A Raesi Estabragh, et al

Original Article
Effective Factors in Implant System Se-
lection by Dentists in Kerman in 2018: A
Cross-Sectional Study
A Raesi Estabragh1, A Golestaneh*2 , M Maleki Gorji3 , L Kheiri3
1- Dentist
2- Assisstant Professor, Department of Oral and Maxillofacial Surgery, Dental School, Islamic Azad University, Isfahan (Kho-
rasgan) branch, Isfahan, Iran ,
3- Postgraduate Student, Department of Oral and Maxillofacial Surgery, Isfahan (Khorasgan) Branch, Islamic Azad University,
Isfahan (Khorasgan) branch, Isfahan, Iran

ARTICLE INFO ABSTRACT

Background and Aim: Since different implant systems are available, dentists are
Article History confronted with the question of which criteria are essential for a proficient implant
Received: May 2019 system selection. This study aimed to investigate the factors affecting implant system
Accepted: Apr 2019 selection by dentists in Kerman.
ePublished: Jun 2019 Materials and Methods:A questionnaire inspecting the key factors in implant system
Corresponding author:
selection was distributed among 120 dentists. Fisher’s exact test was used to analyze
A Golestaneh,Assisstant the data.
Professor, Department of Result: Most dentists used two implant systems at the office (52.5%). For the major-
Oral and Maxillofacial ity of dentists (40.8%), the first factor in choosing an implant system was the implant
Surgery, Dental School, support services. The price of each implant (25.8%) and the satisfaction of previ-
Islamic Azad University, ous cases (23.3%) were the second and third factors, respectively. For most dentists
Isfahan (Khorasgan) (59.2%), the least important reason for choosing an implant system was the manufac-
branch, Isfahan, Iran , turing country. Recommendation from colleagues (24.2%) was of minor importance
Email: drgolestaneh@ in implant system selection. Sixty-one (50.8%) dentists had a history of abandoning
gmail.com an implant system because of failure (59.0%) and lack of support from the importer
(27.9%). The quality of the implant was the major cause of system selection for 68.8%
of dentists and 75% of specialists (P<0.05).
Conclusion: The most important reason for choosing an implant system was post-
sales services. The cost of each implant and the satisfaction of previous cases were
other important factors. The least important factor was the system’s manufacturer.
Keywords: Dentists, Dental Implants, Dental Implantation
J Res Dentomaxillofac Sci 2019;4(4):28-42
DOI: 10.29252/jrdms.4.4.28

Introduction:
Implant treatments aim to reconstruct the
Tooth loss is a very common problem that
contour and improve the function, well-being,
might occur due to trauma and disease. There-
aesthetics, and phonetics of the patient. What
fore, the use of dental implants to replace missing
makes implant dentistry unique to therapeu-
teeth has a long history.(1-3) Since ancient times,
tics is its ability to achieve these goals without
humans have used dental implants to replace lost
causing bone atrophy.(4,8) The use of dental im-
teeth. (2,4,5) The history of dental implants dates
plants is a common method in treating edentu-
back to Ancient Greece when shells or shavings
lous and partially edentulous patients.(9)
were placed into the human jawbone.(3,6,7)
28 J Res Dentomaxillofac Sci 2019; 4 (4) http://www.jrdms.dentaliau.ac.ir
 Effective Factors in Implant System Selection by Dentists

