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1 Implant Maintenance Curriculum Among U.S. Dental Hygiene

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1 Implant Maintenance Curriculum Among U.S. Dental Hygiene Implant Maintenance Curriculum Among U.S. Dental Hygiene Programs Thesis Presented in Partial Fulfillment of the Requirements for the Degree Master of Dental Hygiene in the Graduate School of The Ohio State University By Sarah Jane Youssef Graduate Program in Master of Dental Hygiene The Ohio State University 2020 Thesis Committee Brian B. Partido, BSDH, MSDH, Advisor Rachel Kearney, BSDH, MS Damian Lee, DDS, MS, FACP 1 Copyrighted by Sarah Jane Youssef 2020 2 Abstract Purpose: There is a range of clinical practices that dental professionals use to maintain implants, revealing a need for a more standardized approach. The purpose of this study was to determine the curricular content for dental hygiene programs in the U.S. regarding implant maintenance. This research aimed to find out if that curricular content aligned with the CPG published by the ACP. Methods: This descriptive research study utilized a survey to explore the implant maintenance curriculum in U.S. dental hygiene programs. Descriptive statistics were used to examine the data. Results: A total of 53 participants responded to the survey (n=53). 100% of programs felt that implant maintenance was important to include in the curriculum and 98.1% teach implant maintenance. This study helped identify the curricular content for implant maintenance: 94.3% teach preventative care techniques, 90.6% teach appropriate tools/materials, 92.5% teach patient education, 88.7% teach radiographic interpretation, and 83.0% teach recall frequency. This research has helped recognize where the curricular content aligns with the current CPG published by the ACP and that most programs are not utilizing the CPG as a resource for curricular development. Conclusion: Dental hygiene programs are teaching dental implant maintenance but there is variety among the content and the resources used to develop that content. If more programs were to standardize their content, there could be less variety in treatment modalities in clinical settings for implant maintenance. ii Acknowledgments I would like to express my sincerest gratitude to my advisor and mentor, Brian Partido, for the guidance, encouragement, and unwavering patience that he has provided to me throughout this lengthy process. I would also like to thank my committee members, Rachel Kearney and Damian Lee, for the support and inspiration that they offered me. iii Vita 2013…………………………...….AAS in Dental Hygiene, Youngstown State University 2013-Present………..Registered Dental Hygienist in a Public Health Clinic, Akron, Ohio 2018……………………………....……BS in Dental Hygiene, The Ohio State University Fields of Study Major Field: Dental Hygiene iv Table of Contents Abstract ............................................................................................................................... ii Acknowledgments.............................................................................................................. iii Vita ..................................................................................................................................... iv List of Tables ..................................................................................................................... vi Chapter 1. Review of the Literature .................................................................................... 1 Chapter 2. Materials and Methods ................................................................................... 19 Chapter 3. Results ............................................................................................................ 22 Chapter 4. Discussion ...................................................................................................... 30 References ......................................................................................................................... 35 Appendix A. Tables ......................................................................................................... 39 Appendix B. Survey ......................................................................................................... 46 v List of Tables Table 1. Demographic Characteristics of surveyed U.S. dental hygiene programs……43 Table 2. Frequencies pertaining to Clinical Practice Guidelines……………….……...44 Table 3. Frequencies of what the curricular content for dental implant maintenance is in dental hygiene programs………………………………………………………………..45 Table 4. Frequencies for the recall intervals that dental hygiene programs recommended to their students……………………………………………………….……..………….46 Table 5. Frequencies of dental hygiene programs timing and course type for dental implant maintenance training…………………………………………………………...47 Table 6. Frequencies for resources used to develop curricular content……….……….48 vi Chapter 1. Review of the Literature Background of the Problem Dental implants are quickly becoming the treatment of choice for replacing missing dentition and restoring dental function. According to the American Academy of Implant Dentistry, over 3 million people in the U.S. have dental implants and that statistic is growing by 500,000 each year.1 The regular maintenance of dental implants, including homecare, professional preventative dental care, and dental exams with images, is essential for their long-term success.2–4 There is a wide range of clinical practices that dental professionals use to maintain implants often determined by the individual clinic that treatment is being performed in, which reveals a need for a more standardized approach for dental implant maintenance.4–6 Dental hygienists are frequently the clinicians that are facilitating dental implant maintenance and a knowledge gap has been identified as to what the curricular content is for student dental hygienists regarding dental implant maintenance.7 Due to the significant range of clinical practices that are used and to fill the identified knowledge gap, this study will explore what curriculum is being taught to student dental hygienists about dental implant maintenance. This knowledge gap will be discussed further along with the relative factors involving dental implant maintenance, including an overview of implants, the need for dental implant maintenance, what dental hygiene programs offer 1 for dental implant maintenance through their curriculum, and how that curricular content is aligned with the current clinical practice guidelines for dental implant maintenance. Review of the Literature History of Implants For two millenniums, humans have been finding ways to replace missing teeth and restore masticatory function. While radiographing ancient skulls in the 1970’s, it was discovered that indigenous Mayans were inserting pieces of shells into the mandible effectively replacing missing teeth dating as far back as 600 AD.8 The radiographs showed compact bone formation around the implanted shells in a manner that is similar to how blade implants osseointegrate.8 A similar situation was found in to have occurred around 800 AD when an early Honduran culture first carved a stone and then inserted it into the mandible.8 These early attempts and successes were the starting ground for dental implants. From the 1500’s-1800’s many discoveries in jaw and dental anatomy were made by way of cadaver study.8 Dr. John Hunter spent years systematically dissecting cadavers that were procured by grave robbers, documenting in detail the anatomy of the jaw and mouth.8 During that time span, there was much experimentation with allotransplantation, or the transplantation of real teeth, that came from either impoverished people or cadavers throughout Europe.8,9 Unfortunately, most of the roots on the transplanted teeth would be resorbed by the host body after a period of time.9 Dr. Hunter’s discoveries in anatomy of both the mouth and jaw and his subsequent comprehensive documentation of it, along with his studies of tooth allotransplantation, 2 helped pave the way for future generations of dentists to further hone their approach to dental implants. The exploratory research that had been conducted in the 1800’s led to a significant increased pace in progress towards successfully placed dental implants for the early 1900’s. Many types of materials were tested for biocompatibility for their use in dental implants, such as, silver capsules, corrugated porcelain, gold tubes, and iridium tubes.8 In 1913, Dr. E. J. Greenfield was repeatably placing and restoring dental implants made from an iridio-platinum lattice-like cylinder that was soldered with 24-karet gold.9 His implant was hollow and allowed the bone to completely fill inside the mesh-like cylinder, then he would attach the crown portion after a period of healing—this was a concept that he felt gave the implant greater retention in the bone.9,10 Dr. Greenfield wrote down the materials that he used, the detailed surgical procedures for the dental operation, and his advice for restoring the artificial roots—his name for dental implants.9 He also traveled throughout the United States teaching clinicians the same procedures.9 The fact that this process was able to be replicated by both Dr. Greenfield and the clinicians that he trained further progressed the development of implants. In the 1930’s, advancements were made in material selection for dental implants that were both biocompatible and strong enough for the task at hand. In 1939, Dr. Alvin Strock inserted a screw made from vitallium into a fresh extraction site.10 Vitallium, a chromium-cobalt metal alloy, was discovered by Dr. Strock to be biocompatible,
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