Journal of Periodontal Research

PERSPECTIVE ARTICLE OPEN ACCESS

‘The Past, The Present, The Future’ Series

Education in Periodontology: The Past, the Present, and

the Future
Mariano Sanz | Elena Figuero | David Herrera

ETEP (Etiology and Therapy of Periodontal and Peri-­Implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain

Correspondence: Elena Figuero ([email protected])

Received: 25 April 2025 | Accepted: 25 April 2025

Funding: The authors received no specific funding for this work.

Keywords: competences | dental education | European credit transfer system | learning outcomes | periodontology | specialty training

1   |   Introduction profile of the dentist was defined in the European Union by a di-
rective on the recognition of professional qualifications, which
The harmonization of dental education in Europe occurred stated: “All Member States must recognize the profession of dental
alongside the broader process of European convergence in practitioner, equipped with the skills needed for the prevention,
higher education initiated by the La Sorbonne Declaration in diagnosis, and treatment of diseases related to the teeth, mouth,
1998 and the signing of the Bologna Declaration in 1999. This jaws, and associated tissues.” It was further emphasized that
declaration emphasized the importance of achieving coherence dental training should consist of at least five years of full-­time
within the European higher education area while maintaining theoretical and practical training.
diversity. It established a two-­tier structure consisting of un-
dergraduate and postgraduate cycles [1]. Additionally, it intro- Based on these legal provisions, the proposed ADEE Dental
duced a common credit system known as the European Credit Curricular structure was organized into modules according to
Transfer and Accumulation System or ECTS. It promoted cur- the ECTS and aligned with the profile, domains, and competen-
ricular development, inter-­institutional collaboration, and the cies approved by ADEE. This framework defines competencies
integration of studies, training, and research to enhance mobil- as a combination of knowledge, skills, and attitudes relevant to
ity and ensure comparable criteria and methodologies. With this the dental education process, with a minimum acceptable level
aim, the Association for Dental Education in Europe (ADEE) of performance for graduating dentists, emphasizing speed and
and the “DentEd” thematic network secured funding from the accuracy that is consistent with patient well-­being rather than
European Commission for a third Network Project, “DentEd performance at the highest possible level. Competencies were
III” (2004–2007), to create a curricular model in dentistry that organized into seven domains representing the broad categories
fully complies with the principles of the Bologna Declaration [2]. of professional activity and dimensions that occur in the general
practice of dentistry: (I) professionalism, (II) communication
The first step in this challenge was to agree on a professional and interpersonal skills, (III) knowledge base, (IV) information
profile with a defined set of general and specific competen- handling and critical thinking, (V) clinical information gath-
cies. Despite the need for graduates equipped to undertake in- ering, (VI) diagnosis and treatment planning, and (VII) the es-
dependent dental practice safely, the educational and training tablishment and maintenance of oral health. While domains I,
programs varied significantly, with each school and country II, and IV pertain to all dental disciplines and thus represent
adopting different approaches shaped by their structures, cul- horizontal competencies, those related to domains III, V, and
tures, and resources. Nevertheless, there was a common aspi- VI concern the content, learning outcomes, and specific com-
ration to achieve the highest possible standards in educational petencies of the different classical dental disciplines (cariology,
outcomes and relevant clinical competencies, enabling gradu- periodontology, orthodontics, endodontics, restorative dentistry,
ates to move freely and practice anywhere in Europe [3]. The prosthetics, etc.) [2].

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any
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© 2025 The Author(s). Journal of Periodontal Research published by John Wiley & Sons Ltd.

