ORIGINAL ARTICLE

Year : 2017  |  Volume : 7  |  Issue : 2  |  Page : 54-58

Contemporary dental implant knowledge and attitude: A perspective of budding dentists

Tejal S Sheth, Shilpi S Shah, Dhwanit S Thakore, Mihir N Shah
Department of Periodontics and Oral Implantology, Ahmedabad Dental College and Hospital, Gandhinagar, Gujarat, India

Correspondence Address:
Dr. Tejal S Sheth
Sheth, 402 Ratnakar Flat, Opp. Amrapali III, Judges Bunglow Road, Bodakdev, Ahmedabad – 380 015, Gujarat
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jdi.jdi_16_17

Abstract

Background: Implantology has now penetrated and become a significant part of mainstream dentistry and is here to stay. Although a number of cost-effective implant system being available in India, implant practice requires in-depth acquaintance and skillful competence. It is the need of the hour that a more structured clinical training including some patient treatment be taught in the undergraduate curriculum. The purpose of the present study was to assess the awareness of implants among interns from various colleges across Ahmedabad city and changes in perception of undergraduates toward implantology over 3 years.
Materials and Methods: A questionnaire-based survey was conducted among interns from various dental colleges across Ahmedabad city in 2013 and 2016 to assess the changing trends in knowledge and attitude toward implantology.
Results: A total of 600 questionnaires were distributed, 300 each in 2013 and 2016. Nearly 74%–75% of interns were aware about the implant procedure in both the phases of the study. Approximately 80% admitted their inability to perform implant procedure independently due to lack of professional training. Around 50% agreed to introduce and include implantology as a separate subject in BDS. curriculum.
Conclusion: The present study suggests that there is a very minimal change in the perceptions and knowledge of dental interns toward implantology over 3 years due to minimal exposure to implant dentistry throughout their BDS. They were not satisfied by the lack of knowledge and welcomed the suggestion of introducing implantology as a separate subject in the BDS curriculum.

Keywords: Dental graduates’ perceptions, implants, undergraduate curriculum

Introduction

Since the last decade, implants are sprouting as a routine treatment option for replacement of missing teeth not only in the urban population but also in the rural parts too. This specialty practice of implantology is now being penetrated by a number of general dental practitioners. Although a number of cost-effective implant system being available in India, implant practice requires in-depth acquaintance and skillful competence. The implant practice has been enlarged from predominantly fully edentulous toward more partially edentulous patients, and there is a swing from a functionally oriented toward a prosthetic driven and esthetically oriented patient demand. On the academic level, education in implant dentistry should be incorporated in the undergraduate curriculum, at least a basic level of theoretical information should be provided within the courses of prosthodontics, periodontology, and oral surgery. A more structured, clinical training at preclinical and clinical levels, including some patient treatment, is not commonly taught in the undergraduate curriculum.^[1] Overall treatment protocol and the proposed treatment outcome should be transferred to the patients in as simplest form as possible by the dental practitioner. Hence, it is inevitable to know an attitude and behavior of undergraduate students toward the inclusion of implants in their clinical practice as well as their attitude toward the inclusion of implantology in the BD S curriculum. Furthermore, whatever the level of clinical skills taught to the students within this field, it is agreed that future dentists should be able to communicate with other team members in relation to treatment planning and patient-related problem-solving.^[2] In this respect, it seems obvious to include implant dentistry in the undergraduate dental curriculum.

With the increasing patients’ demand and acceptance for dental implants, it has become mandatory to introduce undergraduate dental students to clinical implantology too. The purpose of the present study was to assess the awareness of implants among interns from various colleges across Ahmedabad city and changes in perception of undergraduates toward implantology over 3 years.

