- Email: [email protected]
A survey of dentists practicing implant dentistry in Israel
A survey
of dentists
Robert Klugman, and Noah Stern,
practicing
D.D.S.,* Harold Sgan-Cohen, D.M.D., M.S.D.***
Hebrew University-Hadassah
implant D.M.D.,
dentistry
in Israel
M.P.H.,**
School of Dental Medicine, Jerusalem, Israel
Due to the increasing interest in the field of implant dentistry, a first survey of dentists in Israel who used implants was conducted. Out of a total of 312 dentists questioned, 97 reported using dental implants in their practice. In spite of the team approach advocated in the literature, 40% of the dentists in the survey conducted both the surgical and the prosthetic phases of treatment. Over 60% of the respondents had less than 3 years’ experience in the field, which is in keeping with the worldwide trend. A smaller number than expected regarded red gingival color and bone resorption based on radiographic findings as grounds for implant failure. In the view of at least 10 respondents, pain, discomfort, exudate, and tlstulization did not indicate unsuccessful implants. A disparity was revealed between the dentists’ practice methods and their hypothetical choice of self-treatment. Although the Core-Vent method was the most widely employed, only 50% of those using this system preferred it for themselves. Even fewer (25%) of those using blade implants considered it their self-treatment of choice. In contrast, although only 10% of the dentists had used the Branemark method, 30% preferred it for their own treatment. (J PROSTHET DENT 1990;64:473-8.)
F.
ive thousand years ago, the ancient Egyptians usedstoneand ivory fixtures to replacemissingteeth. Since then, manhascontinually soughtbetter solutionsto fill this need. During the past decade,there hasbeena marked increase in the useof dental implants to replace missingteeth, due
Presented at the Third Symposium on Oral Rehabilitation, Herzliya, Israel. This study was supported by a research grant from the Israeli Dental Association. *Clinical Senior Lecturer, Department of Prosthodontics. **Senior Lecturer, Department of Community Dentistry. ***Professor and Head, Department of Prosthodontics. 10/l/22696
to recent advancesin implant design,materials, and methods.The application of thesetechniques is expected to become even more widespreadin the near future. In 1972 only part of an issueof the quarterly journal Dental Clinics of North America’ dealt with dental implants, whereasin 19802and 1986b4 two entire issueswere devoted to this topic. According to the National Institute of Health’s “ConsensusDevelopment Conference on Dental Implants”5 held in June 1988with over 1000dentists participating: “It hasbeenestimated that the overall number of dental implants inserted in the United States has increasedfourfold from 1983to 1987,and during the same period, the number of dentists who perform implant therapy hasincreasedtenfold . . . and that asmany as300,000 dental implants will be usedin the United Statesby 1992.“5 What are the reasonsbehind this phenomenalincrease
Fig. 1. Percentageof Israeli conference attendeespracticing implant dentistry. THE
JOURNAL
OF PROSTHETIC
DENTISTRY
473
KLUGMAN,
SGAN-COHEN,
AND
STERN
8.25%
Fig.
2. Percentage of respondentscarrying out various phasesof implant dentistry.
ComVonl
Fig.
Shdaa
Sranema
ITI
Didc
San&am
IMZ
othora
3. Use of different dental implant techniques amongrespondents.
in the useof dental implants? Why were dentists reluctant to use this technique until a few years ago?In December 1986, in a Journal of the American Dental Association “emphasisarticle” entitled, “Advances in Dentistry-Implants,” Kapur” suggestedthat “The scientific data on the efficacy of different implant systems are lacking and unclearbecausethe primary information hasbeenreported by individuals with proprietary interests either in marketing implants or in providing continuing education courses in the use of a special implant system.“6 In another “emphasis article” in the same issue, Adisman and Kapur7 stated “Historically, endosseousand subperiosteal implants are unpredictable. In the past 20 years, clinical research and longitudinal data from the Branemark osseointegrated system show consistently healthy use with a successrate of more than 95% in the mandible and 90% in
474
TrsmoooSubpd
the maxillae.” Clearly, the pioneeringstudiesof the Branemark group of Gothenburg, Swedenwere responsiblefor the renewal of interest in implants in modern dentistry. This study determined the extent of implant dentistry and the types of implants used by dentists attending an international dental conference held in Jerusalem, Israel.
