Outcomes of implants and restorations placed in general dental practices: a retrospective study by the Practitioners Engaged in Applied Research and Learning (PEARL) Network

How far can we go? A 20-year meta-analysis of dental implant survival rates

OBJECTIVE

This meta-analysis aims to investigate the long-term survival rates of dental implants over a 20-year period, providing a practical guide for clinicians while identifying potential areas for future research.

MATERIALS AND METHODS

Data were sourced from recent publications, focusing exclusively on screw-shaped titanium implants with a rough surface. Both retrospective and prospective studies were included to ensure an adequate sample size. A systematic electronic literature search was conducted in the databases: MEDLINE (PubMed), Cochrane, and Web of Science. The risk of bias for all studies was analyzed using a tool by Hoy et al. RESULTS: Three prospective studies (n = 237 implants) revealed a mean implant survival rate of 92% (95% CI: 82% to 97%), decreasing to 78% (95% CI: 74%-82%) after imputation (n = 422 implants). A total of five retrospective studies (n = 1440 implants) showed a survival rate of 88% (95% CI: 78%-94%). Implant failure causes were multifactorial.

CONCLUSION

This review consolidates 20-year dental implant survival data, reflecting a remarkable 4 out of 5 implants success rate. It emphasizes the need for long-term follow-up care, addressing multifactorial implant failure. Prioritizing quality standards is crucial to prevent overestimating treatment effectiveness due to potential statistical errors. While dental implantology boasts reliable therapies, there is still room for improvement, and additional high-quality studies are needed, particularly to evaluate implant success.

CLINICAL RELEVANCE

Never before have the implant survival over 20 years been systematically analyzed in a meta-analysis. Although a long-term survival can be expected, follow-up is essential and shouldn't end after insertion or even after 10 years.

Dental implant failures in Utah and US veteran cohorts

INTRODUCTION

Approximately, 5.5 million dental implants are estimated to be surgically placed in the United States yearly, with an anticipated long-term failure rate ranging from 3% to 10%. At the Salt Lake City Dental Clinic within the Department of Veterans Affairs (VHA), specific protocols have been established to mandate that clinicians present every dental implant case for review by a committee. To understand the effectiveness of this approach, a comparative data analysis was undertaken to compare local dental implant failure data against national VHA data.

METHODS

Leveraging electronic health records of veterans spanning from 2000 to 2021, we gathered procedural records related to dental implant placement or failure, demographic information, and medical history for individuals who received dental care at various dental clinics within the nationwide VHA network. Subsequently, statistical analyses were conducted using mixed-effects Poisson regression models with cluster-robust standard errors. Incident rate ratios (IRRs) for Utah-specific and nationwide cohorts were ascertained.

RESULTS

The Utah VHA dental clinical data showed that there was a slightly lower prevalence of implant failure at 6.7% compared to the national cohort, which had a rate of 6.9%. The implant level failure rates were also low, with 4.20 (confidence interval [CI]: 3.68, 4.81) per 1000 implant placements per year for Utah cohorts. The adjusted IRR indicated a relative 16% reduction in risk among Utah Veterans (IRR 0.84, 95% CI [0.76-0.92]; p < 0.001).

CONCLUSIONS

The stringent protocols in place at Salt Lake City, which integrate evidence-based practices and expert opinion for evaluating patient suitability for dental implant placement and subsequent care, contributed to the reduced risk among Utah Dental Clinic veterans pool compared to veterans of other states.

The referral pattern and treatment modality for peri-implant disease between periodontists and non-periodontist dentists

OBJECTIVES

This study is to investigate the referral pattern and treatment modality of dentists in the management of peri-implant diseases between periodontists and non-periodontist dentists (NPDs).

MATERIALS AND METHODS

A total of 167 validated questionnaires were obtained from periodontists and NPDs, who had experience of placing implants for at least one year. Question I to IV asked how the dentist would respond if a patient came for treatment of their peri-implant diseases with four different scenarios according to resource of patient and disease severity. For each Scenario, dentists also replied which treatment procedures they would use if they decide to treat the patient.

