436Indian Journal of Dental Research, 22(3), 2011

Received : 09-03-10Review completed : 16-06-10Accepted : 16-09-10

review article

Need of implant dentistry at undergraduate dental curriculum in Indian dental colleges

Ramesh Chowdhary, Nagalakshmi Chowdhary1

ABSTRACTEdentulism is the major problem in the developing countries, and is widely spread in the current population, although the prevalence is declining and incidence of tooth loss is decreasing in the developed nations. The prevalence of edentulism in India varies from 60% to 69% of 25 years and above age group. It is obvious that the number of lost teeth increases with age leading to an increase in prevalence of partially edentulous patients. From a biological point of view, the replacement of a single missing tooth with an implant rather than a three-unit fixed partial denture, and the implant-supported complete denture has been proved more efficient in improving the mastication and maintaining the bone for a longer time and also more cost-effective treatment. Many dental schools throughout Europe and America have to a various extent introduced implant dentistry as part of the compulsory undergraduate curriculum. Thus, it becomes more essential to introduce implant dentistry at undergraduate level in Indian dental schools to manage the higher percentage of edentulism.

Key words: Dental College, edentulism, implant education

Branemark Osseointegration Centre India, Golden Plaza Complex, Gulbarga, 1Department of Pedodontics, S. Nijalingappa Institute of Dental Sciences and Research Centre, Gulbarga, India

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Appropriate professional oral healthcare measures have to be planned for this increasing functionally dependent population.[6] With increases in evidence-based treatment, it became necessary to rehabilitate the edentulism with dental implants, thus making it necessary for the dental educational institutes to teach the students about this speciality.

FACTORS OF EDENTULISM

A tooth surrounded by healthy periodontal tissues yields a very high longevity (up to 99.5% over 50 years),[7] periodontally compromised but maintained regularly. The survival of such teeth is still very high (92–93%); similarly, endodontically compromised but successfully treated nonvital teeth yield high survival rates.[8] On the other hand, the survival of oral implants after 10 years varies between 82% and 94% depending on prosthetic modality.[9-12] The prevalence of periodontitis, which is one of the major causes of edentulism in the Indian population, stands to be 60–90% of the Indian population in the age group of 25 years and above.[3]

Thus tooth longevity is largely dependent on the health status of the periodontium. Oral implants when evaluated after 10 years of service do surpass the longevity of even compromised but successfully treated natural teeth.[14]

Address for correspondence: Dr. Ramesh Chowdhary E-mail: drramc@yahoo.com

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DOI: 10.4103/0970-9290.87067

Edentulism is the major problem in the developing countries and is widely spread in the current population although the prevalence is declining and incidence of tooth loss is decreasing in the developed nations.[1,2] It remains to be tackled meticulously in the developing nations. The prevalence of edentulism in India varies from 60% to 69% of 25 years and above age group.[3] It is obvious that the number of lost teeth increases with age leading to an increase in prevalence of partially edentulous patients.[4,5] To meet the standards of a functional dentition for better health these patients will be in need for rehabilitated. There are no proper data and no predictions are available on the impact of the demographic increase of the elderly population and increased life expectancy with regard to the total treatment needs and demands. In institutionalized elderly individuals a higher prevalence of edentulism is still to be expected.

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Indian Journal of Dental Research, 22(3), 2011437

Need of implant dentistry for undergraduate dental curriculum Chowdhary and Chowdhary

TREATMENT OPTIONS FOR EDENTULISM

In India, 30% of edentulism is seen in the age group of 25 years and 40–50% of edentulous patients are rehabilitated mainly with conventional complete denture. It is evident from the WHO report that people rarely visit the dentist and only in the event of pain, as oral rehabilitation is restricted to the necessity. There are no documented data on the restoration of the partial edentulous population. Most of the time only if few teeth are missing, they are replaced with fixed partial dentures or with treatment partial denture or not replaced at all. If more teeth are missing, the likelihood of a removable restoration increases with the number of teeth to be replaced. A higher frequency of removable restorations is present in older age groups in subjects living in rural areas, in those from lower socio-economical status, and in those with less education and lower incomes.

To avoid the shortcomings of fixed partial dentures and demerits of treatment partial denture implant treatment represents probably a more biological approach to reconstructive dentistry than conventional crown and bridge work.[15]

As a major application for implant therapy, the following indications are recognized:The improvement of oral function and subjective chewing comfort.The preservation of tooth structure or existing reconstructions.The replacement of missing, strategically important teeth.

PREDICTABILITY OF IMPLANT TREATMENT

Fixed restorationOf a number of systematic reviews performed in recent years on the longevity of various prosthetic reconstructions on teeth,[10,16] or a combination of teeth and implants, 11 have indicated that the most predictable reconstructions yield a survival rate of close to 90% after 10 years of service. These reconstuctions include the conventional fixed partial denture, the solely implant-supported fixed partial denture and the implant-supported single-crown construction. Conventional single crowns have even a greater survival rate. This, in turn, means that the implant-supported single crown may replace the three-unit-fixed partial denture in many cases.

