A survey of oral implantology teaching in the university dental hospitals and schools of the United Kingdom and Eire

AIM: To provide an overview of the currently available academic teaching and clinical training in oral implantology at the university dental schools and hospitals of the United Kingdom and Eire. METHOD: A questionnaire was sent to the dean or director of dental studies and forwarded to the respective units involved in the academic teaching and clinical training of oral implantology. The setting was the university dental hospitals, and dental schools of the UK and Eire. Information was collected between July 1997 and March 1999. The main outcome measures were course availability, duration and emphasis for undergraduate and postgraduate study in the clinical discipline of oral implantology. The units or departments responsible for training and teaching were identified and formal degree courses were distinguished from non-degree courses. RESULTS: All institutions replied to the survey. All university dental schools provide undergraduate training in oral implantology in accordance with the guidelines provided by the General Dental Council. However, the courses vary with regard to the departments involved and the level of student participation. Thirteen centres provide informal postgraduate training with the duration ranging from one to eighteen days. Just eight centres provide formal academic graduate training based on oral implantology leading to recognised degrees. CONCLUSION: All university dental schools provide undergraduate teaching in oral implantology. Most centres also provide informal postgraduate training based on oral implantology. However, opportunities for academic graduate training, leading to recognised qualifications in this subject, appear limited at present.     

五年制口腔医学生口腔种植修复临床前教学实践探索

经历了几十年的快速发展,口腔种植修复技术已然成熟,口腔种植的概念也已深入人心,尤其在大、中城市。然而,经过专门培训的口腔种植专业医生数量有限,口腔医学本科专业的医学生应该掌握这门技术,为今后快速步入口腔种植修复领域提供保障。本文针对五年制口腔医学专业口腔种植学科人才培养现状,对口腔种植修复临床前教学改革进行思考,使口腔医学专业毕业生在未来口腔种植修复领域有所建树。     

Implants for fixed and removable prostheses.

For those individuals whose oral anatomy contraindicates the use of endosteal implants, there still remains a viable alternative to conventional removable dentures. Both maxillary and mandibular implant dentures of a subperiosteal design will provide a stable implant and a retentive restorative prosthesis. The patient is free from the oral gymnastics required to manipulate such appliances and in the maxilla the dentist is able to eliminate all palatal coverage without compromising the retention of the bridge. The lower subperiosteal implant and the pterygoid extension implant discussed both obtain their stability from accurate fit of the implant substructure to the bone. The implant first becomes more retentive when the periosteum tenaciously reattaches itself to the bone and in turn secures the implant in position (Fig. 13). The restorative procedures follow sound prosthetic prinicples with particular attention on avoiding any impingement of the underlying tissue areas. Implant dentures have truly provided patients a means of exploring alternative treatment modalities other than conventional removable dentures. Literally thousands of patients today are living testimony to the accomplishments of oral implantology when pursued as an exacting science prescribed by colleagues experienced in this revolutionary dental discipline.     

Dental patients’ awareness and knowledge in using dental implants as an option in replacing missing teeth: A survey in Riyadh,Saudi Arabia

Aim

The purpose of this survey was to assess the level, sources, and need for information about dental implants among a selected sample of dental patients in Riyadh, Saudi Arabia.

Materials and methods

Patients’ knowledge and awareness in using dental implants as an option in replacing missing teeth were evaluated through a standardized self- explanatory questionnaire distributed in two places in Riyadh: Military Hospital and College of Dentistry, King Saud University (Darraiyah campus). The questionnaires were handed to the patients during their regular dental visits. A total of 379 subjects were included in this survey.

Results

The results of this study indicate that 66.4% of the subjects knew about dental implants. The subjects’ friends and their relatives were the main source of information about dental implants for 31.5% of the subjects, and dentists were the secondary source for 28.3% of the sample. About 82.4% of the subjects need more information about dental implants and 85.2% of them chose the dentist to be the desired source for such information, followed by the internet in 28.5% of the cases. Almost 74.4% of those surveyed did not know if their regular dentists use dental implants. High cost was the major factor in preventing patients from choosing implants in 86.5% of the cases while the long treatment time and fear of surgery was the factor in 71% and 68.6% of the subjects, respectively.

