CURRICULUM

Rationale – Purpose and context of Training

The purpose of this curriculum is to guide the training of a General Dentist to the core level of competence required for an expert in dental Implantology. In future, this core curriculum will be used as the framework for evaluation of prior training, experience and skill in the development of top up training in Advanced Dental Implantology.

Criteria for entry and completion of the Dental Implantology Program

The trainees should have an accredited BDS, DMD or DDS to register. Proof of competencies will be assessed after gaining entry and such training will be judged by their clinical trainers by observing them treating patients and passing written MCQ tests upon reviews in Oral Implantology.

Structure and Delivery of Training Program

The preferred training pathway is one which integrates experience gained in several environments. This could include periods of training in a dental institute with relevant attachments in Oral Implantology. It is desirable that several specialists in Oral and Maxillofacial Surgery, Prosthodontics, Periodontics, Dental Radiology are required for the training Program.
A minimum of two trainers – both on relevant specialist lists will be available. These trainers conform to the requirements for educational and clinical supervisors of multiple European Dental Schools.
The training Program includes suitable rotational arrangements to cover all the necessary areas of the curriculum and includes an appropriate balance between theoretical teaching in amphitheaters, preparation of study groups for taking the Final written exam and practice through hands – on laboratory courses and clinical exposure and practice in the premises of the Cyprus Academy of Implantology (CAoI) and over patients of the Founders of the Academy. In such a way, each trainee will gain the breadth of training required to complete the curriculum satisfactorily.
The program is structured in a way that training will take precedence over service provision. The training Curriculum has been planned in modules linked to various topics. Modules need not necessarily be studied in the order presented.

Duration of Training

The usual training period is one year but the theoretical topics that need to be covered along with the multiple practical sessions need more extensive references. So, the expected duration will be around 15 months (see calendar below).

In order to complete training and be recommended for the Certificate of Basic Oral Implantology Course, trainees must have:

• Satisfactorily completed the 15 months of training
• Satisfactorily completed all areas of the curriculum
• Satisfactorily present two Completed clinical cases of their own after practicing in the Academy’s premises (treatment plans and final outcomes – 1 Assisted case and 1 Supervised case)
• Passed the 10 Preparation (upon Modules) written Exams (at least 70% each) and the Final (written) Exam of Oral Implantology Review – also over 70% success rate (MCQ).

Distribution of Time within the Training Program

The trainees should spend two sessions (8 hours daily) over one weekend every month for the first 10 months AND in the next 5 monthly periods, every other weekend (on a monthly basis). To be more precise:

8 (Saturdays) + 8 (Sundays) = 16 hrs (one weekend per month) x 10 months = 160 hrs theoretical analysis

[8 (Saturdays)+ 8 (Sundays)] x 2 = 32 hrs (two weekends per month) x 5 months = 160 hrs practical sessions (hands on and clinical upon surgical and prosthodontic phases of Oral Implantology) of which 64 hrs Hands-on labs and 96 hrs clinical practice on multiple patients. TOTAL: 320 hrs.

The trainees will spend eight (x 8hr) sessions on surgical and prosthetic hands-on labs to cover the whole spectrum of basic oral implantology practice and twelve (x 8hr) sessions to devote to assisted and supervised operating (work-based experiential learning).

This balanced program will, for all trainees, comprise supervised personal treatment sessions, diagnostic sessions, review clinics, formal teaching, research and reading time. The workload for the Oral Implantology trainee will be sufficient to ensure that a full range of basic cases is experienced.

Trainer Training

The quality and ability of the trainers is an important element in successful training. Our Trainers have completed specialty or subspecialty training in Oral and Maxillofacial Surgery, Oral Surgery, Prosthodontics, Periodontology, Dental Radiology, Lasers in Dental Practice.