Recently, implant treatment has become the most cess is the collaboration between surgeons and
predictable replacement of lost teeth, which dem- prosthodontists as every uncertainty in patient
onstrates a very high success rate.(6,10) Dental selection, diagnosis, and treatment design results
implants replace the missing teeth with minimal in implant failure.(15,20)
changes in other teeth and tissues in the mouth. Several studies have stated the success rate of
(11,12)
Implants with different designs, placed in a 20-year implant to be 92% to 98%. (16,17,21)
bones of different qualities, have variable degrees By 2003, more than 200 brands and implant sys-
of stability, depending on bone density and the tems were introduced to the dental market by 80
diameter and length of the implant.(8,13) Achieving manufacturers.(18,22)
an acceptable result and best aesthetics in implant Since different implant systems are available,
treatment depends on several factors, including dentists are confronted with the issue of choos-
the position of the three-dimensional (3D) im- ing one system for treatment. Although there are
plant, the quality of the tissue and mucosa, align- some primary requirements for the clinical use of
ment of the implant with the surrounding tissues, implant systems, ultimately, the dentist chooses
and sufficient bone volume in the buccal area.(9) the implant system for treatment.(19,23) Due to
The success of dental implants depends on the the lack of consensus and the lack of documents
initial and long-term stability, integrity, design, related to the best implant system, dentists are
gender, size, dimensions, implantation method, confronted with the question of which criteria to
soft tissue complications, as well as mechani- use to select an implant system.(20,24,25) Dentists
cal properties, including abutment design and choose an implant system according to various
technique of using the screw.(10,14,15) In addition, factors, such as the scientific evidence available,
the long-term success of implants depends on the cost-effectiveness, cost of each implant, post-
biocompatibility and mechanical compatibility. sales services, the brand, recommendation by
The manufacturers have resolved the biocompat- colleagues, the manufacturing country, dentist’s
ibility problem with the optimal use of materi- previous experiences, the complexity of the sur-
als and manufacturing techniques. Mechanical gical and prosthetic stages, the Food and Drug
adaptation is heavily dependent on the treatment Administration (FDA) and CE standards, the
plan. (11,16) The selection of implant type depends quality, and surface properties of the implant.
(19,26)
on factors such as jaw space, the remaining pros-
thetic space, emergence profile, bone volume, Considering the information gap related to the
and occlusal pattern.(9,17) priority of dentists for implant system selection
The survival of an implant depends on several in Iran, this study aimed to investigate the factors
factors and varies from one patient to another. affecting implant system selection by dentists in
(12,18)
The variables identified as the risk factors the city of Kerman in 2018.
for implant failure include demographic variables
(gender and age at implant placement), health
status variables (smoking, history of periodontal Materials and Methods
disease and root canal therapy), anatomical vari- Materials and Methods
ables (implant position, bone quality, implant’s The present analytical cross-sectional study in-
proximity to other teeth and implants, and the volved dentists working with dental implants in
number of implants per patient), and variables the city of Kerman in 2018.
specific to implants (short length, small diam- Data collection:
eter, and type of implant covering). Other vari- The method of collecting data was field-
ables include lack of keratinized gingiva, poor based; therefore, the information was collected
oral and dental health, plaque, and parafunction by interviewing and the completion of the ques-
habits. (13,14,19) tionnaire by 120 dentists from Kerman city, who
Another factor contributing to implant suc- were involved with implantation.

