of Knowledge and Awareness of Dentists Regarding
Digital Implantology in The State of Maharashtra-A Questionnaire
Based Survey

Dr. Shrishrimal Mahavir D. 1
, Dr. Dixit Santosh Y.2
, Dr. Deshpande Varun A.3
, Dr. Rathod Vikram E. 3
,
Dr. Jain Pooja4
, Dr. Waychal Sejal1
1
(BDS) Post Graduate Student,
2
(MDS) Head of the Department,
3
(MDS) Reader,
Department of Prosthodontics, Pandit Deendayal Upadhyay Dental College, Solapur, India.
4
(BDS)Post Graduate Student
Department of Prosthodontics, Government Dental College and Hospital, Ahmedabad, India

ABSTRACT
Aim This study aims to assess the knowledge, attitude, and practice of students and dental practitioners
in the state of Maharashtra towards digital approach used in Implantology.
Materials and methodology: The study was conducted as a questionnaire-based survey amongst dental
students and dental practitioners in the state of Maharashtra India. A questionnaire consisting of 14 close
ended questions was prepared to obtain information about their knowledge, attitude, and practice
towards various digital approaches available in today’s scenario regarding implantology right from
diagnosis to implant placement. A total of 500 people involving dental students and dental practitioners
were chosen as the participants. The questionnaire was sent to the participants via Google forms and
their responses on the same were collected. The data was then analysed.
Results: The response obtained from the participants was a reflection of their knowledge, attitude, and
practice on digitization in the field of Implantology. It was observed that interns and those with limited
clinical experience weren’t much updated about the advances in digitization when compared to postgraduates and established practitioners who were quite updated.
Conclusion: Considering the method of dental implant placement, most of the participants agreed to
the fact that the digital approach is a better approach when compared to the conventional one, but at the
same time, they also accepted that they weren’t much aware or exposed to the newest advancements in
the field of digitisation. Digitally fabricated surgical templates, digital planning, impression techniques,
are the factors that might lead to simple yet effective implant procedures in terms of prosthodontically
driven surgeries. Therefore, it should be considered of utmost importance to initiate and spread
awareness at a larger scale and right from the beginning so that more and more number of patients can
Assessment of Knowledge and Awareness of Dentists Regarding
Digital Implantology in The State of Maharashtra-A Questionnaire
Based Survey
Dr. Shrishrimal Mahavir D. 1
, Dr. Dixit Santosh Y.2
, Dr. Deshpande Varun A.3
, Dr. Rathod Vikram E. 3
,
Dr. Jain Pooja4
, Dr. Waychal Sejal1
1
(BDS) Post Graduate Student,
2
(MDS) Head of the Department,
3
(MDS) Reader,
Department of Prosthodontics, Pandit Deendayal Upadhyay Dental College, Solapur, India.
4
(BDS)Post Graduate Student
Department of Prosthodontics, Government Dental College and Hospital, Ahmedabad, India
.
Shrishrimal et. al.: Assessment and awareness of dentists regarding digital implantology -a survey
The JPDM | Vol 3 | Issue 1 | 2022 10
be benefited by the same. Various courses and CDE programs can help to update their knowledge and
skill regarding digital implant dentistry
Keywords: Digital workflow, Implantology, Awareness, STL, Questionnaire survey
Citations: Shrishrimal M, Dixit S, Deshpande V, Rathod V, Jain P, Waychal S. Assessment of
Knowledge and Awareness of Dentists Regarding Digital Implantology in The State of Maharashtra-A
Questionnaire Based Survey. J Prosthodont Dent Mater 2022;3(1):9-23.

INTRODUCTION
Implant dentistry is going through a digital revolution. Through the development of new types
of equipment and their corresponding workflows, the diagnosis and treatment of our patients are
becoming simpler and more efficient. Digital technology has become assimilated into every part of our
daily life. The nearly universal acceptance and use of smartphones, tablets, and other technologies have
made our lives more productive and efficient. A similar trend has made its way into our clinical practice
as well. The leveraging of digital tools and technologies has produced workflows that can make our
delivery of care more productive as well as efficient. Implant dentistry is one clinical area where digital
technology can be used to its fullest extent. With the advent and dissemination of intra-oral (IO) scanning
devices, cone beam computed tomography (CBCT), implant planning software, and dental laboratory
software to design and manufacture restorative components, the ability to harness and apply these
technologies on a daily clinical basis has never been greater. Ultimately, by learning the proper use and
application of these tools, our patients can benefit from more streamlined and effective workflows. 1
Implant dentistry is one clinical area where digital technology can be utilized to its fullest extent.
Guided implant surgeries bestowed enhanced therapeutic workflow and safety. With increasing
availability, reduced radiation and lower costs of three-dimensional imaging because of cone-beam
computer tomography, pre-operative three-dimensional implant planning is becoming more popular in
dentistry. Navigated implant surgery provides for improved implant positioning at anatomically
sensitive structures such as the maxillary sinus, the mandibular canal, and the mental foramen. Recently
a radiological template free implant guided surgery workflow has been introduced for partially edentate
patients. As soon as the techniques and advantages flourished, the current decade of activity by early
adopters fueled innovation. Digital technology is driving a remarkable change in the practice of dental
implantology