RESULTS

Periodontal training, resource of patient, and disease severity were shown to significantly influence the referral pattern and treatment modality in the management of peri-implant disease (p < 0.05). Periodontists were more likely to use variable treatment procedures, including occlusal adjustment (OR = 2.283, p < 0.01), oral hygiene instruction (OR = 3.751, p < 0.001), topical antiseptic agent (OR = 2.491, p < 0.005), non-surgical mechanical therapy (OR = 2.689, p < 0.001), surgical therapy (OR = 2.009, p < 0.01), and remove implant (OR = 3.486, p < 0.001) to treat peri-implant diseases, compared to NPDs.

CONCLUSION

The periodontal specialty training, resource of patient, and disease severity significantly influenced the referral pattern and treatment modality of dentist treating an implant diagnosed with peri-implant disease. This study also highlighted the importance of educating basic periodontal and peri-implant disease-related knowledge to all dentists regularly performing dental implant treatments.

CLINICAL RELEVANCE

Peri-implant diseases are highly prevalent among patients with dental implants. Periodontal specialty training could enhance using variable treatment procedures to treat peri-implant diseases for dentists.

Increasing the margin of patient safety for periodontal and implant treatments: The role of human factors

Early complications following periodontal and dental implant surgeries are typically attributed to technique or poor biological response, ignoring the possibility of the human element. Interestingly, significant experience is not correlated with increased success, whereas evidence supports the impact of clinical behavior on patient outcome. This is the result of errors, much like those scrutinized in other high-risk technical fields, such as aviation. What can be surprising is that those who make these errors are very well acquainted with best practices. Given this, how is it possible for the conscientious practitioner to fail to apply protocols that are nonetheless very well known? Recently, the concepts of human and organizational factors have been translated to medicine, though dentistry has been slow to recognize their potential benefit. This review lists specific human factor behaviors, such as use of checklists and crew resource management, which might improve postsurgical outcome.

Impact of salivary contamination during implant placement with different surface characteristics in native and augmented bone: An in vivo study in sheep calvaria model

OBJECTIVES

The aim of this study was to evaluate whether salivary contamination during placement of implants with different surface characteristics affects osseointegration in native and in augmented bone areas.

MATERIALS AND METHODS

Forty eight implants with machined surface (MS) and 48 implants with moderately rough surface (RS) were tested in the calvaria of 12 sheep. At the first surgery, 64 bony critical defects were randomly created and were subsequently augmented with two materials (autogenous or bovine bone). After 5 weeks of graft healing, 8 implants were placed per sheep, in native bone and in the centre of the augmented defects. Forty eight implants were soaked with saliva before placement (contaminated group [CG]), while 48 implants were not (non-contaminated group [NCG]). Five weeks after implant placement, bone-to-implant contact (BIC) and bone material area fraction occupancy (BMAFO) were calculated histomorphometrically.

RESULTS

Saliva contamination showed a significant negative effect (p = .000) on BIC, especially in augmented areas. RS showed significant positive effect on BIC, compared to MS (p = .000), while there were no significant differences for different bone conditions (p = .103). For BMAFO, the contamination showed a significantly negative affect (p = .000), while there were no significant differences for surface characteristics (p = .322) and for bone condition (p = .538).

CONCLUSION

Saliva contamination during dental implant placement has a negative effect on osseointegration in augmented areas. Moderately rough surface has a possible advantage in the aspect of initial bone to implant contact. However, it seems to be advisable to avoid saliva contamination especially for implants placed in augmented bone areas.

Interproximal implant thread exposure after initial bone remodeling as a risk indicator for peri-implantitis

BACKGROUND

Due to the clinical challenges involved in successfully treating peri-implantitis, it is imperative to identify patient- and implant-level risk factors for its prevention. The main goal of this retrospective longitudinal radiographic and clinical study was to investigate whether interproximal radiographic implant thread exposure after physiological bone remodeling may be a risk factor for peri-implantitis. The secondary goal was to evaluate several other potential risk indicators.