Journal of Periodontal Research, 2025; 0:1–9 1 of 9

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These well-­established disciplines have defined the specific competencies in Periodontology, within the ADEE competence-­
supporting competencies relevant to their respective fields, based curriculum, organized into domains, major competen-
outlining the attitudes, skills, and learning outcomes expected cies, and the referred supporting competencies. While the major
of dental graduates. This framework provides a benchmark for ADEE competencies were fully adopted from the ADDE's doc-
reviewing, refining, and reshaping the undergraduate curric- ument, the supporting competencies for Periodontology were
ulum, enhancing student evaluation processes, and imple- defined as a specific set of competencies and learning outcomes
menting outcome measures to assess the effectiveness of the aimed at unifying periodontal education and training in Europe
educational process. Among these disciplines, Periodontology to serve as a model for universities framing periodontal educa-
is one of the major oral health sciences that studies the biol- tion within the dental curriculum.
ogy of periodontal and peri-­implant tissues and the diagnosis,
prevention, and treatment of their associated conditions and Within the major competencies of professionalism, ethics, com-
diseases. In the last 25 years, formal education and training munication, and interpersonal skills, the workshop proceedings
in Periodontology have been redefined as part of the harmo- highlighted the dentist's leading role in the oral health team,
nization process of higher education in Europe, defined by specifically in providing periodontal services. It emphasized the
the Bologna Declaration and, specifically for dentistry, by the need to develop competencies in communication and behavior
DENTED project. change to facilitate effective oral hygiene practices and manage
risk factors, such as smoking cessation interventions, which
This perspective article aims to examine this process by focus- are crucial for optimal periodontal treatment outcomes. It also
ing on past, present, and future perspectives in Education in stressed the importance of recognizing one's own limitations, as
Periodontology. the complexity of certain periodontal conditions may exceed the
competencies acquired during dental graduation, underscoring
the necessity of referring patients to specialists or professionals
2   |   The Past—Development of Education in with advanced postgraduate training in Periodontology.
Periodontology in Europe
Within the supporting competencies for establishing the knowl-
2.1   |   Undergraduate Periodontal Education edge base of Periodontology, the workshop outlined the levels of
understanding in fundamental biological, medical, and techni-
The European Federation of Periodontology (EFP) was founded cal subjects, as well as clinical sciences, to equip graduates with
in 1991 as a nonprofit organization structured as a federation the ability to differentiate between normal and pathological
that includes national societies of Periodontology. Its aim is conditions or disorders of the periodontium pertinent to clinical
to promote Periodontology and oral health in Europe and be- dental practice [5].
yond. To achieve these goals, the EFP established an Education
Committee focused on maintaining high and equitable stan- In the domain of gathering clinical information, diagnosing and
dards in undergraduate and postgraduate periodontal education treatment planning in Periodontology, the Workshop outlined
and training across member societies. the competencies necessary to obtain all the patient's medical,
oral, and periodontal information relevant for diagnosing peri-
In 2009, the EFP organized a workshop on periodontal education odontal and peri-­implant diseases and conditions within the
[4], which brought together experts from all European countries in framework of a comprehensive oral diagnosis. This included
academia and representatives from the ADEE. The specific objec- biological, medical, clinical, radiological, psychological, and so-
tives of this workshop were to review trends in the epidemiology of cial information pertinent to evaluating the patients' periodontal
periodontal diseases and the treatment needs in Europe; to make and peri-­implant condition. After acquiring these competencies,
recommendations on the scope and limits of periodontal educa- the graduating dentist must demonstrate a degree of decision-­
tion at the undergraduate, postgraduate, and continuing education making, clinical reasoning, and judgment to develop a diagnosis
levels; and to define the competencies, learning outcomes, teach- and treatment plan that meets the needs and demands of pa-
ing methods, and evaluation systems suitable for undergraduate, tients while recognizing treatments that are beyond their skills
postgraduate, and continuing education in Periodontology. and necessitate referral for specialist opinions and treatment.

At undergraduate training level, the EFP's objective was to prepare For the establishment and maintenance of periodontal and peri-­
modern dentists to meet the periodontal health needs and public implant health, the workshop defined the competencies of the
demands for most patients. This implied the necessary training graduating dentists for managing plaque-­ induced gingivitis,
to enable dentists to implement both population-­based and in- peri-­implant mucositis, acute periodontal conditions, mild to
dividual preventive strategies for improved periodontal health, moderate periodontitis, and peri-­implantitis, as well as mild oral
including the diagnosis and treatment of the most common oral mucosal diseases. When addressing the most advanced peri-
periodontal diseases and conditions. Considering the epidemiolog- odontal and peri-­implant issues, the workshop acknowledged
ical trends in Europe, there was a need to address the demands the necessity for graduates to gain skills in performing basic
of an increasingly aged and medically compromised population, periodontal and peri-­implant surgery, while also recognizing
which requires enhanced and increasingly sophisticated educa- the limitations of the university environment in providing the
tion in both clinical medicine and modern restorative therapy. infrastructure, faculty, and patient supply needed for training
in these surgical interventions. Nevertheless, the workshop
In this context, the results from the EFP Workshop on Dental proceedings stressed the importance of graduates understand-
Education [4] defined a set of recommended supporting ing the principles of tissue reconstruction and being familiar

