Implants in US Dental Schools: State of the Game Management or Mismanagement

DISCLOSURE I 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. Page 2

How Much is Enough? Page 3 “If you keep on doing what you've always done, you'll keep on getting what you've always got.” W.L. Bateman

Literature Page 4 “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 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 Page 5 “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 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 Page 6 “Survey of Implant Training in Oral and Maxillofacial Surgery Residency Programs in the United States” Journal Oral and Maxillofacial Surgery 2007:65: Maico D. Melo, DMD, Grant McGann, DDS, and George Obeid, DDS Survey of 559 residents in % 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 Page 7 “Residents’ Perceptions of Implant Surgical Training in Advanced Education in Prosthodontic Programs” Journal of Prosthodontics 2010; (19) Sukotjo, C; et. al. Survey sent to all 442 residents in the US in % (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 Page 8 “Should Endodontists Place Implants? A Survey of U.S. Endodontists” Journal of Endodontics 2009; (35) # Potter, K; et. al. Survey sent to 1505 randomly selected Endodontists practicing in the US in May % (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 Page 9

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 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. Page 10

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. Page 11

SAMPLE RESULTS 3 of the 60 schools ed a response that revealed there were no clinical students enrolled during the academic year 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. Page 12

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. Page 25

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. Page 26

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 Page 27

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 Page 28

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 Page 29

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 Page 30

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 Page 31 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 Page 32

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 Page 33

Total of All Placement Programs Page 34  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 Min 3.0 Median 17.3 Mode 8 Average Implants placed per resident 20.3 Page 35

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 Page 36

Implant Management or Mismanagement at CDM

Page 38 CDM Implant History Operational 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.

Page 39 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. Page 40

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. Page 41

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. Page 42

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 Page 43

Implant Inventory Room Page 44

Bar Coding Page 45

Inventory Requisition: Surgical and Prosthetics Page 46

Procurement of Materials Page 47

Custom Reports Spending By Vendor Implant Placement by Vendor Implant Placement by Program Implant Placement by Program by Vendor Page 48

Page 49 Custom Reports

Custom Reports Outstanding Inventory Page 50

Page 51 QUESTIONS

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