Implants in US Dental Schools:State of the Game

Management or Mismanagement

DISCLOSUREI declare that neither I nor any member of my immediate family has a financial interest/arrangement or affiliation with any corporate organization offering financial support or grant money for this presentation, nor do I have a financial interest in any commercial product(s) or service(s) I will discuss in this presentation.

I affirm the images and AV material that I will use for my presentation are my own and unaltered or if they are someone else’s that the owner will receive immediate credit.

This survey received Institutional Review Board (IRB) approval AAAI8759.

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How Much is Enough?

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“If you keep on doing what you've always done, you'll keep on getting what you've always got.”

W.L. Bateman

Literature

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“Pre-doctoral Implant Education in U.S. Dental Schools” Journal of Prosthodontics Vol. 14, No. 1 (2005)Petropoulos, V; et. al. University Pennsylvania

• Survey done 2002• 54 survey’s 38 responded for a rate of 70%• 84% had an Implant Course• 78% had a laboratory Course• 88% allowed Predoctoral Students to restore

Literature

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“Teaching Implant Dentistry in the Pre-doctoral Curriculum: Report from the ADEA Implant Workshop’s Survey of Deans” JDE Vol. 20, No. 5 (2006)Alfano, M; et. al.• 2004 Survey of Deans• 56 Survey’s 39 responded for a rate of 70%• 97% Reported a didactic program• 86% Reported a clinical experience• 57% actually restored• Support from Implant companies is common mostly

by providing discount products.

Literature

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“Survey of Implant Training in Oral and Maxillofacial Surgery Residency Programs in the United States”

Journal Oral and Maxillofacial Surgery 2007:65: 2554-2558Maico D. Melo, DMD, Grant McGann, DDS, andGeorge Obeid, DDS

• Survey of 559 residents in 2006• 40% response rate• 57% said they would place less that 20 implants in the coming

year• 52% said they would place more than 50 in their residency

program• 28% felt inadequately prepared in implant dentistry

Literature

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“Residents’ Perceptions of Implant Surgical Training in Advanced Education in Prosthodontic Programs”

Journal of Prosthodontics 2010; (19) 557-564Sukotjo, C; et. al.

• Survey sent to all 442 residents in the US in 2009• 44.8% (198) response rate• 73% (144) of the responders said they were allowed to place

implants.• 53% (76) of the residents that were allowed felt Proficient (18)

and Competent (58)• While 31% (45) reported only a level of exposure and 15% felt

their level was limited.• 51% will place 0-5 implants in a year.

Literature

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“Should Endodontists Place Implants? A Survey of U.S. Endodontists”

Journal of Endodontics 2009; (35) #7 966-970Potter, K; et. al.

• Survey sent to 1505 randomly selected Endodontists practicing in the US in May 2008

• 46% (692) response rate• 57% supported Endodontists placing implants• 5.7% actually place implants in their current practice

A Survey of Implant Dentistry in US Dental Schools

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Methods and materials

•A survey was developed with input from faculty and staff to determine the state of postgraduate implant activity in the US.

•A survey consisting of 20 questions was sent via email using Survey Monkey to all 60 Clinical Deans listed in the ADEA Directory of Institutional Members.

•The survey was originally sent at the beginning of August and was followed with two subsequent reminders at 10 day intervals.

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Methods and materials

•The responses did not require any personal identification of the responder or the institution name. The only identifying information would be school location, type of institutional support and size of pre-doctoral class and matched with postdoctoral programs offered.

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SAMPLE RESULTS•3 of the 60 schools emailed a response that revealed there were no clinical students enrolled during the academic year 2010-11.

•Thus there were 57 possible responders.

•37 of these 57 responded giving a response rate of 65%

•Of the 37 responders 3 did not give an approximate number of implants placed by the entire institution for the academic years

•Of the 37 responders 5 did not give the actual numbers requested on implant placement for each postdoctoral program that places implants.

•40% or 15 responders said placing implants was required in the Pre-doctoral program of which 4 said it was a requirement.

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Comparison of Postdoctoral Programs and those Placing Implants

RESULTS BY TYPES OF PROGRAMS

•Program analysis of implant placement was done by determining the total number of residents in all years of all identified programs that place implants and dividing the number of implants placed by the residents.

•In the case of OMFS dual degree programs were asked the number of residents directly in clinical care.

•Those programs that did not give specific implant placement numbers were eliminated.

•Overall average implants placed for all programs in an institution were determined by total number of postdoctoral students/residents in programs placing implants in that institution divided by the approximate number of total implants placed.

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RESULTS BY TYPES OF PROGRAMS

•The actually numbers of implants placed listed by programs were for the most part lower than the total approximate number. 9 of the numbers were lower and 2 were higher.

•Pre-doctoral student numbers were not used to determine the average numbers of implants placed as the data for pre-doctoral students was inadequate.

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Periodontics•31 of the 37 responders or 84% have Periodontal Programs

•Of the 31 with programs 27 provided numbers of implants placed but all replied that they place Implants

•Total number of Residents 301

•Total number of Implants Placed 8748

•Average placed per resident per year 29

•Median 21

•Min 4

•Max 156

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Periodontics•Removal of the Outlier which was 1400 implants for 9 Residents

•Total number of Residents 292

•Total number of Implants Placed 7348

•Average placed per resident per year 25

•Median 21

•Mode 13

•Min 4

•Max 62

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Oral Surgery

•32 of the 37 responders have Oral Surgery Programs

•Of the 32 with programs 24 provided numbers of implants placed but all said they place implants.