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 A Raesi Estabragh, et al

a measurement tool. The concept is con-

Dentists working in the field of implants, cerned with how much the measurements
who were willing to participate, were includ- under the same conditions give the same
ed in the study while dentists who refused results. The range of trust is from zero (no
to cooperate and complete the questionnaire relation) to +1 (full relation). If research is
were excluded along with incomplete ques- not reliable, it is difficult to interpret the
tionnaires. results with certainty or generalize them to
Questionnaire preparation: other conditions.
The questions were designed after identi- There are several methods to determine
fying the research objectives. The question- reliability. In this study, Cronbach’s alpha
naire included demographic variables (age coefficient, which is one of the methods of
and gender) and questions about determin- internal consistency, was used to determine
ing the criteria for the selection of implant the reliability of the questionnaire.(32) To
systems. The answers were evaluated based this end, using the data obtained from the
on the prioritization. In this questionnaire, 10 questionnaire and SPSS 19 software (SPSS
criteria for the selection of implant systems Inc., Chicago, IL, USA), the confidence co-
were mentioned. The dentists were asked to efficient was calculated using Cronbach’s
specify their criteria in order of priority.(27-29) alpha according to the following formula:
Both Likert and Guttman scales were used to Ra: Coefficient of validity
prepare the questionnaire and to choose the J: Number of questionnaires or tests
questions.(27-29) The purpose of the research : The variance of the J test
was explained to the dentists, and informed : Total test variance
consent was obtained for participation in the The coefficients of reliability for the ques-
study. Then, the questionnaires were distrib- tionnaire of effective factors in selecting
uted among the dentists. After the comple- implant systems were calculated and were
tion of the questionnaires, the answers were all higher than 0.7, which indicated the ac-
evaluated according to the order of criteria curacy of the measurements used in this
selection and priorities. study.
Content Validity: Statistical analysis:
The most important factor to be taken into SPSS software (version 22; SPSS Inc.,
consideration in the evaluation of a test is its Chicago, IL, USA) was used to analyze
validity. The first step in determining the va- the data. To evaluate the distribution of
lidity of a test is to examine its content valid- the obtained grades, Kolmogorov-Smirnov
ity. Content validity depends on the logical method was utilized. Fisher’s exact test was
analysis of the content of a test and its de- used to analyze the data.(33) The significance
termination based on individual and mental level was set at 0.05.
judgments. Content validity is of two types:
formal and logical validity. (30,31) To test
the content validity of a test, two methods are
used: content validity ratio (CVR) and con-
tent validity index (CVI).
The minimum acceptable value for the
CVI is 0.79. If the CVI is less than 0.79, the
item should be deleted. In this study, the CVI
was used to determine content validity.
Reliability:
Reliability is one of the technical features of
30 J Res Dentomaxillofac Sci 2019; 4 (4) http://www.jrdms.dentaliau.ac.ir
 Effective Factors in Implant System Selection by Dentists

Results tists with more than 5 years of experience, the

The analysis was carried out at two descriptive least important factor in choosing an implant
and inferential levels. At the descriptive level, the system was the manufacturing country. Fisher’s
mean and standard deviation (SD) and frequency exact test showed no significant difference in
distribution tables were used, and at the inferen- the least important reason for selecting an im-
tial level, Fisher’s exact test was used to compare plant system between the two groups (P>0.05).
the opinions of dentists based on gender, work According to Fisher’s exact test, there was no
experience, and specialty. The tests were per- significant difference between dentists with less
formed at a 5% error level using SPSS version than 5 years and more than 5 years of experience
22. (P>0.05; Table 2).
The average duration of implant treatment The most important reason for choosing an
performed by dentists was 4.5±2.6 years. 26.6% implant system for 46.9% of general dentists
of the participants were specialists, and 73.3% and 38.6% of specialists was post-sales services
were general dentists. Two implant systems were and support of the companies. Fisher’s exact test
the most frequent in the office (52.5%). did not show any significant difference between
For the majority of dentists (40.8%), the prior- general dentists and specialists for the priority in
ity for selecting an implant system was the post- choosing an implant system (P>0.05). The least
sales services of the company. On the other hand, important factor in choosing an implant system
for the majority of dentists (59.2%), the least based on the opinion of 62.5% of general den-
important reason for choosing an implant system tists and 58% of specialists was the manufacturer.
was the manufacturing country. The most impor- Fisher’s exact test did not show any significant
tant criterion in choosing a brand for most clini- difference in the selection of an implant system
cians (52.5%) was the presence of official repre- between the opinions of general dentists and
sentation and post-sales services in the country. specialists (P>0.05). The most important crite-
50.8% of dentists had a history of abandoning an rion for selecting an implant brand for 43.8% of
implant system. The main reason (59.0%) was general dentists and 55.7% of specialists was the
the lack of support from the importing company, presence of official representation and post-sales
and poor service was the second cause (27.9%). services. Fisher’s exact test did not show any sig-
Fisher’s exact test did not show any significant nificant difference between general dentists and
difference between male and female dentists for specialists for choosing a brand (P>0.05). The
the priority and the least important reason for implant quality was important for 68.8% of gen-
choosing an implant system (P>0.05). The most eral dentists and 75% of specialists. The result of
important criterion for choosing an implant brand Fisher’s exact test showed a significant difference
for 52.6% of male dentists and 52.3% of female between general dentists and specialists in this
dentists was the presence of official representa- respect (P<0.05). Accordingly, the importance
tion and post-sales services for implants. Fisher’s of accepting the cost of the implant treatment by
exact test did not show any significant difference patients was significantly higher for general den-
between male and female dentists (P>0.05; Ta- tists than for specialists. The importance of ease
ble1). of the procedure was significantly higher for
The most important reason for choosing an specialists (Table 3).
implant system for 42.2% of dentists with less According to Fisher’s exact test, there was
than 5 years of experience and 36.7% of dentists no significant difference between male and
with more than 5 years of experience was post-
female dentists in any of the factors related
sales services and support from the companies.
Fisher’s exact test did not show any significant to the selection of implant systems (P>0.05;
difference between these two groups in terms of Table 4).
the priority in the choice of an implant system
(P>0.05). According to 62.2% of dentists with
less than 5 years of experience and 50% of den-

