Certification > Body of Knowledge

Body of Knowledge

"What the candidate shall be able to do"

1. The theoretical basis of implant-based therapy

The candidate shall be able to demonstrate knowledge of theoretical and clinical implant-based therapy.

ANATOMY:

The candidate shall have a detailed knowledge of oro-facial anatomical structures, including the mandible, maxilla and related structures and shall be familiar with anatomical features of the head and neck, including vascular and nerve paths as well as patterns of bone resorption.

PATHOLOGY:

The candidate shall have a detailed knowledge of:

- Extra-oral and systemic pathologies affecting implant-based therapy

- Intra-oral hard and soft tissue diseases affecting implant-based therapy.

- Plaque and periodontal inflammatory diseases interfering with implant-based therapy.

- Infection control before implant-based therapy.

BIOMECHANICS:

The candidate shall have a detailed knowledge of:

- Bone structures

- Implant components

- Implant design and surfaces, material selection and surface properties.

- Interaction between soft / hard tissue and implant surface.

- Load distribution of implants and effect of load on the implant – bone interface.

- Load distribution to combinations of implants and natural teeth

PHYSIOLOGY and HISTOLOGY:

The candidate must be aware of cell function, bone marrow stem cells, cell-matrix interaction, bone response to implant placement, roles of cytokines and growth factors, wound healing, osseointegration, and soft tissue reaction.

APPLIED DENTAL MATERIALS:

The candidate shall have a detailed knowledge of:

 - Implant components materials

 - Impression materials

 - Restorative materials for immediate, early and definitive loading

APPLIED PHARMACOLOGY:

The candidate shall have a detailed knowledge of local analgesics, pain control and antibiotics as well as drugs that could jeopardizing the outcome of implant therapy. Possible interactions between systemic medications.

RADIOLOGY:

The candidate shall have a detailed knowledge of oral imaging technique and associated soft wares.

- The candidate shall be able to diagnose normal and pathological structures on intra-oral and extra-oral radiographs of the jaws and the surrounding bone structures

- The candidate must be aware of regulations relating to ionising radiation and of the detrimental effect of ionizing radiation on healing and remodelling of the bone tissue.

BIOSTATISTICS:

The candidate must be trained in basic medical statistics.

2. Clinical assessment skills

For the patient presenting with an established or anticipated need for oral rehabilitation, the candidate shall be able to record the following data:

MEDICAL HISTORY:

- The candidate shall elicit and record a comprehensive medical and oral history and understand the relevance of that information to the individual case.

- The candidate shall evaluate the risk factors due to diseases or medications.

CLINICAL EXAMINATION:

The candidate shall proceed to:

1. An extra-oral examination

2. An intra-oral examination

3. An evaluation of remaining dentition, including periodontal status

4. An evaluation of restorations

5. An examination of oral mucosa

6. An evaluation of residual alveolar ridges 

7. An evaluation of aesthetic requirements

8. An analysis of occlusion and its relevance in relation to the proposed treatment

INVESTIGATIONS:

The candidate shall recognize the need for appropriate further medical or local investigations and will be able to request and interpret them. The candidate shall write a report of the findings to the general dentist and the house doctor.

DIAGNOSIS:

The candidate shall collate and interpret the information gathered in the history and examination process understanding the interface between implant-based therapy and other medical or dental disciplines and establish a correct diagnosis.

PROGNOSIS:

The candidate shall establish the prognosis of the remaining dentition and of the proposed rehabilitation by means of implants.

CONCLUSIONS:

The candidate shall be able to communicate clearly to the patient and/or referring doctor and/or dentist, verbally and in writing, the findings of the examination, the diagnosis and the treatment options, including the risk of complications.

EVIDENCE:

The candidate shall show an awareness of the current literature relating to different treatment options considered including oral implants to offer his patients evidence-based solutions.

TREATMENT PLANNING:

The candidate shall produce a comprehensive treatment planning considering all options for oral functional rehabilitation and the preventive, functional, aesthetic, psychological and financial requirements involved for the patient.

PROSTHETICS:

The candidate shall be aware of the fact that prosthetic care for the patient is an integral part of the total treatment sequence.

The candidate shall have an understanding of the differences between fixed and removable prosthesis, screwed and cemented ones, provisional and definitive rehabilitation.

The candidate shall have a thorough knowledge of the different materials used for the prosthetic reconstruction.

The candidate shall evaluate the advantages and disadvantages of the different prosthetic solutions for the patient's benefit.

The candidate shall have an understanding of occlusion to avoid undue stress concentration on the implants.

RADIOLOGY:

The candidate shall have a thorough knowledge of different radiological and other imaging technique needed for the case he/she has to treat and the concomitant radiation doses to achieve a proper diagnosis and treatment plan.