Award of the Certificate of Completion of Training in Basic Oral Implantology

On successful completion of the Program and having passed the Clinical Evaluation (Oral Exam upon two Completed Clinical Presentations – at least 70% success rate) and Written Tests with MCQ (10+1 with also total average equal or over 70% success rate), a Certificate will be awarded to the trained dentists by the Committee of the Cypriot Academy of Implantology and by the Nicosia – Kerynia Dental Association. To be more precise:

1. 1 Assisted + 1 Supervised Clinical Case: total grade equal or above 70% where a maximum score of 10% will be given to each of the 10 following Domains:
   1. Alveolar preparation (10%)
   2. Soft tissue handling (10%)
   3. Free hand fixture placement (10%)
   4. Flapless (guided) fixture placement (10%)
   5. Healing abutment placement – 2^nd phase (10%)
   6. Digital impressions for prosthesis (10%)
   7. Screw retained or cemented prosthesis placement (10%)
   8. Pain management – prescription drugs (10%)
   9. Medical history review and postoperative instructions (10%)
   10. Patient education and consent form (10%)
       Total Score of 100%

2. 10 Module Sessions in Oral Implantology written exams (MCQ): total grade equal or above 70% where a maximum score of 10% will be given to each of the 10 following modules:
   1. Medical evaluation of Compromised patients (10%)
   2. Treatment plan over simple and moderate difficulty cases (10%)
   3. Anatomy of the Head and Oral Cavity (10%)
   4. Surgical techniques and Complications handling (10%)
   5. Pharmacology – pharmacokinetics – pharmacodynamics (10%)
   6. Biomechanics in the Oral Cavity (10%)
   7. Prosthodontics in Implantology (10%)
   8. Bone grafting – guided bone regeneration (10%)
   9. Pterygoid Implants in severe maxillary atrophy (10%)
   10. Growth Factors and osteoimmunology (10%)
       Total Score of 100%

3. 1 FINAL written Exam (MCQ): maximum score of 100%.

The average score between the added scores (1+2+3) from the above oral and written tests has to be equal or above 70% to PASS the Course and receive the Certificate Award.

Content of Learning – Methods of Assessment

The purpose of training is to promote patient safety by working to ensure that specialists in Oral Implantology have achieved the appropriate learning outcomes. The Scientific Advisory Committee in Oral Implantology aims to promote excellence in the Practice of dental Implants placement and rehabilitation in partially and totally edentulous patients. Also to have trained dentists become responsible for maintaining standards through training, assessments, examinations and professional development.
The close relationship between specialists and trainees in Oral Implantology will facilitate frequent feedback. This will be supplemented by regular appraisal by the educational supervisors and other senior members of the staff.

Forms of Assessment of trainees:

1. Written Examination (MCQ over Oral Implantology Reviews)
2. WBA (Workplace-Based Assessments): the principal form of continuous assessment of progress and competence will be WBA throughout the entire duration of training. Trainees are assessed on work that they are doing on a day-to-day basis and in that the assessment is integrated into their daily laboratory and clinical performance.

*A total of TWO satisfactory clinical outcomes will be required per 15-month period while trainees will have to manage and complete them properly (1 Assisted and 1 Supervised) with the placement and prosthetic rehabilitation of a minimum of 4 dental implants.

• Ability to work in area with direct supervision
• Knowledge in subject area as expected of a subspecialty in Oral Implantology
• Performance of tasks and approach to tasks as expected of an expert in basic Oral Implantology
• Attitudes as expected of an expert in basic Oral Implantology

It is also expected that trainees will participate in individual or group tutorials which may also involve a degree of assessment. It is not intended that each component of the curriculum is assessed by each method. The assessment methods are indicative of the methods that may be used for each subject area and should be applied as appropriate to the stage of training and circumstances of the training environment.

Trainees are also expected to keep a portfolio during their training. This should contain as a minimum:

• Personal details
• Copy of current curriculum
• Details of current clinical activities (cases upon surgical and prosthetic phases)
• Teaching activities (courses attended)
• Supporting documentation
• Record of research activities.