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 A Raesi Estabragh, et al

There was a significant difference in the

effect of implant design on the choice of
an implant system between dentists with
experience less and more than 5 years
(P<0.05), which indicates that the effect of
implant design on choosing an implant sys-
tem was significantly higher on dentists with
more than 5 years of experience. Fisher’s
exact test did not show any significant dif-
ference between dentists with less and more
than 5 years of experience (P>0.05; Table 5).
There was a significant difference between
specialists and general dentists in choosing
an implant system (P<0.05). The effect of
factors related to choosing an implant system
was significantly higher on specialists. In
other cases, there was no significant differ-
ence in the selection of an implant system by
clinicians. According to Fisher’s exact test,
there was no significant difference between
specialists and general dentists in this respect
(P>0.05; Table 6).

32 J Res Dentomaxillofac Sci 2019; 4 (4) http://www.jrdms.dentaliau.ac.ir

 Effective Factors in Implant System Selection by Dentists

Table 1. Comparison of the reasons and criteria for choosing an implant system based on the gender
of the dentist

Variable Group Male Female P-value

Number % Number %
The most important Cost of each implant 18 23.7 13 29.5 .844
reason for choosing Post-sales service 30 39.5 19 43.2
an implant system Brand 3 3.9 1 2.3
Recommendation by colleagues 5 6.6 1 2.3
Manufacturing country 1 1.3 1 2.3
Satisfaction of previous patients 19 25.0 9 20.5
The most Cost of each implant 5 6.6 2 4.5 .428
insignificant reason Post-sales service 2 2.6 1 2.3
for choosing an Brand 6 7.9 1 2.3
implant system Recommendation by colleagues 15 19.7 14 31.8
Manufacturing country 47 61.8 24 54.5
Satisfaction of previous patients 1 1.3 2 4.5
An important Implant manufacturer 6 7.9 1 2.3 .684
criterion in Existence of official 40 52.6 23 52.3
choosing a brand representation and post-sales
service
Having FDA and CE standard 16 21.1 11 25.0
The success or failure of 14 18.4 9 20.5
different implant brands
Ease of work for the clinician 10 13.2 7 15.9 .895
Patient’s awareness and right to 0 0.0 0 0.0
choose an implant
Acceptance of the cost of the 6 7.9 4 9.1
implant by the patient
Implant quality 56 73.7 32 72.7
Ability to achieve the goals 4 5.3 1 2.3
without causing bone atrophy
Total 76 100.0 44 100.0

FDA=Food and Drug Administration

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 A Raesi Estabragh, et al

Table 2. Comparison of the reasons and criteria for selecting an implant system based on the experi-
ence of the dentist