MATERIAL
AND
METHODS
The Israeli participants in the Second World Dental Conference, held in Jerusalem in 1988, constituted the study population. Five final-year dental students, trained in interviewing methodsand familiar with the presetquestionnaire, approached the subjects at random. They initially posed the following question: “Do you practice implant dentistry in your dental clinic?” They then pro-
OCTOBER
1990
VOLUME
64
NUMBER
4
ISRAEL
IMPLANT
SURVEY
Fig. 4. Years of experience of respondents.
c-5
6 - 10
11 - 20
21
- 50
> 50
Fig. 5. Number of patients treated and fixtures inserted by respondents.
ceeded with the questionnaire only among those answering in the affirmative. Eleven questions were presented: nine with multiple-choice options and two open-ended. Five questions concerned implant types, stages of treatment, and techniques; three questions related to the degree of success; one question attempted to assess the dentists’ clinical knowledge of dental implants; and in the last question, they were asked which type of implant they would choose if they themselves needed such treatment.
RESULTS The present survey revealed that out of a total of 312 dentists approached (estimated at about 40% of all the Israeli participants), 97 (31%) practiced implant dentistry (Fig. 1). Among these, 8.25% only carried out preimplant surgery, 50.52 % performed only the prosthetic phase, and 41.24% conducted both types (Fig. 2).
TEE
JOURNAL
OF PROSTHETIC
DENTISTRY
The techniques used by the interviewees were as follows: the Core-Vent system (Core-Vent Corp., Encina, Calif.) (61), blades (39), Branemark (Nobelpharma, Gothenburg, Sweden) (9), IT1 (Institute Straumann AG, Waldenberg, Switzerland) (6), disk (5), transosseous (5), subperiosteal (5), Sandhous (C.B.S., Lausanne, Switzerland) (5), IMZ (Friedrichsfeld GmbH, Mannheim, W. Germany) (4), and others (15) (Fig. 3). In terms of years of experience, 23 dentists had less than 1 year, 38 had from 1 to 3 years’ experience, 19 had from 3 to 5 years’ experience and 1’7had over 5 years’ experience (Fig. 4). The total numbers of patients treated were less than 5 for 35% of the respondents, from 6 to 10 for 17%) from 11 to 20 for 17%) from 21 to 50 for 13%) and over 50 for 15 % . In these subjects, 33 % of the dentists had carried out more than five separate implants, 18% had done from 6 to 10, 10% had performed from 11 to 20,19% had done 475
KLUGMAN,
no answer.
<
25%
26%
-50%
51%
- 75%
76%
SGAN-COHEN,
AND
STERN
> 90%
- 60%
Fig. 6. Success rates with respect to number of patients and fixtures.
pmslh.
pham
in@. design
0
10
20
30
40
50
Fig. 7. Reasons for failure of dental implants.
