About the Faculty of Dentistry

Gerald Niznick First Nations Implant-Retained Overdenture Program

Background: The University of Manitoba Faculty of Dentistry has been engaged in a “Drive for Top Five” and desires to be recognized as one of the top five dental schools in North America. The core of this campaign is based on “Nine Pillars of Innovation” that represent state-of-the-art initiatives and programs that will distinguish the Faculty as superior within the dental education community. One of the nine pillars involves implant dentistry as the Faculty seeks to provide the most comprehensive educational experience and patient services of any dental school. 

Dr. Gerald Niznick, a 1966 Graduate of the U of M Dental Faculty and has a MSD degree in Prosthodontics from Indiana University. He is recognized as an international leader in the field of implant dentistry with 35 US Patents.  Dr. Niznick is one of the most successful dental entrepreneurs, being the founder and CEO of Core-Vent Corporation (1982), Implant Direct (2004) and Implant Direct Sybron Int’l (2011). Dr. Niznick is a long-time supporter of the Faculty and has contributed generously to dental education and research of implant dentistry on a global basis. He continues to innovate and to be engaged in the future of the Faculty of Dentistry.

This program unites goals and objectives of the Faculty of Dentistry with Dr. Niznick’s desire to further educate dentists regarding specific applications of implants for supporting and/or retaining overdentures for improving the oral health and well-being of edentulous patients. First Nations populations in Canada typically suffer from many unmet oral health needs that significantly reduce their quality of life. They have a very high rate of tooth loss and often require full dentures to maintain adequate chewing function, nutrition, and overall health. Traditional lower complete dentures are inherently unstable and it has been demonstrated that individuals with implant-supported and/or retained overdentures have better oral function and quality of life.¹  These procedures were first reported by Dr. Niznick² and have become accepted as minimum standard of care for edentulous lower jaws by the American College of Prosthodontists, the specialty organization of which Dr. Niznick is a Life Member. Dr. Niznick’s recent development of two 1-piece implant systems (GoDirect™ and ScrewIndirect™)³ greatly simplify the surgical and prosthetic procedures for treating edentulous jaws. These innovative implants reduce the cost of treatment, making implant-retained and/or supported overdentures affordable to a greater segment of the population suffering the discomfort and indignity of loose lower dentures.

Dr. Niznick has the ability and desire to partner with the Faculty to develop a novel program that will further demonstrate the efficacy of implant overdentures. The goal of this joint project is to provide treatment for edentulous First Nations patients and to thereby demonstrate that this standardized, cost-effective procedure can and should be a part of conventional dental therapy available to and affordable by all edentulous patients. At the same time, an important state-of-the-art educational curriculum component will be created at three Canadian dental schools with the University of Manitoba Faculty of Dentistry establishing a leadership role in managing this unique program, thereby contributing to the rapidly expanding field of implant dentistry education, research, and service.

The program will initially involve three Canadian dental schools (Manitoba, Saskatchewan, and Alberta) with Manitoba as the lead and coordinating school. This program will be the first of its kind nationally or internationally and although it will initially involve three dental schools in Canada, it could easily be expanded to additional dental schools throughout North America. The program will provide an international leadership position for the Faculty of Dentistry in the area of implant dentistry and graduating students will be among the best prepared graduates for patient care in this increasingly important area of dental practice. The program will be structured to ensure success and to comprehensively document educational and patient services outcomes.

1. Ingeborg; et al., Comparison of Three-Implant-Supported Fixed Dentures and Two-Implant-Retained Overdentures in the Edentulous Mandible: a Pilot Study of Treatment Efficacy and Patient Satisfaction. JOMI 26: 415-426, 2011.


2. Niznick G. A. The Core-Vent Implant System. Oral Implantology X: 379-418, 1982.


3. Niznick G. A. Restoration of the Totally Edentulous Jaw With Application Specific One-Piece Implants. Dental Economics 100:12-14, 2010.

Purpose: To establish an education and service program for implant-retained overdentures that will provide students with a unique education/training experience and that will also address a critical oral health need among First Nations populations.

Three-Year Program Commitment:

Implant Fellows - An “Implant Fellow” will be recruited at each participating dental school to specialize in the various applications of GoDirecttm and ScrewIndirecttm implants and to assist with the teaching, research, and service components of the program. Dental students and practicing professionals will be taught how to use these 1-piece implant systems for denture patients both in preclinical and patient care settings. Activities of the implant fellows at the three dental schools will be coordinated by the University of Manitoba (administrative time for an assigned support staff and instructor). Coordination will be based on collaboration with designated supervisors at the partner schools.   


Patients - First Nations patients will be recruited into the school dental clinics to receive the low-cost dentures through existing patient records and local advertisement. Services will be provided directly by implant fellows, and/or dental students (implant fellows will initially be supervised and treatment will follow a standardized protocol approved by Dr. Niznick, i.e., with the GoDirect, three free-standing implants with an implant-retained overdenture will be used in the symphysis. The middle implant, while not necessary for successful treatment, provides an additional implant in case one fails and the middle implant also provides indirect retention preventing the denture from flipping up in the back when patients bite on the front). To provide a more extensive educational experience, selected cases will be treated with 4-5 ScrewIndirect placed in the symphysis and splinted with a cast or CAD-milled bar, to provide an implant supported overdenture. Each of the partner schools has extensive community treatment centers with large populations of First Nations patients and access to large numbers of new patients. If necessary due to limited availability or drop-out of First Nations patients, schools will include other indigent patients coming through the dental school for denture treatment. This will maintain acceptable outcomes as the intent is not only to initiate a program to treat First Nations patients but to also demonstrate that implant overdenture treatment should be taught in dental schools and readily available to all edentulous patients.


Outcomes Measures - The primary outcomes measures to be utilized will be related to:

1. number of dental students participating in the program;
2. number of dentures completed by dental students;
3. number of patients served;
4. number of curricular hours of instruction and patient care;
5. dollar amount of donated dental services; and
6. amount of disseminated research findings.

 
Steering Committee - The Faculty will establish a program steering committee that will consist of the Department Head of Restorative Dentistry, Associate Dean Academic, Associate Dean Clinics and the implant fellows and their supervisors from each dental school. Dr. Niznick will serve as an external advisor to the committee and will be able to provide advice and expertise related to the implant overdenture treatment systems and troubleshooting of any problems as they may arise. The steering committee will meet quarterly and be charged with finalizing program development/implementation, monitoring progress, and reviewing quarterly progress reports. The committee will determine any necessary program adjustments as required and appropriate to meet program goals and objectives.