Materials and Methods

A questionnaire-based survey was conducted among interns from various dental colleges across Ahmedabad city. Clearance for conducting the study was obtained from the Institutional Ethical Committee. Informed consent was taken from all the subjects participating in the study and a closed-ended questionnaire was recorded to assess the awareness of implants among these students. This survey was carried out twice; in 2013 and 2016 to assess the changing trends in knowledge and attitude toward implantology. The descriptive data were statistically analyzed using SPSS Software version 15.5, IBM inc. India software, and the results were obtained.

Results

A total of 600 questionnaires were distributed, 300 in the year 2013 and 300 in the year 2016. Of these 300 each questionnaires, 192 and 203 were completely with a response rate of 54% and 67% in the year 2013 and 2016, respectively.

Out of 23 questions, around 12 questions assessed the knowledge of fundamentals of basic implantology and the remaining questions assessed regarding their attitude and behavior toward including implants in their clinical practice as well as their attitude toward the inclusion of implantology in the BDS curriculum. Approximately everyone was aware of the implant as an alternative therapy for missing teeth and had come to know about it through their undergraduate program during clinical postings. About 74%–75% interns were aware of the implant procedure in both the phases of the study. There was no upgradation in the knowledge of implant placement protocol. Approximately 84% interns had heard about implant prosthodontics. When asked about the placing implants in systemically compromised patients, only 39.4% and 38.9% agreed, respectively, in 2013 and 2016 survey, whereas 43.1 and 46.7% disagreed, respectively, showing their lack of knowledge about implant dentistry protocols. Only 72.1% in 2013 survey suggested the significance of both hard and soft tissue as selecting criteria before planning implant placement while that increased to 80% in 2016 survey suggestive of increased awareness about soft tissue profile significance around implants and its role in implant success rate. Regarding the best radiographic diagnostic aid for implants, 27.3% and 18.4% voted for Dentascan and cone beam computed tomography (CBCT), respectively, in 2013 survey, whereas 17.2% and 43.8% voted, respectively, for Dentascan and CBCT in 2016 survey, pointing toward a definitive rise in interest for learning implant dentistry. When questioned about osseointegration and time taken for osseointegration, around more than half of them during both the phases were aware of it. Most of them in both the phases were familiar with, i.e., had heard of different implant systems. Only 24.7% interns were of the opinion that immediate implant is a better alternative over the delayed implant, whereas the opinion changed drastically with approximately 50% opining immediate implant to be a better treatment alternative.

Questions 14–23 assessed the attitude and behavior of interns towards including implants in their clinical practice as well as their attitude toward including implantology in the BDS. curriculum. When asked to score long-term survival of implant over fixed partial denture/removable partial denture/complete denture (FPD/RPD/CD), 50% of interns approximately rated it good, whereas only around 28% rated it excellent, whereas only 1% rated it poor. Nearly 61.5% interns in 2013 showed a positive attitude towards including implant in clinical practice that raised to 88% in 2016. The reason being higher treatment charges (17.3% and 65%, respectively), better treatment option over FPD (37.8% and 53.2%, respectively) and patients’ demand (35.2% and 28.5%, respectively). Approximately 80% (84.2% and 79.8%, respectively) admitted their inability to perform implant procedure independently due to the lack of professional training. More than 80% (87.3% and 81.2%) exhibited interest in doing a certificate/degree course in implantology. Around 50% (48.4% and 49.2%, respectively) agreed to introduce and include implantology as a separate subject in BDS curriculum. When questioned about their preference, 59.2% and 72.9%, respectively, preferred company assisted training over self-training (38.4 and 26.6%, respectively) and 66.8% and 78.3%, respectively selected complete module course over hands-on crash course (28.9 and 21.1%, respectively) clearly suggestive of their sincerity toward learning basic implantology systematically and including implant dentistry in their day-to-day clinical practice.

Discussion

Dental implants have become a significant part of mainstream dentistry and are here to stay. With the advent of implants since the past few decades, there is a paradigm shift in patients’ demand for replacement of missing teeth with dental implants along with patients’ perception and acceptance of newer treatment modalities and also has changed the perspective of dental therapy regarding the long-term successful outcomes.