from 21 to 50, and 17 % had carried out more than 50 separate implants (Fig. 5). Other questions were directed toward determining the effectiveness of this form of therapy. Asked to evaluate success rates with respect to implant treatment and individual fixtures, 10 (15% ) respondents did not answer this question, none reported a success rate of less than 25%) three (3 % ) reported a success rate from 25 % to 50 % , seven (11% ) reported a rate from 51% to 75 % , 23 (15 % ) had a rate from 76 % to 90 % , and 54 (53 % ) reported over a 90 % success rate (Fig. 6). The dentists were also requested to define their reasons for failure according to eight categories (the percentage of respondents who gave each answer is shown in parentheses): (1) mobility of fixtures-O degrees (0% ), 1 degree (58%), 2 degrees (91%); (2) pocket depths around 476
fixtures-< 3 mm (lo%), 3 to 5 mm (69%), >5 mm (79% ); (3) gingival color-pink (2%), red (56%); (4) radiographic data-cervical bone resorption (25% ), apical bone resorption (80%); (5) purulent exudate-(87%); (6) fistulization-(87% ); (7) pain-(70%); and (8) inconvenience(58%). Asked to attribute the main reasons for failure-either the surgical, or the prosthetic phases, or the design and composition of the implant-42, 26, and 5 dentists stipulated the first, second, and third options, respectively (Fig. 7). In an open-ended question regarding the success of treatment, respondents were allowed to give up to three reasons. Among these answers: 55 dentists referred to the surgical phase, 39 to patient selection, 37 to the prosthetic phase, 12 to following the manufacturer’s instructions, 11
OCTOBER
1990
VOLUME
64
NUMBER
4
ISRAEL
IMPLANT
SURVEY
sug. ph6ss casemkl prosfi.m nlanu.instN. skill 6 knd owl MlOCCI. sdjusa bonefacwr othsm
Fig.
0
Fig.
8. Reasonsfor successof dental implants.
10
DISCUSSION The present study was conducted among dentists attending an international conferenceheld in Jerusalem,and therefore should not be regarded as representative of the generalpopulation of dentists in Israel. However, it is rea-
JOURNAL
OF PROSTHETIC
30
40
9. Dentists’ choice of dental implant system for their own treatment.
to skill and knowledge,10 to oral hygiene, sevento occlusal adjustment, six to osseousfactors, and 22 to patient cooperation in diagnosis,correct indication, or follow-up and other factors (Fig. 8). In the last question, the dentists were askedwhich type of implant system they would chooseif they themselves neededsuchtreatment. Many of the respondents(21) gave no answer;among the others, 32 preferred the Core-Vent system,30 the Branemark system,eight the blade, four the IMZ, onethe ITI, and onethe Sandhaustechnique (Fig. 9).
THE
20
DENTISTRY
sonableto assumethat a large number of dentists practicing implant dentistry asa relatively new clinical technique would attend this type of meetingto keep abreastof recent developments.This survey is significant, sinceit is the first of its kind carried out in this country. However, the findingsamongconferenceattendeesmay be different from the actual practice of implant dentistry by the dental community. It may be assumedthat the conference participants, asleadersin implant dentistry, have a major influence on general dental attitudes and policy. In spite of the team approach generally advocated,sthe findings demonstratedthat 40% of the dentists practicing implant dentistry in Israel carried out both the surgicaland the prosthetic phases of treatment. The most popular technique wasthe Core-Vent system.Over 60% of the respondents had lessthan 3 years’ experience in the field,
471
KLUGMAN,
which is in keeping with the worldwide trend. However, 18% had been practicing for over 5 years. According to these data, collected from 97 respondents,over 2000people in the country have received dental implants to date. Over 80% of the respondentsclaimed successrates exceeding 90%, which is higher than expected with more conventional dental treatment methods such as fillings, crowns,and complete dentures. A certain degreeof mobility wasgenerally thought to be acceptable in implants (in contrast to the osseointegratedapproach, which recommendsthat implants be removed if there is any movement at allg). It was generally held that pockets of moderate depth around the implant could be treated and should not be regarded as an indication of failure. A smaller number than expected regarded gingival color and bone resorption, basedon radiologic findings, as grounds for failure. In the view of at least 10 respondents,pain, discomfort, exudate, and fistulization did not meanthat the implants were unsuccessful.Thus the criteria for successamongdentists in Israel are not asstringent as those cited by the American Dental Association and by various other internationally recognizedresearchteams.According to the majority view, the surgical rather than the prosthetic phase was most critical for prognosis. The question relating to the implant technique that dentists would choosefor their own treatment proved most revealing. Almost 20% would not undergo any form of dental implant treatment. Although the Core-Vent method wasthe most widely used, only 50% of those practicing it preferred this technique for themselves,and even fewer (25%) of those using dental implants by the blade technique consideredit the method of choice.In contrast, even though only nine dentists had usedthe Branemark system, 30 selectedit for their own treatment.