SURGERY AND LOADING:

According to the medical history, the analysis of the risk factors, the local conditions and the radiological analysis, the candidate shall consider and recommend the timing of implant placement and reconstruction and have an understanding of the current evidence in relation to the different types of implant and implant placement techniques.

INFORMED CONSENT:

The candidate shall be able to understand and evaluate discrepancies between patient's expectations and complaints or therapeutic limitations.

The candidate shall be able to explain to the patient the phases of the treatment as well as the possible complications to obtain the valid consent for the proposed treatment.

EVALUATION OF COMPLEX CASES:

The candidate shall recognize cases of a complexity that are beyond his/her competence, understand the range of treatment options and provide or refer for appropriate allied treatment and re-evaluate prior to rehabilitation by means of oral implants.

MANAGEMENT OF COMPLICATIONS

3. Practical procedures

For the patient requiring implant-based therapy, the candidate shall be able to understand and/or carry out the treatment with respect to the following data:

RECORDS:

The candidate shall obtain sufficient case-related records to mount and evaluate study casts and prescribe diagnostic wax-ups.

DIAGNOSTIC WAX-UPS:

The candidate shall demonstrate an understanding of the diagnostic wax-up in the construction of radiographic and surgical guides and order appropriate radiographic templates and prescribe and interpret appropriate radiographs.

SURGICAL PLANNING:

The candidate shall plan in detail the placement of oral implants and be able to transfer that information to the surgical procedure via the use of appropriate guides, even soft ware planning and guided surgery when needed.

SURGERY:

The candidate shall be able to:

- Select the appropriate form of analgesia and manage patient anxiety such as by sedation.

- Maintain infection control and follow an appropriate aseptic surgical protocol.

- Have a detailed knowledge of the design of appropriate muco-periosteal flaps as well as an awareness of flapless surgery and other advanced surgical procedures.

- Carry out surgical implant placement. This may involve alveolar ridge augmentation for the repair of small dehiscences and fenestration defects.

- Understand the principles of hard and soft tissue handling and wound closure, including basic wound healing principles.

BONE EVALUATION:

The candidate shall have an understanding of the different methods to determine bone characteristics, bone defects and how to manage them.

GRAFTING AND BARRIER MEMBRANES:

The candidate shall understand the different types of grafting materials and barrier membranes used for minor augmentation and their application to rehabilitation by means of implants.

POST-SURGERY:

The candidate shall provide post-operative care and advice including the prescription of analgesia, antiseptics and antibiotics as appropriate.

The candidate shall document the surgical procedure in details.

The candidate shall demonstrate an understanding of the management of intra-operative and post-operative complications.

RECONSTRUCTION:

The candidate shall understand and/or carry out the following treatment with respect to restoring oral implants:

-  provisional reconstructions

-  abutment selection

-  impression techniques

-  jaw registration

-  laboratory prescription

-  prosthetic try-in and adjustment

-  final prosthesis delivery and fit

OUTCOME ASSESSMENT:

The candidate shall assess the outcome of implant therapy with respect to function, aesthetics and peri-implant health.

MAINTENANCE:

The candidate shall plan and implement an appropriate maintenance and re-evaluation programme while recognizing and managing complications during restorative treatment and throughout the maintenance programme.

4.Case Reports content

Case reports must contain 2 fully edentulous cases (at least one with a fixed reconstruction), 2 single tooth replacements (at least one in the aesthetic zone) and 2 partial edentulous cases (download of example):

• A full history of the case, an assessment of patient's wishes, expectations and motivation
• A clinical examination materialised by pictures with an extensive evaluation of the oral health
• A radiographic examination oral and extra-oral (OPG), CT scan if necessary and software programme analysis
• Photographic status: anterior view of both arches in occlusion, oral view of the lateral arches, lingual views before treatment, during treatment and after treatment
• Special tests when indicated: haematological tests and others
• Casts: Study casts shall be made of all cases
• Diagnosis and prognosis: concerns the overall case as well as each individual tooth.
• Treatment plan: treatment must be described in details as well as possible alternatives
• Surgical phase: pictures of the surgery, number of implants, position of the implants
• Prosthetic phase: pictures of the prosthetic rehabilitation fixed or removable, cemented or screwed, type of material used, occlusion and follow-up
• The case shall have an up to 6 months follow-up

Examples are available here on how documentation should be done. The candidate may remove pictures and words from the foil and replace them with his own patients. This provides a uniform scheme for the documentation. The candidate evaluates him/herself, which information needs to be given for the case presentation to be relevant. The template only provides a frame as a template.