INTRODUCTION:

As the aesthetic and functional demands of patients have significantly risen in the last few years, dental implants have become the most popular choice for replacing missing teeth, which in turn may reduce the damage or wear of tooth structure with fixed prosthetics or removable dentures.

Recent advances in implant materials, improved surgical techniques and protocols have played a significant role in making dental implant treatments more practical and therefore more successful and cost effective, rendering it a highly preferable option to dentists worldwide. Therefore, it has been mandatory for general practitioners to expand their knowledge and experience with respect to implant dentistry and its related procedures.

Nowadays, universities have increased the application of clinical experience for the implant with more and more prosthetic procedures in their curricula. Several implant prosthetic procedures are achieved by undergraduate students¹. Clinical attachments related to implant prosthetics involve assisting others, permitted procedures are mostly straightforward cases in the posterior region. However, continuous conflict amongst dental educators does still exist as to whether implant dentistry should be included or excluded in the undergraduate program². Mattheos et al suggested that the undergraduate dental syllabus should include: Implant indications, the ability to diagnose and categorize the case according to its difficulty, clarify risks and possible treatment options to the patient and, identify restrictions and the time to refer. They considered the implant dentistry an essential part of the undergraduate curriculum ³.

Many studies have evaluated the views of dental students, dentists and educators towards dental implant education. A survey was conducted by Schweyen et al to evaluate the perspectives of 678 dental students, clinical educators, and experienced dentists in Germany with regards the theoretical and practical teaching content for implant dentistry in undergraduate dental education. The outcome of this study showed that all participants recommended that undergraduate dental syllabi should offer the students at least the basis and awareness foundation of implant dentistry, especially for straightforward cases, and to include the advanced and complicated cases for post-graduate courses ². Barwacz assessed the status of the predoctoral implant program by asking the directors of ten American and Canadian dental schools, half of the directors rejected the thought that the undergraduate program efficiently enables students to preform regular implant placements after graduation, the other half of them believed that their students are not adequately prepared to provide regular dental implant treatment upon graduation ⁴. Similar results were obtained from other two studies, revealing that undergraduate students are not satisfied with the knowledge and clinical experience of implant-based treatments provided by the degree syllabus, and would choose further training or teaching in this field ^5,6. Prasad and Bansal documented the improvement in students’ satisfaction and confidence regarding their implant education after attaining simulation and clinical training ⁷.

Moreover, numerous studies have revealed that the integration of implant dentistry in the dental undergraduate curriculum still proves a challenge with several obstacles, such as time limitations within the curriculum, high cost of materials and equipment, unavailability of trained staff, and inadequate patient flow ^{2, 3, 8, 9}. Ferro et al highlighted an additional challenge amongst qualified students who possessed a desire to learn, but were still educated in an outdated fashion. Knowledge was shared as opposed to direct knowledge application for the purpose of preventing or solving clinical problems¹⁰.

The implementation of computer‐aided dynamic implant navigators has shown considerable improvement in reducing surgical errors of students by correction of angulation deviation and speed after multiple implant placements, which in turn can enhance implant surgical placements in beginner and senior students with their first attempts for implant placement ¹¹.

Aims and Objectives:

The purpose of this study is to assess the basic dental implant knowledge of newly graduated dental practitioners at the Ajman and Sharjah Dental schools.

MATERIALS AND METHODS:

A self-administered questionnaire was handed to 200 dental practitioners of various experience levels in both Ajman and Sharjah dental schools, out of which only 173 participants responded. Knowledge, attitude, practice and additional information required with respect to implant dentistry was collected.

The study protocol was approved by the Ethics Committee of The College of Dentistry / Ajman University (RD- 2015/16 - 06) and The College of Dentistry /Sharjah University (REC11/15/027). Participation in this study was completely voluntary and anonymous. The questionnaire was distributed after obtaining the participant's approval.

A well-structured, 16-item questionnaire with close-ended questions, eight questions pertained to scientific knowledge on implant dentistry and the participant's knowledge about this field, four questions were about dental implant incorporation and its difficulties. Opinions regarding implant education and training were also obtained in the remaining questions. The questions were in the form of “Yes/No”. Data was presented in the form of descriptive statistics and percentages (analyzed by SPSS, 22V).

