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Table of Contents   
ORIGINAL RESEARCH  
Year : 2012  |  Volume : 23  |  Issue : 2  |  Page : 297
A survey on the use of techniques, materials in dental implantology practice


1 Department of Prosthodontics, S. Nijalingappa Institute of Dental sciences and Research, Gulbarga, India
2 Department of Prosthodontics Monica Dental Clinic, Hyderabad, India
3 Department of Prosthodontics, Govt. Dental College, Raipur, India

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Date of Submission01-Mar-2011
Date of Decision03-Aug-2011
Date of Acceptance22-Nov-2011
Date of Web Publication3-Sep-2012
 

   Abstract 

Purpose: To present results of a survey on the status of an implantology amongst implant-practicing dentist across the world in 2009.
Materials and Methods: A questionnaire was sent to the members of EAO (European Association of Osseointegration), ICOI (International Congress of Osseointegrated Implants), ISOI (Indian Society of Oral Implantologists), Asian Academy of Osseointegration (AAO), Deutsche Gasellschaft Fur Orale Implantologie (DGOI), Philippines Implant Organization, Korean Society of Oral Implantologist, Japanese Association of OralIimplantologists, Chinese Dental Association, Pakistan Dental Association, asking for the personal (anonymous) background data and their implantology concepts. Specific questions dealt with level of recognition of implants, use of implants, superstructures, techniques followed, and materials used.
Results: A total of 1500 (63.6%) of the 2358 questionnaires were answered. Dental implants were the most preferred treatment modality for restoring the missing teeth. Threaded implants were the most preferred. Cement retained implant prosthesis was the most preferred restoration procedure. Dentists believe that the general dentist should practice dental implant treatment modality, preferably teamwork. Immediate loading was the much-accepted concept among the dentists of the developed nations.
Conclusion: Dental implants were much accepted treatment modality for the replacement of missing teeth. Most the dentists follow the well documented technique and proven materials, which have been documented in the literature, an evidenced based practice, thus, delivering the best to their patients. Dentists from the developing nations agreed to have standardization in implants.

Keywords: Dental implantology, International, survey

How to cite this article:
Chowdhary R, Hosadettu SR, Chandrakar N. A survey on the use of techniques, materials in dental implantology practice. Indian J Dent Res 2012;23:297

How to cite this URL:
Chowdhary R, Hosadettu SR, Chandrakar N. A survey on the use of techniques, materials in dental implantology practice. Indian J Dent Res [serial online] 2012 [cited 2021 Jul 29];23:297. Available from: https://www.ijdr.in/text.asp?2012/23/2/297/100465

   Introduction Top


Use of dental implants to provide the support for the dental prosthesis has been a treatment option since the late 1930, but the popularity of this treatment approach increased with an introduction of the concept of osseointegration. [1],[2],[3],[4],[5] The Toronto implant experience introduced osseointegration to the North American dental community in the early 1980's by describing the clinical studies that replicated the earlier experiences in Sweden. [6],[7],[8],[9],[10],[11],[12] As a result of high-success rates and the predictability of the dental implants, their prevalence in the rehabilitation of partially dentate and edentulous patients is increasing year on year. [10] With about 1 million implants inserted annually worldwide, [13] this subspecialty of rehabilitative dentistry has become an integral partin the treatment modality amongst the increasing number of the dentists acrossthe world.

In the absence of common opinion and randomized controlled trials, an opinion remains divided over which materials and techniques are the most effective in an oral implantology. However, a varietyof materials and techniques used in this context based on the availability, clinical situations and economical constrain across the globe varying in opinions. The following are the objectives of the survey, 1) to determine the acceptance of dental implant as treatment modality; 2) to know the the most accepted techniques and materials used by the professionals across the world.