Variable Group <5 years >5 years P-value

Number % Number %

The most Cost of each implant 23 25.6 8 26.7 .915

important Post-sales service 38 42.2 11 36.7
reason for Implant brand 3 3.3 1 3.3
choosing an Recommendation by 5 5.6 1 3.3
implant colleagues
system Manufacturing 1 1.1 1 3.3
country
Satisfaction of 20 22.2 8 26.7
previous patients
The most Cost of each implant 5 5.6 2 6.7 .463
insignificant Post-sales service 3 3.3 2 6.7
reason for Implant brand 5 5.6 11 36.7
choosing an Recommendation by 18 20.0 0 0.0
implant colleagues
system Manufacturing 56 62.2 15 50.0
country
Satisfaction of 3 3.3 0 0.0
previous patients
An important Implant manufacturer 5 5.6 2 6.7 .091
criterion in Existence of official 52 57.8 11 36.7
choosing a representation and
brand post-sales service
Having FDA and CE 20 22.2 7 23.3
standard
The success or failure 13 14.4 10 33.3
of different implant
brands
Ease of work for the 11 12.2 6 20.0 .356
dentist
Patient’s awareness 0 0.0 0 0.0
and right to choose
the implant
Acceptance of cost of 9 10.0 1 3.3
the implant by the
patient
Implant quality 65 72.2 23 76.7
Ability to achieve the 5 5.6 0 0.0
goals without causing
bone atrophy
Total 90 100.0 30 100.0
FDA=Food and Drug Administration

34 J Res Dentomaxillofac Sci 2019; 4 (4) http://www.jrdms.dentaliau.ac.ir

 Effective Factors in Implant System Selection by Dentists

Table 3. Comparison of the reasons and criteria for choosing an implant system based on the
dentist's specialty

Variable Group General dentist Specialist P-value

Number % Number %
The most Cost of each implant 6 18.8 25 28.4 .620
important Post-sales service 15 46.9 34 38.6
reason for Implant brand 1 3.1 3 3.4
choosing an Recommendation by 3 9.4 3 3.4
implant colleagues
system Manufacturing country 0 0.0 2 2.3
Satisfaction of previous 7 21.9 21 23.9
patients
The most Cost of each implant 2 6.3 5 5.7 .946
insignificant Post-sales service 1 3.1 2 2.3
reason for Implant brand 2 6.3 5 5.7
choosing an Recommendation by 6 18.8 23 26.1
implant colleagues
system Manufacturing country 20 62.5 51 58.0
Satisfaction of previous 1 3.1 2 2.3
patients
An Implant manufacturer 1 3.1 6 6.8 .098
important Existence of official 14 43.8 49 55.7
criterion in representation and post-sales
choosing a service
brand Having FDA and CE standard 6 18.8 21 23.9
The success or failure of 11 34.4 12 13.6
different implant brands
Ease of work for the dentist 1 3.1 16 18.2 .003
Patient’s awareness and right 0 0.0 0 0.0
to choose the implant
Acceptance of the cost of the 7 21.9 3 3.4
implant by the patient
Implant quality 22 68.8 66 75.0
Ability to achieve the goals 2 6.3 3 3.4
without causing bone atrophy
Total 90 100.0 30 100.0

FDA=Food and Drug Administration

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 A Raesi Estabragh, et al

Table 4. Comparison of various factors affecting the choice of an implant system based on the
gender of the clinician
Gender Yes No No difference No idea P-value