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with current surgical approaches and technologies used in peri- presented in a written report suitable for publication in an inter-
odontal regeneration and the surgical treatment of peri-­implant national peer-­reviewed scientific journal [7].
conditions.
In 2005, ten graduate programs in Periodontology achieved EFP
accreditation: the Academic Centre for Dentistry Amsterdam
2.2   |   Postgraduate Periodontal Education: The EFP in the Netherlands; the University of Bern in Switzerland; the
Framework for Periodontal Specialty Training University of Nijmegen in the Netherlands; the University of
Gothenburg in Sweden; the Jonkoping Institute for Postgraduate
While the guarantee of a minimum duration of studies and the Dental Education in Sweden; the Eastman Dental Institute in
fulfillment of the minimum standards in undergraduate educa- London, UK; the Catholic University of Leuven in Belgium;
tion mentioned above have ensured some degree of uniformity, the Complutense University of Madrid in Spain; the Hadassah
this does not guarantee that the graduating dentist is compe- Faculty of Dental Medicine in Jerusalem, Israel; and Yeditepe
tent to treat every periodontal health issue for every patient. University in Istanbul, Turkey.
Therefore, while the community can be assured that dental
graduates can take responsibility for treating the most common In 2009, during the EFP workshop on periodontal education [4],
periodontal health problems, the undergraduate dental curricu- the scope, competencies, proficiencies, and learning outcomes
lum cannot be expected to provide enough knowledge and expe- of postgraduate periodontal education were redefined [8], using
rience to address all periodontal/peri-­implant pathologies. This the ADEE framework described previously for undergraduate
is particularly relevant given that European epidemiological education. A periodontist is defined as a specialist in a specific
data indicate that most of the population has mild to moderate field of dentistry that encompasses the prevention, diagnosis,
forms of periodontal diseases. However, a significant percent- and treatment of diseases and conditions affecting the support-
age of the population is affected by severe forms of periodontal ing and surrounding tissues of the teeth and their substitutes,
diseases, complex interdisciplinary restorative needs, and in- including dental implants. This definition includes all interven-
creased patient expectations that require advanced periodontal tions related to maintaining the health, function, and esthetics
therapy. Furthermore, these advanced periodontal treatments of periodontal and peri-­implant tissues and the surgical place-
are also necessary to address the less common diseases or condi- ment of dental implants.
tions that may require extended competencies. Therefore, there
is a need for a healthcare provider with specialized training as In these proceedings [8], the ADEE's competence taxonomy was
a periodontist [6]. used (be familiar with, have knowledge of, and be competent at).
However, unlike the undergraduate education document, an ex-
In 2005, the European Union published a new European tended competency is defined as “be proficient in”, which is de-
Directive, Article XXIV, which clearly specifies the require- scribed as responsible for carrying out the procedure accurately,
ments for specialist dental training. According to this directive, independently, and in a timely manner.
specialist dental training should be provided for at least three
years full-­time. It must include theoretical and practical instruc- Upon graduation, the specialist should be able to demonstrate
tion at a university center or in a health establishment approved not only a full understanding of the procedure's indications, pro-
for that purpose by the relevant authorities or bodies. cesses, and outcomes but also the ability to incorporate these
procedures into a logically sequenced and integrated advanced
As part of the remit of the EFP Education Committee, one of treatment plan that considers the patient's needs, wishes, and
its primary objectives is to promote the standardization of high-­ level of cooperation. In this framework, these workshop pro-
quality postgraduate education by creating a formal postgradu- ceedings outline the competencies and proficiencies needed to
ate specialty program in Periodontology. The first step was the achieve specialist status across various domains.
publication in 1996 of “the quality standards for graduate pro-
grams in Periodontology,” which aimed not only to harmonize In the knowledge base domain, the document emphasizes the
the content, guidelines, and quality standards for postgradu- importance of acquiring extensive knowledge in the biomedical
ate training programs in Periodontology but also to define the and fundamental sciences relevant to Periodontology, as well
competencies and learning outcomes that graduates of these as the ability to critically evaluate scientific literature, continu-
programs should attain upon completing their education and ously update the knowledge base, and assess emerging scientific
training as specialists in Periodontology. This document estab- and technological developments. Furthermore, the specialist
lishes the three main components required for accreditation of in training should have comprehensive knowledge of medical
the Periodontology and Implant Dentistry postgraduate pro- aspects pertinent to periodontics and should be competent in
grams: didactic, clinical training, and research. In the didactic interacting with their respective healthcare providers. They
component, the knowledge base in Periodontology and Implant should possess a thorough understanding of all possible inter-
Dentistry necessary to attain specialist level is defined, and actions between oral and systemic diseases and be capable of
this should be organized into courses, lectures, seminars, and managing the periodontal problems of medically compromised
tutorials, including an extensive literature review. The clinical patients.
content should encompass all diagnostic and therapeutic areas
of Periodontology and the surgical aspects of Implant Dentistry. In the diagnosis, treatment planning, and patient management
The research component should enable the specialist in train- domains, a specialist in Periodontology must evaluate the rel-
ing to develop competencies in research methodology and de- evant clinical conditions to design a comprehensive treatment
sign, alongside completing a research project, which must be plan and implement the appropriate treatment. They should be