   Materials and Methods Top


An online questionnaire was made, consisting of 17 questions by the authors with discussion with the specialists in the field. The potential criteria were discussed at length in focus groups with the practicing implantologists to identify the questions and their focus. Following changes to clarity and design, the questionnaire was piloted on to a small sample of colleagues; again following feedback from them, the final and agreed questionnaire was posted in June 2009. The questionnaire was sent to 3000 randomly selected dentists, practicing implantology from organizations like Association of Osseointegration(AO), American Academy of Implant Dentistry (AAID), European Association of Osseointegration (EAO), International Congress of Oral Implantologists (ICOI), Indian Society of Oral Implantologist (ISOI), Deutsche Gasellschaft Fur Orale Implantologie (DGOI), Philippines Implant Organization, Asian Academy of Osseointegration (AAO), Korean Society of Oral Implantologist, Japanese Society of Oral Implantologists, Pakistan Dental Association, Russian Dental Association etc. Out of which, 642 electronic mails were not valid because the mail bounced back. The first mailing was sent out in June 2009, subsequently second and third reminders were posted at 6 and 9 weeks respectively to those, from whom the replies were not received. The survey was stopped when we received 1500 replies in total, which took 6 months 17 days. When the data was evaluated, we had received replies from the dentists of 16 countries. Those were United States of America, Canada, Philippines, Australia, Russia, China, Japan, Korea, India, Pakistan,Sweden, Norway, Germany, Poland, France, Netherland. European Union countries were combined in one group [Table 1].
Table 1: List of countries and the number of dentist participated in the survey

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   Results Top


96.59% in United States of America (USA), 88.9% in Canada, 100% in Russia, preferred an implant as a better treatment modality, whereas 22.44 % of dentists from India, and 41% from Pakistan still feel it is not [Graph 1]. Threaded implants were the preferred design with 100% in Australia, whereas 53% Russia preferring non-threaded. For implant-supported over denture, 31.97% of Indian preferred support with 2 implants, while 47.22% of Japanese preferred support with 4 implants. For the over-denture attachments, 24.36% of dentists preferred dolla-bona attachment, whereas locator® (Zest Anchors, USA) attachment were the most preferred by 84.15% in Australia, 82.5% in Philippines, 72.22 in Canada, and 75% in Japan. Bar-retained over dentures were least preferred. For the question regarding choice of an impression technique, most of the dentists across the world preferred both, open-tray and closed-tray techniques. Open-tray was only preferred by 54.49% dentists in India, and 59.62% in Pakistan. In china, 63.43% dentists preferred closed-tray technique.



Cement-retained prosthesis was the restoration of choice by most of the dentists across the countries surveyed. Short-implants were not much preferred in USA, Canada, Russia and European Union, with 2.27%, 4.17% and 3.25%, respectively [Graph 2].



Computer tomography (CT) was the preferred diagnostic technique by 33.3% implantologists in Japan, 26.32% in Russia, 23.58% in Europe, 96.59% of Americans, 98.62% European Union dentists. 96.47% of Indians agreed that surgical stents made using navigation system, was not mandatory. General dentists should be trained for carrying out implant supported treatment modality, was the most common reply.

82.11% of European and 75.6% of Australian dentists considered that the standardization of implant surgical kit across all the brands is not required, whereas Indian, Japanese, Chinese and Pakistani dentists felt that, with standardization, the procedure will become simpler and less expensive [Graph 3].



Most of the dentists across the world had similar positive opinion regarding the splinting of implant. Immediate loading concept was accepted by 96.5% dentists in Australia, 95.12% in Europe; less preferred by dentists in India and Pakistan with 32.69% and 25%, respectively. Single-piece implants should be restricted to an anterior region, was the most common opinion.


   Discussion Top


Oral rehabilitation with an implant-supported prosthesis has been well documented in the dental literature. [14] This therapy is widely used in the dental clinics, and there is a growing demand from clinicians and patients to optimize the treatment protocols. Since the discovery of osseointegration, changes in implant-design, surface configuration, surgical techniques, restorative modalities and improvements in diagnostic techniques and pre-surgical planning tools has occurred. Change in technology and material advancement has tremendous commercial impact for the patients and dentists. [15] This survey was carried out to analyze the most preferred techniques and materials used by the dentists in an implant retained restorations across the world.