The Benefits of Digital Technology1. A Most important advantage of digital workflow is it makes a positive impact on the patient’s
mind.

  1. The Patient can simulate the final outcome of the treatment with the help of a digital workflow.
  2. Digital scanners are helpful to avoid messy conventional impression techniques. Accuracy of
    these digital impressions provides a precise recording of hard and soft tissues.
  3. Because of the proven accuracy of digital scanners, final restorations also obtain a better
    marginal fit.
  4. It provides us an easy way to communicate with the lab and patient itself.
  5. Electronically recorded .STL file can be sent to the other specialties to discuss and deliver the
    best possible treatment to a patient.

Steps in the implant-prosthetic digital workflow 3
1 Patient CBCT
2.A Digital impression
2.B Digital Wax up

  1. Cast+ Wax up+3D optical scan
  2. DICOM+. STL matching
  3. 3D implant planning
  4. Guided surgery and immediate loading
  5. Intraoral optical scans
  6. CAD-CAM restorations
    Table 1-Digital Workflow for Dental Implants
    The questionnaire for the current research
    Name (Optional):
    Age/ Gender:
    Designation:
    Years of Practice1. Do you use digital technologies in your practice? (e.g.-RVG, CBCT, Intraoral Scanner)

Yes

No

Are the currently available digital technologies users friendly?

Are the currently available digital technologies users friendly?

nal training in implant placement?

METHODOLOGY
A web-based survey was conducted through an online questionnaire (prepared in Google forms
software) comprising of 14 close-ended questions and assessed using percentage with the intention of
evaluating awareness among 800 participants. The Questionnaire was framed in English to encourage
participation and to serve better understanding of the questions by the respondents. All the respondents
were informed about the aims and objectives of the study which were mentioned along with the
questionnaire. The questions were directed towards the evaluation of knowledge and assess how far the
participants are updated about the recent advances in the field of digital implantology. Of the 800
participants, only 500 reverted to the questionnaire, thus participated in the study. A total of 115 dental
students and 387 dental practitioners participated in this current study. The questionnaire survey for
dental students was distributed among interns and postgraduate students.
A web-based questionnaire assisted in ease of data collection, compiling, and maintenance of data. The
additional advantage was that since the survey was conducted online it allowed participants to participate
in the study as per their own convenience. The data obtained was easily available instantly and could be
easily transferred into specialized statistical software or spreadsheets for further analysis. A Descriptive
analysis was carried out to evaluate the responses.
RESULT
The response obtained from the participants was a reflection of their knowledge, attitude, and
practice on digitization in the field of Implantology. It was observed that interns and those with limited
clinical experience weren’t much updated about the advances in digitization when compared to
Postgraduates and established practitioners who were quite updated. The detailed response of the
participants to each question is discusseed as under.

Regarding the first question, use of digital tools such as RVG, CBCT, etc. in the dental office, most of
the dental students and dental practitioners (85%) had the knowledge and are currently using it in their
routine practice successfully. On the other hand, 15% of the participants still use conventional tools in
their office.

In response to the second question on ease of handling such digital modes, 432 participants
(86.4%) found it easy to use whereas 68 participants (13.6%) opted ‘No’ which makes us infer that they
may be coming across some difficulty with these digital tools.

In response to the third question based on the opinion regarding the precision of digital technology over
the conventional one, 448 participants (89.6%) agreed that digital technology yields better precision .

regarding diagnosis and treatment planning in the dental field. On the other hand, 52
participants (10.4%) still prefer conventional modes when it comes to diagnostics and thinks they are
better as compared to digital.

Regarding the fourth question about the most commonly used imaging modality prescribed in
dental clinics while planning implant placements, 333 participants (66.6%) chose to prescribe some
additional hematological tests along with OPG and CBCT. 64 responses (12.8%) were in favor of
imaging modalities like OPG, CBCT, and CT. 46 participants (9.2%) opted for OPG and CBCT whereas
57 participants (11.4%) chose to prescribe just a single radiographic evaluation i.e., OPG.