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proficient in collecting and interpreting all data necessary to [9, 10]. However, the very limited penetration of this initiative
establish these diagnoses, including all diseases and conditions and the heterogeneity of regulations among the European coun-
affecting the periodontium, peri-­implant tissues, and neighbor- tries [11] prevent the discussion of this mode of education within
ing structures. They must also demonstrate proficiency in deter- the present perspective article. Given the high prevalence of peri-
mining prognosis and developing a comprehensive periodontal odontal diseases, dentists with specialist-­level training (if avail-
treatment plan, including implant therapy, and effectively com- able) can care for only a very limited proportion of patients with
municating with patients about their periodontal health status periodontal needs. Therefore, general practitioners and dentists
and treatment options. Additionally, they should be proficient in with a specific interest in periodontal practice are essential for
the full spectrum of non-­surgical and surgical periodontal and managing the periodontal health of the general population.
implant therapies essential for establishing and maintaining
periodontal health, including selecting and prescribing adjunc-
tive medications. Furthermore, they should possess compre- 3.1   |   Current Status of Undergraduate Education
hensive knowledge of the interrelationships among endodontic, in Periodontology
orthodontic, restorative therapies, and periodontal treatment,
and be able to establish a multidisciplinary treatment plan in Given the previous rationale, providing periodontal competen-
collaboration with these disciplines. They should also be profi- cies and learning outcomes to dental students during their un-
cient in evaluating the results of periodontal and implant ther- dergraduate education is crucial for addressing the population's
apy and, in cooperation with other oral health team members, periodontal needs. This is especially important if the goal is to
provide each patient with a suitable, customized maintenance meet the targets outlined by the World Health Organization,
program that includes evaluating likely risk factors. which recommends that by the year 2030, dentistry should be
included within primary health care with universal access [12].
In implant therapy, a specialist in Periodontology should be
proficient in all surgical implant techniques, including site de- In Europe, the educational curricular framework, which in-
velopment, surgical placement, and soft and hard tissue recon- cludes the set of competencies and learning outcomes, is the re-
struction procedures. Furthermore, they should be proficient in sponsibility of each country's educational and health authorities.
treating all diseases affecting the peri-­implant tissues. However, the consensus report on the periodontal curricular
framework in undergraduate education from the 1st European
The workshop proceedings also updated the 1996 EFP doc- Workshop on Periodontal Education in 2009 [4] published in
ument “Quality Standards of Postgraduate Education in 2010 [13] has provided a unique opportunity for individual coun-
Periodontology” by defining the EFP-­accredited program dura- tries and universities to converge and strive to harmonize peri-
tion in three years (full-­time), comprising 180 ECTS distributed odontal education across borders.
across three components: didactic training, clinical training, and
research. The organization of the final exam for acquiring the When dental schools in Europe were required to design their
EFP certification as a specialist in Periodontology and Implant undergraduate curricula in response to the legal demands of
Dentistry was established as an oral examination in front of a the Bologna process, the availability of these recommendations
Board of Examiners, including an external examiner appointed proved to be very valuable. In 2014, the EFP Undergraduate
by the EFP. In this exam, students must defend five fully docu- Education Committee assessed the degree of implementation
mented cases encompassing the entire field of Periodontology of the 59 competencies recommended at the 2009 European
and Implant Dentistry, as well as a report on the research project Workshop on Periodontal Education. Between November 2014
conducted by the student, formatted to demonstrate the poten- and July 2015, 244 professors of Periodontology and/or depart-
tial for publication in a peer-­reviewed scientific journal. ment heads from 24 EFP member countries were invited to par-
ticipate in a survey based on a questionnaire consisting of 57
multiple-­choice questions divided into three sections: curricular
3   |   The Present—Current Status of Education in content in Periodontology and Implant Dentistry, teaching and
Periodontology in Europe assessment methods, and the organization of periodontal clini-
cal training. Seventy-­six dental schools (31.1%) from 16 countries
As explained above, education in Periodontology encompasses (66.7%) responded to the survey, and results were categorized
various tiers, ranging from formal undergraduate training to into five regions (Nordic, Bismarckian, British, Southern, and
become a dentist, to postgraduate education and training for Eastern) to facilitate a regional interpretation of the data [14].
achieving specialist status and including other forms of educa-
tion in Periodontology. These forms allow general dentists to One significant finding was that Periodontology was taught
complement and enhance the competencies and learning out- as an independent discipline in most dental schools (92%). A
comes acquired during their undergraduate training as part of competence-­based education model was implemented in most
continuing education or professional development. This is par- centers (86.3%), although only half utilized ECTS. The re-
ticularly relevant in dentistry, where advances in research and sponses regarding learning methods indicated that most cen-
technology clearly surpass the framework of the undergraduate ters maintained a traditional educational model, with didactic
curriculum and require the development of new competencies, lecture-­based teaching (98%) and case-­based learning (74%)
learning outcomes, and skills needed to stay current in modern being the most common educational methods. Conversely, using
periodontics. In fact, the European Union developed a frame- modern approaches to learning and student-­centered methods,
work for this mode of education, under the name “vocational ed- such as information technology, networking, and small group
ucation and training”, based on the Bruges/Copenhagen process activities recommended by the Bologna process, was rarely