SUMMARY
AND
CONCLUSIONS
Dental implant therapy has been used for a relatively large number of patients in Israel. In keeping with world-
478
SGAN-COHEN,
AND
STERN
wide trends, most local dentists only beganpracticing implant dentistry within the last 5 years, and many provide both the prosthetic and the surgical phasesof treatment. The successrates seemto be similar to those reported in other countries, although the criteria for failure were not as stringent. Clearly, it is important to establish stringent criteria for evaluating the successof implants, which should be basedon characterization of the patient population, larger and more representative samples,detailed documentation and follow-up, standardization of reporting methods, and the appointment of independent examiners rather than a reliance upon self-assessments madeby individual dentists. The findings of the survey indicate that many dentists are practicing implant dentistry without adequate knowledge, skill, or training. REFERENCES 1. Lew I. The evaluation of dental implants-a discussion of success and failure. Dent Clin North Am 1972;16:225-37. 2. Babbush C, ed. Implants. Dent Clin North Am 1980;24:399-594. 3. Guersney LH, ed. Reconstructive implant surgery and implant prosthodontics. I. Dent Clin North Am 1986;30:1-174. 4. Reconstructive implant surgery and implant prosthodontics. II. Dent Clin North Am 1986;30:175-355. 5. Consensus development conference statement: dental implants. Bethesda, Md, NIH, June 1987. 6. Kapur KK. Advances in dentistry-implants. J Am Dent Assoc 1986;113:822-79. 7. Adisman IK, Kapur KK. Advances in dentistry-implants. J Am Dent Assoc 1986;113:872-9. 8. Barnett BG, Krump JL. Implant dentistry-the significance of the team approach. J PROSTHET DENT 1987;58:69-73. 9. Adell R, Lekholm U, Rockier 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. Reprint requests to: DR. NOAH STERN SCHOOL HEBREW
P.O.B.
OF DENTAL UNIVEFCWY
MEDICINE
1172
JERUSALEM ISRAEL
OCTOBER
1990
VOLUME
64
NUMBER
4
of dentists
Robert Klugman, and Noah Stern,
practicing
D.D.S.,* Harold Sgan-Cohen, D.M.D., M.S.D.***
Hebrew University-Hadassah
implant D.M.D.,
dentistry
in Israel
M.P.H.,**
School of Dental Medicine, Jerusalem, Israel
Due to the increasing interest in the field of implant dentistry, a first survey of dentists in Israel who used implants was conducted. Out of a total of 312 dentists questioned, 97 reported using dental implants in their practice. In spite of the team approach advocated in the literature, 40% of the dentists in the survey conducted both the surgical and the prosthetic phases of treatment. Over 60% of the respondents had less than 3 years’ experience in the field, which is in keeping with the worldwide trend. A smaller number than expected regarded red gingival color and bone resorption based on radiographic findings as grounds for implant failure. In the view of at least 10 respondents, pain, discomfort, exudate, and tlstulization did not indicate unsuccessful implants. A disparity was revealed between the dentists’ practice methods and their hypothetical choice of self-treatment. Although the Core-Vent method was the most widely employed, only 50% of those using this system preferred it for themselves. Even fewer (25%) of those using blade implants considered it their self-treatment of choice. In contrast, although only 10% of the dentists had used the Branemark method, 30% preferred it for their own treatment. (J PROSTHET DENT 1990;64:473-8.)
F.