According to Figure 5, 59.8% (299) participants conveyed that patient in their practice are aware
and prefer going for digital implant placement whereas 201 participants (40.2%) reported that their
patient still chose with conventional methods. Additional Cost pertaining to the use of digital tools could
be the reason for patients still opting for conventional over digital placement.
Regarding the 6th question about preference of the clinicians for opting digital methods over the
conventional, 55.4% of participants (277 participants) preferred digital technology. 35.4% of
participants (177 participants) were in a dilemma about it, whereas 9.2% of participants (46 participants)
chose conventional methods.

In response to the question about the professional training for implant placement, 362 participants
(72.4%) stated that they did not receive any professional training in implant placement whereas 138
participants (27.6%) have received professional training in implant placement.

Simultaneous insertion of multiple implants may exhibit suboptimal positions, especially in edentulous
jaws considered for a fixed restoration. Arısan et al. carried out a study to compare the incidence of and
confounding factors in implant positioning errors related to the use of freehand and computer-aided
treatment methods and stated that the highest probability of positioning error (88%) was associated with
the use of the freehand method, whereas the lowest (6%) was associated with single-type, mucosasupported guides with other significant confounding factors.4
Regarding the opinion of clinicians whether any additional benefits will be provided by digital
workflow, 88.6% (443) of participants believed it to be true. On the other hand, 11.4% participants (57)
believed that there will be no advantage of digital technology regarding implant placement.

In response to the question to clinicians about their awareness about recent advances in field of digital
implantology, 102 (20.4%) participants said they were unaware that, 37.6% were unsure (188 response).

Whereas 210 responses (42%) were suggestive of awareness regarding digital implantology.

In 1988, a breakthrough concept was introduced. Dental software that reformatted CBCT images
in a way that was useful planning. The software continued to evolve. In 1993, software was introduced
allowing overlay virtual implants on cross-sectional images. The most powerful way to use CBCT
technology is in concert with implant planning software. These programs allow the user to view all of
the characteristics of a future implant site by allowing for the precise assessment of bone volume, bone
density, and restorative space in conjunction with the ability to identify and mark anatomic landmarks
such as nerves, sinuses, and proximal teeth (Fig.11). Beyond site assessment, the most useful tool is the
ability to virtually place an implant into the proposed site. This allows for accurate implant width, depth,
and size determinations prior to surgery to aid in the pre- surgical planning stages.(1) After the CBCT
data are acquired, the images are exported into DICOM (Digital Imaging and Communications in
Medicine) files, a standard for the distribution and viewing of medical images regardless of their origin.
For implant planning purposes, the cross-section is the primary diagnostic image used for the assessment

of bone volume and quality. All the software programs allow the visualization of the data set in the
multiplanar reconstruction view, which is the default visualization mode in CT and CBCT imaging.

of bone volume and quality. All the software programs allow the visualization of the data set in the
multiplanar reconstruction view, which is the default visualization mode in CT and CBCT imaging.

Digital techniques of impression making demonstrated superior outcomes in comparison with
conventional methods, and the direct technique was better than the indirect conventional technique.
Connection type and implant angulation were other factors that influenced accuracy in the conventional
impression making. However, when the digital impression was applied, accuracy was not affected by
the type of connection and angulation 5
. The percentage of participants who have used scanners for
digital impression is approximately 36.9% (184 responses). Whereas 63.1% (315 responses) of
participants have not made a digital impression (Fig 13). Those who have made digital impressions
convey that patient’s response was pleasant after the impression making .

According to Figure 14, the majority of participants 75.8% (379 responses) stated that the
introduction of digital technology would improve the quality and function of rehabilitation. Whereas 9
respondents (1.8%) stated there would be no difference, and 22.4% (112 responses) stated that they were
unsure about it .

ability to discriminate alveolar bone thicknesses between 0.13 to 0.3 mm, and without over or
underestimation. Precise knowledge of oral radiology along with CBCT in the dental fraternity is
important due to its wide applications and profound potential of CBCT in different specialties of
dentistry. According to Rai et.al 7
, it was found that a maximum of 94.7% of clinicians advised CBCT
to their patient for a successful diagnosis which is having similar results to our study (89.6%).
On the contrary, a study conducted by R. Chowdhary 8 Computed tomography (CT) was the
preferred diagnostic technique by 33.3% implantologists in Japan, 26.32% in Russia, 23.58% in Europe,
96.59% of Americans, 98.62% European Union dentists.
At present, computer-based technologies are well established in designing and manufacturing
dental appliances and prostheses but they are still too expensive and their maintenance and repair costs
are high like any other new technology. Apart from the reason mentioned above, a lack of awareness
about the complications and usage of too