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applied. Although more than half of the respondents reported availability of formal postgraduate training in Periodontology
using problem-­based learning (57%), self-­directed learning, peer at the specialist level in the respective European countries. A
group practices, and laboratory simulations were infrequently 28-­item questionnaire was answered by all member countries
implemented (16%). (29 out of 31), except for the Czech Republic and Russia [17].
Seventeen of the 29 responders indicated that the specialty of
Regarding evaluation methods, the supporting competencies Periodontology is legally recognized in their respective coun-
related to the etiology of periodontal diseases and their di- tries. In contrast, it is either not recognized or only partially
agnosis, prevention, and treatment were primarily assessed recognized in 11 countries (it is only legally established in one
through written examinations that predominantly relied on region of Germany) [17]. This lack of homogeneous specialty
multiple-­choice questions, accompanied by oral examinations recognition is likely because, despite the existence of a European
for knowledge-­based content. Clinical grading in the clinical Directive on the Recognition of Professional Qualifications,
setting was the standard method for evaluating clinical compe- which in its article 24 defines “specialist dental training,” only
tencies. Competency tests, such as objective structured clinical two specialties (Orthodontics and Oral Surgery) are listed in
examinations (OSCEs) and self-­assessment tools, were rarely Directive 2005/36/EC. The EFP has taken the lead in pursuing
utilized. the addition of Periodontology to this list, but it has still not been
formally recognized.
The conclusions from this project recommended periodically
updating the set of 59 competencies, identifying a minimum set Regarding postgraduate training in Periodontology at the spe-
that should be strongly endorsed to promote more uniform com- cialist level, most countries (21) require three full-­time years;
pliance throughout Europe and globally [14]. however, seven countries offer part-­time training. In approxi-
mately half of the countries (14 out of 23), training is conducted
In parallel with the previously described project, periodon- exclusively at universities, while the remaining countries
tal education was evaluated in the United Kingdom [15]. A provide a combination of institutions for this training, in-
25-­question survey was completed by all UK dental schools cluding hospitals, accredited public or private clinics, and
(14). The published results closely resembled those of the military clinics. The evaluation of graduates primarily occurs
EFP project: Periodontology is a core subject in most schools, within a university setting (24 of the 25); however, in some
taught primarily in the third year; however, it receives fewer countries, it also takes place in hospital settings (n = 4),
hours than the median EFP evaluation (250 versus 350 h). As by mentors or specialist supervisors (n = 3), or by the Royal
expected, the UK survey indicated greater internal consis- Colleges of Surgeons in the United Kingdom. The final ex-
tency among the 14 surveyed dental schools than that of the amination for granting specialty status is mostly conducted
EFP evaluation. within the university environment (n = 11). However, in some
countries, other systems are in place, as a combination of
While these projects were cross-­ sectional in nature, a pro- the university and government, hospital, and national soci-
spective evaluation was conducted over two years (2011–2013) ety (n = 2), university and EFP (n = 3), National Examination
among the teaching staff of the Department of Periodontology Board (n = 3), and the Ministry of Health and Royal Colleges
at ACTA (Amsterdam, The Netherlands) [16]. In 2011, 21 out of of Surgeons (n = 1 each). Regarding assessment methods, the
58 respondents (36%) considered that the competencies were not following were reported by the 25 responders: written ex-
adequately covered; however, by 2013, only 8 (14%) responded amination (n = 15), oral examination (n = 20), OSCE (n = 9),
similarly, indicating a statistically significant improvement. portfolio of treated cases (n = 22), research report (n = 3), a
published paper, and examination of previously unseen pa-
In summary, the 2010 EFP periodontal curricular framework tients (n = 1 each).
and set of competences in undergraduate education [13] has
been a significant element in ensuring consistency in under- To evaluate the impact of the EFP specialty training model in
graduate education in Periodontology in Europe [14, 16, 17]. Periodontology (updated in 2019 [20]), a recent survey was con-
However, additional efforts should be made to ensure that a ducted at two levels: one targeted at graduates from specialty
minimum set of competences and learning outcomes is taught programs and the other at their respective program directors
across all European countries and, ideally, worldwide [18]. [19]. This survey for graduates was sent in June–July 2023, and
22 responses were received from 18 different programs across
12 different countries. The number of accredited programs is
3.2   |   Current Status of Specialist Training in relatively small when considering the total number of European
Periodontology dental schools. However, it is important to highlight that the
requirements of the EFP-­accredited Postgraduate Program in
The status of specialist training in Periodontology in Europe Periodontology, with its strong emphasis on excellence, may not
has recently been evaluated by three surveys: one completed by be feasible for all countries. Nonetheless, this program is a clear
national scientific societies, members of the EFP [17], another reference for universities aiming to establish postgraduate pro-
completed by graduates of the EFP-­ accredited Postgraduate grams at the specialist level.
Programs in Periodontology and Implant Dentistry [19], and the
third by their program directors [19]. As stated in the quoted review conducted in preparation for
the 2nd European Consensus Workshop on Education in
The first survey targeted national scientific societies to gather Periodontology [19], “the goal of modern specialist postgraduate
information on the status of the periodontal specialty and the education is to produce a caring, knowledgeable, proficient and