ive thousand years ago, the ancient Egyptians usedstoneand ivory fixtures to replacemissingteeth. Since then, manhascontinually soughtbetter solutionsto fill this need. During the past decade,there hasbeena marked increase in the useof dental implants to replace missingteeth, due
Presented at the Third Symposium on Oral Rehabilitation, Herzliya, Israel. This study was supported by a research grant from the Israeli Dental Association. *Clinical Senior Lecturer, Department of Prosthodontics. **Senior Lecturer, Department of Community Dentistry. ***Professor and Head, Department of Prosthodontics. 10/l/22696
to recent advancesin implant design,materials, and methods.The application of thesetechniques is expected to become even more widespreadin the near future. In 1972 only part of an issueof the quarterly journal Dental Clinics of North America’ dealt with dental implants, whereasin 19802and 1986b4 two entire issueswere devoted to this topic. According to the National Institute of Health’s “ConsensusDevelopment Conference on Dental Implants”5 held in June 1988with over 1000dentists participating: “It hasbeenestimated that the overall number of dental implants inserted in the United States has increasedfourfold from 1983to 1987,and during the same period, the number of dentists who perform implant therapy hasincreasedtenfold . . . and that asmany as300,000 dental implants will be usedin the United Statesby 1992.“5 What are the reasonsbehind this phenomenalincrease
Fig. 1. Percentageof Israeli conference attendeespracticing implant dentistry. THE
JOURNAL
OF PROSTHETIC
DENTISTRY
473
KLUGMAN,
SGAN-COHEN,
AND
STERN
8.25%
Fig.
2. Percentage of respondentscarrying out various phasesof implant dentistry.
ComVonl
Fig.
Shdaa
Sranema
ITI
Didc
San&am
IMZ
othora
3. Use of different dental implant techniques amongrespondents.
in the useof dental implants? Why were dentists reluctant to use this technique until a few years ago?In December 1986, in a Journal of the American Dental Association “emphasisarticle” entitled, “Advances in Dentistry-Implants,” Kapur” suggestedthat “The scientific data on the efficacy of different implant systems are lacking and unclearbecausethe primary information hasbeenreported by individuals with proprietary interests either in marketing implants or in providing continuing education courses in the use of a special implant system.“6 In another “emphasis article” in the same issue, Adisman and Kapur7 stated “Historically, endosseousand subperiosteal implants are unpredictable. In the past 20 years, clinical research and longitudinal data from the Branemark osseointegrated system show consistently healthy use with a successrate of more than 95% in the mandible and 90% in
474
TrsmoooSubpd
the maxillae.” Clearly, the pioneeringstudiesof the Branemark group of Gothenburg, Swedenwere responsiblefor the renewal of interest in implants in modern dentistry. This study determined the extent of implant dentistry and the types of implants used by dentists attending an international dental conference held in Jerusalem, Israel.
MATERIAL
AND
METHODS
The Israeli participants in the Second World Dental Conference, held in Jerusalem in 1988, constituted the study population. Five final-year dental students, trained in interviewing methodsand familiar with the presetquestionnaire, approached the subjects at random. They initially posed the following question: “Do you practice implant dentistry in your dental clinic?” They then pro-
OCTOBER
1990
VOLUME
64
NUMBER
4
ISRAEL
IMPLANT
SURVEY
Fig. 4. Years of experience of respondents.
c-5
6 - 10
11 - 20
21
- 50
> 50
Fig. 5. Number of patients treated and fixtures inserted by respondents.
ceeded with the questionnaire only among those answering in the affirmative. Eleven questions were presented: nine with multiple-choice options and two open-ended. Five questions concerned implant types, stages of treatment, and techniques; three questions related to the degree of success; one question attempted to assess the dentists’ clinical knowledge of dental implants; and in the last question, they were asked which type of implant they would choose if they themselves needed such treatment.
RESULTS The present survey revealed that out of a total of 312 dentists approached (estimated at about 40% of all the Israeli participants), 97 (31%) practiced implant dentistry (Fig. 1). Among these, 8.25% only carried out preimplant surgery, 50.52 % performed only the prosthetic phase, and 41.24% conducted both types (Fig. 2).