Conclusion

The results of this survey showed an acceptable level of awareness about dental implants among a selected sample of dental patients in Riyadh. It also showed the need for providing more general and accurate information to the patients about this treatment modality.     

The effectiveness of out-of-hours dental services: I. Pain relief and oral health outcome

OBJECTIVE: To compare the effectiveness of four types of out-of-hours emergency dental service, including both 'walk-in' and telephone-access services. BASIC DESIGN: Questionnaire survey of patients attending weekend emergency dental services, with measurement of self-reported oral health status and dental pain (at attendance and follow-up) and retrospective judgements of change in oral health status. SETTING: Two health authorities in South Wales, UK. SUBJECTS: A total of 783 patients who completed questionnaires at attendance, and 423 who completed follow-up questionnaires. RESULTS: For patients who saw a dentist there were no consistent differences in the effectiveness of the four services, whether measured as pain relief, oral health gain or using patients' retrospective transition judgements about feeling better after their episode of emergency dental care. The proportion of patients reporting no improvement (transition judgements), either an hour after or the day after seeing the dentist, was surprisingly high (30-40% and 23-38% respectively). Although the 'rotas for all' - a telephone-access GDP-provided service for both registered and unregistered patients - achieved both the highest reductions in pain scores and the greatest improvements in dental health status between attendance and follow-up, this effect may reflect health gains due to care received after the episode of emergency dental care. CONCLUSIONS: Neither the setting where emergency dental patients are seen, nor the type of dentist who sees them, appear to have any significant effect on patient-reported health outcomes. Although further exploration of the factors that predict poor pain relief or low oral health gain is required, future research on these services should focus on the process of care and accessibility.     

The New York State Minority Health Survey: determinants of oral health care utilization

OBJECTIVES: To determine the factors associated with visits to a dentist and more specifically the role of dental insurance coverage and to explore the reasons for not visiting a dentist among minorities in New York State. METHODS: The Minority Health Survey was a one-time, statewide, random digit-dialed telephone survey. We drew a directed acyclic graph (DAG) of the potential determinants of oral health care utilization for our population of interest and modeled the independent variables as determinants of oral health care utilization. The data for this study were analyzed in SUDAAN using appropriate weights and variance adjustments that accounted for the complex sampling design. Hence, this report is generalizable to the New York State adult "minority" population. RESULTS: About 63 percent respondents had visited a dentist in the past one year. Having dental insurance (adjusted odds ratio [adj OR]=2.5), having more than high school education (adj OR=1.9), being younger (adj OR=2.3 for 18-25 years vs age 40 years or older), being married (adj OR=1.7), being dentate (adj OR=0.3 for edentulousness), and having higher income (adj OR=0.5 for middle vs high income) were significantly associated with having visited a dentist in the past year. Cost and awareness-related factors were the most common reasons for not visiting a dentist. Most of the year 2000 oral health objectives measurable in this survey were not met. CONCLUSION: Increasing dental insurance coverage and increasing awareness about oral health care would be the two biggest factors in meeting the goals of year 2010.     

Dental implants in patients with osteoporosis: a clinical reality?

Osteoporosis is a systemic disorder characterized by generalized decrease in bone mineral density. Dental implantology is a specialty with high predictability when both quantity and quality of the bone are respected. Therefore, the diagnosis and the implant treatment in patients with osteoporosis are important. In the current study, a literature review about osteoporosis and dental implant therapy was conducted. PubMed, Cochrane, ISI, Dentistry Oral Science, SciELO, and Bireme databases were consulted over the last 20 years. English- and Portuguese-language articles were included in this revision. Some authors stated that the osteoporotic bone is similar to the proposed model of bone type IV. Randomized clinical studies reported implant failure in patients with osteoporosis after menopause. Studies that contraindicate the use of implants in patients with osteoporosis infer that the impaired bone metabolism led to reduction of bone healing around the implants. Nevertheless, other authors believe that the presence of osteoporosis is not a definitive condition to contraindicate the therapy with dental implants. In these cases, the dentist should perform a proper treatment planning, modifying the implant geometry, and use larger implant diameter and with surface treatment. Thus, osteoporosis is not a contraindication for implant surgery because an accurate analysis of bone quality by means tomography is performed.     