Overview of Competencies in Oral Implantology

Core clinical competencies to be achieved in the 15-month training include:

• Insertion of osseointegrated dental implants including minimal bone augmentation techniques and soft tissue management
• Appropriate pain and anxiety control including the administration of superior and inferior alveolar blocks
• Placements of a screw retained or cemented intermediate or final prosthesis
  Basic Competencies in the management of health care delivery include:
  • An understanding of evidence-based practice, clinical guidelines and monitoring of outcomes
  • Awareness of medico-legal responsibilities and ethics
• Teaching sessions which will occur on a regular extracurricular basis and will include case reviews, journal clubs and other forms of didactic/seminar-based teaching (the American Academy affiliated Study Club of Nicosia already performs scheduled meetings).

DATES OF THE TRAINING COURSE

3-4 May 2025
24-25 May 2025
28-28 June 2025
5-6 July 2025
13-14 September 2025
4-5 October 2025
1-2 November 2025
29-30 November 2025
13-14 December 2025
10-11 January 2026
31 January – 1 February 2026
21-22 February 2026
14-15 March 2026
18-19 April 2026
25-26 April 2026
2-3 May 2026
16-17 May 2026

The CURRICULUM will include the following MODULES:

Module 1: Basic Science Knowledge relevant to Oral Implantology Practice (THEORY)

Update of Orofacial Anatomy, Histology and Molecular Biology, Pharmacology and Microbiology

• Knowledge of Applied anatomy – physiology – microbiology – pharmacology relevant to surgical practice
• The pharmacology and safe prescribing of drugs used in the treatment of surgical conditions and complications (haematoma, abscess etc) of the oral cavity including antibiotics, analgesics, cardiovascular drugs, anticoagulants, respiratory drugs, drugs used for the management of endocrine disorders (including diabetes) and local anaesthetics
• Describe the effects and potential for harm of alcohol and other drugs including common presentations (e.g. depression, hypertension), the range of interventions, treatments and prognoses for use of alcohol and other drugs
• Knowledge of pathology of specific organ systems relevant to surgical care including cardiovascular, respiratory, gastrointestinal, neurological and endocrine systems
• Surgically important microorganisms including blood born viruses, soft tissue infections (cellulitis, abscess), sources of infection, asepsis and antisepsis, principles of disinfection and sterilisation, prophylactic antibiotics and resistance, principles of high-risk management

Module 2: Common Surgical Conditions – Clinical Diagnosis and Evidence for Dental Implants (THEORY)

• To assess and initiate investigation and management of common surgical conditions which may confront any patient whilst under the care of dental surgeons
• To have sufficient understanding of these conditions so as to know what and to whom to refer in a way that an insightful discussion may take place with colleagues who will be involved in the definitive management of these conditions
• Outline the failure rates for implants in the maxilla and mandible
• Longitudinal studies of implant success rates
• Discussing the pivotal research papers that have looked at the long-term success rates for dental implants
• Discussing the factors that determine implant success

Module 3: Diagnostic Radiology in Oral Implantology (THEORY and CLINICAL practice)

• Computer Technology and Surgery
• Background of computer-guided surgery planning
• Rationale for guided surgery
• Reformatted CBCT
• Panoramic images analysis
• Discuss the use of imaging in surgical planning for dental implant placement and the significance of image magnification
• The advantages of CBCT in planning
• Surgical splints and CT guidance

Module 4: The Principles of Assessment and Management of the surgical patient (THEORY and CLINICAL practice)

Progress Notes Professional writing, Presentations of clinical Cases (PowerPoint), article Research through PubMed, Discussions and Reviews

• To assess the surgical patient
• To elicit a history that is relevant, concise, accurate and appropriate to the patient’s problem
• To produce timely, complete and legible clinical records
• To assess the patient adequately prior to operation and manage any preoperative problems appropriately
• To initiate surgical or non-surgical management as appropriate
• To take informed consent
• Effective and safe hand washing, gloving and gowning
• Creation of a sterile field, infection control
• Prescription of preoperative antibiotics
• Discussion regarding optimum drill speed for the site preparation and use of the torque wrench

Module 5: Basic Surgical Skills – Immediate (post extraction) fixture placement, computer guided and free hand placements (THEORY, LAB and CLINICAL practice)

Soft tissue management – flap designs – immediate and late post extraction fixture placement decisions – suturing techniques