A survey of a representative sample of the Austrian population found that dentists are the primary source of patient information on dental implants followed by friends and acquaintances, print media, and general practitioners.^[3] A similar national survey of the general population in India found that dentists were the most important source of information about dental implants, suggesting that most patients look to their dentists to provide them with sound information regarding dental implants.^[4] Kaurani and Kaurani reported dentist to be the focal source of information.^[5] It was recorded by Zimmer et al. in 1992 that only 17% of the people were cited dentist as a source of information.^[6]

With little or no training for dental implants incorporated in BDS curriculum, a freshly graduated dental student may have little or no knowledge about dental implants, which today has become the indispensable part of treatment options. Hence, this survey was conducted among interns of various dental colleges of Ahmedabad City to assess their knowledge and attitudes toward dental implants and changes in their perceptions toward Implant Dentistry. At a consensus meeting organized by the Association for Dental Education in Europe, there was widespread agreement among the academicians and implant-industry representatives about the urgent need to increase the penetration of implant dentistry within the dental curriculum.^[7]

In the present survey, approximately more than 95% interns were aware of implants as an alternative treatment option for missing tooth and around 70%–80% had received the information during clinical postings, and only 20% had heard it from other sources which are in contrast to the conclusion made by Saxena et al.^[8] in their study in 2014 where 50% students learnt about dental implants from their print and electronic media. In the study conducted by Rustemeyer and Bremerich ^[9] reported that the contribution of internet, books, and magazines was very low.

In the present study, only 39.4% and 38.9%, in 2013 and 2016 survey respectively, agreed that implants can be placed in systemically compromised patients, whereas 43.1 and 46.7% disagreed, respectively, showing their lack of knowledge about implant dentistry protocols. Only 72.1% in 2013 survey suggested the significance of both hard and soft tissue as selecting criteria before planning implant placement while that increased to 80% in 2016 survey suggestive of increased awareness about soft tissue profile significance around implants and its role in implant success rate. In a study by Chaudhary et al. 2015, 65.1% of the surveyed population believed that case selection is the most important criterion for implant success.^[10] Studies have shown that like in any other treatment in dentistry, the prognosis of this treatment modality is highly dependent on appropriate case selection. Surgical procedures, patient’s systemic conditions and local oral factors were not considered as a major limitation by many subjects. Successful fusion of the bone to the implant requires good periodontal health.^[11] Hence, people at higher risk of experiencing periodontal disease such as those with diabetes ^[12] or those who smoke ^[13] might not be good candidates for implant therapy. This suggests that multiple factors have a role to play in the overall success of an implant and a single factor cannot be considered as the only limitation. Approximately 90% were aware of implant osseointegration in contradiction to study by Prashanthi and Mohan 2013^[11] where it was surprising to note that only 40% of patients knew that implants were retained through osseointegration. This striking difference suggests the incongruity in the knowledge base pertaining to implant dentistry is the result of lack of uniformity in the Implant Education protocols throughout the country because implantology is not a part of BDS curriculum.

Nearly 50% interns approximately rated long-term survival of implant over FPD/RPD/CD good while only around 28% rated it excellent, whereas only 1% rated it poor in the presented survey. Tepper et al. also showed 54% of patients believed expected mean durability of the implant is 10–20 years and 21% <10 years.^[14] In the study done by Rustemeyer and Bremerich only 3% of the patients expected durability of <10 years.^[9] Whereas in a study by Chaudhary et al. 2015 when asked about the longevity of dental implants, 17.1% of respondents believed that dental implants last a lifetime.^[10] This is again indicative of discrepancy in the implant teaching protocols across the country.