口腔种植专题研讨会学术回顾与展望

此次研讨会有国内15所大学的23位种植学专家就上颌窦底提升术、上颌后区骨量不足及无牙颌种植修复三个重点进行典型病例研讨。针对上颌窦底提升、onlay植骨、种植体长度直径及冠根比、种植导航、上颌后牙骨量不足种植的风险、即刻负载、不翻瓣种植、all-on-4种植及附着龈等9个问题进行了专家与听众互动式提问、解答及争论。通过研讨认为应该强调循证医学,临床创新,处理好常规与尝试、安全与风险、一般和特需及需要与可能的关系。专家共同的体会是:口腔种植的发展已进入"自由王国"阶段,快速的学科发展是不断创新的结果,如何迎接种植大潮,遵守自然规律防止进入误区是至关重要的。     

口腔医学本科生学习目的与专业及职业选择的现状调查

目的：调查目前口腔医学本科生专业学习的目的与动机,分析学生对于不同口腔专业选择偏好及对未来职业选择的意愿。方法：选择国内三所大学一、四、五年级在校口腔医学本科生,并邀请其填写相应调查问卷表,根据对每个调查项目的个人主观态度进行打分,采用SPSS统计软件分析提取学习动机的主要因素。结果：共计向各院校口腔医学本科生发出调查问卷表368份,收回326份,参与率88.6％。其中一年级学生142名,男55人,女87人,平均年龄18.77岁;四、五年学生184名,男51人,女133人,平均年龄22.79岁。调查结果显示,帮助他人改善口腔健康（3.49％）是国内口腔医学生最主要的学习动机来源,收入较高（3.38％）排第二,同时还会受到个人兴趣和他人建议的影响。从专业选择偏好分析调查问卷结果显示正畸（6.92％）、种植（6.44％）、修复（6.16％）位列三甲,粘膜病专业（3.29％）和儿童牙病专业（4.14％）不受青睐。职业选择倾向顺序依次为公立医院（6.49％）,研究生深造（6.41％）,在私立医院、连锁诊所的医生或从事管理工作的民营机构执薪者（6.15％）、个体牙医（5.66％）、民营机构合伙人（5.10％）、牙科领域科学研究（4.46％）、口腔公众健康机构（4.39％）、初级卫生医疗机构（3.57％）,非口腔专业领域工作（1.84％）。结论：口腔医学生热爱专业,学习动机主要来源于为他人服务、收入较高和个人兴趣,正畸、种植及修复专业受到青睐。公立医院仍然是学生们的职业首选,但也不排斥进入私营医疗机构工作。     

北京市城乡居民口腔医疗服务利用与费用分析

目的 对北京市城乡居民口腔医疗服务利用和费用进行定量研究，为口腔医疗保障制度的制定提供依据。方法 采用分层、整群、随机抽样方法抽取城区人口1517人，农村人口1878人，利用人户调查方式进行口腔医疗服务利用和费用的调查。结果 城乡居民口腔疾病就诊率均处于较低水平，但次均费用较高。农村居民就诊率为城区居民的1／3，次均费用约为城区居民的1／2。农村居民口腔费用支出占年收入的2．07％，城区居民为1．77％。不同人口、社会经济学背景的人群费用支出差异有显著性。结论 北京市居民的口腔医疗费用水平较高，在收入中占相当比重，并且农村居民的费用负担要重于城区居民。本研究中所调查的费用水平可为北京市口腔医疗保险覆盖提供一定参考依据。     

The Influence of Dental Insurance on Institutionalized Older Adults in Ranking Their Oral Health Status

To assess whether dental insurance influences how institutionalized older adults ages 65 and older rank their oral health status, a census survey was designed for residents of Durham's (Canada) Municipal Homes for the Aged. The odds ratio (OR) and the Cochran & Mantel‐Haenszel's OR were used to estimate the crude and adjusted effect of dental insurance on oral health status, respectively. Overall, 64 percent participated in the interview. Oral health status was ranked as “good,”“very good” or “excellent” by 57 percent of the participants. This ranking was clearly unrelated to the residents having dental insurance, as only 28 percent had dental coverage. Significant effect modifiers included age, dental status and whether the participant had visited the dentist within the last year. Dental insurance positively influenced how dentate participants ranked their oral health status (OR = 2.26; 95 percent CI 1.19; 4.28). In edentulous participants, age and visiting the dentist within the last year modified the effect of dental insurance on oral health status. Having dental insurance reduced the odds of reporting “good,”“very good” or “excellent” oral health (OR = 0.20; 95 percent CI = 0.08; 0.49) among the participants ages 85 and older who did not visit the dentist within the last year; however, the opposite was true for their younger counterparts who visited the dentist within the last year (OR = 7.20; 95 percent CI = 1.08; 47.96). In this population, therefore, dental insurance was associated with higher oral health status rank among the dentate, but its effect on the edentulous population depended on age and the pattern of visiting the dentist.     