• To prepare oneself for surgery
• To safely administer appropriate local anaesthetic agents
• To identify and handle surgical instruments safely and suitable methods of retraction
• To handle tissues safely and gently
• To incise and close superficial tissues accurately
• To tie secure knots
• To achieve haemostasis of superficial vessels
• To assist helpfully, even when the operation is not familiar
• To understand basic principles of surgery
• To discuss flapless implant placement and its indications
• To discuss the importance of appropriate alveolar crest incisions
• To outline the relationship between keratinised gingiva and the implant collar
• Describing the types of flaps utilised for implant placement
• Describing the types of sutures used to close implant sites
• Discussing the indications for extraction and immediate implant placement

Module 6: Perioperative Care of the surgical patient (THEORY and CLINICAL practice)

• To manage patient care in the perioperative period
• To assess and manage preoperative risk
• To take part in the contact of safe surgery in the operative environment
• To assess and manage bleeding disorders
• Single handed – double handed and instrument knot tying
• Deep and superficial suturing (in layers)
• To care for the patient in the postoperative period including the assessment of common complications
• To assess and plan perioperative nutritional management

Module 7: Guided Bone Regeneration (GBR), socket preservation, assessment of implant integration (THEORY, LAB and CLINICAL practice)

• Discussing the concept of GBR
• Indications for GBR
• Definitions of the terms “osteoinduction” and “osteoconduction”
• Different approaches and combination of different materials (autogenous – allogenous – heterogenous – alloplastic bone grafts)
• Properties of different bone materials
• Types of surfaces and shapes of fixtures
• Definition of the term osseointegration
• Describing how biocompatibility of different implant surfaces is influenced by the type of material that it is composed of
• Describing the histological appearance of the bone-implant interface
• Main types of membranes used in clinical practice and their fixation
• Discussing the main differences between resorbable and non-resorbable membranes and their respective advantages and disadvantages
• Outline of clinical assessment of implant integration
• Discussing the clinical signs and symptoms of “ailing” and failing dental implant
• Explanations upon principles of resonance frequency analysis (Ostell Mentor)
• Description of explanting a fixture and possible problems

Module 8: Minor Maxillary and Mandibular Bone augmentations and internal sinus floor elevations (THEORY, LAB and CLINICAL practice)

• The relevance of the maxillary sinus to dental implant placement
• Discussion of the blood supply of the maxilla and mandible
• The use of onlay grafting to anterior maxilla and its indications
• Onlay grafts and the relevance of the inferior alveolar nerve to dental implant placement
• Describing the use of bone mills and bone collectors
• Description of instruments for sinus tapping and limitations

Module 9: Alveoloplasty and complex bone augmentations / combined reconstructions / advanced preprosthetic surgery (THEORY and CLINICAL practice)

• Outline the measures in pre-prosthetic surgery that can help to reduce future prosthetic difficulties
• Classification of ridge morphology
• Classification of the bone quality
• Tuberosity reduction technique
• Indications of maxillary split thickness osteotomy in the edentulous patient
• Disadvantages and complications of the maxillary split thickness osteotomy

Module 10: Types of Implant Prostheses – overdentures with bars or locators, fixed screw retained vs cemented prostheses (THEORY, LAB and CLINICAL practice)

• Indications and contraindications / advantages and disadvantages of each prosthetic treatment plan
• Discussing the restorative preparation and planning required prior to implant placement
• Benefits and use of a diagnostic wax-up
• Description of “all on 4” technique

Module 11: 3D model printing and multiple guides – Immediate prosthetic loading with digital assistance (THEORY, LAB and CLINICAL practice)

• The importance of step-by-step application of the protocol for each implant system
• The importance of passive and early setting of the intermediate prosthesis
• Discussing the indications and protocol for immediate loading
• Discussing the indications and protocol for early loading
• Discussing the indications and protocol for late loading
• Definition for “healing time” for dental implants

Module 12: Complications in surgical and prosthetic phases of Oral Implantology – how preventable is Peri-implantitis and treatment Protocols (THEORY and CLINICAL practice)

