Current status of implant prosthetics in Japan: a survey among certified dental lab technicians

Hagiwara et al. International Journal of Implant Dentistry (2015) 1:4 DOI 10.1186/s40729-015-0005-3 RESEARCH ARTICLE Open Access Current status of implant prosthetics in Japan: a survey among certified dental lab technicians Yoshiyuki Hagiwara1*, Tatsuya Narita1, Yohei Shioda1, Keisuke Iwasaki1, Takayuki Ikeda1, Shunsuke Namaki1 and Thomas J Salinas2 Abstract Background: There are many implant cases in which dental technicians take initiative with regard to the design of implant prostheses, and to a certain extent, this area of care is one in which dentists do not necessarily play the leading role. Moreover, inadequate communication between dental technicians and dentists and insufficient instructions for technicians has been highlighted as issues in the past. The purpose of this questionnaire is to improve the quality of implant prostheses and thereby contribute to patient service by clarifying, among other aspects of treatment, problem areas and considerations in the fabrication of implant prostheses, conceptual-level knowledge, and awareness of prosthodontics on the part of the dentists in charge of treatment and methods for preventing prosthetic complications. Methods: A cross-sectional survey was given to 120 certified dental technicians. To facilitate coverage of a broad range of topics, we classified the survey content into the following four categories and included detailed questions for (1) the conditions under which implant technicians work, (2) implant fixed prostheses, (3) implant overdentures, and (4) prosthetic complications. Results: Out of 120 surveys sent, 74 technicians responded resulting in a response rate of 61.6%. Conclusions: This survey served to clarify the current state of implant prosthodontics, issues, and considerations in the fabrication of implant prostheses, and the state of prosthetic complications and preventive initiatives, all from a laboratory perspective. The results of this survey suggested that, to fabricate prostheses with a high level of predictability, functional utility, and aesthetic satisfaction, it is necessary to reaffirm the importance for dentists to increase their prosthetic knowledge and work together with dental technicians to develop comprehensive treatment plans, implement an organized approach to prosthesis design, and accomplish occlusal reconstruction. Keywords: Questionnaire; Survey; Implant prosthesis; Certified dental technicians; Prosthetic complications Background Currently, dental implant treatment is evaluated on the basis not only of restoring masticatory function, but also a variety of other factors, including the implant and superstructure survival rate and psychological impacts [1-3]. Numerous factors must be taken into account, to offer highly predictable implant treatment, and there is no doubt that prosthetic-related factors such as the type and compatibility of the prosthesis, as well as occlusion, make a major contribution to that goal [4-9]. * Correspondence: 1 Implant Dentistry, Nihon University School of Dentistry, Dental Hospital, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo 101-8310, Japan Full list of author information is available at the end of the article Recently, a restoration-driven approach to implant treatment has gained recognition and is being put into practice on a broad basis [10,11]. However, an increasingly diverse range of patient cases has led to a situation in which it is impossible to ascertain such aspects of actual practice as prosthesis type and design, making it necessary to reaffirm the importance of treatment carried out from a prosthetic perspective [12]. Many surveys querying dentists or patients with regard to implant treatment have been reported in the literature, addressing such topics as the state of implant treatment in particular countries and regions [13,14], quality of life and patient satisfaction [15-17], peri-implantitis and mucositis [18], and implant education [19,20]. However, very few surveys have queried © 2015 Hagiwara et al.; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. Hagiwara et al. International Journal of Implant Dentistry (2015) 1:4 dental technicians, whose job it is to fabricate implant prostheses [21,22]. Dental technicians play a major role in current implant treatment because of increases in both the importance of their participation as part of the treatment team from the treatment planning stage [21] and the frequency of prosthesis repairs, refabrication, and related procedures in the event of prosthetic complications. In particular, the types of prosthetic complications being experienced and associated trends are becoming clear thanks to numerous systematic reviews undertaken recently to investigate the implant complications. Fixed prostheses are prone to issues such as screw loosening, crown detachment, and fracturing of the veneering material on a frequent basis [23-27]. Similarly, implant overdentures are frequently affected by progressive loosening of attachments, denture base fractures, and a sequential need for relining [28,29]. However, because understanding the status of these complications is based on the results of surveys targeting dentists, information is needed on the situation as seen from the standpoint of implant technicians, to clarify the causes of these complications and the techniques for dealing with them. Issues including inadequate communication between dental technicians and dentists and insufficient instructions for technicians have been pointed out in the past [21,30,31]. These reports derive from surveys targeting older fixed or removable prosthesis designs, leaving it unclear not only whether those issues have been rectified in the face of expanding use of implant prostheses in recent years, but also to what degree the opinions and wishes of dental technicians are being reflected in implant treatment. This survey consists of a questionnaire targeting the certified dental technicians of the Japanese Society of Oral Implantology (JSOI) [32] who are primarily involved in fabricating dental implant restorations. It was formulated to clarify the current status of implant prostheses from a prosthetic and technician-oriented standpoint through questions addressing current trends among dental implant technicians, fixed prostheses, implant overdentures, and prosthetic complications and measures. The certified dental technicians of JSOI queried by the survey are involved in implant-related laboratory work on a comparatively frequent basis, and the responses they provided can be expected to accurately reflect the current state of implant laboratory practice in Japan. Our goal through this questionnaire is ultimately to improve the quality of implant prostheses and (...truncated)