METHODS

Of 4325 active dental school patients having implants placed, 165 partially edentulous adults (77 men, 88 women) aged 30-91 with ≥2 years of follow-up upon implant restoration were included. Implants with ≥1 interproximal thread exposed (no bone-to-implant contact) (n = 98, 35%) constituted the test group and those without exposed threads (n = 182, 65%) the control group. Descriptive, binary, and multivariate regression analyses were evaluated for goodness of fit. Wald tests were used to evaluate for significance set at 0.05.

RESULTS

Of the 280 implants (98 test, 182 control), 8 (2.9%) failed over a mean follow-up period of 7.67 (±2.63) years, and 27 implants (19 test, 8 control) developed peri-implantitis, with the exposed group having eight-fold (7.82 times) adjusted greater odds than the non-exposed. The risk increased four-fold (3.77 times) with each thread exposed. No other patient- or implant-related potentially confounding risk factors were identified.

CONCLUSIONS

Exposed interproximal implant threads after physiologic bone remodeling may be an independent risk indicator for incident peri-implantitis. Hence, clinicians should closely monitor patients with implant threads that have no bone-to-implant contact for incident peri-implantitis.

Patient-reported oral hygiene and implant outcomes in general dental practice

BACKGROUND

This study investigated the possible correlations between patient-performed implant hygiene and peri-implant success and disease, as well as patient-reported outcomes, in a community-based cohort.

METHODS

Fifty-one patients (78 implants) from two private general practices were surveyed on their dental implant treatment history, oral hygiene instructions (OHI) received, home hygiene habits and current implant concerns. Their dentition, plaque/calculus scores and clinical implant parameters were examined. Correlations between hygiene habits, risk factors, implant success and peri-implant disease rates were assessed.

RESULTS

Implants had a patient-reported mean time in function of 6.7 years. Floss (74.4%), interdental brushes (IDB) (44.9%) and mouthwash (39.7%) were commonly used, while 7.7% of implants were only cleaned by brushing. Over half (56.4%) of implants fulfilled the success criteria, 61.5% had peri-implant health, 24.4% had mucositis and 7.7% had peri-implantitis. Only brushing (P < 0.001) and detectable plaque/calculus (P < 0.001) were significantly associated with more peri-implant disease. Local prosthetic factors affecting cleaning accessibility significantly reduced implant success (P < 0.001). Patients reported mixed recall of implant OHI, 7.7% of implants were aesthetically unsatisfactory and 9.0% had peri-implant symptoms.

CONCLUSIONS

Lack of interproximal cleaning and the presence of plaque/calculus were significantly associated with peri-implant disease in a community-based general practice setting, and patients reported mixed recall of OHI.

The effectiveness of immediate implant placement for single tooth replacement compared to delayed implant placement: A systematic review and meta-analysis

AIM

To compare immediate implant placement (IIP) to delayed single implant placement (DIP, ≥3 months post-extraction) in terms of implant survival (primary outcome), surgical, clinical, aesthetic, radiographic and patient-reported outcomes (secondary outcomes).

MATERIALS AND METHODS

Two reviewers independently performed an electronic search in PubMed, Web of Science, EMBASE and Cochrane and a hand search to identify eligible studies up to May 2018. Only randomized controlled trials (RCTs) and non-randomized controlled studies (NRSs) comparing IIP to DIP with at least 1 year of follow-up were selected for a qualitative analysis and meta-analysis.