ols, etc. are the main influencing factors. 10 This has similar
patters with our study.
Focusing only on the prosthodontics curriculum, educators are engaging in emerging digital
technologies. A recent survey of US dental school deans conducted by Brownstein et al (2015) reported
that greater penetration of digital technology occurred in preclinical didactic courses and the lowest was
in preclinical laboratories. CAD/CAM has reached the clinical environment as well. One important
observation regarding digital dentistry in the academic environment is that technology adoption in US
dental schools is keeping pace with or exceeding the early adoption in private practices. This type of
system should also be implied in India

CONCLUSION
Within the limitation of the study few questions were framed on the practitioner’s opinion, but not
literature evidence. The findings of this study clearly point out a need for a high level of awareness
among students. However, a large number of participants were interested in using digital tools to provide
successful restoration and to work in a hassle-free environment. High costs, lack of knowledge were the
main disadvantages of digital implant treatment according to participants. With web-based surveys, the
respondents are able to answer the questionnaire by means of inputting their answers while connected
to the Internet. Then, the responses are automatically stored in a survey database, providing hassle-free
handling of data and a smaller possibility of data errors.
It can be concluded from the survey that; High percentage of participants prefer digital impression. It
also showed the need for providing more information and knowledge about impression techniques
available for dental implants among dental students. Hence, proper dental education with an interesting
way of delivering is necessary to develop a positive attitude among the dental student population toward
dental implants holistically. It can also be observed from the survey, lack of awareness, and lower level
of education related to the digitization in the field of prosthodontics brings the negative attitude in the
practitioners. This situation can be improved by guiding and motivating students to use digital
techniques from the dental school itself and by undertaking various CDE programs for practitioners to
keep their knowledge updated and serve the patients in the best way possible.
Shrishrimal et. al.: Assessment and awareness of dentists regarding digital implantology -a survey
The JPDM | Vol 3 | Issue 1 | 2022 23
REFERENCES

  1. Ludlow M, Renne W. Digital workflow in implant dentistry. Current Oral Health Reports. 2017
    Jun;4(2):131-5.
  2. Suresh Kamble., Ajit Jankar. SF, ., Dishita Chokha

ni. SG and, Patil G and S. International Journal
of Current Advanced Research. Notes. 2017;1(01):444.

  1. Arcuri L, Lorenzi C, Cecchetti F, Germano F, Spuntarelli M, Barlattani A. Full digital workflow
    for implant-prosthetic rehabilitations: A case report. ORAL Implantol. 2016;8(4):114–21.
  2. Arısan V, Karabuda CZ, Mumcu E, Özdemir T. Implant Positioning Errors in Freehand and
    Computer-Aided Placement Methods: A Single-Blind Clinical Comparative Study. Int J Oral
    Maxillofac Implants. 2013;28(1):190–204.
  3. Alikhasi M, Siadat H, Nasirpour A, Hasanzade M. Three-Dimensional Accuracy of Digital
    Impression versus Conventional Method: Effect of Implant Angulation and Connection Type. Int
    J Dent. 2018;2018.
  4. Timock AM, Cook V, McDonald T, Leo MC, Crowe J, Benninger BL, Covell Jr DA. Accuracy
    and reliability of buccal bone height and thickness measurements from cone-beam computed
    tomography imaging. American journal of orthodontics and dentofacial orthopedics. 2011 Nov
    1;140(5):734-44.
  5. Shalu Rai, Deepankar Misra, Ayush Dhawan, Kuber Tyagi, Mukul Prabhat MK, Department.
    Knowledge, Awareness, and Aptitude of General Dentists Toward Dental Radiology and CBCT:
    A Questionnaire Study. J Indian Acad Oral Med Radiol. 2019;31(1):36–9.
  6. Chowdhary R, Hosadettu SR, Chandrakar N. A survey on the use of techniques, materials in
    dental implantology practice. Indian journal of dental research. 2012 Mar 1;23(2):297.
  7. Mora MA, Chenin DL, Arce RM. Software tools and surgical guides in dental-implant-guided
    surgery. Dent Clin North Am. 2014;58(3):597–626.
  8. Raja’a M, Farid F. Computer-based technologies in dentistry: types and applications. Journal of
    Dentistry (Tehran, Iran). 2016 Jun;13(3):215.
  9. Brownstein S, Murad A, Hunt R. Implementation of New Technologies in U.S. Dental School
    Curricula. Journal of Dental Education. 2015;79(3):259-264