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Guest Editorial

Incorporation of Implant Overdentures Into the Predoctoral Dental Curriculum

Alfano, Michael C. DMD, PhD*

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Despite the best efforts of dedicated dental school faculty, deans and curriculum committees across the globe, there are many problems with the dental educational process today. It is not simply that the curriculum is out of date; it is that parts of it are irrelevant, and some of the vectors that drive dental education in general should be redirected. For example, the various board and licensing examinations tend to measure what dentistry was, not what it should be. Thus, well-intentioned people have created a system that, at best, tends to celebrate the status quo, and change comes slowly and with great difficulty. A full discussion of this issue is beyond the scope of this editorial; however, an analysis of one aspect of important curriculum change could serve to illustrate the general problem and be of interest to the readers of this journal. Specifically, a discussion of the contemporary problem of incorporating implant-retained overdentures in the predoctoral curriculum is worthy of consideration.

For mandibular edentulism, an implant-retained overdenture (IO) should certainly be considered a first choice for prosthodontic care, if not the standard of care. Yet, it is not presented as a first choice in many dental schools today. There are a variety of reasons for this lapse. They are all good, but they are all unacceptable. For example, poor people for whom the costs of an IO can be prohibitive dominate the basic patient pool at dental schools. In addition, a conventional mandibular denture remains an acceptable restoration that must be taught in the dental curriculum. Furthermore, many faculty members who teach in the general dental clinics are not conversant with the benefits of IO restorations versus conventional dentures and might not have placed such a restoration themselves. Finally, dental schools located in fluoridated communities or in affluent areas can have a difficult time identifying an adequate pool of denture patients in general. There is a litany of other reasons why IO techniques are not mainstream in the predoctoral curriculum. For example, the curriculum is already crowded, the pool of surgeons available to place implants is sometimes limited, the public does not understand the therapy, and there is the inevitable issue of “turf” in terms of the particular specialty that should drive this service. Clearly, this is not a simple problem or IO would already be the standard of instruction in the predoctoral curriculum.

Difficult problems require innovative approaches, cooperative protagonists, and a willingness to rethink the status quo to be solved. The particular problem of IO is under review by a group of dental deans in the United States, and they have scheduled a workshop on the topic, and on single-tooth implants, at the American Dental Education Association (ADEA) Annual Meeting of the Council of Deans in November 2004. Because curriculum change is always difficult, the leadership of ADEA is commended for addressing this need with such a short lead-time. Although the outcome of the IO Workshop cannot be predicted with certainty, at the time of this writing, the approach used to study the problem is encouraging. Specifically, it is expected that the deans will be partnering with specialty dental groups, including those focused on prosthodontics, periodontics, and oral surgery; dental implant and prosthodontic companies; and focused interest groups including the Academy of Osseointegration and the International Congress of Oral Implantologists. Although each of these groups has been interested in this problem in the past, they have not previously coalesced in a common cause to resolve the problem.

Thus, the stage is set for a relatively rapid change in the way mandibular edentulism is managed in the predoctoral dental curriculum. To succeed, the deans will need to create an alliance of the specialty organizations, the manufacturers, the focused interest group, and the faculty. Implant fixtures and other materials will need to be provided at a low to no cost to the schools, and the faculty will need to be educated about the technique in a comprehensive in-service education program. Hopefully, something can be dropped from the curriculum to achieve this important improvement, because we cannot keep adding to the curriculum interminably. Accordingly, this will be a difficult challenge, but it is one that is well worth the effort. Patients prefer IO therapy 9:1 versus conventional therapy; and, most importantly, if implants are placed, the height of the alveolar bone can be sustained, and the patient is likely to function for a much longer period of time. It is after all, the needs of our patients specifically, and those of society generally, which should be primary drivers of innovation in dental educational process. Therefore, I am hopeful that you, the members of the ICOI, will assist in this endeavor in your capacities as faculty members, as thought leaders in the dental community, as advisors to industry, and as philanthropists of your local dental school! There are tens of millions of people worldwide with mandibular edentulism. Success in this venture will be good for the profession, the educators, and the manufacturers, but most of all, it will be wonderful for our edentulous patients.

© 2004 Lippincott Williams & Wilkins, Inc.