RESULTS

The search identified 3 RCTs and 5 NRSs out of 2,589 titles providing data on 473 single implants (IIP: 233, DIP: 240) that had been in function between 12 and 96 months. One RCT showed unclear risk of bias, whereas all other studies demonstrated high risk. Meta-analysis showed significantly lower implant survival for IIP (94.9%) as compared to DIP (98.9%) (RR 0.96, 95% CI [0.93; 0.99], p = 0.02). All were early implant failures. A subgroup meta-analysis demonstrated a trend towards lower implant survival for IIP when postoperative antibiotics had not been administered (RR: 0.93, 95% CI [0.86; 1.00], p = 0.07). This was not observed among studies including the administration of postoperative antibiotics (RR: 0.98, 95% CI [0.94; 1.02], p = 0.35). Meta-analyses showed similar probing depth (WMD 0.43 mm, 95% CI [-0.47; 1.33], p = 0.35) and aesthetic outcomes as assessed by the pink aesthetic score (standardized WMD -0.03, 95% CI [-0.46; 0.39], p = 0.88) for IIP and DIP. Data on marginal bone loss were conflicting and highly biased. Soft tissue recession was underreported and available data were highly biased. Patient-reported outcomes were underreported, yet both IIP and DIP seemed well tolerated.

CONCLUSION

Immediate implant placement demonstrated higher risk for early implant loss than DIP. There is a need for RCTs comparing IIP to DIP with CBCT analyses at different time points and data on midfacial recession with the preoperative status as baseline. In these studies, the need for hard and soft tissue grafting should also be evaluated.

Risk factors in bone augmentation procedures

Bone augmentation is an extremely common procedure in implant dentistry today because of significant advancements with reactive biomaterials, a better understanding of the mechanism of action that is found with growth factors contained in platelets, and improvements in surgical techniques. The expectation is for the surgeon to place the dental implant in the position that best serves the requirements of the prosthetic restorations. With the increasing demands that patients have for ideal prosthetic results, surgeons are expected to predictably augment both hard and soft tissues to provide the anticipated esthetic and functional outcomes. Bone grafting can be performed before, during, and after the implant placement; however, these augmentation procedures come with increased cost, the risk of complications such as infection or failure, and lengthening of the total treatment time. In addition, a plethora of grafting materials are available commercially, where they are often inadequately studied, or there is minimal information regarding their predictability or long-term success, or ability to support dental implants. It is clear that although the surgical field has seen major progress since early implant surgical techniques in the 1980s, major challenges still exist with hard tissue augmentation procedures. This review will discuss these challenges that are increased and often specific to bone graft healing, and which are becoming more common as implant site development often requires bone augmentation to improve volume or contour deficiencies. The risk factors that patients may present with that will affect outcomes with bone augmentation procedures are identified, and recommendations for the prevention of complications or managing complications once they have occurred are provided.

Surgical extrusion of a maxillary premolar after orthodontic extrusion: a retrospective study

Objectives

Crown-root fracture and cervical caries in maxillary premolars constitute a challenge in cases of subgingival placement of restoration margins. Surgical extrusion has been practiced successfully in permanent anterior teeth. The aim of the present retrospective study was to assess the clinical outcome of surgical extrusion after orthodontic extrusion in maxillary premolars.

Materials and Methods

Twenty-one single, tapered root maxillary premolars with subgingival crown-root fracture or caries were included. Presurgical orthodontic extrusion was performed on all teeth to prevent root resorption. Extent of extrusion and rotation was determined based on crown/root ratio. The postoperative splinting period was 7 to 14 days. Clinical and radiographic examination was performed at an interval of 1, 2, and 3 months.

Results

After the mean follow-up of 41.9±15.2 months, failure was observed as increased mobility in 3 of 21 cases. No significant difference was observed in the outcome of surgical extrusion based on tooth type, age, sex, 180° rotation, or time for extraction. Furthermore, marginal bone loss was not observed.

Conclusion

Surgical extrusion of maxillary premolars can be a possible therapeutic option in cases of subgingival crown-root fracture.

Long-term (10-year) dental implant survival: A systematic review and sensitivity meta-analysis

OBJECTIVES

To identify and appraise the most recent studies reporting dental implant survival in adults (≥18 years) using contemporary implant systems (solid screw, roughened surface) for a period of 10 years; and explore new predictors of implant survival.

SOURCE

MEDLINE, Scopus, and the Cochrane Central Register of Controlled trials were searched from 1997 to January 2018 to focus on contemporary implant systems.