Number % Number % Number % Number %

Single-stage or two- M 36 47.4 30 39.5 7 9.2 3 3.9 .529
stage F 23 52.3 19 43.2 2 4.5 0 0.0
Implant design M 26 34.2 43 56.6 4 5.3 2 2.6 .125
F 7 15.9 32 72.7 4 9.1 1 2.3
Implant surface M 63 82.9 9 11.8 1 1.3 2 2.6 .871
F 38 86.4 6 13.6 0 0.0 0 0.0
Patient gender and age M 14 18.4 57 75.0 3 3.9 2 2.6 .791
F 10 22.7 32 72.7 2 4.5 0 0.0
Systemic disease M 26 34.2 46 60.5 3 3.9 1 1.3 .518
F 10 22.7 32 72.7 1 2.3 1 2.3
Parafunctional habit M 24 31.6 44 57.9 3 3.9 3 3.9 .892
F 14 31.8 26 59.1 3 6.8 1 2.3
Smoking M 36 47.4 34 44.7 4 5.3 2 2.6 .486
F 16 36.4 25 56.8 2 4.5 0 0.0
Tooth type M 25 32.9 40 52.6 11 14.5 0 0.0 .363
F 13 29.5 28 63.6 3 6.8 0 0.0
Type of edentulism M 32 42.1 39 51.3 5 6.6 0 0.0 .706
F 16 36.4 26 59.1 2 4.5 0 0.0
Bone density in the M 63 82.9 12 15.8 1 1.3 0 0.0 1.00
edentulous area F 36 81.8 7 15.9 1 2.3 0 0.0
Implant area M 28 36.8 41 53.9 6 7.9 1 1.3 .425
F 11 25.0 30 68.2 2 4.5 1 2.3
Prosthesis space M 46 60.5 26 34.2 4 5.3 0 0.0 .453
F 30 68.2 11 25.0 2 4.5 1 2.3
Emergence profile M 13 17.1 53 69.7 6 7.9 4 5.3 .610
F 10 22.7 31 70.5 1 2.3 2 4.5
Bone quality M 69 90.8 5 6.6 1 1.3 1 1.3 .265
F 36 81.8 7 15.9 1 2.3 0 0.0
Bone volume M 61 80.3 13 17.1 1 1.3 1 1.3 .246
F 29 65.9 12 27.3 2 4.5 1 2.3
Bone pattern M 56 73.7 18 23.7 2 2.6 0 0.0 .705
F 30 68.2 12 27.3 2 4.5 0 0.0
Occlusal pattern M 19 25.0 50 65.8 1 1.3 6 7.9 .598
F 7 15.9 33 75.0 1 2.3 3 6.8

M=Male, F=Female

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 Effective Factors in Implant System Selection by Dentists

Table 5. Comparison of different factors affecting the choice of an implant system based on the
work experience of the dentist

Experience Yes No No difference No idea P-value

(years)

Number % Number % Number % Number %

Single-stage or two- ≤5 45 50.0 35 38.9 7 7.8 3 3.3 .890

stage >5 14 46.7 14 46.7 2 6.7 0 0.0
Implant design ≤5 19 21.1 62 68.9 5 5.6 3 3.3 .023
>5 14 46.7 13 43.3 3 10.0 0 0.0
Implant surface ≤5 74 82.2 12 13.3 1 1.1 2 2.2 .899
>5 27 90.0 3 10.0 0 0.0 0 0.0
Patient gender and ≤5 18 20.0 69 76.7 2 2.2 1 1.1 .180
age >5 6 20.0 20 66.7 3 10.0 1 3.3
Systemic disease ≤5 24 26.7 62 68.9 2 2.2 2 2.2 .209
>5 12 40.0 16 53.3 2 6.7 0 0.0
Parafunctional habit ≤5 28 31.1 53 58.9 4 4.4 4 4.4 .756
>5 10 33.3 17 56.7 2 6.7 0 0.0
Smoking ≤5 40 44.4 42 46.7 5 5.6 2 2.2 .848
>5 12 40.0 17 56.7 1 3.3 0 0.0
Tooth type ≤5 32 35.6 48 53.3 10 11.1 0 0.0 .329
>5 6 20.0 20 66.7 4 13.3 0 0.0
Type of edentulism ≤5 34 37.8 51 56.7 5 5.6 0 0.0 .609
>5 14 46.7 14 46.7 2 6.7 0 0.0
Bone density in the ≤5 76 84.4 13 14.4 1 1.1 0 0.0 .414
edentulous area >5 23 76.7 6 20.0 1 3.3 0 0.0
Implant area ≤5 27 30.0 56 62.2 5 5.6 2 2.2 .455
>5 12 40.0 15 50.0 3 10.0 0 0.0
Prosthesis space ≤5 58 64.4 27 30.0 4 4.4 1 1.1 .823
>5 18 60.0 10 33.3 2 6.7 0 0.0
Emergence profile ≤5 18 20.0 65 72.2 3 3.3 4 4.4 .201
>5 5 16.7 19 63.3 4 13.3 2 6.7
Bone quality ≤5 79 87.8 9 10.0 1 1.1 1 1.1 .704
>5 26 86.7 3 10.0 1 3.3 0 0.0
Bone volume ≤5 69 76.2 18 20.0 1 1.1 2 2.2 .292
>5 21 70.0 7 23.3 2 6.7 0 0.0
Bone pattern ≤5 66 73.3 22 24.4 2 2.2 0 0.0 .383
>5 20 66.7 8 26.7 2 6.7 0 0.0
Occlusal pattern ≤5 19 21.1 63 70.0 0 0.0 8 8.9 .121
>5 7 23.3 20 66.7 2 6.7 1 3.3

