Pre-doc implant exposure

[free99]

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At Buffalo, we start taking an implant didactic course in the second semester of second year, and move into surgical guide fabrication afterward. We get modest exposure to their use in removable and fixed prosthodontics in those respective didactic courses as well. One of our graduation requirements is to restore an implant, but we won't have any opportunity to place at the pre-doc levels, as all of those cases go to the post-grads (AEGD, OMFS, perio, prosth).

Curious how much experience you all are getting with implants at your school? Do you have implant didactics? Surgical guide fabrication lab courses? Will you get to restore an implant at any point in your clinical years, maybe even place one? How comfortable do you feel with implant dentistry in general?

 

[jeffity]

Lots of implants going on at MWU-AZ. At the moment, whether you get to place them just depends. You do all the work-up leading up to placement and you are there at the time of placement. Then you restore, of course. It wasn't a requirement for me to restore any, but they just made it a requirement for the class of 2017 and beyond. So many get placed around here, that it's not going to be an issue to restore any...much like the other requirements. Back in the day (first couple of classes), a lot of pre-docs were getting to place (I think there were less protocols in place back then). These days, it's kind of hit-and-miss. Depends on the complexity of the case, the patient med history , is it under IV or local anes, etc. I think if you show you care and want to learn and you're not a total idiot, your chances increase of them letting you get in there. When you're taking your patient to OS for implants, you never count on placing the implants, but if you get to place....that's a bonus. Students complained about not getting to do more during the surgery and it seems they're listening. The worst case scenario is that you assist for the whole procedure. More common is that you'll get a little hands on...maybe just the flap or closure, or maybe an osteotomy drill or two, or maybe just the actual implant placement. But I wouldn't call it uncommon to place, these days. I'm done in a few weeks, and I'd say that a majority of classmates have been able to place at least one. By place, I'm talking start-to-finish...flap, pilot, osteotomy, place, close. I've taken VERY few cases down there compared to classmates (for whatever reason) and even I've done one start to finish with the surgeon completely hands-off.

For future classes, they're starting something new. I don't know the details (nor do I really care because I'm graduating), but it seems like all students are going to be placing at least two BICONs as part of the curriculum. I believe they're even doing them free. Don't know if it's going to be added to the list of competencies to graduate or not, but it appears that everyone is going to get to place at least two. BICON is sort of it's own animal, but it's still a good tool to have in your arsenal as a GP.

Overall, I think they've done pretty good about exposing us to implants, and they're ramping it up, obviously. This school has always been about training GPs. And the fact is, more and more GPs are placing implants. So it's only natural that curriculums reflect that. I think all schools should at least be letting you restore...cause that's just real-world dentistry.

 

[DoctaFauci]

We took three implant didactics first through third year. Repetitive material, plus the lab component with different guide fabrication techniques, locators, etc. We place an implant in the lab to simulate. In clinic, we treatment plan patients in an implant clinic, refer them to grad for CBCT, then final treatment plan with the undergrad fabricating the guide in school or sometimes sending it off to the lab. Grad perio (sometimes OMS) places the implant, and we always restore the pros. We scan with 3shape or take traditional impressions depending on the case.

I don't foresee undergrads getting to place implants any time soon. Not enough volume for both the residents and undergrads to equitably distribute. Honestly, you can learn posterior implant placement through weekend CE. Guided therapy is pretty failsafe. It's the anterior esthetic stuff that should be referred. And while implants are lucrative and it's nice to keep them in house for your patients, remember that it increases your malpractice and overhead. Restoring is as easy as taking an impression...

 

[znny19]

At NYU, all students have a requirement to restore at least one implant crown ( only pre-doc approved cases i.e nothing in the aesthetic zone). As a D4 you can apply and take an implant honors elective. At the end of the elective, you get an opportunity to place an implant. The elective only accepts 6-10 students, so not all get the chance. We also have an over-denture requirement though its just to change the housings on an existing denture.