RESULTS:

A total of 173 responses were collected in this cross-sectional survey. The distributions of the answers to the questions evaluating the knowledge, attitude and practice level of the participants are shown in Table 1.

Table 1: knowledge toward dental implants

Results revealed that the majority of dental practitioners (82.1%) displayed general awareness of dental implants in addition to their various related systems (table 1). A total of 80.9% (140) participants were aware of the surgical techniques related to placing implants and the distance between two implants (table 1).

With respect to knowledge level analysis, the results of the fourth question showed that a total of (83.2%) were aware of the anatomical structures that should be avoided during implant placement (table 1).

Dental Implant placement has no absolute contraindication. However, in order to minimize risks and in turn boost success rates, a number of key factors must be placed into consideration when placing dental implants for the purpose of avoiding complications in high-risk individuals such as smokers, diabetic patients, as well as patients with poor oral hygiene. More than half of the participants (66.5%) were not fully aware of dental implant contraindications (table 1).

In numerous circumstances, implant placements require additional procedures before, during and after treatment. Quite a significant number of respondents (82.6%) correctly answered the question about additional surgical procedures performed to enhance successful implant placement (table 1).

Participants were asked two questions regarding immediate and delayed implants and the protocol of their placement. The total awareness of knowledge with regards to immediate and delayed implant placement amongst all participants was 78.6%, whilst only 64.7% were aware of loading protocols such as immediate loading, early loading and delayed loading (table 1).

Participants were asked questions pertaining to attitude and opinions related to the options and challenges around dental implant treatment. Most dentists (89.0%) agreed to present implants as a treatment option to patients for the purpose of replacing missing teeth, as dental implants can function like real teeth as well as possessing a natural appearance. Furthermore, damage of the surrounding tooth structures is avoided as no tooth preparation is required. The jaw bone is consequently preserved and the implant lasts longer than other prosthetic replacements. Facial contour is also enhanced, rendering this treatment option an aesthetically pleasing one to patients (table 2).

Table 2: attitude toward dental implant.

The response to the tenth question about the difficulties of dental implants compared with other treatments revealed that 63.6% of the total number of dental practitioners thought that the difficulties of dental implant procedures are related to the lack of instrumentation and materials required, while 74.6% thought that the difficulties are skills-related. A higher percentage of the respondents (83.8%) thought that the challenges of the dental implant procedure are related to elevated costs (table 2).

The majority of the participants (87.9%) agreed to incorporate implant treatment in their future practice, while very few of them (1.7%) chose not to replace their missing mandibular 1st molar by implants (table 2).

Participants were asked a series of questions regarding dental implant training and education. Among the dental practitioners who participated in this survey, only 27.7% have undergone formal training in dental implant placement and the participants who were satisfied with the implant education given at undergraduate level were only a total of 54.3%. Therefore, the majority of the participants (94.8%) felt that they needed further training and education in the field of dental implant placement (table 3).

Table 3: responses regarding training and education of participants

Regarding implant education levels, two-thirds of the respondents (66.5%) said that implant education and training methods are best at post-graduate level, while only 33.5% stated that implant education and training is best at undergraduate level (table 4).

Table 4: implant education level

DISCUSSION:

Some global variation exists with regards to the teaching hours of implant dentistry, ranging between 10 and 40 ⁵. At Ajman and Sharjah University, implant dentistry is given as a theoretical course but lacks preclinical or clinical sessions.

The results of this study have displayed that the newly graduated dentists who responded to the questionnaire wished to incorporate dental implant education in their future practice (66.5%). Nevertheless, only 33.5% preferred to include it in the undergraduate program. This reveals that they have considered the practical part of implant therapy as a postgraduate specialty. These results are similar to the ones found by Basutkar and Jayachandran et al ^8,
12. However, Schweyen et al showed two reactions, one from both educators and practicing dentists who believed that teaching basic theoretical knowledge, postoperative maintenance and care of the prosthetic part of implants, were much more important than implantation achieved by undergraduates. Whereas the second response from novice dentists revealed that they preferred to include a comprehensive implant program in undergraduate level ², which is dissimilar from the present study. This difference in results may be due to the novice dentists sample incorporated into our study is double that of Schweyen’s sample.