• Knowing the different mechanisms of delivering analgesia to relieve postoperative oral surgery pain
• Knowing the list of the most appropriate medicaments and their principal side effects
• Knowing the adjunctive techniques which may help minimise the pain experienced
• Knowing the principal reasons why excessive postoperative haemorrhage may occur and how this may be minimized at surgery
• Diagnosis of the aetiology of excessive haemorrhage
• Describing the methods of stopping the local postoperative haemorrhage
• Describing how to minimize postoperative infection during minor oral surgery
• Knowing which microorganisms are the most likely causative agents
• Knowing how to manage periimplantitis
• Knowing how to manage early and late implant failures (fractured fixtures and internal prosthetic screws)
• Knowing how to manage aseptic necrosis
• Discuss the relevance of radiotherapy to dental implant placement
• Discuss the relevance of bisphosphonate treatment to dental implant placement
• Tooth damage in implant surgery
• Significance of implant spin and wobble in primary stability

Module 13: The Medically compromised patients – the Consent Form – Patient Education and Postoperative Instructions – Prescription drugs pre/intra/post – operatively – Medico-legal issues in Oral Implantology (THEORY and CLINICAL practice)

• Knowing the principles of consent for Oral Implantology
• Knowing the specific issues regarding minor surgery in the oral cavity
• Describing the causes of anxiety in patients undergoing minor oral surgery
• Knowing how to manage anxiety by modification of patient management
• Knowing which patients may be immunocompromised
• Knowing how to manage patients who may have decreased immunity
• Knowing the causes of the most common coagulopathies
• Knowing the protocols of managing patients with the most common coagulopathies
• Knowing the mechanism of antiplatelet medication
• Knowing the indications and risks for their modification and the evidence
• Knowing the indications for antibiotics and contraindications to their use
• Describing when it would be appropriate to use prophylactic antibiotics
• Knowing the consequences of inappropriate antibiotic use
• Knowing the evidence and how and when to administer certain indicated antibiotics
• Explaining the required competencies for the surgical and prosthetic phases in Oral Implantology
• Discussion of the term “duty of care”
• Definition of the term “negligence”
• Discussion of the most common reasons for litigation in the field of Oral Implantology

Theoretical Tutorials – preparation for Final Written Exams

FINAL written EXAMS

Trainees’ Broad Competencies

A trainee eligible to take the “Certificate of Mastering in Oral Implantology” should be able to:

• Manage the implant patient from assessment through to, and understand prosthetic rehabilitation
• Independently and safely manage the implant patient including the preprosthetic soft and hard tissue management of such patients
• Identify (discuss/explain/evaluate/differentiate between/compare and contrast) various methods involved with implant reconstruction
• Select appropriate investigative tools that are cost-effective and useful
• Appropriately select between the various methods involved with implant reconstruction according to the symptoms and needs of each patient
• Communicate with patients (and their families) about procedures, potentials, and risks associated with pre-prosthetic surgery and implants to the oral cavity in ways that encourage their participation in informed decision making
• Demonstrate basic surgical skills and competently carry out specific surgical procedures applying appropriate and safe operative techniques within each of these parameters
• Communicate and co-ordinate her/his team to achieve an optimal clinical environment
• Converse with and work with colleagues in allied specialties
• Manage patients in ways that demonstrate sensitivity to their psychological needs
• Develop a care plan for a patient in collaboration with members of a multidisciplinary team
• Make clinical decisions and judgements based on sound evidence for the benefit of the patient
• Demonstrate insight into her/his limitations of expertise and refer patients
• Consult, cooperate and discuss with other clinicians as require
• Use a learning Portfolio Checklist (examination – diagnosis – treatment plan for implant surgery and prostheses / imaging interpretation)
• Literature review regarding implant placement, GBR, grafting, immediate implants, loading protocols with multiple prostheses, fixture designs and surface coatings
• Establish and maintain a legitimate and safe implant practice.

© All rights reserved. This Curriculum’s content or any part thereof may not be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying or otherwise, without written permission of the Scientific Advisor (Dr. Panos Kessaris – e-mail: kessarispanos@hotmail.com).