Oral rehabilitation by means of an implant-retained mandibular over denture is known to improve oral functions. [16] With slight variation of implants used for support, this is satisfactorily used across the world. McGill consensus statement suggests that for the restoration of an edentulous mandible, two implant-retained over denture should be the first choice of the treatment. [17] This treatment modality was preferred by most of the dentists across the world with variation in number of implants used for treating their mandibular edentulous patients.

Polyether was the material of choice for making implant impressions by most of the dentists across the world, as mentioned by many studies done to find out an accuracy of impression materials. [18],[19] Open-tray technique was proved to be the most accurate impression technique in literature, [20] and it was probably for this reason that this technique was preferred by most of the dentists. Even though the debate between screw-versus-cement retained implant prosthesis is well documented in the literature, the best type of prosthesis still remains debatable among practitioners. [21] Lee et al concluded in his review that, the current trend tends to favor cement-retained implant restorations for their superior esthetics, occlusion, ease of fabrication, and reduced chair side time. Similar results were found in the present survey, wherein most of the dentists preferred cement-retained restorations.

The survey showed that, the short implants were more preferred by the dentists of Asian countries; the reason needs to be investigated, because there is no evidence in the literature on its use. The dentists used all the diagnostic aids mentioned in the questionnaire across the world, with not much emphasis on a particular method. Most of the dentists agreed that the surgical stent is not required for all the cases treated for implant restorations. Most emphasis was shown on teamwork in an implant practice involving specialists. [22],[23] The dentists from the developing nations supported standardization of dental implants dimensions, because they believe that it will reduce the cost of the treatment and make the procedure simpler. Similarly, due to the lack of standardization of endodontic instruments, lot of confusion was present in the use of endodontic instruments, hence in the mid 1950s, an international standard on size, type and performance of endodontics was developed to simplify the treatment procedure to the dentists and the patients. Hence, it is necessary to think on these terms. [24]

Though the success of single-piece implants have reportedly been used successfully in maxilla and mandible, most of the dentists believes that the single-piece implant should be restricted to an anterior region, this could be because of the results of few single-piece implants like Nobel Direct (Nobel biocare, Sweden) have shown lower success rates and more bone resorption when used in posterior region and immediately loaded. [25] Immediate loading concept has demonstrated high implant survival rates, but cautiously recommended for certain clinical situations, [26] which was rightly agreed by most of the dentists across the world, sparing dentists from India and Pakistan, the reason for which needs to be investigated. Many dentists preferred sinus elevation with an immediate-implant placement procedure.


   Conclusion Top


Within the limitation of the study few questions were framed on the practitioner's opinion, but not literature evidence. It can be concluded from the survey that, most of the dentists follow the well documented technique and proven materials, which have been documented in the literature and in an evidenced based practice, thus delivering the best to their patients. It can also be observed from the survey that the dentists from the developing nation's desires for standardization ion of the implants, which could reduce the cost of the inventories, thus benefiting to many more patients especially in the developing nations. Hence, efforts have to be made to simplify the technique and to make this treatment modality reach many more deserved patients across the world. Implant dentistry should not be restricted to any particular specialty, which came out as a general opinion of most dentists with more emphasis on teamwork involving specialists.


   Acknowledgement Top


We would like to sincerely thank Dr Vakil HK for his timely support in framing the questionnaire.