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skillful specialist in periodontology, who is able, upon graduation, 4   |   The Future of Education in Periodontology
to accept professional responsibility for the ethical, effective and
safe care of all patients with a special emphasis on those in need At both undergraduate and postgraduate levels, the future of
of specialist care”. The results from the survey targeting recent periodontal education in Europe was recently discussed during
graduates of EFP-­ accredited programs demonstrated a very the second EFP European Consensus Workshop on Periodontal
high level of employability, with 46% working in clinical practice Education in 2023. One of the objectives of this workshop was
within private settings, while 10% had their primary working to ensure the full integration of the 2018 classification for peri-
activity in academia and 38.6% engaged in both clinical practice odontal and peri-­ implant diseases and conditions [21] into
and academic activities. This finding highlights the high qual- the periodontal undergraduate curriculum, along with the S3
ity of the EFP-­accredited Periodontal Postgraduate Programs, Clinical Practice Guidelines for the treatment of periodontitis
which provide a significant source of employment for teaching patients and the prevention and treatment of peri-­implant dis-
staff in European universities. eases [22–24]. It also aimed to adapt the 2009 EFP periodontal
educational framework to the updated educational framework
When exploring graduates' satisfaction with their training, 80% for Dental Undergraduate Education and Training adopted by
rated the quality of their perceived instruction as good or very ADEE in 2017 [25].
good. When asked about their proficiency in periodontal surgi-
cal procedures, 80%–85% rated it as good or very good, although
30% considered their training in mucogingival procedures to be 4.1   |   Undergraduate Curriculum
insufficient. Additionally, evaluations for their training in surgi-
cal dental implant procedures were also positive, with 78% rat- The 2009 EFP recommended framework for undergraduate ed-
ing the quality and 64% rating the quantity as good or very good. ucation in Periodontology was based on the ADEE competence-­
However, modest scores were reported for the more demanding based education, structured in modules organized into
implant-­related surgical procedures, such as sinus lifting or domains, each containing a detailed description of general and
bone regeneration. Regarding teaching quality, graduates gave specific competencies [2]. However, the recent ADEE curricular
very positive scores for seminars and lectures, with 88%–93% recommendations are based on a more flexible framework with
providing good or very good ratings. fewer domains (Domain I: Professionalism; Domain II: Safe
and Effective Clinical Practice; Domain III: Patient-­Centered
The results from the survey targeting program directors of the Care; Domain IV: Dentistry in Society) and a comprehensive de-
EFP-­ accredited Periodontal Postgraduate Programs received scription of the learning outcomes, teaching methods, learning
23 responses [19]. All program directors acknowledged that strategies, and assessment tools for each domain [25]. This shift
the requirements stated in the document “Quality Standards from competencies to learning outcomes aims to ensure that the
for Graduate Programs in Periodontology” [20] have had a huge educational process not only focuses on acquiring the relevant
influence on their programs. They reported that the program knowledge, skills, and attitudes needed to meet the oral health
content had been periodically adapted to advances in diagnosis, demands of specific environments but also fosters the learn-
classification, and treatment, including the 2018 classification ing processes that are pertinent to dentistry while being more
[21] and the EFP clinical practice guidelines [22–24], which have adaptable and transferable to other areas of study.
been fully implemented. Regarding evaluation and assessment,
theoretical knowledge was primarily assessed through a combi- Furthermore, ADEE has recently introduced a fifth domain
nation of oral exams and essays (78.3%), while the assessment focused on research, aiming to immerse undergraduate stu-
of clinical skills/competences frequently utilized direct observa- dents in the culture of science by outlining specific learning
tion in clinical settings, simulated environments, and case port- outcomes in research methodology and evidence-­based den-
folios. Quality assurance, including that of teaching staff, was tistry (https://​adee.​org/​g radu​ating​-­​europ​ean-­​denti​st/​g radu​
mainly conducted through feedback from staff, patients, and ating​-­​europ​ean-­​denti​st-­​curri​culum​). At the same time, the
specialty trainees (69.6%). The quality of training and the degree European Parliament and the EU Council have amended the
of fulfillment of expected learning outcomes/competences were 2005/36/EC directive for professional training in dentistry
assessed through student portfolios and audits of clinical treat- (EU) 2024/782, identifying new scientific and technical ad-
ment records (95.6%). vancements in dentistry, such as “implantology, gerodontol-
ogy, interprofessional collaborative care, dental public health
Generally, training at the specialist level in Europe is primar- – community oral health, practice management, genetics and
ily influenced by the legal recognition of the specialty in each genomics, immunology, regenerative medicine/dentistry, and
country, rather than by European Union directives. However, digital technology in dentistry”, which are not typically in-
the Quality Standards of the EFP-­ accredited postgraduate cluded in current dental curricula and should be considered
programs serve as a reference for training in Periodontology at in present and future curricular development.
the specialty level and provide significant leverage for recruit-
ing manpower in academic centers for undergraduate and Within this context, the recent EFP European Workshop on
postgraduate training in Periodontology. Like undergraduate Education in Periodontology (2023) has updated the curricu-
education, a comparable effort should be made at the specialty lar framework for periodontal undergraduate education, orga-
level to develop a minimum set of competencies and learn- nized into four concentric circles. The first level (inner circle)
ing outcomes to assist postgraduate programs in Europe and represents the foundational domains of learning, followed by
worldwide. the areas of competence directly related to each domain [26].