Removal prosthesisNew denture can result in improvements in patient reports of overall satisfaction including aesthetics, comfort, and speech.[17] But they will often not improve functional outcome.[17] When compared with younger patients, older denture wearers tend to experience more functional problems.[18,19] This may be related to age-related physiological changes, such as decreased motor control of

the tongue, decreased biting force, and medication-induced reduced salivation. Therefore, the long-term denture patient who has acceptable function with age and time may need to be considered for an implant-supported overdenture due to a decrease in function over years. The McGill consensus statement on overdentures suggested mandibular two-implant overdentures as the first choice of standard care for edentulous patients.[20] The evidence currently available suggests that the restoration of the edentulous mandible with a conventional denture is no longer the most appropriate first-choice prosthodontic treatment. The dental literature manifested that a two-implant overdenture should become the first choice of treatment for the edentulous mandible, because the overall satisfaction and improvement of patient-centred outcomes with such treatment appear to be very high and may be considered successful even by nonspecialists.[21,22]

Why implants dentistry to be taught?During the last two decades, dental implant treatment has become widely performed and documented, resulting in implants being firmly established as part of mainstream dentistry with significant expansion of indications for implant treatment; the recent advances in implant treatment modalities have resulted in a rapid increase of interest from the public for such treatment especially in Europe. Consequently, oral healthcare professionals will increasingly encounter patients restored with dental implants, provide dental care and maintenance for them, or treat new patients seeking implant treatment. A modern curriculum should therefore adequately prepare dental students with knowledge and competencies in implant dentistry at both undergraduate and postgraduate level of studies.

Basic required knowledge for an undergraduate to be taught implant dentistry• The graduate should be capable of deciding on the most

appropriate treatment option to replace missing teeth whether that should be a removable or fixed partial denture supported by teeth with emphasis on evidence-based treatment modalities.

• Hence knowledge and understanding of how to establish a clinically healthy oral environment through plaque control caries removal and treatment of periodontal and other oral pathologies of patients who are going to receive oral implants.

• The graduate should have adequate knowledge and understanding of the surgical and prosthetic procedures involved in implant treatment is mandatory, as well as anticipating possible complication. Successful dental implants necessitate careful treatment planning including differentiation between low-, medium-, and high-risk situations.

• The graduate should beware of the risk of as well as treatment options for different prosthodontic problems leading to peri-implant tissue destruction.

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438Indian Journal of Dental Research, 22(3), 2011

Need of implant dentistry for undergraduate dental curriculum Chowdhary and Chowdhary

• The graduate should beware of the risk as well as treatment options for peri-implant tissue destruction because of a combination of infection and inflammation.

• The graduate should have knowledge and understanding of the criteria for success of oral implants as well as of the long-term prognosis of osseointegrated implants and associated restorations. This includes the ability to diagnose and manage failing and failed implants and associated restorations.

• The graduate should have knowledge of basic radiographic and other imaging technique relevant to implant dentistry and to interpret the results competently.

Hence students should have a sound theoretical knowledge and understanding of the subject together with and adequate clinical experience to be able to resolve clinical problems encountered, independently or without assistance.

CONCLUSION

On the basis of the demographic changes in the population with an increasing proportion of elderly, it can be assumed that implants will be installed to replace missing, but strategically important teeth, and to improve oral function and perceived comfort. Moreover, from a biological point of view, the replacement of a single missing tooth with an implant rather than a three-unit-fixed partial denture represents a reasonable and also more cost-effective treatment.

There is no doubt that dental students should learn how to incorporate the indication of oral implants in their overall treatment planning. Therefore, they will have to understand the basic aspects of healing and tissue integration, basic biomechanical and material science principles as well as surgical and prosthetic technique. They will have to be able to monitor continuously the peri-implant tissues, render appropriate supportive therapy, and cope with biological and technical complications.

While it is evident that the surgical procedure purse may require additional competence, the remainder of the aspects mentioned should be taught in the dental curriculum. This should include the attribution of responsibility for maintenance of implants and handling of biological and technical complications. Moreover, it is desirable to include the surgical technique for implant placement for straightforward cases into the dental curriculum.

As the aspects of competence and the responsibility for assessment lie within the authority of the universities, the levels and limitations to which the various aspects of implant dentistry and related skill should be taught are to

be determined by the academic community. Obviously, ethical and legal aspects of implant dentistry should not be forgotten.

REFERENCES

1. Osterberg T, Carlsson GE, Sundh V. Trends and prognoses of dental status in the Swedish population: analysis based on interviews in 1975 to 1997 by Statistics Sweden. Acta Odontol Scand 2000;58:177-82.