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 A Raesi Estabragh, et al

Table 6. Comparison of different factors influencing the choice of an implant system based
on the dentist's specialty

Specialty Yes No No difference No idea P-value

Number % Number % Number % Number %

Single-stage or Specialist 9 28.1 19 59.4 4 12.5 0 0.0 .013
two-stage General dentist 50 56.8 30 34.1 5 5.7 3 3.4

Implant design Specialist 16 50.0 11 34.4 3 9.4 2 6.3 <.001

General dentist 17 19.3 64 72.7 5 5.7 1 1.1

Implant surface Specialist 27 84.4 4 12.5 0 0.0 1 3.1 .749

General dentist 74 84.1 11 12.5 1 1.1 1 1.1

Patient gender and Specialist 7 21.9 22 68.8 3 9.4 0 0.0 .297

age General dentist 17 19.3 67 76.1 2 2.3 2 2.3

Systemic disease Specialist 13 40.6 16 50.0 1 3.1 2 6.3 .033

General dentist 23 26.1 62 70.5 3 3.4 0 0.0

Parafunctional Specialist 13 40.6 13 40.6 1 3.1 4 12.5 .003

habit General dentist 25 28.4 57 64.8 5 5.7 0 0.0

Smoking Specialist 12 37.5 16 50.0 1 3.1 2 6.3 .267

General dentist 40 45.5 43 48.9 5 5.7 0 0.0

Tooth type Specialist 16 50.0 11 34.4 5 15.6 0 0.0 .008

General dentist 22 25.0 57 64.8 9 10.2 0 0.0
Type of Specialist 20 62.5 7 21.9 5 15.6 0 0.0 <.001
edentulism General dentist 28 31.8 58 65.9 2 2.3 0 0.0

Bone density in Specialist 27 84.4 5 15.6 0 0.0 0 0.0 1.000

the edentulous General dentist 72 81.8 14 15.9 2 2.3 0 0.0
area
Implant area Specialist 16 50.0 10 31.3 4 12.5 2 6.3 <.001
General dentist 23 26.1 61 69.3 4 4.5 0 0.0

