Charter of the Clinical Implant Training Concept (CITC) program

• The subjects of the program are based on international scientific literature, especially reviews with meta-analyses of literature or conclusions of international consensus conferences.

• Treatments in the clinical training concept (CITC) program, comply with the SAC Assessment Tool: {(Straightforward (S), Advanced (A) and Complex (C)}. used by the Swiss Society of Oral Implantology (SSIO)}, the International Team for Implantology (ITI), and the European Association for Osseointegration (EAO).

• The program covers simple implants placement  as well as simultaneous implants placement  and bone augmentations (S and A of the SAC classification). Complex cases with bone augmentations before implants placement are part of a complementary program.

• The implant systems, which are used for the CITC clinical course, have technical properties that comply with actual scientific knowledge (material, surface, geometry, dimensions, connection, and prosthetic components).    
  

• The surgery kits are adapted to the basics of clinically guided Implantology, in relation  with  advanced Implantology  presented during the CITC program.

• The program is aimed at dentists who do not yet have clinical experience in  advanced minimally invasive Implantology. This has to be constantly taken into account by the course instructors. In each step the course instructors must teach necessary theoretical and practical Implantology skills.

• The program concerns the use of classical techniques while observing osseointegration basics: implantation in the healed jaw ridge and denture after the necessary duration of osseointegration.

• The implants utilization is recommended as one of the best solutions for any edentulous situation.

• The implantation is a part of the whole dental treatment, following good care practice in dentistry and is adapted to the medical and psychosocial situation of the patient, like any medical treatment.

•  Most medical diseases are not contraindications for implantations and do not necessarily increase the failure risk. They have to be discussed with the patient and his/her physician. The only limitations are  situations, where there is a  high risk pathology like endocarditis or secondary bone necrosis because of previous irradiation in the jaw, or a treatment with bisphosphonates as well as similar therapies.

• The patient must be fully informed about different therapy possibilities, their steps, expected results, and possible complications allowing his  Informed consent.
  

• Any systematic biological evaluation  is not necessary  before implants placement.

• Usual Care of the buccal cavity (instructions and care for hygiene and treatment of any active pathology) is necessary before implant placement.

• Preoperative planning is performed according to the needs of the patients, medical anamnesis, clinical study, and conventional X-ray evaluation. 
  

• According to radiation protection rules, 3D imagery, as scanner or cone beam  should only be used when  absolutely necessary for the treatment plan.   When  clinical examination and conventional X-ray images indicates  a   limited bone volume with a need of  radiological information about the jaw ridge thickness, localized imagery techniques (conventional tomography, even cone beam) can be exceptionally used. In these situations patients must be informed about additional radiations because of these techniques and about the reasons for use and have to give their agreement.
  

• The implants planning depends on the prosthodontic treatment needed. The implants must be placed as an endosseous extension of the future crowns. The use of a surgery template is not necessary. Through intraoperative visual measures and checks, the implants can and have to be placed be placed in correct position and axis. 
  

• An implant placement session  does not require other aseptic conditions than those of conventional dental care and can therefore be performed in any dental office while complying with classical asespsis rules.

• Due to the potential risk associated with aluminium and vanadium, implants  produced with grade 5 titanium that is not pure titanium  but alloy  with aluminium(Ti-6Al-4V) are not used for the CITC program.

• The implants that are used for the program are made of cold-formed titanium (pure titanium grade 4 B) or non toxic like titanium-Zirconia alloys. With their strong mechanical resistance and their high-quality textured surface, short implants (standard 8 mm) as well as small-diameter implants can be used.

• In this way, prosthetic restaurations can  be supported by a limited  number of implants.  

• These implant types are always placed the same way, independently from the bone density observed during the preparation of  the implant site.

•  Clinically guided implantation by the dentists and  the dental assistant until the final placement, allows the optimal placement of the implant in perfect  positioning and axis.
  

• There is no need of adaptation of clinical procedure  in relation with the implant insertion  torque measurement.

• A submerged healing of the implants is not necessary for osseointegration

• The clinical and X-ray checks of the osseointegration are performed 8 weeks after insertion, without a difference between the maxilla and the mandible.

• Computer-supported surgery is not considered as a helpful technique for dentists with little Implantology experience and is not part of the CITC program. This technique for complicated cases can be the subject of a specific program.

• Immediate implantation and/or immediate loading techniques are not subject of the CITC-program and can be subject of  specific programs.

• Transgingival implant placement technique  technique without any gingival incision is  not subject of the CITC-program and can be subject of a complementary program