 

[asne0407]

Lots of implants going on at MWU-AZ. At the moment, whether you get to place them just depends. You do all the work-up leading up to placement and you are there at the time of placement. Then you restore, of course. It wasn't a requirement for me to restore any, but they just made it a requirement for the class of 2017 and beyond. So many get placed around here, that it's not going to be an issue to restore any...much like the other requirements. Back in the day (first couple of classes), a lot of pre-docs were getting to place (I think there were less protocols in place back then). These days, it's kind of hit-and-miss. Depends on the complexity of the case, the patient med history , is it under IV or local anes, etc. I think if you show you care and want to learn and you're not a total idiot, your chances increase of them letting you get in there. When you're taking your patient to OS for implants, you never count on placing the implants, but if you get to place....that's a bonus. Students complained about not getting to do more during the surgery and it seems they're listening. The worst case scenario is that you assist for the whole procedure. More common is that you'll get a little hands on...maybe just the flap or closure, or maybe an osteotomy drill or two, or maybe just the actual implant placement. But I wouldn't call it uncommon to place, these days. I'm done in a few weeks, and I'd say that a majority of classmates have been able to place at least one. By place, I'm talking start-to-finish...flap, pilot, osteotomy, place, close. I've taken VERY few cases down there compared to classmates (for whatever reason) and even I've done one start to finish with the surgeon completely hands-off.

For future classes, they're starting something new. I don't know the details (nor do I really care because I'm graduating), but it seems like all students are going to be placing at least two BICONs as part of the curriculum. I believe they're even doing them free. Don't know if it's going to be added to the list of competencies to graduate or not, but it appears that everyone is going to get to place at least two. BICON is sort of it's own animal, but it's still a good tool to have in your arsenal as a GP.

Overall, I think they've done pretty good about exposing us to implants, and they're ramping it up, obviously. This school has always been about training GPs. And the fact is, more and more GPs are placing implants. So it's only natural that curriculums reflect that. I think all schools should at least be letting you restore...cause that's just real-world dentistry.

Soon to be third year here at MWU. And yes, we are now required to place two BICONs ourselves as part of the curriculum.

 

[THS]

At Buffalo, we start taking an implant didactic course in the second semester of second year, and move into surgical guide fabrication afterward. We get modest exposure to their use in removable and fixed prosthodontics in those respective didactic courses as well. One of our graduation requirements is to restore an implant, but we won't have any opportunity to place at the pre-doc levels, as all of those cases go to the post-grads (AEGD, OMFS, perio, prosth).

Curious how much experience you all are getting with implants at your school? Do you have implant didactics? Surgical guide fabrication lab courses? Will you get to restore an implant at any point in your clinical years, maybe even place one? How comfortable do you feel with implant dentistry in general?

We are about the same. We will restore, but not place.

 

[dmdluffy]

Glad to hear about that from MWUAZ. When I was there, seemed like all the implants and a good amount of thirds were going to your OS attendings and the OS residents rotating through.

We get to place at Roseman, start to finish. Restoring implants as well. I've placed 5 myself and most of my classmates have placed as well. It's partially the luck of the draw based on your patient needs, but we do do all our own surgeries.

 

[honesty pays]

Please does anyone know of hands on implant courses at afforadable prices

 

[StrugglingDS]

We are required to do two implant work-up cases, place two implants, and restore two prior to graduation.

 

[power5643]

Same in LECOM, we do not place but we restore.

 

[wengerout]