TEE
JOURNAL
OF PROSTHETIC
DENTISTRY
The techniques used by the interviewees were as follows: the Core-Vent system (Core-Vent Corp., Encina, Calif.) (61), blades (39), Branemark (Nobelpharma, Gothenburg, Sweden) (9), IT1 (Institute Straumann AG, Waldenberg, Switzerland) (6), disk (5), transosseous (5), subperiosteal (5), Sandhous (C.B.S., Lausanne, Switzerland) (5), IMZ (Friedrichsfeld GmbH, Mannheim, W. Germany) (4), and others (15) (Fig. 3). In terms of years of experience, 23 dentists had less than 1 year, 38 had from 1 to 3 years’ experience, 19 had from 3 to 5 years’ experience and 1’7had over 5 years’ experience (Fig. 4). The total numbers of patients treated were less than 5 for 35% of the respondents, from 6 to 10 for 17%) from 11 to 20 for 17%) from 21 to 50 for 13%) and over 50 for 15 % . In these subjects, 33 % of the dentists had carried out more than five separate implants, 18% had done from 6 to 10, 10% had performed from 11 to 20,19% had done 475
KLUGMAN,
no answer.
<
25%
26%
-50%
51%
- 75%
76%
SGAN-COHEN,
AND
STERN
> 90%
- 60%
Fig. 6. Success rates with respect to number of patients and fixtures.
pmslh.
pham
in@. design
0
10
20
30
40
50
Fig. 7. Reasons for failure of dental implants.
from 21 to 50, and 17 % had carried out more than 50 separate implants (Fig. 5). Other questions were directed toward determining the effectiveness of this form of therapy. Asked to evaluate success rates with respect to implant treatment and individual fixtures, 10 (15% ) respondents did not answer this question, none reported a success rate of less than 25%) three (3 % ) reported a success rate from 25 % to 50 % , seven (11% ) reported a rate from 51% to 75 % , 23 (15 % ) had a rate from 76 % to 90 % , and 54 (53 % ) reported over a 90 % success rate (Fig. 6). The dentists were also requested to define their reasons for failure according to eight categories (the percentage of respondents who gave each answer is shown in parentheses): (1) mobility of fixtures-O degrees (0% ), 1 degree (58%), 2 degrees (91%); (2) pocket depths around 476
fixtures-< 3 mm (lo%), 3 to 5 mm (69%), >5 mm (79% ); (3) gingival color-pink (2%), red (56%); (4) radiographic data-cervical bone resorption (25% ), apical bone resorption (80%); (5) purulent exudate-(87%); (6) fistulization-(87% ); (7) pain-(70%); and (8) inconvenience(58%). Asked to attribute the main reasons for failure-either the surgical, or the prosthetic phases, or the design and composition of the implant-42, 26, and 5 dentists stipulated the first, second, and third options, respectively (Fig. 7). In an open-ended question regarding the success of treatment, respondents were allowed to give up to three reasons. Among these answers: 55 dentists referred to the surgical phase, 39 to patient selection, 37 to the prosthetic phase, 12 to following the manufacturer’s instructions, 11
OCTOBER
1990
VOLUME
64
NUMBER
4
ISRAEL
IMPLANT
SURVEY
sug. ph6ss casemkl prosfi.m nlanu.instN. skill 6 knd owl MlOCCI. sdjusa bonefacwr othsm
Fig.
0
Fig.
8. Reasonsfor successof dental implants.
10
DISCUSSION The present study was conducted among dentists attending an international conferenceheld in Jerusalem,and therefore should not be regarded as representative of the generalpopulation of dentists in Israel. However, it is rea-
JOURNAL
OF PROSTHETIC
30
40
9. Dentists’ choice of dental implant system for their own treatment.
to skill and knowledge,10 to oral hygiene, sevento occlusal adjustment, six to osseousfactors, and 22 to patient cooperation in diagnosis,correct indication, or follow-up and other factors (Fig. 8). In the last question, the dentists were askedwhich type of implant system they would chooseif they themselves neededsuchtreatment. Many of the respondents(21) gave no answer;among the others, 32 preferred the Core-Vent system,30 the Branemark system,eight the blade, four the IMZ, onethe ITI, and onethe Sandhaustechnique (Fig. 9).