Prosthesis space Specialist 23 71.9 6 18.8 2 6.3 1 3.1 .103

General dentist 53 60.2 31 35.2 4 4.5 0 0.0

Emergence profile Specialist 9 28.1 17 53.1 5 15.6 1 3.1 .011

General dentist 14 15.9 67 76.1 2 2.3 5 5.7

Bone quality Specialist 27 84.4 4 12.5 1 3.1 0 0.0 .650

General dentist 78 88.6 8 9.1 1 1.1 1 1.1

Bone volume Specialist 21 65.5 8 25.0 2 6.3 1 3.1 .203

General dentist 69 78.4 17 19.3 1 1.1 1 1.1

Bone pattern Specialist 19 59.4 11 34.4 2 6.3 0 0.0 .145

General dentist 67 76.1 19 21.6 2 2.3 0 0.0

Occlusal pattern Specialist 9 28.1 14 43.8 2 6.3 7 21.9 <.001

General dentist 17 19.3 69 78.4 0 0.0 2 2.3

38 J Res Dentomaxillofac Sci 2019; 4 (4) http://www.jrdms.dentaliau.ac.ir

 Effective Factors in Implant System Selection by Dentists

Discussion: or provide brochures containing such infor-

Today, there are about 1300 different im- mation on their websites. Only a few of these
plant systems with different shapes, dimen- websites give customers an idea of which
sions, materials, designs, surface topogra- product or company complies with interna-
phy, surface chemistry, and the ability to tional standards.(19,37)
moist and modify surface features.(34,35) In The most important criterion in choosing a
recent years, the number of implant manu- brand in the opinion of most dentists (52.5%)
facturers has increased, and dentists have a was the presence of official representation
variety of implant systems to choose from. and post-sales services in the country. There-
(19,36)
This study aimed to investigate the ef- fore, the dentist must be sure of the implant
fective factors in selecting an implant sys- manufacturer's support in the country. The
tem among clinicians in Kerman city. One implant quality was reported as an important
of the main advantages of this study was the factor for 73.3% of dentists.
ability to determine the criteria for selecting In the present study, for the majority of
dental implants among dentists in Iran. dentists (59.2%), the least important reason
In terms of the number of implant sys- for choosing an implant system was the man-
tems present in the office, the highest fre- ufacturing country. Recommendation from
quency was observed for dentists who colleagues (24.2%) was of minor importance
had two implant systems in their offices in the choice of an implant system. Contrary
(52.5%). This may be related to the follow- to our study, Hagiwara and Carr, in Japan,
ing factors; first, different companies pro- stated that dentists often choose an implant
duce implants with different characteristics system because of its simplicity or their col-
that may be suitable for one case and not leagues' suggestions.(25) This difference can
suitable for the other. Second, some den- be due to the difference in the type of as-
tists prefer using multiple implant systems sessment or to the lack of sufficient scientific
to protect themselves from problems in the evidence regarding different types of implant
future that may arise due to the use of just systems.
one implant system. Also, clinicians might The success of dental implants is multi-
prefer to use more than one implant system factorial and depends on several factors, such
because of market fluctuations and prob- as the quality and quantity of bone, surgical
lems related to implant import. In a study and prosthetic techniques and construction,
by Al-Wahadni et al, the majority of den- and the applied load.(24,38)
tists utilized two or more implant systems. Early failure of the implant due to inad-
(19)
equate osseointegration occurs in 1-2% of
For the majority of dentists (40.8%), patients in the first few months. Secondary
the priority for choosing an implant system failure of the implant happens several years
was post-sales services and support of the after successful osseointegration in about
company. It seems that the availability of 5% of patients and is usually due to peri-
implant systems in Iran is very important implantitis.(34) The primary index for the suc-
to clinicians and dentists. The cost of each cess of dental implants is osseointegration
implant and the satisfaction of previous pa- or direct bone-implant contact, which is the
tients were the next major reasons, which direct attachment between the bone tissue
suggest that implant systems should also be and the titanium implant surface. Successful
tested clinically. On the other hand, few im- osseointegration is an indication of favora-
plant system companies refer to scientific ble bone response to the insertion of a dental
research in support of their implant systems implant.(39) However, the long-term success-
http://www.jrdms.dentaliau.ac.ir Journal of Research in dental and maxillofacial sciences 39
 A Raesi Estabragh, et al

ful osseointegration of dental implants in the

jawbones is due to the precision of the bio- Also, for the majority of dentists, the most
mechanics of implants and their superstruc- important reason for choosing an implant
ture. Implant surface topography and surface system was the system’s manufacturer. Fur-
roughness, bone-implant interface, implant ther studies with a larger sample size as well
design, implant length and diameter, geomet- as comparative studies on the factors affect-
ric features of the edentulous site, and sup- ing the choice of implant system between
porting properties of bone have been report- maxillofacial surgeons and periodontitis are
ed as important factors in the load transfer required to achieve the best outcomes.
mechanism and bone-implant response.(24)
Clinicians have reported some effective
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Please cite this paper as:

Raesi Estabragh A, Golestaneh A, Maleki Gorji
M, Kheiri L. Effective Factors in Implant Sys-
tem Selection by Dentists in Kerman in 2018: A
Cross-Sectional Study. J Res Dentomaxillofac
Sci. 2019; 4 (4) :28-42

42 J Res Dentomaxillofac Sci 2019; 4 (4) http://www.jrdms.dentaliau.ac.ir