•Total number of Clinical Residents 169

•Total number of Implants Placed 4949

•Average placed per resident per year 29

•Mode 16

•Min 3

•Max 150

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Prosthodontics•23 of the 37 responders or 62% have Prosthodontic Programs

•Of the 23 with programs 18 (73%) have programs that place implants but only 16 reported numbers of implants.

•Total number of Clinical Residents in these 16 programs was 168 who placed 1022 implants

•Average placed per resident per year 6

•Mode 5

•Min 1

•Max 29

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Endodontics•30 of the 37 responders have Endodontic Programs

•Of the 30 with programs 6 (20%) have programs that place implants but only 3 reported numbers of implants placed.

•Total number of Clinical Residents in these 3 programs was 27 who placed 7 implants

•Average placed per resident per year was less than 1

•Min 1

•Max 4

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Orthodontics•35 of the 37 responders have Orthodontic Programs

•Of the 35 with programs 5 (14%) have programs that place implants but only 1 reported numbers of implants placed.

•Total number of Clinical Residents in this program were 9 who placed 27 implants

•Average placed per resident per year was less than 3

AEGD•22 of the 37 responders or 60% have AEGD Programs

•Of the 22 with programs 16 (73%) have programs that place implants but only 12 reported numbers of implants.

•Total number of Clinical Residents in these 12 programs was 127 who placed 648 implants

•Average placed per resident per year 6

•Median 4

•Min 1

•Max 29

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GPR•19 of the 37 responders or 51% have GPR Programs

•Of the 19 with programs 10 (53%) have programs that place implants but only 8 reported numbers of implants.

•Total number of Clinical Residents in these 8 programs was 66 who placed 400 implants

•Average placed per resident per year 6

•Median 4

•Min 1

•Max 33

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Total of All Placement Programs

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Of the 37 responders all 37 had 2 or more Postgraduate Programs.

32 of the 37 responders gave actual numbers of Implants placed and the number of Postgraduates/Residents for each program.

The total number of Postgraduates/Residents placing implants in these programs was 876

The total number of Implants placed by these providers was 15,843

The Average number of Implants placed per year per resident 18.1

Total of All Placement Programs•Max 152.9

•Min 3.0

•Median 17.3

•Mode 8

•Average Implants placed per resident 20.3

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Total of All Placement Programs•Removing the Outlier of 2600 Implants and 17 residents.

•Max 33.3

•Min 3.0

•Median 16.7

• Mode 8

•Average Implants placed per resident 16.0

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Implant Management or Mismanagement

at CDM

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CDM Implant HistoryOperational Plan for the Implant Center:

•25 years ago: All patients reviewed in one area by a team of faculty from OS, Prosthodontics and Periodontics. The Team Leader was a Prosthodontist.

•20 years ago: The Dean assigned an Endodontic Faculty member to do an assessment of the implant program

•15 years ago: Implants were primarily placed through two divisions with much separation and discourse. There was no coordinated activity.

•10 years ago: Construction of a two chair Implant Suite and an Operational Plan for its use along with the initiation of a multi-divisional Implant Oversight Committee. All surgical activity within the Suite.

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CDM Implant History•5 years ago to present:

• Two Faculty Retreats: April 2007 and July 2011

• Partnerships with Implant companies,

• Increase in activity along with Fee Reductions

• Movement of OS back to their clinic

• Implant Inventory tracking

• Increase in Implant CE Programs

• Implant Fellowship

• Marketing of Programs

• Implant Coordination

•Challenges:• How much is enough?

Establishment of Implant Inventory Management•Implant Oversight Committee limits number of systems

•Central Closets filled with Implant Materials both in Implant Center and OMFS with no real means of maintaining inventory control.

•Established a paper system for each surgical case to replenish inventory after every case. The surgical material sheet became the order form submitted to accounts payable.

•A copy of the surgical material sheet was maintained on file with patient information as well as the chart maintaining tracking stickers.

•Implant representatives helped maintain the inventory of their product and informed us of our needs.

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Establishment of Implant Inventory Management•A tracking system needed to be developed with all materials maintained centrally.

•Bar coding of materials was essential.

•Initially all items within the school were bar coded and entered.

•Tracking and reports were established

•A protocol for procurement was put into place• Treatment Plan Established

• Surgical Case Planned

• Material Request Form is completed and approved by the supervising faculty.

• Material Request Form submitted one week prior to surgery with materials to be picked up the day before or day of surgery.

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Establishment of Implant Inventory Management•A protocol for procurement was put into place

• All materials are scanned to the provider

• After surgery all empty packages and any unused materials are returned to the Implant Inventory Room.

• The used items are scanned to the Patient

• Unused materials scanned back into inventory.

• Outstanding inventory is tracked by provider.

•After the first 4 months• A review of materials revealed a large amount of inventory that did not move

at all. The odd sizes. The less desirable surfaces.

• This allowed us to reduce the order forms and the size of our on site inventory.

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Establishment of Implant Inventory Management

•Custom Reports Available • Custom reports are possible

• Implant Spending by Vender by Month

• Implant Placement by Program by Month

• Implant Vendor by Program

• Implant Placement by Provider YTD

• Outstanding Inventory By Provider

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Implant Inventory Room

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Bar Coding

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Inventory Requisition: Surgical and Prosthetics

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Procurement of Materials

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Custom Reports

Spending By Vendor

Implant Placement by Vendor

Implant Placement by Program

Implant Placement by Program by Vendor

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Custom Reports

Custom ReportsOutstanding Inventory

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QUESTIONS

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