In the stated survey 61.5% interns in 2013 showed a positive attitude toward including implant in clinical practice that raised to 88% in 2016. The reason being higher treatment charges (17.3% and 65%, respectively), better treatment option over FPD (37.8% and 53.2%, respectively) and patients’ demand (35.2% and 28.5%, respectively). Approximately 80% (84.2 and 79.8%, respectively) admitted their inability to perform implant procedure independently due to the lack of professional training. Furthermore in a study by Saxena et al.^[8] among 480 students, 52.7% of students are willing to undergo implant procedure, whereas only 17% of students were not willing to undergo the procedure in which 38.5% found this treatment option to be costly and 52% was not willing due to fear of surgical procedure and 31% of students are not sure whether they going for treatment procedure or not as they are not clear about the procedure. The study done by Kaurani and Kaurani ^[5] reported different results in their study only 29% of the people were willing to use dental implants as a treatment and 56% of people were not willing to undergo the procedure because 61.6% found this treatment option to be costly and 19.6% stated that it was a surgical procedure and 18.7% were not clear about the procedure.

Such perceptions regarding the infallibility of implants could lead to highly unrealistic patient expectations. Additional knowledge and training in the use of dental implants could expose these students to the veracity of implant survival and help to create problems of unsatisfied patients arising from overoptimistic expectations.

When asked to introduce implantology as a separate subject in the BDS. curriculum, approximately 50% showed their agreement to the proposal. Over 70% of subjects feel the need to have implant training as a part of their undergraduate clinical curriculum whereas about 56.6% feel that it should be made into a separate specialty in a study by Prashanthi and Mohan 2013.^[11] Chaudhary et al.^[10] in their study got a whopping 91.7% response about wanting more information to be provided regarding the same in their BDS program representing increasing student demands of integration of a well-organized dental implant curriculum at the undergraduate level because this will directly affect how well they learn and incorporate implant treatment options in their daily clinical practice. Huebner ^[15] also found that students’ learning about implant treatment in predoctoral education greatly affected their involvement in implant treatment after graduation. In a report of the US and Canadian dental schools deans in 2004, incorporation of implant education into the undergraduate curriculum was seen on the rise over a number of years with 97% of schools having incorporated aspects and strategies for implant training in their curriculum.^[16],[17]

Nearly 59.2% and 72.9%, respectively, preferred company assisted training over self-training (38.4 and 26.6%, respectively) and 66.8% and 78.3%, respectively selected complete module course over hands-on crash course (28.9 and 21.1%, respectively) clearly suggestive of their sincerity towards learning basic implantology systematically and including implant dentistry in their day-to-day clinical practice. Around 67.5% of the surveyed internees in a study by Chaudhary et al.^[10] were of the view that they would like to get more reliable information through 1-year certificate or module-based courses conducted by colleges or trained implantologists, whereas 10.2% preferred short-term CDE programs and workshops conducted by the implant companies a meager 3% favored study groups and internet. Similarly, 52% of the surveyed internees wished to receive formal training on implants through 1-year certificate or module-based courses conducted by institutions or trained implantologists, whereas only 12.5% preferred the vendor-led workshops.

Both surveys suggest that a majority of the dental graduates believed in gaining knowledge through an appropriately structured implant education protocol uniformly followed throughout the country. The surveyed interns are of the opinion that knowledge gained from the short-term workshops or crash courses is not sufficient and provided only little basic knowledge.

There are many discrepancies in the outlook and opinions of the undergraduate dental students toward implantology with the lack of any definitive consensus. This is indicative of lack of academic and clinical training of the undergraduate students considering implant dentistry. Implantology introduced right from the undergraduate level can bridge the information gap still existing in the society.