 
   References Top

1.Adell R, Lekholm U, Rockler B, Branemark PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 1981;10:387-416.  Back to cited text no. 1
    
2.Adell R. Clinical results of osseointegrated implants supporting fixed prostheses in edentulous jaws. J Prosthet Dent 1983; 50:251-4.  Back to cited text no. 2
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3.Branemark PI, Hansson BO, Adell R, Breine U, Lindstrom J, Hallen O, et al. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10- year period. Scand J Plast Reconstr Surg Suppl 1977;16:1-132.  Back to cited text no. 3
    
4.Branemark PI, Adell R, Albrektsson T, Lekholm U, Lundkvist S, Rockler B. Osseointegrated titanium fixtures in the treatment of edentulousness. Biomaterials 1983;4:25-8.  Back to cited text no. 4
    
5.Branemark PI, Adell R, Albrektsson T, Lekholm U, Lindstrom J, Rockler B. An experimental and clinical study of osseointegrated implants penetrating the nasal cavity and maxillary sinus. J Oral Maxillofac Surg 1984;42:497-505.  Back to cited text no. 5
    
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13.Brunski JB. In vivo bone response to biomechanical loading at the bone/dental-implant interface. Adv Dent Res 1999;13:99-119.  Back to cited text no. 13
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14.Young MP, Sloan P, Quayle AA, Carter DH. A survey of clinical members of the association of dental implantology in the United Kingdom. Part II. The use of augmentation materials in dental implant surgery. Implant Dent 2001;10:149-55.  Back to cited text no. 14
    
15.Lambrecht JT, Cardone E, Kuhl S. Status report on dental implantology in Switzerland in 2006. A cross-sectional survey. Eur J Oral Implantol 2010;3:71-4.  Back to cited text no. 15
    
16.Vander Bilt A, Burgers M, Van kampen FM, Cune MS. Mandibular implant-supported over dentures and oral function. Clin oral Implants Res 2010;21:1209-13.  Back to cited text no. 16
    
17.The McGill consensus statement on over dentures. Quintessence Int 2003; 34:78-79.  Back to cited text no. 17
    
18.Lee H, So JS, Hochstedler JL, Ercoli C. The accuracy of implant impressions: a systematic review. J Prosthet Dent 2008;100:285-91.  Back to cited text no. 18
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19.Hariharan R, Shankar C, Rajan M, Baig MR, Azhagarasan NS. Evaluation of accuracy of multiple dental implant impressions using various splinting materials. Int J Oral Maxillofac Implants 2010;25:38-44.  Back to cited text no. 19
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20.Daoudi MF, Setchell DJ, Searson LJ. A laboratory investigation of the accuracy of two impression techniques for single-tooth implants. Int J Prosthodont 2001;14:152-8.  Back to cited text no. 20
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21.Lee A, Okayasu K, Wang HL. Screw- versus cement-retained implant restorations: Current concepts. Implant Dent 2010;19:8-15.  Back to cited text no. 21
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22.Stanford CM, Wagner W, Rodriguez YB, Norton M, McGlumphy E, Schmidt J. Evaluation of the effectiveness of dental implant therapy in a practice-based network (FOCUS). Int J Oral Maxillofac Implants 2010;25:367-73.  Back to cited text no. 22
    
23.Stanford CM. Dental implants. A role in geriatric dentistry for the general practice? J Am Dent Assoc 2007;138 Suppl:34S-40S.  Back to cited text no. 23
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24.New American Dental Association Soecification no. 28 for endodontic files and reamers. Council on Dental Materials and Devices. J Am Dent Assoc 1976;93:813-7.  Back to cited text no. 24
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25.Ostman PO, Hellman M, Albrektsson T, Sennerby L. Direct loading of Nobel Direct and Nobel Perfect one-piece implants: A 1-year prospective clinical and radiographic study. Clin Oral Implants Res 2007;18:409-18.  Back to cited text no. 25
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26.Henry PJ, Liddelow GJ. Immediate loading of dental implants. Aust Dent J 2008 53 Suppl 1:S69-81.  Back to cited text no. 26
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Correspondence Address:
R Chowdhary
Department of Prosthodontics, S. Nijalingappa Institute of Dental sciences and Research, Gulbarga
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.100465

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