Lots of implants going on at MWU-AZ. At the moment, whether you get to place them just depends. You do all the work-up leading up to placement and you are there at the time of placement. Then you restore, of course. It wasn't a requirement for me to restore any, but they just made it a requirement for the class of 2017 and beyond. So many get placed around here, that it's not going to be an issue to restore any...much like the other requirements. Back in the day (first couple of classes), a lot of pre-docs were getting to place (I think there were less protocols in place back then). These days, it's kind of hit-and-miss. Depends on the complexity of the case, the patient med history , is it under IV or local anes, etc. I think if you show you care and want to learn and you're not a total idiot, your chances increase of them letting you get in there. When you're taking your patient to OS for implants, you never count on placing the implants, but if you get to place....that's a bonus. Students complained about not getting to do more during the surgery and it seems they're listening. The worst case scenario is that you assist for the whole procedure. More common is that you'll get a little hands on...maybe just the flap or closure, or maybe an osteotomy drill or two, or maybe just the actual implant placement. But I wouldn't call it uncommon to place, these days. I'm done in a few weeks, and I'd say that a majority of classmates have been able to place at least one. By place, I'm talking start-to-finish...flap, pilot, osteotomy, place, close. I've taken VERY few cases down there compared to classmates (for whatever reason) and even I've done one start to finish with the surgeon completely hands-off.

For future classes, they're starting something new. I don't know the details (nor do I really care because I'm graduating), but it seems like all students are going to be placing at least two BICONs as part of the curriculum. I believe they're even doing them free. Don't know if it's going to be added to the list of competencies to graduate or not, but it appears that everyone is going to get to place at least two. BICON is sort of it's own animal, but it's still a good tool to have in your arsenal as a GP.

Overall, I think they've done pretty good about exposing us to implants, and they're ramping it up, obviously. This school has always been about training GPs. And the fact is, more and more GPs are placing implants. So it's only natural that curriculums reflect that. I think all schools should at least be letting you restore...cause that's just real-world dentistry.

During my interview they said we would be required to place two and have the opportunity to place more so I'm hoping that's what's going to happen lol


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[gatorfan99]

Talking from experience here.... learn the principles of general dentistry and basic surgery (such as proper flap reflection and extractions) first.. I know that as dental students implants are these "gold mountains" in the distance but, trust me, most of you guys need to focus on the basics first.

You can only squeeze so much in 4 years, and whatever pre-doc implant education you are getting (I got some too) is probably bare bones crap and will not at all make you competent. Focus on the basics first!!

 

[wengerout]

Talking from experience here.... learn the principles of general dentistry and basic surgery (such as proper flap reflection and extractions) first.. I know that as dental students implants are these "gold mountains" in the distance but, trust me, most of you guys need to focus on the basics first.

You can only squeeze so much in 4 years, and whatever pre-doc implant education you are getting (I got some too) is probably bare bones crap and will not at all make you competent. Focus on the basics first!!

I always here conflicting info on this. MWU-AZ says that their students come out competent in placing implants but others say conflicting information.


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[gatorfan99]

I always here conflicting info on this. MWU-AZ says that their students come out competent in placing implants but others say conflicting information.


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Sorry if I sound harsh but...

if a dental student said that to you then its because they don't know anything..

if someone from admissions told you that its because they are trying to sell their school to you..

if you thought that by glancing at their curriculum then (just like I was with my school) you are probably wrong..

Learning how to properly diagnose a patient, create a treatment plan and (if indicated) place implants takes waaaay longer than anything basic dental school education can provide you.

You will need to: 1) specialize,
2) do one of those 1yr post grad implant program (which, to be honest, I find to be sort of shady - just personal experience and seeing the stuff their grads do)
3) get some experience at an AEGD/GPR,
4) get lucky to find a job where a very experienced provider/specialist is willing to take his/her time to teach you (this will take a lot of time/patience and "hand holding")
5) finally, and yes, this is the least favorable option because there's a huge chance it won't prepare you either, find a decent CE courses and take them

 

[wengerout]

Sorry if I sound harsh but...

if a dental student said that to you then its because they don't know anything..

if someone from admissions told you that its because they are trying to sell their school to you..

if you thought that by glancing at their curriculum then (just like I was with my school) you are probably wrong..

Learning how to properly diagnose a patient, create a treatment plan and (if indicated) place implants takes waaaay longer than anything basic dental school education can provide you.

