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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.

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.

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.

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].

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 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 thereby contribute to patient service. We aim to do this by clarifying, among other aspects of treatment, problem areas, and considerations in the fabrication of implant prostheses, the conceptual-level knowledge base and awareness of prosthodontics on the part of the dentists in charge of treatment and methods for preventing prosthetic complications.

Because implant treatment (implant prostheses) requires a significant amount of specialized, high-precision laboratory procedures, this area of dental care exhibits slightly different trends than prosthetic treatment as it was practiced in the past, and this work is concentrated at specialized fabrication labs. Moreover, there are many 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. In light of these circumstances, it was intended for this questionnaire to verify trends in implant treatment from a different perspective than has been used in the past, by investigating the current state of practice in the field from the dental technician perspective. By evaluating implant treatment from the standpoint of dental technology/prosthodontics and identifying current trends and problem areas, it was expected to gain information that enables highly predictable implant treatment.

The dental technicians who responded to this questionnaire have an average of about 17 years of experience in the field, indicating that they possess an adequate level of fabrication experience. In light of the reality that dental implant treatment is a comparatively new field, these personnel can be proficient with digital techniques as they differ from past generations of technicians who practiced the craft. On average, each dental technician serves about 36.5 customers, although that number varies depending on the scale of the fabrication lab at which they work. While implant laboratory work consists of complex processes, the fees are high, and labs generate a stable flow of revenue given a constant stream of work requests (Q1).

Dentists play a leading role in 39.3% of the time in implant treatment planning and prosthetic design, and dental technicians are consulted concerning cases and part usage 34.7% of the time, suggesting the approach to implants is driven by prosthetic considerations (by dentists) to some degree. However, because dental technicians indicated that they take the initiative 15% of the time, it is impossible to ignore issues involving the care, skill, and judgment of dentists offering implant treatment. This is distinct from the question of whether communication or information transmission between dentists and dental technicians is adequate, but rather relates to implant treatment knowledge, especially decisions about which prostheses