OMP and MFOS specialists would undertake additional training in Prosthodontics, and Prosthodontic specialists would undertake additional training in surgical techniques beyond the Simple or Straightforward level.

The Academy will support all efforts at establishing such education and training opportunities in the four dental schools.

The Academy would welcome comments on these proposals, especially from our OMP and MFOS colleagues.

The Academy of Prosthodontics of South Africa
August 2012

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