You will need to: 1) specialize,
2) do one of those 1yr post grad implant program (which, to be honest, I find to be sort of shady - just personal experience and seeing the stuff their grads do)
3) get some experience at an AEGD/GPR,
4) get lucky to find a job where a very experienced provider/specialist is willing to take his/her time to teach you (this will take a lot of time/patience and "hand holding")
5) finally, and yes, this is the least favorable option because there's a huge chance it won't prepare you either, find a decent CE courses and take them

School and the students here have both said that. I'll wait for one of the students to come and tell their side of the story. They also have students doing ridiculous amounts of other clinical work there so they might be an exception to the rule.

customx , cello , fogorvostan

 

[Cello]

School and the students here have both said that. I'll wait for one of the students to come and tell their side of the story. They also have students doing ridiculous amounts of other clinical work there so they might be an exception to the rule.

customx , cello , fogorvostan

I think that what @gatorfan99 says is accurate for students from most programs. There are some programs which are clinically focused and give their students far more clinical exposure than others. MWU-AZ is one of those programs, though certainly not the only one.

I know that many schools are giving their students the opportunity to place only a handful (like 3-5) crowns before they graduate. At MWU-AZ our students average over 30 with some students doing well over 60 before graduation. As far as dental implants go, we are required to place two BICON implants. As I said in another thread though, competent students who express a desire to see as many implants as possible are seeing dozens of implant cases before finishing school (I mentioned the guy who helped place 25 in one year). That doesn't mean that everyone in the clinic will see those numbers, in fact the majority of us won't probably come close to that I imagine.

Much of your experience as a D3 is dependent upon who your D4 partner turns out to be. Midwestern also tailors its clinic to the kind of clinician you want to be. You work with your clinical care coordinator to get as many cases as you can in your desired area of practice. I spoke with a D4 this year who did 10 removable dentures and 70 extractions during her 3rd year because that's where her interests lie. Talk to people from other programs and you will get an appreciation for how bonkers those numbers are. There are a couple of areas which our clinic struggles to find enough patients to satisfy student demand, endo is one of them as I understand it.

With regard to what gator said about AEGD/GPR residencies; I shadowed and volunteered in a GPR clinic, so I did see firsthand what the residents there were doing. First of all, where you go to school absolutely matters. I was astonished at the disparity in training which exists between different programs across the country. I will say that UoP absolutely lives up to its reputation. The one UoP grad we had was wicked fast, efficient, and confident. I dare say he was almost as speedy as the more seasoned general dentists I shadowed. We had two VCU residents who were both really good too. There are a few programs I won't name which put out students who have so little experience with even basic procedures that I think it is almost criminal. When you have completed a four year program and can't place a dental dam without help or pull off a class II restoration in less than 90 minutes then I think there is a problem.

There were implant placements in that program, but nothing more than it sounds like we will see in the clinic here at Midwestern. If anything, the GPR residents I shadowed probably perform less implants than D3 / D4 students at MWU are able to.

With regard to the dentists I shadowed, one of them got a certificate for implants. In the entire time I saw him he didn't place a single one sadly. The other dentist I shadowed had only ever placed one implant, and that was a huge deal for him. He was super excited about it, but he received no training in implant placement through his school from which he graduated 6 years ago.

So, getting back to what gator said, I think he has really solid advice. At the very least it would be a good idea to cut your teeth (sorry) as an associate for a couple of years while avoiding corporate if you can (less likely with each passing year it seems). Our program is intended to train us to the level of a 4th year student when we finish our 3rd year. Our 4th year is intended to serve as the equivalent to an AEGD. Students may see up to 5 patients per day in our clinic if they so choose which is significantly more than the 1-2 patients dental students are seeing at many schools across the country. I believe you can see more, but 5 is the number I keep hearing. We don't have the competition for limited available seats, our clinic is extremely efficient, we don't do much of our own lab work, and we always have an assistant (our partner D3/D4). The GPR residents I shadowed typically saw 3-5 patients per day as well depending on what procedures were being done.

 

[BeaverLover]

70 extractions during her 3rd year

Thanks for sharing those numbers. Do you know the average amount of extractions done by students at MWU though???