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TABLE 1    |    List of European Federation of Periodontology TABLE 1    |    (Continued)
accredited university centers providing specialty training programs in
Postgraduate program Country
Periodontology.
Postgraduate program in Periodontology and Switzerland
Postgraduate program Country
Implant Dentistry, School of Dental Medicine,
Postgraduate programme in Periodontology of Australia Dept. of Periodontology, University of Bern
the University of Queensland, Brisbane
Graduate program in Periodontology and Turkey
Post-­graduate program in Periodontology and Belgium Implant Dentistry, Yeditepe Univ, Fac
Implant dentistry, University of Liège Dentistry & Dental Hospital, Istanbul

Master-­after-­Master in Periodontology and Belgium Periodontology MClinDent, UCL Eastman United

clinical post-­graduate, KU Leuven Dental Institute, London Kingdom

Master of Science in Advanced Dentistry Belgium Periodontology MClinDent at King's College, United
(Periodontics), Ghent University London Kingdom

Master of Dental Surgery in Periodontology, China

University of Hong Kong
Additionally, the learning outcomes specific to Periodontology
Postgraduate program in Periodontology, France have been established within each domain [18], and various
University of Strasbourg teaching and learning activities, along with assessment meth-
Postgraduate program in Periodontology and France ods, have been proposed for each learning outcome based on
Implant Dentistry, Université Paris Cité their specific cognitive process dimensions [26].

Postgraduate programme in Periodontology Germany The foundational domains relate to learning outcomes that are
of the Center for Dentistry and Oral Medicine
transversal to all disciplines, focused on professionalism [27]
Goether University Frankfurt
and emphasizing good dental practice in three areas of compe-
Postgraduate programme in Periodontology, Greece tence: ethics, regulation, and professional behavior. Similarly,
National and Kapodistrian University of the domain of safe and effective clinical practice [28] encom-
Athens passes competencies in evidence-­based practice, management
Postgraduate programme in Periodontology, Greece and leadership, teamwork and communication, audit and risk
Aristotle University, Thessaloniki management, and professional education and training.

Graduate program in Periodontology and Ireland In the domains focusing on patient-­centered care [29] and den-
Implant Dentistry, Dublin Dental University tistry in society [30], the specific learning outcomes related to
College, Trinity College, Dublin the scientific basis of periodontal and peri-­implant healthcare,
Perio Postgraduate Program, Health Care Israel the diagnosis of periodontal and peri-­implant diseases and con-
Campus Rambam ditions, and the provision of preventive and therapeutic care at
both individual and public health levels are detailed, consider-
Graduate Program in Periodontology, Hebrew Israel
ing the aforementioned scientific and technical advancements
University Medical Center
in Periodontology.
Postgraduate Program in Periodontology, Italy
University of Turin
Master programme in Periodontology and Italy 4.2   |   Specialist Training in Periodontology
Implant Dentistry, University of Florence
As stated above, specialist education and training in periodontol-
Graduate program in Periodontology and The ogy is coordinated and accredited in Europe by the EFP through
Implant Dentistry, Academic Centre of Netherlands
the EFP Committee of Education and the EFP Postgraduate
Dentistry, Amsterdam
Accreditation.
Postgraduate programme in Periodontology, Norway
Oslo University In 2024, twenty-­ four accredited university centers provided
Master's Degree in Periodontology, UIC Spain
specialty training programs (Table 1). This accreditation sys-
Barcelona tem fulfills the provisions of the current European Directive
(October 2023), which requires a minimum of three years of
Specialized Postgraduate Programme in Spain full-­time education during which specialists in training should
Periodontology, Dental School, Complutense gain not only a deep knowledge of periodontology and related
University, Madrid areas but also acquire proficiency in all diagnostic, preventive,
Graduate program in Periodontology and Sweden and therapeutic interventions related to periodontology and the
Implant Dentistry, Sahlgrenska Academy, surgical phases of implant therapy.
University Gothenburg
In the First European Consensus Workshop on Periodontal
(Continues) Education [8], the recommended competencies and proficiencies