Histologic and histomorphometric evaluation of new zirconia-based ceramic dental implants: A preclinical study in dogs

ObjectiveHealing of soft tissues and improvement of aesthetics have become major research objectives in implantology and renewed the interest for ceramics implants. The aim of this study was to evaluate the pre-clinical performance of screw-shaped sandblasted-etched implants processed from an innovative zirconia-based ceramic composite, in comparison to titanium.MethodsTwenty-four ceramic and twenty-four titanium screw-shaped sandblasted-etched dental implants were tested in a split-mouth design in six Beagle dogs. Surface topographies were investigated by confocal microscopy. Local tissue effects were evaluated at 4 and 13 weeks after implantation through histology. An ANOVA statistical analysis (5% risk; p < 0.05) was performed to compare peri-implant quantitative histomorphometric parameters on buccal and lingual sides, including Bone to Implant Contact (BIC) among test groups and time-periods.ResultsTitanium and ceramic implants presented respectively moderate and minimal roughness. After 4 and 13 weeks, ceramic implants showed an inflammatory tissue response close to titanium implants. At both period of time there was no significant difference between the titanium and ceramic groups in terms of BIC values (mean ± SD) at the lingual or buccal sides or when combining buccal + lingual BIC values (respectively for titanium and ceramic, 68.4 ± 14.7 % and 75.0 ± 13.5 % at 4 weeks, and 92.0 ± 8.6 % and 86.1 ± 13.8 % at 13 weeks).SignificanceWithin the limits of the present study, it can be concluded that newly developed zirconia-based ceramic composite dental implants have similar biocompatibility and osseointegration to those observed in titanium implants. These pre-clinical results corroborate the potential for the use of these new zirconia-based ceramics in oral implantology.     

口腔种植手术的配合和护理

目的:总结口腔种植手术中的护理经验。方法:回顾本科室98例口腔种植牙患者资料,总结种植术前、术中和术后的护理方法。结果:经过恰当的临床配合和护理,共植入种植体112颗,手术护理过程顺利,术后无明显并发症。经过3～44个月的追踪观察,无一例种植体脱落,临床种植体取得成功患者满意度好。结论:口腔种植手术的成功需要完善的术前准备精确的手术操作,精细的术中护理,医生、患者和护士的良好配合,以及术后的精心护理。     

Overview of factors important in implant design.

Forty-two percent of the population over the age of 65 is totally edentulous. The use of dental implants as a means of treating these patients has accelerated in the last decade, and there are now 300,000 dental implants used in the United States. It is therefore imperative that a greater understanding of the parameters which govern the long-term success of implants be developed. In order for the effectiveness of implants to be better quantified, a fundamental, quantitative understanding of the physical parameters governing the complex synthetic material/tissue aggregate is needed. The design of an "optimal" implant requires the integration of material, physical, chemical, mechanical, biological, and economic factors. The approach taken for a specific property objective to be met should be based on a materials science approach, in which the synergistic relationships among processing, composition, structure, and properties are characterized. Implant success is a function of biomaterials and biomechanical factors, including: materials and material processing; mechanisms of implant/tissue attachment; mechanical properties; implant design; loading type; tissue properties; stress and strain distributions; initial stability and mechanisms of enhancing osseointegration; biocompatibility; and surface chemistry, mechanics, and bone-binding ability of the implant. This paper presents an overview of physical parameters important to implantology. Following a general presentation of implantology concepts, the physical parameters listed above are discussed in greater detail.     

