ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Survival Rates for Implants Placed by Specialists or in Academic Settings May Be Higher Than for Implants Placed by General Dentists
Clinical Question In healthy patients needing a single-tooth implant, is the 5-year survival rate for implants placed by general dentists equal to that of specialists?
Clinical Bottom Line Implant survival rates may be slightly higher in specialty settings, but survival rates depend more upon adequate existing bone, timing of implant placement, and location of implant placement.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22533954Pjetursson/201217 studies/1384 implant-supported FDPs; 12 studies/465 implant-supported single crownsMeta-analysis
Key resultsMeta-analysis was performed on studies performed in academic settings with a mean follow-up time of 5 years. For implant-supported fixed dental prostheses (FDPs), the annual failure rate was estimated at 0.99%, which translates into a 5-year survival rate of 95.2% (95% CI: 92.7%–96.8%). For implant-supported single crown, the annual failure rate was estimated as 1.14%, which translates into a 5-year survival rate of 94.5% (95% CI: 92.0%–96.2%).
#2) 24982276Da Silva/2014922 patients/922 implantsRetrospective
Key resultsThis study was a retrospective analysis of 922 patients of general dentists who were enrolled in a Dental Practice-Based Research Network. 64 of 920 implants for which complete records were available were classified as failures (7%); 93% were deemed successful. The mean follow-up time was 4.2 years. All of these implants were either placed surgically by a general dentist or by a specialist to whom the patient had been referred. However, all implants were restored by the general dentist. Univariate analysis showed that “a history of severe periodontitis, sites with preexisting inflammation or type IV bone, immediate versus delayed implant placement and placement in the incisor or canine region were associated with an increased risk of implant failure.”
Evidence Search “Implants placed in general dental practices”
Comments on
The Evidence
Validity: The Da Silva study was a records-based retrospective study of general dentists in private practices. The types and quality of data were therefore not likely to have been recorded in a standardized manner. The Pjetursson meta-analysis was based on prospective and retrospective cohort studies conducted in academic settings. An extensive literature review was conducted and there were clear inclusion and exclusion criteria for the studies. Perspective: The Pjetursson article provides a good point of comparison to the Da Silva (general dentist) article because their mean follow-up times were similar (5 years and 4.2 years, respectively). It is important to note that some of the implants in the Da Silva article were placed by specialists. Furthermore, it is possible that general dentists choose not to treat more difficult cases, which could artificially inflate the success rate in the Da Silva study. Similarly, data collected from academic centers may slightly skew results as there is potentially more access to resources and collaboration amongst clinicians. More studies analyzing the types of training a clinicians can undergo to improve their success rates would be beneficial.
Applicability While the rate of implant failures was slightly higher for implants placed by general dentists, factors other than specialty training were shown to be related to implant failure. Appropriate training, taking the appropriate precautions, and conservative patient selection are important considerations for both generalists and specialists. Patients needing implants with severe periodontitis and inadequate bone should be referred to specialists. Avoidance of immediate placement or placement in the incisor to canine region also could improve success rates in general practice settings.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics)
Keywords Implant success, implant failure, general dentist, periodontist, oral surgeon, specialist
ID# 3025
Date of submission: 03/22/2016spacer
E-mail rossbj@livemail.uthscsa.edu
Author Brian Ross
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Mark Littlestar, DDS
Faculty mentor/Co-author e-mail Littlestarm@livemail.uthscsa.edu
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