2. Mojon P. The world without teeth: demographic trends. In: Feine JS, Carlsson GE, editors. Implant overdentures. The standard of core for edentulous patients. chicago: Quintessence; 2003. P. 3-14.

3. Shah N, Pandey RM, Duggal R, Mattur IP, Rajan K. Oral health in india: a report of the multicentre study ministry of health, Govt of India. WHO: 2007.

4. Hugoson A, Koch G, Gothberg C, Helkimo AN, Lundin SA, Norderyd O, et al. Oral health of individuals aged 3-80 years in Jonkoping, Sweden during 30 years (1973-2003). I. Review of findings on dental care habits and knowledge of oral health. Swed Dent J 2005;29:125-38.

5. Hugoson A, Koch G, Gothberg C, Helkimo AN, Lundin SA, Norderyd O, et al. Oral health of individual aged 3-80 years in Jonkoping, Sweden during 30 years (1973-2003)-II review of clinical and radiographic findings. Swed Dent J 2005;29:139-55.

6. Lang NP, Muller F. Epidemiology and oral function associated with tooth loss and prosthetic dental restorations. Consensus report of Working Group I. Clin Oral Implants Res 2007;18:46-9.

7. Schätzle M, Löe H, Lang NP, Bürgin W, Anerud A, Boysen H. The clinical course of chronic periodontitis. J Clin Periodontol 2004;31:1122-7.

8. Fristad I, Molven O, Halse A. Nonsurgical retreated root filled teeth- radiographic findings after 20-27 years. Int Endod J 2004;37:12-8.

9. Pjetursson BE, Tan K, Lang NP, Brägger U, Egger M, Zwahlen M. A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. Clin Oral Implants Res 2004;15:625-42.

10. Pjetursson BE, Tan K, Lang NP, Brägger U, Egger M, Zwahlen M. A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. Clin Oral Implants Res 2004;15:667-76.

11. Pjetursson BE, Tan WC, Tan K, Brägger U, Zwahlen M, Lang NP. A systematic review of the survival and complication rates of resin-bonded bridges after an observation period of at least 5 years. Clin Oral Implants Res 2008;19:131-41.

12. Lang NP, Pjetursson BE, Tan K, Brägger U, Egger M, Zwahlen M. A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. II. Combined tooth--implant-supported FPDs. Clin Oral Implants Res 2004;15:643-53.

13. Jung RE, Pjetursson BE, Glauser R, Zembic A, Zwahlen M, Lang NP. A systematic review of the 5-year survival and complication rates of implant- supported single crowns. Clin Oral Implants Res 2008;19:119-30.

14. Pjetursson BE, Karoussis I, Bürgin W, Brägger U, Lang NP. Patients' satisfaction following implant therapy. A 10-year prospective cohort study. Clin Oral Implants Res 2005;16:185-93.

15. Pjetursson BE, Lang NP. Prosthetic treatment planning on the basis of scientific evidence. J Oral Rehabil 2008;35:72-9.

16. Tan K, Pjetursson BE, Lng NP, Chan ES. A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. Clin Oral Implants Res 2004;15:654-66.

17. Awad MA, Lund JP, Dufresne E, Feine JS. Comparing the efficacy of mandibular implant-retained overdentures and conventional dentures among middle-aged edentulous patients: satisfaction and functional assessment. Int J Prosthodont 2003;16:117-22.

18. Allen PF, McMillan AS. A longitudinal study of quality of life outcomes in older adults requesting implant prostheses and complete removable

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Indian Journal of Dental Research, 22(3), 2011439

Need of implant dentistry for undergraduate dental curriculum Chowdhary and Chowdhary

How to cite this article: Chowdhary R, Chowdhary N. Need of implant dentistry at undergraduate dental curriculum in Indian dental colleges. Indian J Dent Res 2011;22:436-9.Source of Support: Nil, Conflict of Interest: None declared.

dentures. Clin Oral Implants Res 2003;14:173-9.19. Smith JM, Sheiham A. How dental conditions handicap the elderly.

Community Dent Oral Epidemiol 1979;7:305-10.20. Feine JS, Carlsson GE, Awad MA, Chehade A, Duncan WJ, Gizani S,

et al. The McGill consensus statement on overdentures. Mandibular two-implant overdentures as first choice standard of care for edentulous patients. Gerodontology 2002;19:3-4.

21. Attard NJ, Laporte A, Locker D, Zarb GA. A prospective study on immediate loading of implants with mandibular overdentures: patient-mediated and economic outcomes. Int J Prosthodont

2006;19:67-73.22. De Bruyn H, Besseler J, Raes F, Vaneker M. Clinical outcome of

overdenture treatment on two nonsubmerged and nonsplinted Astra Tech Microthread implants. Clin Implant Dent Relat Res 2009;11:81-9.

Dr.M.S.Gowd , prosthodontist of Andhra Pradesh has written a book titled "Tooth Care and Oral Health"which was released by Governor of TamilNadu on 24th march 2011

Announcement

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