Trends in implant dentistry: Implant systems, complications and barriers in Riyadh, Saudi Arabia

The file attached to this record is the Publisher's final version. Open access article.Background. Patients who are partially dentate or edentulous can receive both conventional and implantsupported fixed prostheses, which leads to improvement in function, esthetics and self-esteem. Currently, implant dentistry is one of the fastest-growing disciplines in dentistry. Objectives. The aim of the study was to assess the education and training of dentists practicing implant therapy in the Riyadh region of Saudi Arabia, including their preferred dental implant systems, the clinical complications experienced as well as the barriers to implant therapy they encounter. Material and Methods. A self-administered questionnaire was distributed among dentists in Riyadh performing dental implants in both the state and private sectors. The questionnaire included demographic data, such as nationality, the practitioner’s affiliated specialist category and their respective qualifications. Other data included their main sources of education pertaining to implant dentistry, the most commonly used implant systems, common clinical complications, and barriers to implant therapy. A descriptive statistical analysis of the data was carried out. Results. A significant majority of non-Saudi dental practitioners were employed in the private sector (p = 0.001), whereas a significant majority of Saudi dental practitioners were employed in the state sector (p = 0.001). The largest group of practitioners performing implants were general dentists (48.1%). The 3iTM implant system was the most widely utilized (35.4%). Failed osseointegration (12.6%) and peri-implantitis (12%) were the most common clinical complications. The biggest barrier to placing implants was the cost of implants to patients (59.1%). Conclusion. Fundamental to implant practice is the clinical practitioner and patient selection. The utilization of implant systems should preferably be based on the chemical properties of implant surfaces which promote early osseointegration. Comparative studies investigating the reasons for failed osseointegration and other clinical complications are needed locally and internationally. Further research, together with advanced clinical specialist training, can lead to improvement in the quality of implant therapy for the benefit of patients

Timeframe of socket corticalization after tooth extraction : A retrospective radiographic study

Background The formation of a hard-tissue bridge covering the tooth extraction socket is termed corticalization. In dogs this process takes >60d, however, this process has hardly been investigated in humans. Recent reports have indicated increased primary implant stability and reduced bone strain after immediate implant loading in the presence of a (thick) cortical layer, thus, knowledge of the timeframe between tooth extraction and hard-tissue bridging of the extraction socket appears clinically relevant in some situations. Aim/Hypothesis To determine the timeframe between tooth extraction and radiographically detectable corticalization of the socket in humans and to evaluate the possible impact of various factors on this process, e.g., history of periodontitis, smoking status, systemic disease, medications, etc. Material and Methods Two-hundred-fifty patients with a CT scan μ 8804, 36 months after tooth extraction and without any manipulation at the extraction site were included. Three orthoradial multiplanar reconstruction slices per extraction socket were scored, by a single calibrated examiner, regarding the degree of corticalization as: (a) healed, i.e., complete/continuous corticalization of the socket entrance, or (b) non-healed. Thereafter, each extraction socket was classified as (1) non-corticalized, i.e., all 3 slices classified as non-healed, (2) partially corticalized, i.e., 1 or 2 slices classified as non-healed, or (3) corticalized, i.e., all 3 slices classified as healed (Figure 1). The possible effect of several independent parameters, i.e., age, gender, timeframe between tooth extraction and CT scan, tooth type, periodontal status, gap dimension, smoking status, presence of any systemic disease, and medication intake, on the corticalization status was statistically evaluated. Results Three to 6 months after tooth extraction, 27% of the sockets were judged as non-corticalized, and 53% were judged as partially corticalized. After 9 to 12 months, >80% of the sockets were corticalized, but some non-corticalized sockets were detected up to 15 months post-extraction (Figure 2). Each additional month after tooth extraction contributed significantly to higher likelihood of a corticalized socket (OR 1.645, 95% CIs 1.471–1.841, P < 0.001). Periodontal attachment loss of μ 8805, 75% significantly prolonged corticalization time, i.e., teeth with <75% attachment loss were judged more often as corticalized (OR 1.984, 95% CIs 1.011–3.896, P = 0.047). No other independent variable had a significant effect on corticalization status. Conclusions and Clinical Implications Three to 6 months after tooth extraction one out of 4 sockets was still completely non corticalized, and only 9 to 12 months after tooth extraction complete corticalization was observed in about 80% of the sockets. The results, indicating a considerably long timeframe until corticalization of extraction sockets, imply that in cases where immediate loading requiring high primary implant stability is considered, waiting μ 8805,9 months post-extraction appears advisable