Nikos Mattheos

Problem-based learning in academic health education. A systematic literature review.

Problem based learning (PBL) arguably represents the most significant development in education over the past five decades. It has been promoted as the curriculum of choice, and since its introduction in the 1960s, has been widely adopted by many medical and dental schools. PBL has been the subject of much published literature but ironically, very little high quality evidence exists to advocate its efficacy and subsequently justify the widespread curriculum change. The purpose of this review is to classify and interpret the available evidence and extract relevant conclusions. In addition, it is the intent to propose recommendations regarding the relative benefits of PBL compared with conventional teaching. The literature was searched using PubMed, ERIC and PsycLIT. Further articles were retrieved from the reference lists of selected papers. Articles were chosen and included according to specific selection criteria. Studies were further classified as randomised controlled trials (RCTs) or comparative studies. These studies were then analysed according to intervention type: whole curricula comparisons and single educational interventions of shorter duration. At the level of RCTs and comparative studies (whole curricula), no clear difference was observed between PBL and conventional teaching. Paradoxically, it was only comparative studies of single PBL intervention in a traditional curriculum that yielded results that were consistently in favour of PBL. Further research is needed to investigate the possibility that multiple PBL interventions in a traditional curriculum could be more effective than an exclusively PBL programme. In addition, it is important to address the potential benefits of PBL in relation to life-long learning of health care professionals.

Teaching and assessment of implant dentistry in undergraduate and postgraduate education: a European consensus.

This paper constitutes a summary of the consensus documents agreed at the First European Workshop on Implant Dentistry University Education held in Prague on 19-22 June 2008. Implant dentistry is becoming increasingly important treatment alternative for the restoration of missing teeth, as patients expectations and demands increase. Furthermore, implant related complications such as peri-implantitis are presenting more frequently in the dental surgery. This consensus paper recommends that implant dentistry should be an integral part of the undergraduate curriculum. Whilst few schools will achieve student competence in the surgical placement of implants this should not preclude the inclusion of the fundamental principles of implant dentistry in the undergraduate curriculum such as the evidence base for their use, indications and contraindications and treatment of the complications that may arise. The consensus paper sets out the rationale for the introduction of implant dentistry in the dental curriculum and the knowledge base for an undergraduate programme in the subject. It lists the competencies that might be sought without expectations of surgical placement of implants at this stage and the assessment methods that might be employed. The paper also addresses the competencies and educational pathways for postgraduate education in implant dentistry.

A survey on undergraduate implant dentistry education in Europe

INTRODUCTION The aim of the survey was to assess the status of implant dentistry education and addressed various aspects related to competence level, practical implementation and barriers for further development in the field. MATERIALS AND METHODS An e-mail survey was performed amongst 73 opinion leaders from 18 European countries invited to the Association for Dental Education in Europe (ADEE) workshop on implant dentistry. RESULTS Forty-nine surveys were returned (67%) and it was found that theoretical and pre-clinical courses to an average of 36 h are given to undergraduates; 70% reported that students assist or treat patients with prosthetics; 53% reported that students assist with surgery and only 5% is operating patients. In 23% of the schools optional undergraduate courses are available and 90% offer postgraduate training. Barriers for including prosthetics and surgery are lack of time, funding or staff. Partial restorations, including surgery, in the posterior regions may be provided by dentists after attendance at additional courses but complex treatments should be limited to specialists. CONCLUSION This survey confirms that implant dentistry is part of the undergraduate curriculum, albeit with a disparity in time. Whereas implant dentistry is an important part of clinical practice, coverage in the curriculum is limited and when compared with 10 years ago, even stagnating. Priorities within the curriculum should be evaluated depending on demands and treatment needs of the population. To optimise education, learning guidelines should be developed, based on the expected competencies for practicing dentists. Undergraduate education may start the process that must continue through all levels of education, including the postgraduate level.