Good occlusal practice in the provision of implant borne prostheses

The increased use of endosseous dental implants means that many dentists will encounter patients with dental implants in their everyday practice. Dental practitioners might be actively involved in the provision of implant borne prostheses at both the surgical and restorative phases, or only at the restorative stage. This section is written for all dentists and aims to examine the subject of occlusion within implantology. It aims to provide guidelines of good occlusal practice to be used in the design of the prosthesis that is supported or retained by one or more implants. As implantology is a 'new' discipline of dentistry, there are fewer standard texts and this section, therefore, is much more extensively referenced than the subjects that have been considered to date.     

Oral health knowledge and dental health practices among schoolchildren in Jerash district/Jordan

Abstract:  Objective: This study aims at determining the oral health awareness level, the patterns of dental health practices and their potential relationship with certain socio-demographic factors, including gender (sex), mother's education and the socio-economic status of the family, among 14–15-year-old schoolchildren in Jerash Governorate, Northern Jordan. Participants and method: Cross-sectional survey including 1362 public schoolchildren, who completed a self-administered structured questionnaire. Results: Overall, the level of oral health knowledge among the surveyed children was low. Of the 1362 schoolchildren included in this survey, only 18 and 17% did know the meaning of plaque and what plaque can cause, respectively. Female performance was significantly better than male performance on two of the six knowledge questions ( P <  0.01). While 17% of children have never been to the dentist, there are 10% only who visit the dentist on regular basis. The majority (56%) of these pupils said they visit the dentist when there is a serious dental or oral health problem. Fear of the dentist and difficulty in obtaining an appointment with the dentist were the causes of irregular visit to the dental clinic in 28 and 19% of the cases, respectively. Conclusion: Results of this study prove that oral health awareness level among public schoolchildren in Jordan is still poor and needs to be improved. Based upon these findings, the establishment of a long-term school-based oral health education programme in Jordan is highly recommended.     

Representative marketing-oriented study on implants in the Austrian population. I. Level of information,sources of information and need for patient information

The number of dental implants inserted annually worldwide has been estimated to come close to a million. But the level of information available to patients about realistic, evidence-based treatment options by implants is often enough more than fragmentary, and what is disseminated by the media and the industry does not always reflect evidence-based empirical data. This survey of 1000 adults presented with 18 questions was designed to shed light on several points. These were (1). level of subjective patient information, (2). sources of information and prejudices, (3). future demand for implant treatment and target groups for patient information campaigns, and (4). potential misinformation, information deficits, discrepancies of information and how these come about. Of those questioned, 20% said unprompted that implants were a possibility to replace missing teeth. When prompted, 72% said that they knew about dental implants. Most of those questioned felt poorly informed about the options for replacing missing teeth and many knew less about implants than about other alternatives. The dentist was said to be the desired source of information, but 77% of those questioned reported that their dentists did not practice implant dentistry. More than 79% of those questioned did not know whether their dentist worked with implants. Forty-four percent thought that implants should only be placed by specially trained doctors. Sixty-one percent were of the opinion that dentists who provide implant dentistry were better qualified than their nonimplanting colleagues. Half of those questioned attributed implant failures to allergies and incompatibilities, the other half to poor medical care. Only 29% incriminated poor oral hygiene as a cause of implant failure. Future strategies should be geared to more professional public relations and patient information. Internationally operating qualified implant institutions could contribute much to balance discrepant information.     

Dental ingenuity 2. Implant treatment using transitional implants

The applications in oral implantology are strongly increased due to the advance in the field of osseointegration and in material technology. As a result of this gained knowledge the area of indications increased in both edentulous and partially dentate patients. With the extension of the indications of dental implants there also is a growing patients' demand for direct replacement of lost tooth. Sometimes it is possible to fulfill the expressed wish of immediate loading. In case of poor bone quantity or quality this is impossible. Transitional implants supply the prosthodontist with an additional possibility to fulfill the need for uninterrupted healing as well as patients' demands for immediate functional and esthetic restorations.     

Laser explantation of a failing endosseous dental implant

Explantation of failed dental implants has traditionally been performed by mechanical bone removal techniques. The advent of intraoral laser surgery has seen increasing numbers of applications in oral implantology. The technique demonstrates safe and efficient explantation of a failed dental implant using Er,Cr:YSGG laser. Laser assisted explantation of dental implants is a minimally invasive technique providing an alternative to conventional mechanical explantation techniques.