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for specialist training in Periodontology were approved. 3. M. Sanz, E. Treasure, W. van Dijk, et al., “Profile of the Dentist in the
This list has been recently updated in the second European Oral Healthcare Team in Countries With Developed Economies,” Euro-
Consensus Workshop on Education in Periodontology [18], pean Journal of Dental Education 12, no. 1 (2008): 101–110.
emphasizing the diagnosis of periodontal and peri-­ implant 4. M. Sanz and I. L. Chapple, “First European Consensus Workshop in
diseases and conditions using the 2018 EFP/AAP classification Periodontal Education–Objectives and Overall Recommendation,” Eu-
system [21], and adhering to the clinical practice guidelines for ropean Journal of Dental Education 14, no. 1 (2010): 1.
treating periodontitis [23, 24] and peri-­implant diseases [22], 5. C. Martinez-­A lvarez, M. Sanz, and P. Berthold, “Basic Sciences Edu-
particularly in the competencies and proficiencies requiring cation in the Dental Curriculum in Southern Europe,” European Jour-
advanced knowledge and skills, such as those needed during nal of Dental Education 5, no. 2 (2001): 63–66.
step III of periodontal or peri-­implant therapy or in the com- 6. M. Sanz, E. Widstrom, and K. A. Eaton, “Is There a Need for a Com-
plex interdisciplinary treatments necessary for stage IV peri- mon Framework of Dental Specialties in Europe?,” European Journal of
odontitis patients. Dental Education 12, no. 3 (2008): 138–143.
7. M. Sanz, U. van der Velden, D. van Steenberghe, and P. Baehni, “Peri-
Moreover, there should be an emphasis on the evolving trends in odontology as a Recognized Dental Speciality in Europe,” Journal of
dental, periodontal, and implant treatments. These treatments Clinical Periodontology 33, no. 6 (2006): 371–375.
require a thorough understanding of the basic sciences related to 8. U. Van der Velden and M. Sanz, “Postgraduate Periodontal Education.
periodontology and clinical epidemiology to address the needs Scope, Competences, Proficiencies and Learning Outcomes: Consensus
of current and future periodontal care demands. Furthermore, Report of the 1st European Workshop on Periodontal Education–Posi-
future specialists should be well-­versed in the latest scientific tion Paper 3 and Consensus View 3,” European Journal of Dental Educa-
tion 14, no. 1 (2010): 34–40.
and technological advancements, including digital and artificial
intelligence technologies, as well as progress in bioengineering 9. Cedefop, “The Bruges Communiqué. Policy Documents and Stud-
and regenerative therapies. ies,” (2010), http://​w ww.​cedef​op.​europa.​eu/​en/​conte​nt/​bruge​s-­​commu​
nique​.
In the future, specialists will treat increasingly aging popula- 10. Cedefop, “The Future of Vocational Education and Training in Eu-
tions with more complex medical problems, where noncom- rope: Synthesis Report,” in Cedefop Reference Series; no 125, vol. 2023
municable diseases are interconnected and where periodontitis (Publications Office of the European Union, 2023).
and peri-­implantitis must be treated as part of the overall pa- 11. J. Meyle, F. Lambert, L. Winning, et al., “Continuing Professional
tient care. Consequently, future specialists must possess a broad Development (CPD) and Vocational Education and Training (VET) in
knowledge of medical sciences and strong communication skills Periodontology and Implant Dentistry,” Journal of Clinical Periodontol-
ogy 51, no. 27 (2024): 91–116.
to participate actively in the patient's systemic care. Similarly,
complex periodontal treatments will need to combine the nec- 12. World Health Organization, “Follow-­Up to the Political Declaration
essary arrest of the inflammatory processes with the rehabilita- of the Third High-­L evel Meeting of the General Assembly on the Pre-
tion of the functional and esthetic needs of the patient. This will vention and Control of Non-­Communicable Disease: WHO,” 2022.
require specialists in periodontology to be proficient in planning 13. M. Sanz and J. Meyle, “Scope, Competences, Learning Outcomes
multidisciplinary care and to have the appropriate skills for and Methods of Periodontal Education Within the Undergraduate Den-
teamwork. tal Curriculum: A Consensus Report of the 1st European Workshop on
Periodontal Education–Position Paper 2 and Consensus View 2,” Euro-
pean Journal of Dental Education 14, no. 1 (2010): 25–33.
14. M. Gursoy, A. Wilensky, N. Claffey, et al., “Periodontal Educa-
Acknowledgements tion and Assessment in the Undergraduate Dental Curriculum-­ A
This manuscript is part of “The Past, the Present, the Future” se- Questionnaire-­Based Survey in European Countries,” European Jour-
ries, celebrating the 60th anniversary of the Journal of Periodontal nal of Dental Education 22, no. 3 (2018): e488–e499.
Research [31]. 15. P. A. Heasman, J. Witter, and P. M. Preshaw, “Periodontology in the
Undergraduate Curriculum in UK Dental Schools,” British Dental Jour-
Conflicts of Interest nal 219, no. 1 (2015): 29–33.

The authors declare no conflicts of interest. 16. M. Schoonheim-­K lein, T. S. Ong, and B. G. Loos, “Implementation
Process of All Periodontal Competences and Assessments as Proposed
in the 2010 European Consensus Meeting Into the Existing Local Un-
Data Availability Statement dergraduate Curriculum,” European Journal of Dental Education 20, no.
The authors have nothing to report. 4 (2016): 197–205.
17. K. A. Eaton, N. X. West, N. H. F. Wilson, and M. Sanz, “European
Federation of Periodontology Survey of Postgraduate and Specialist
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