Defect healing with various bone substitutes

OBJECTIVE Biphasic calcium phosphates (BCPs), mixture of hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP) are synthetic bone substitutes, which are increasingly used in adjunctive implant and periodontal surgery. The aim of this study was to evaluate the rate and amount of bone regeneration in defects filled with three different BCPs in relation to deproteinized bovine bone mineral (DBBM). METHOD Ten New Zealand rabbits were used in the experiment. Four defects of 6 mm in diameter were prepared in each rabbit, and they were filled with different biomaterials: BCP with HA/β-TCP ratio of 60/40 (BCPG1), ratio of 10/90 (BCPG2), a BCP with polylactide incorporated (moldable BCP) and DBBM. Group A (n = 5) rabbits were sacrificed after 3 months, and group B (n = 5) were sacrificed 6 months after surgery. Histological and histomorphometric analyses were performed. Mean percentages of mineralized new bone (%MNB), bone marrow (%BM), residual grafting material (%RG) and soft tissue (%ST) were calculated for each bone substitute. RESULTS Percentages of MNB in defects filled with the four bone substitutes were comparable after 3 months and 6 months. Amount of MNB regenerated for moldable BCP and DBBM after 6 months were significantly higher than after 3 months (P < 0.05), whereas those for BCPG1 and BCPG2 did not show significant change. Percentage RG was significantly higher in moldable BCP compared with BCPG1 (P < 0.05) after 3 months. CONCLUSION After 3 months, the granules-form synthetic materials performed better than DBBM in terms of bone regeneration. The grafting materials performed similarly after 6 months of healing. Addition of polylactide in moldable BCP may slow down osteogenesis in grafted defects.

Impact of excessive occlusal load on successfully osseointegrated dental implants: a literature review

The aim of the present study was to review the available evidence on the response of the peri-implant bone when subjected to excessive occlusal forces. The search strategy included papers published in English in the Medline database and the Wiley Online Library from January 1991 to December 2011. Experimental or review papers reporting the conditions of the peri-implant bone of dental implants submitted to excessive occlusal loading in the presence of a controlled oral hygiene regime were eligible for inclusion. The knowledge regarding the response of the peri-implant bone when the dental implant is excessively loaded is limited, and the level of evidence is poor. With animal experimental studies showing conflicting results, it is unclear whether occlusal overload might cause marginal bone loss or total loss of osseointegration to already osseointegrated dental implants when the applied load exceeds the biologically-acceptable limit. This biological limit is also unknown. Furthermore, higher remodeling activity of the peri-implant bone is found around implants subjected to high loading forces.

Systematic Review of Soft Tissue Alterations and Esthetic Outcomes Following Immediate Implant Placement and Restoration of Single Implants in the Anterior Maxilla

BACKGROUND The aim of this review is to assess the outcome of single-tooth immediate implant placement and restoration (IPR) in the maxillary anterior region, with a particular emphasis on soft tissue and esthetic outcomes. METHODS An electronic search in Medline, EBSCOhost, and Ovid (PubMed) was performed to identify studies that reported on soft tissue outcomes following immediate placement and restoration of implants in the maxillary esthetic region with a mean follow-up of ≥1 year. RESULTS Nineteen studies on single implants inserted immediately into fresh extraction sockets and provisionally restored in the maxillary esthetic region were included. Soft tissue changes were found to be acceptable, with most studies reporting mean gingival recession of 0.27 ± 0.38 mm and mean papillary height loss of 0.23 ± 0.27 mm after follow-up of ≥1 year. Advanced buccal recession (>1 mm) occurred in 11% of cases. Long-term follow-up studies (>2 years) reported that the interdental papillae, in particular, showed a tendency to rebound over time. The few studies that reported on patient-centered outcomes showed a high level of patient satisfaction with the outcomes of IPR treatment. CONCLUSIONS The IPR protocol resulted in generally acceptable soft tissue and esthetic outcomes, with suboptimal results reported in ≈11% of low-risk cases. Factors such as preoperative tissue biotype or use of a flap or connective tissue graft did not significantly influence soft tissue and esthetic outcomes. Long-term prospective controlled clinical trials are necessary to identify factors that may influence the esthetic outcomes associated with IPR.

Effect of systemic antibiotics on clinical and patient-reported outcomes of implant therapy - a multicenter randomized controlled clinical trial.

OBJECTIVES To determine the effect of various systemic antibiotic prophylaxis regimes on patient-reported outcomes and postsurgical complications in patients undergoing conventional implant installation. MATERIAL AND METHODS Three hundred and twenty-nine healthy adults in need of conventional implant installation were randomly assigned to one of four groups: (i) preoperatively 2 g of amoxycillin 1 h before surgery (positive control, PC), (ii) postoperatively 2 g of amoxycillin immediately following surgery (test 1, T1), (iii) preoperatively 2 g of amoxycillin 1 h before and 500 mg thrice daily on days 2 and 3 after surgery (test 2, T2), (iv) preoperatively 2 g of placebo 1 h before surgery (negative control, NC). Subjects were examined clinically by blinded examiners over 8 weeks after implant installation. In addition, Visual Analogue Scales (VAS) for pain, swelling, bruising and bleeding were obtained over 14 days. ANOVA was performed for the VAS. Chi-square tests were applied for postsurgical complications. RESULTS All VAS scores were low for all groups and decreased over time (P < 0.001). There were no significant differences for the VAS scores between the various groups at any time point (P > 0.05). There was only a significant difference in flap closure at week 4, where NC had 5% of the subjects not achieving complete wound closure compared to 0% for the three other groups (P = 0.01), with no other significant differences for any postsurgical complications (P > 0.05). CONCLUSION For standard single implant placement, prophylactic systemic antibiotics either before or after, or before and after the surgical procedure do not improve patient-reported outcomes or prevalence of postsurgical complications.