STUDY SELECTION

Only prospective observational studies with at least 10 participants and 35 implants were included. The unit of study was the 'absolute survival' rate of dental implants after 10 years in the oral cavity. Study quality was assessed utilising a modified Hoy risk of bias tool for prevalence studies. A sensitivity meta-analysis was undertaken utilising a plausibly imputed model for missing data.

DATA

18 studies met the inclusion criteria. The summary estimate for 10-year survival at the implant level was 96.4% (95% CI 95.2%-97.5%) and the prediction interval was 91.5%-99.4%. The sensitivity meta-analysis summary estimate of survival was 93.2% (95% CI 90.1% to 95.8%)p = 0.041 with a prediction interval of 76.6%-100%. Older age (≥ 65 years) was a significant predictor at 91.5%, p = 0.038 in the sensitivity meta-analysis.

CONCLUSIONS

A traditional analysis produced similar 10-year survival estimates to previous systematic reviews. A more realistic sensitivity meta-analysis accounting for loss to follow-up data and the calculation of prediction intervals demonstrated a possible doubling of the risk of implant loss in the older age groups.

CLINICAL SIGNIFICANCE

Improved analysis provides the clinician with better estimation of the real-world risk of implant failures so helping the clinician communicate the potential risk to patients.

Survival rates of hybrid rough surface implants and their alveolar bone level alterations

BACKGROUND

The design of hybrid surface implants takes advantage of characteristics of two different textures to improve clinical outcomes. To date, there are limited numbers of studies reporting the clinical results of hybrid surface implants. This study aimed to assess hybrid surface implants with two different rough textures in regard to survival, marginal bone level change, and biological complications.

METHODS

Retrospective review of dental records was conducted for 161 patients who had 460 hybrid surface implants to analyze survival rate. These implants had the dual sandblasted and anode oxidized surface. Sixty patients with 192 implants who had consecutive radiographs taken at specific time points and complete clinical examinations were included in the comprehensive analysis. The associations between patient- and implant-related characteristics, and clinical results were analyzed by log-rank test, Cox regression, and linear regression analysis.

RESULTS

Cumulative survival at 12, 36, and 60 months after placement was 97.4%, 96.4%, and 95.8%, respectively. The average marginal bone level change from baseline to the last visit was 0.31 ± 0.68 mm and 0.34 ± 0.77 mm at the mesial and distal sites, respectively. Prevalence of peri-implantitis was 0.5% at the implant level and 1.7% at the patient level. Implant site was associated with implant failure (P = 0.03). Smoking habit, history of periodontitis, and implant site were significantly associated with marginal bone level change (P = 0.001, < 0.001, 0.01, respectively).

CONCLUSIONS

Hybrid rough surface implants had high survival rate, stable bone level, and low prevalence of biological complications. This surface design demonstrated promising clinical outcomes. More studies are needed to further support the clinical advantages of hybrid surface implants.

Fatigue resistance of all-ceramic fixed partial dentures - Fatigue tests and finite element analysis

OBJECTIVE

To estimate the fatigue resistance of a new translucent zirconia material in comparison to lithium disilicate for 3-unit fixed partial dentures (FPDs).

METHODS

Eighteen 3-unit FPDs (replacement of first upper molar) with a connector size of 4mm×4mm were dry milled with a five-axis milling machine (Zenotec Select, Wieland, Germany) using discs made of a new translucent zirconia material (IPS e.max ZirCAD MT, Ivoclar Vivadent). Another 9 FPDs with a reduced connector size (3mm×4mm) were milled. The zirconia FPDs were sintered at 1500°C. For a comparison, 9 FPDs were made of IPS e.max Press, using the same dimensions. These IPS e.max Press FPDs were ground from a wax disc (Wieland), invested and pressed at 920°C. All FPDs were glazed twice. The FPDs were adhesively luted to PMMA dies with Multilink Automix. Dynamic cyclic loading was carried out on the molar pontic using Dyna-Mess testing machines (Stolberg, Germany) with 2×10⁶ cycles at 2Hz in water (37°C). Two specimens per group and load were subjected to decreasing load levels (at least 4) until the two specimens no longer showed any failures. Another third specimen was subjected to this load to confirm the result. All the specimens were evaluated under a stereo microscope (20× magnification). The number of cycles reached before observing a failure, and their dependence on the load and on the material, were modeled, using a Weibull model. This made it possible to estimate the fatigue resistance as the maximum load for which one would observe less than 1% failure after 2×10⁶ cycles. In addition to the experimental study, Finite Element Modeling (FEM) simulations were conducted to predict the force to failure for IPS e.max ZirCAD MT and IPS e.max Press with a reduced cross-section of the connectors.