Conclusion

To summarize, the present study suggests that there is a very minimal change in the perceptions and knowledge of dental interns toward implantology over a period of 3 years. This is because dental undergraduates are minimally exposed to implant dentistry throughout their BDS. tenure. It is not in the best interest of the new dentist if the clinical environment they experienced at dental school has lagged behind the new clinical settings that they enter on graduation. A majority of the interns were not satisfied by the lack of knowledge and showed an increased desire for knowledge in the field of implants and welcomed the suggestion of introducing implantology as a separate subject in the BDS. curriculum. Dental implants, and the teaching of dental implants has to be a significant part of dental practice in the coming years. The challenge to the education system is to produce a dental graduate who is competent enough to incorporate the fundamentals of dentistry in fusion with the current trends in an independent clinical practice.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Petropoulos VC, Arbree NS, Tarnow D, Rethman M, Malmquist J, Valachovic R, et al. Teaching implant dentistry in the predoctoral curriculum: A report from the ADEA implant workshop’s survey of deans. J Dent Educ 2006;70:580-8.
2.	Plasschaert AJ, Holbrook WP, Delap E, Martinez C, Walmsley AD, Association for Dental Education in Europe, et al. Profile and competences for the European dentist. Eur J Dent Educ 2005;9:98-107.
3.	Pommer B, Zechner W, Watzak G, Ulm C, Watzek G, Tepper G, et al. Progress and trends in patients’ mindset on dental implants. I: Level of information, sources of information and need for patient information. Clin Oral Implants Res 2011;22:223-9.
4.	Chowdhary R, Mankani N, Chandraker NK. Awareness of dental implants as a treatment choice in urban Indian populations. Int J Oral Maxillofac Implants 2010;25:305-8.
5.	Kaurani P, Kaurani M. Awareness of dental implants as a treatment modality amongst people residing in Jaipur (Rajasthan). J Clin Diagn Res 2010;4:3622-6.
6.	Zimmer CM, Zimmer WM, Williams J, Liesener J. Public awareness and acceptance of dental implants. Int J Oral Maxillofac Implants 1992;7:228-32.
7.	Mattheos N, Albrektsson T, Buser D, De Bruyn H, Donos N, Hjørting Hansen E, et al. Teaching and assessment of implant dentistry in undergraduate and postgraduate education: A European consensus. Eur J Dent Educ 2009;13 Suppl 1:11-7.
8.	Saxena V, Lohiya J, Bhambal A, Vanka S, Talreja N, Kankane N. “Out-look of undergraduate dental students on dental implants in Bhopal, central India”. Int J Sci Study 2014;1:2-8.
9.	Rustemeyer J, Bremerich A. Patients’ knowledge and expectations regarding dental implants: Assessment by questionnaire. Int J Oral Maxillofac Surg 2007;36:814-7.
10.	Chaudhary S, Gowda TM, Kumar TA, Mehta DS. Knowledge, attitudes, and perceptions of undergraduate dental students toward dental implants – an all India survey. Implant Dent 2015;24:160-5.
11.	Prashanthi E, Mohan M. Awareness of dental implants among undergraduate dental students at Mangalore, India. Indian J Appl Res 2013;3:1-2.
12.	Fiorellini JP, Chen PK, Nevins M, Nevins ML. A retrospective study of dental implants in diabetic patients. Int J Periodontics Restorative Dent 2000;20:366-73.
13.	Jones JK, Triplett RG. The relationship of cigarette smoking to impaired intraoral wound healing: A review of evidence and implications for patient care. J Oral Maxillofac Surg 1992;50:237-9.
14.	Tepper G, Haas R, Mailath G, Teller C, Zechner W, Watzak G, et al. Representative marketing-oriented study on implants in the Austrian population. I. Level of information, sources of information and need for patient information. Clin Oral Implants Res 2003;14:621-33.
15.	Huebner GR. Evaluation of a predoctoral implant curriculum: Does such a program influence graduates’ practice patterns? Int J Oral Maxillofac Implants 2002;17:543-9.
16.	Lim MV, Afsharzand Z, Rashedi B, Petropoulos VC. Predoctoral implant education in U.S. dentalschools. J Prosthod 2005; 14:46-56.
17.	Chappell RP. Dental school implants survey. Oral Implantol 1974; 5:24-32.