THE
20
DENTISTRY
sonableto assumethat a large number of dentists practicing implant dentistry asa relatively new clinical technique would attend this type of meetingto keep abreastof recent developments.This survey is significant, sinceit is the first of its kind carried out in this country. However, the findingsamongconferenceattendeesmay be different from the actual practice of implant dentistry by the dental community. It may be assumedthat the conference participants, asleadersin implant dentistry, have a major influence on general dental attitudes and policy. In spite of the team approach generally advocated,sthe findings demonstratedthat 40% of the dentists practicing implant dentistry in Israel carried out both the surgicaland the prosthetic phases of treatment. The most popular technique wasthe Core-Vent system.Over 60% of the respondents had lessthan 3 years’ experience in the field,
471
KLUGMAN,
which is in keeping with the worldwide trend. However, 18% had been practicing for over 5 years. According to these data, collected from 97 respondents,over 2000people in the country have received dental implants to date. Over 80% of the respondentsclaimed successrates exceeding 90%, which is higher than expected with more conventional dental treatment methods such as fillings, crowns,and complete dentures. A certain degreeof mobility wasgenerally thought to be acceptable in implants (in contrast to the osseointegratedapproach, which recommendsthat implants be removed if there is any movement at allg). It was generally held that pockets of moderate depth around the implant could be treated and should not be regarded as an indication of failure. A smaller number than expected regarded gingival color and bone resorption, basedon radiologic findings, as grounds for failure. In the view of at least 10 respondents,pain, discomfort, exudate, and fistulization did not meanthat the implants were unsuccessful.Thus the criteria for successamongdentists in Israel are not asstringent as those cited by the American Dental Association and by various other internationally recognizedresearchteams.According to the majority view, the surgical rather than the prosthetic phase was most critical for prognosis. The question relating to the implant technique that dentists would choosefor their own treatment proved most revealing. Almost 20% would not undergo any form of dental implant treatment. Although the Core-Vent method wasthe most widely used, only 50% of those practicing it preferred this technique for themselves,and even fewer (25%) of those using dental implants by the blade technique consideredit the method of choice.In contrast, even though only nine dentists had usedthe Branemark system, 30 selectedit for their own treatment.
SUMMARY
AND
CONCLUSIONS
Dental implant therapy has been used for a relatively large number of patients in Israel. In keeping with world-
478
SGAN-COHEN,
AND
STERN
wide trends, most local dentists only beganpracticing implant dentistry within the last 5 years, and many provide both the prosthetic and the surgical phasesof treatment. The successrates seemto be similar to those reported in other countries, although the criteria for failure were not as stringent. Clearly, it is important to establish stringent criteria for evaluating the successof implants, which should be basedon characterization of the patient population, larger and more representative samples,detailed documentation and follow-up, standardization of reporting methods, and the appointment of independent examiners rather than a reliance upon self-assessments madeby individual dentists. The findings of the survey indicate that many dentists are practicing implant dentistry without adequate knowledge, skill, or training. REFERENCES 1. Lew I. The evaluation of dental implants-a discussion of success and failure. Dent Clin North Am 1972;16:225-37. 2. Babbush C, ed. Implants. Dent Clin North Am 1980;24:399-594. 3. Guersney LH, ed. Reconstructive implant surgery and implant prosthodontics. I. Dent Clin North Am 1986;30:1-174. 4. Reconstructive implant surgery and implant prosthodontics. II. Dent Clin North Am 1986;30:175-355. 5. Consensus development conference statement: dental implants. Bethesda, Md, NIH, June 1987. 6. Kapur KK. Advances in dentistry-implants. J Am Dent Assoc 1986;113:822-79. 7. Adisman IK, Kapur KK. Advances in dentistry-implants. J Am Dent Assoc 1986;113:872-9. 8. Barnett BG, Krump JL. Implant dentistry-the significance of the team approach. J PROSTHET DENT 1987;58:69-73. 9. Adell R, Lekholm U, Rockier 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. Reprint requests to: DR. NOAH STERN SCHOOL HEBREW
P.O.B.
OF DENTAL UNIVEFCWY
MEDICINE
1172
JERUSALEM ISRAEL
OCTOBER
1990
VOLUME
64
NUMBER
4