Metallic implants fail in physiological environments due to many reasons over time. I need year wise (last 5 years) data on production and failures of the metallic implants for some research purpose and to know how big the problem is at present. Where can I get that data? Is there any specific agency/group, which takes care of such analysis? Are such figures made public online?
Kindly help.
Thanks.
Obviously you can find the information by screening PubMed, Web of Science, Google Scholar or alternative databases by collecting case reports or simply by reading review articles. It takes about 5 minutes to find a review article on your topic and to get familiar with the question.
Wish you good luck to find what you are looking for.
I don't think it's quite that easy. I have a implant database on my EndNote library of 47,000 articles. When I search the topic of "dental implant failure" I find fewer than 150 hits. Since the database is dental implants I can search the term "failure" all by itself and the number goes above 5300 hits. When I add the qualifying term "incidence" the number drops to 256. Then when you look at those 256 articles very few of them truly are articles that are identifying the incidence of implant failure on an annualized basis. Surprisingly if you use the term "prevalence" the number of articles actually drops to about 100.
If you're going to do a search as described above you certainly don't want to do a search of case reports because case reports demonstrate results from one patient treatment intervention. In scientific journals we don't see that many case reports primarily because it's only the first time that a specific treatment is identified that it is of particular interest as a report of that individual case. Once it's been identified one time the next thing that should be done is that there should be a case series or a cohort study. Although the logical step after that would be to have a randomized controlled clinical trial it becomes very difficult to conduct RCTs for a surgical intervention because it's difficult to control surgical skill, demonstrate substantial equivalence among the test and control groups (this has to be done before randomization and it generally creates a hyper normal group of patients that may not reflect clinical reality) and create a study number and a duration that makes a difference. Most RCTs are underpopulated and are conducted for two short of the duration.
The question above sets the duration of the study because it is looking for a one year incidence of implant failure. Of course then the question is when does the clock starts ticking? Does the clock start when the implant is placed in the bone which means that that is a clock that has started ticking before the Osseo integration has occurred. Or do you start the clock after the implant has been surgically placed, allowed to heal, thereby ensuring that the implants involved in the study have already Osseo integrated, and then look at only the implants that fail following the achievement of Osseo integration. Both approaches have merit but if you want to know about the failure of Osseo integration you have to ensure that Osseo integration has been achieved first. You would probably need to demonstrate some sort of primary and secondary stability so a device like the Osstell device might be helpful because it will give an objective number that represents the relative stability of the implant from the day that it was first measured until the day that it was decided that Osseo integration had occurred. When we think about primary and secondary stability the primary stability might be simplistically described as mechanical stability and the secondary stability might be simplistically described as the biologic stability. Biologic stability should be higher, represented by a higher resonance frequency value or ISQ as it is known ( implant stability quotient) than the original mechanical stability.
I agree with the comments from the previous response to some extent but you have to be aware that the performance of implants over time is going to be documented with either life table presentations of the data or through the use of Kaplan-Meier survival curves. Kaplan-Meier curves allow the censoring of implants that are lost to follow-up and provide good predictors of the performance at a certain time interval with confidence intervals. This is nice but it's not that prevalent. I was fortunate enough to participate in one of the first dental implant articles that use Kaplan-Meier analysis published in 1997 (Parein, A. M., et al. (1997). "Implant reconstruction in the posterior mandible: a long-term retrospective study." J Prosthet Dent 78(1): 34-42.). a number of years later I participated in an article that discussed the ways that we should look at scientific literature. That article preceded a lot of the evidence-based discussions which now are pretty well understood in are considered as the standard for dental research. Unfortunately the use of life tables and/or Kaplan-Meier survival curves continues to be more rare than common.
So put it all together and gathering this information from the literature sounds easy but is probably associated with a fair number of pitfalls or at least the potential thereof.
Dear Irshad Sharafutdinov ,
Thanks for your response. I am trying for the same as suggested, got the review articles. However, it takes more time to reach meaningful conclusion.
Regards,
Satwinder Singh Danewalia.
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