Another dissimilar reaction from the students of the University of Barcelona who recommended a syllabus expansion in order to include both theory and practical parts. This difference from the present study may be due to these students perception about implants as essential part of their future practice, as Spain is considered one of the highest European countries with respect to the number of implants per year ⁵. Temmerman et al clarified the value of implementing the clinical surgical and prosthetic practice together with theoretical and pre-clinical teaching, which showed promising improvement of implant dentistry education in undergraduate programs ¹³. Other studies have stated that additional dental implant education is preferable to assist dentists to enhance their confidence levels when utilizing this type of treatment, as well as aiding to feel more in control when managing dental implant patient ^{7, 8}.

The questions evaluating the awareness of graduates have displayed a reasonable percentage of basic knowledge. Positive responses ranged from 78.6 % to 83.2%. The lowest score (66.5%) was for the question regarding contraindications for implant placement. The results are in harmony with the previous studies that have shown an increase in awareness amongst dentists and specialists than previous decades ⁶^{, 14, 15}. Saad & Salem have reached lower percentage of awareness, this may be due to more than 40% of their sample being undergraduate students, unlike the present study in which all participants were graduate dentists ¹⁶.

Approximately three quarters (74.6%) of the participants considered the dental implant as more difficult than the fixed partial denture, a result that they related to lack of skills, results that were related to the lack of instruments and materials were 63.6%, while 83.8% of them linked it to high treatment costs, which may well affect patient availability. The same results obtained by Garcés et al students’ sample, which revealed that 45-69 % felt that implant placement ranged between difficult to very difficult ⁵. However, Schweyen et al clarified that such courses need expansive tools and experienced instructors for direct supervision ², while Jayachandran, et al referred to the shortage of space in the syllabus ⁸.

The results of dentist satisfaction towards their implant education at undergraduate level showed quite a low level of 54.3%, and very high percentage of them 94.8 % felt they needed more education and training to be able to practice implantology. The same results were obtained by Dragan et al in which the newly graduated dentists from 84 countries admitted that they were not well prepared for implant practice ⁶. Dentists expressed their desire to be more in control of all the stages involved in the dental implant placement procedure, rather than receiving minimal training at undergraduate level ^4,8,17.

Only 27.7% of the dentist in the present study had undergone formal training in dental implantology. This low percentage may be due to the sample of this study rooting from newly graduated dentists who were not fully enrolled in practice. This percentage is less than the Glücker et al sample (41.9%) ¹⁸, that was mainly due to the fact that the dentists who participated in the study had more experience than the present sample.

Most of the participants (98.3%) preferred to replace their own missing molar (if any) with an implant, which reflected that they perceived it as the best type of restoration for a missing tooth, determining the importance of incorporating this type of treatment into their education. Similar results were obtained from the dental practitioners included in Basutkar’s study and Murkute et al ^{12, 17}_.

Quality‐improvement and more practice education are required at an international level, in order to specifically support new graduates who are involved with implant dentistry as part and parcel of their profession. Although the inclusion of implant dentistry as a major subject in the undergraduate curriculum has proved to be a challenge, there seem to be promising results with regards to guided surgical implant placement, together with virtual reality technology, rendering dental implant education less challenging.

CONCLUSION:

Considering the general limitations of this study, newly graduated dentists have good levels of awareness regarding basic knowledge of implant dentistry. However, they are unsatisfied with the level of their implant education and wanted to integrate it more in the undergraduate program. Most of the dentists in this study considered dental implants the first choice of treatment for tooth replacement.

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Received on 16.01.2022 Modified on 06.03.2022

Research J. Pharm. and Tech 2022; 15(11):5139-5143.

DOI: 10.52711/0974-360X.2022.00864