RESULTS

The failure mode of the zirconia FPDs was mostly the fracture of the distal connector, whereas the failure mode of the lithium disilicate FPDs observed to be the fracture of the connectors or multiple cracks of the pontic. The fatigue resistance with 1% fracture probability was estimated to be 488N for the IPS e.max ZirCAD MT FPDs (453N for repeated test), 365N for IPS e.max ZirCAD MT FPDs with reduced connector size and 286N for the e.max Press FPDs. All three IPS e.max ZirCAD groups statistically performed significantly better than IPS e.max Press (p<0.001). On the other hand, no significant difference could be established between the two IPS e.max ZirCAD MT3 groups with a 4mm×4mm connector size (p>0.05). The allowable maximum principal stress (σ_max) which did not lead to failure during fatigue testing for IPS e.max ZirCAD MT3 was calculated between 208MPa and 223MPa for FPDs with 4mm×4mm connectors for 2×10⁶ cycles. This value could also be verified for the FPDs of the same material with 3mm×4mm connectors. On the other hand fatigue strength in terms of σ_max at 2×10⁶ cycles of IPS e.max Press was calculated to be between 78 and 90MPa.

SIGNIFICANCE

The fatigue resistance of the translucent zirconia 3-unit FPDs was about 60-70% higher than that of the lithium disilicate 3-unit FPDs, which may justify their use for molar replacements, provided that a minimal connector size of 4mm×4mm is observed. Even with a limited number of specimens (n=9) per group it was possible to statistically differentiate between the tested groups.

A survey of undergraduate orthodontic teaching and factors affecting pursuit of postgraduate training

Background Undergraduate orthodontic teaching has been focused on developing an understanding of occlusal development in an effort to equip practitioners to make appropriate referrals for specialist-delivered care. However, there is a growing interest among general dentists in delivering more specialised treatments, including short-term orthodontic alignment. This study aimed to assess the levels of knowledge of occlusal problems among final year undergraduate dental students, as well as their interest in various orthodontics techniques and training.Methods A 36-item electronic questionnaire was sent to all final year undergraduate students in four dental institutes in the UK (Barts and the London, Kings College London, Cardiff and Dundee). The questionnaire explored satisfaction with undergraduate orthodontic teaching; students' perception of knowledge, based on General Dental Council learning outcomes; perceptions of the need for specialist involvement in the management of dental problems; interest in further training in orthodontics; and potential barriers to undertaking specialist training.Results The overall response rate was 66% (239/362). The majority of students (84.1%) were aware of GDC guidance in terms of undergraduate teaching. Students reported a preference for case-based and practical teaching sessions in orthodontics, with less interest in lectures or problem-based learning approaches. A high percentage were interested in further teaching in interceptive orthodontics (60.3%) and fixed appliance therapy (55.7%). Further training including specialist orthodontic training (36.4%), Invisalign (59%) and Six Month Smiles (41%) courses appealed to undergraduates. Levels of student debt, course fees and geographical issues were seen as potential barriers to formal, specialist training pathways.Conclusions Satisfaction with undergraduate orthodontic teaching is high and interest in further training, including specialist training pathways, continues to be high. While short-term orthodontics is not taught at undergraduate level, there appears to be an appetite to undertake alternatives to conventional orthodontics among dental students.