Assessment of knowledge and competencies related to implant dentistry in undergraduate and postgraduate university education

Learning in academic settings is strongly related to the way the students are tested or examined. Assessment therefore must be integrated in the curriculum design, coordinated and should reflect the learning outcomes of the education. Assessment within the field of implant dentistry must fulfil four major objectives: complete and direct the learning process with feedback (formative), ensure that students are adequately prepared (summative), assess attitudes and skills such as critical thinking, reflection and self-assessment ability, and supply continuous feedback to teachers on curricular content and impact. Different assessment methods should be used to assess different levels of competencies throughout the curriculum. Various forms of written or oral assessment methodologies are applicable at earlier stages in the curriculum. At intermediate levels, interactive assessment methods, such as patient simulations (paper based or virtual) and more could encourage the necessary synthesis of several disciplines and aspects of the theoretical knowledge. At higher levels of competence, documentation of clinical proficiency by means of reflective portfolios and diaries is an appropriate assessment method with both formative and summative potential. The highest level of competence requires performance assessment using structured, objective, clinical criteria. The group strongly encourages the use of reflective forms of assessment methods which engage the students in a process of self-appraisal, identification of individual learning needs and self-directed learning. The ultimate goal of this would be to allow the student to develop a lifelong learning attitude.

Implant dentistry education in Europe: 5 years after the Association for Dental Education in Europe consensus report

INTRODUCTION To promote consensus on implant dentistry university education in Europe, a workshop amongst university teachers and opinion leaders was organised in 2008. As a result, guidelines on both under- and postgraduate education were issued. This study aims to investigate the current status of university teaching of implant dentistry and the impact of the recommendations for teaching and assessment, 5 years after the first consensus. Finally, this report attempts to identify future directions in education within the discipline. MATERIALS AND METHODS An online survey was distributed amongst 105 academic leaders in implant education in Europe, and 52 questionnaires were returned (response rate 50%). RESULTS The average amount of implant dentistry in undergraduate curricula has increased to 74 h, compared to 36 h in 2008, and the inclusion of pre-clinical and clinical education has increased. No change occurred with regard to the aimed competence levels. It was suggested that certain implant procedures including surgery should be provided by dentists after attending additional courses, whilst complex treatments will still require specialist training. The 2008 workshop guidelines have been implemented to a varying extent (25-100%) in under- and postgraduate education. Main reported implementation barriers included limited time availability in the curriculum and limited financial/material resources. Future discussions about implant dentistry in Europe should be focused towards integration in current dental curricula, approaches to overcome barriers and the relations with and role of industrial partners. CONCLUSION Implant dentistry is increasingly integrating in undergraduate dental education. Development of the consensus guidelines in 2008 may have facilitated this process. Nevertheless, further progress is needed on all educational levels to align training of professionals to the growing treatment needs of the population.

Specialists' management decisions and attitudes towards mucositis and peri-implantitis

Background Pathology of the peri-implant tissues, namely peri-implant mucositis and peri-implantitis are conditions that are often encountered and can threaten the long term survival of the implants.Aim This study aimed to compare the attitudes of registered specialists in periodontology in Australia and the UK towards aetiology, prevalence, diagnosis and management of mucositis and peri-implantitis.Methods A validated questionnaire was used and the sample consisted of UK and Australian specialists.Results There were differences in the demographics of specialists in the two countries, with the Australian specialists being significantly younger. Most specialists in both countries identified the prevalence of peri-implant pathology between 0-25%. Although there was agreement as to the role of plaque in the aetiopathogenesis of the diseases, UK specialists were more likely to include adverse loading and smoking as etiological factors. There were significant differences in the management of the disease between the groups, including the use of mouth rinses, local and systemic antibiotics. Australians were more likely to use systemic antibiotics than in the UK.Conclusions The results suggested that differences in professional demographics, educational resources and market factors, and the absence of consensus treatment standards can significantly affect the treatment modalities patients finally receive.