Use of Technology in Dental Education Integration of Digital Dentistry into a Predoctoral Implant Program: Program Description, Rationale, and Utilization Trends Fatemeh S. Afshari, DMD, MS; Cortino Sukotjo, DDS, MMSc, PhD; Maria F. Alfaro, DDS; Jeri McCombs, DDS; Stephen D. Campbell, DDS, MMSc; Kent L. Knoernschild, DMD, MS; Judy Chia-Chun Yuan, DDS, MS Abstract: A recently revised predoctoral implant curriculum at the University of Illinois at Chicago College of Dentistry integrat- ed digital dentistry into both the preclinical dental implant course and clinical activities. Traditionally, competence in the didactic and clinical parts of predoctoral education in single tooth implant restorations has emphasized the analog impression technique and subsequent mounting of soft tissue working casts. However, computer-aided design/computer-aided manufacturing (CAD/ CAM) implant restorations can play a significant role in predoctoral dental education utilizing digital technologies.The goal of the curriculum expansion is to transition from analog to partially digital and, finally, complete digital workflow. The aim of this article is to describe the specific components, implementation, and rationale for the new digitally integrated implant curriculum and present short-term clinical utilization trends. Dr. Afshari is Clinical Associate Professor, Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago; Dr. Sukotjo is Associate Professor, Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago; Dr. Alfaro is a prosthodontics resident, Department of Biological and Materials Sciences and Division of Prosthodon- tics, School of Dentistry, University of Michigan; Dr. McCombs is a dental graduate of the College of Dentistry, University of Illinois at Chicago; Dr. Campbell is Professor and Head, Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago; Dr. Knoernschild is Professor and Program Director of Advanced Prosthodontics, Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago; and Dr. Yuan is Associate Professor and Predoctoral Implant Program Director, Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago. Direct correspon- dence to Dr. Judy Chia-Chun Yuan, Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, 801 S. Paulina Street, Chicago, IL 60612; 312-355-4027; [email protected]. Keywords: dental education, dental implant, digital dentistry, educational methodologies, educational technologies, CAD/CAM Submitted for publication 8/26/16; accepted 12/26/16 doi: 10.21815/JDE.017.050 ore than 20 years ago, the first commer- reduced treatment cost.5 These efficiencies support cially viable computer-assisted design and cost-effectiveness with savings estimated at 60% to manufacturing (CAD/CAM) system was 70%, along with better quality control and improved M 2,3 introduced to the dental profession. Chairside CAD/ patient experiences. This breakthrough technology CAM systems typically consist of three main com- thus holds the potential to profoundly impact the ponents: 1) a chairside optical scanner that captures future of oral health care and revolutionize dentistry. the geometry of a prepared tooth, transforming it into The use of CAD/CAM systems in dentistry has three-dimensional digital data; 2) computer software increased as new materials and improved hardware that allows the user to design a dental prosthesis; and and software have been introduced to the market. In 3) an additive or subtractive manufacturing process 2011, Davidowitz and Kotick estimated that 10,000 that transforms the data into a final prosthesis.1-3 units were being used in North America, which CAD/CAM technology combined with advances in translates to 15% of dental practices in the U.S.2 In material technology allows for a reduction in labor, that year, according to Davidowitz and Kotick, Wil- reduced clinical and laboratory work steps,4 and liam Blair and Company estimated that sales would 986 Journal of Dental Education ■ Volume 81, Number 8 further expand with an increase of 9,100 units per future.13,14 The aim of this article is to describe the year as of 2017. Nevertheless, the adoption of this specific components, implementation, and rationale revolutionizing technology has been gradual. In U.S. for the new digitally integrated implant curriculum dental schools, training in CAD/CAM indirect res- and present short-term clinical utilization trends. torations occurs in a majority of preclinical didactic settings (76%), but only about half of responding schools reported incorporating it in the preclinical Key Components of the laboratory and clinical patient experience.6 However, both students and faculty members have expressed Implant Curriculum enthusiasm and given positive feedback regarding 7,8 Descriptions of the college’s predoctoral learning about and using this technology. implant program, competency categories, pedago- In light of Iacopino’s observation that most new gies, and assessments for implant-supported, single practitioners use technologies they were exposed to 9 unit digital restorations have been previously pub- in their dental training, the University of Illinois at lished15-17 and are summarized in Table 1. Briefly, Chicago College of Dentistry introduced CAD/CAM the predoctoral implant curriculum starts in the technologies to its four-year predoctoral curriculum. spring semester (beginning in January) of the sec- Since 2014, the college has used CAD/CAM technol- ond year. Approximately 104 students participate ogy in both its predoctoral and postdoctoral student in the pre-patient didactic and hands-on laboratory clinics, so that graduates are competent in providing sessions. During this four-month period, they re- both tooth- and implant-supported digital restora- ceive an extensive 24 hours of lectures presented tions. The college introduced a competency statement by multidisciplinary faculty members, followed by with learning objectives, acquired multiple hardware 30.5 hours of pre-patient laboratory exercises. In the and software units, trained the faculty, employed a third year, students matriculate into the clinic for im- digital design technician (DDT), and established a plant patient care until graduation. The competency, digital center that consists of a training center and a teaching pedagogy, and assessment tools vary based centralized clinic that allow for in-house fabrication on the year. Digital implant dentistry instruction is of provisionals and all-ceramic inlays, onlays, single integrated into the core implant curriculum, which crowns, veneers, and fixed dental prostheses. consists of lectures and hands-on preclinical and Traditionally, digital dentistry relative to dental clinical experiences. implants focused more on the surgical placement of the implant.10 On the other hand, most predoctoral implant clinical curricula focus on the restorative Assessment and Learning aspect.11 Today, digital technologies can be incor- Objectives porated and taught as part of implant planning and Formal competency statements, learning objec- restoration. The University of Illinois at Chicago Col- tives, and performance exams were established for lege of Dentistry has incorporated digital dentistry as implant-supported, single unit digital restorations. an integral part of the predoctoral implant program The competency statement reads: “Students must as it potentially provides significant advantages in be competent in the assessment, diagnosis, treat- time efficiency and esthetics over traditional crown ment planning, and application of digital technolo- fabrication procedures. Patient experiences may be gies with implant-supported single unit restorations transformed relative to comfort and time as digital for partially edentulous patients.” The intent is for technologies have been found to be patient-pre- students to receive the instruction and experience ferred.12 Student education may be further enhanced necessary to become competent in providing care relative to assessment, diagnosis, treatment planning, using digital technologies to restore single tooth and treatment of patients who require single tooth implants (STIs). Students should also be able to implant-supported restorations. As today’s patients describe available digital techniques for single unit are more knowledgeable about dental technologies restorations, collaborate with a DDT for these types and seek state-of-the-science dental care, graduating of restorations, and properly implement the referral practitioners must be properly trained. The millennial process for more complex patient scenarios. At the generation of dental students quickly adapt and fre- end of their clinical training, all students are expected quently use emerging technology, so exposing them to complete their first implant-supported restora- to digital dentistry will better prepare them for the tions using the conventional or analog approach via August 2017 ■ Journal of Dental Education 987 a partial digital workflow and all other restorations and delivery of a custom abutment and all-ceramic using the complete digital workflow. Furthermore, a restoration. This exam will ensure that students are performance exam has been formulated for intraoral competent in providing single tooth implant digital scanning of implant fixtures followed by fabrication restorations. Table 1.