Establishment of Epithelial Attachment on Titanium Surface Coated with Platelet Activating Peptide

The aim of this study was to produce epithelial attachment on a typical implant abutment surface of smooth titanium. A challenging complication that hinders the success of dental implants is peri-implantitis. A common cause of peri-implantitis may results from the lack of epithelial sealing at the peri-implant collar. Histologically, epithelial sealing is recognized as the attachment of the basement membrane (BM). BM-attachment is promoted by activated platelet aggregates at surgical wound sites. On the other hand, platelets did not aggregate on smooth titanium, the surface typical of the implant abutment. We then hypothesized that epithelial BM-attachment was produced when titanium surface was modified to allow platelet aggregation. Titanium surfaces were coated with a protease activated receptor 4-activating peptide (PAR4-AP). PAR4-AP coating yielded rapid aggregation of platelets on the titanium surface. Platelet aggregates released robust amount of epithelial chemoattractants (IGF-I, TGF-β) and growth factors (EGF, VEGF) on the titanium surface. Human gingival epithelial cells, when they were co-cultured on the platelet aggregates, successfully attached to the PAR4-AP coated titanium surface with spread laminin5 positive BM and consecutive staining of the epithelial tight junction component ZO1, indicating the formation of complete epithelial sheet. These in-vitro results indicate the establishment of epithelial BM-attachment to the titanium surface.

Knowledge and practice of implant-retained restorations among dental students in Saudi Arabia

Objectives:

The aim of the study was to assess the knowledge and practice of implant retained restorations (IRR) among senior dental students in Saudi Arabia.

Methods:

Four hundred questionnaires were distributed among senior dental students of five dental schools in Saudi Arabia. Student’s knowledge was assessed regarding which implant restoration [cement retained restoration (CRR) or screw retained restoration (SRR)] better provides the desired clinical properties. Students’ practice of IRR, perception of their knowledge and need for further education related to IRR were also assessed. Descriptive statistics and chi-square test were employed to assess collected data.

Results:

Three hundred and fifty four senior dental students responded at a response rate of 88.5%. Thirty three percent respondents did not have any practical experience of IRR. Students showed a clear preference for CRR with regards to aesthetics (71.4%), passive fit (55.3%), fabrication ease (57.3%) and fracture resistance (40%). SRR were considered to provide better retention (59.6%), soft tissue health (51.1%) and ease of retrievability (72%). Nearly 40% of students agreed that they did not get sufficient information related to IRR in undergraduate courses.

Conclusions:

Clinical training of IRR is compromised in the undergraduate curriculum in dental schools of Saudi Arabia. The knowledge of dental students regarding IRR was broadly in line with current evidence.

DENTAL IMPLANT TREATMENT AT A NIGERIAN TEACHING HOSPITAL

BACKGROUND

There has been an increase in the awareness of dental implant as a replacement option for missing teeth and this has consequently led to an increased demand for dental implant.

AIM & OBJECTIVES

To determine the distribution and pattern of implant placement in a tertiary hospital in a developing country.

MATERIALS & METHODS

This retrospective study was conducted at the University College Hospital to assess the treatment outcome of all the patients who had had osseointegrated root form endosseous dental implants over a period of five years. The data obtained included age, gender, socioeconomic status (SES), medical history, reason for implant placement, number of implants per patient, distribution of missing teeth, complications and treatment outcome. The data were analyzed for percentages, means, SD and presented in tables and figures.

RESULTS

Forty two implants (40 conventional & 2 immediate) were placed in the 23 patients (M-15, F=8).There were 15(65.2%) males and 8(34.8%) females. Pre-implant placement ridge augmentation was done in 3(7.1%) patients while 9 (39.1%) patients had augmentation during implant placement surgery. Left maxillary central incisor was the most commonly replaced tooth in 31% followed by the right maxillary central incisor in 19%. The success rates in the study at 1 year and 5 years were 97.4% and 95.2% respectively.

CONCLUSION

A high success rate (95.2%) of implant therapy at 5 years recorded in this study compared favorably with what is obtainable in many other countries of the world.