Journal of Dental Implants

: 2019  |  Volume : 9  |  Issue : 2  |  Page : 53--59

Awareness, knowledge, and attitude of dental practitioners to the one-stage protocol of dental implant loading: A sub-Saharan African perspective

Kolawole Obagbemiro1, John Ademola Adeoye2, Yetunde Olusola Ajayi3, Patricia Adetokunbo Akeredolu3,  
1 Department of Dental Services, Restorative Dentistry Unit, Federal Medical Centre, Abeokuta, Ogun State, Nigeria
2 Division of Research, Cleft and Craniofacial Deformity Foundation, International Craniofacial Academy, Gwarinpa, Abuja-FCT, Nigeria
3 Department of Restorative Dentistry, Lagos University Teaching Hospital and College of Medicine, University of Lagos, Lagos, Nigeria

Correspondence Address:
Dr. Kolawole Obagbemiro
Department of Dental Services, Restorative Dentistry Unit, Federal Medical Centre, Abeokuta, Ogun State


Objectives: Dental implant therapy is still considered an evolving field in the sub-Saharan Africa, with most dental surgeons skilled in implant placement favoring the delayed loading protocol (>3 months) even in the rehabilitation of missing anterior teeth. This study aims to evaluate the current level of knowledge and attitude of Nigerian general dental practitioners toward the immediate loading protocol of dental implants. Materials and Methods: This is a descriptive, cross-sectional survey conducted among Nigerian dental practitioners. Self-administered, pretested questionnaires were used to collect data regarding their knowledge and attitude to immediate loading of implants. Data collected were analyzed using the Statistical Package for the Social Sciences version 22 (IBM Corp, Armonk, NY, USA) Results: A total of 237 dentists completely filled the questionnaires. Nearly 46% of the participants had good knowledge on the procedure and advantages offered by the immediately loading dental implants with provisional restorations, whereas 81% had negative reservations toward implant placement using the protocol. In addition, this study found a statistically significant association (P < 0.05) between the knowledge and attitude of the dental practitioners regarding the protocol. Conclusion: There is slighlty poor knowledge and significant negative attitude of dentists toward the immediate implant loading protocol in Nigeria. Improved information dissemination from general dental practitioners to patients, and practice of the protocol in indicated cases by implantologists is expected with increased awareness and subsequent training on its use and viability.

How to cite this article:
Obagbemiro K, Adeoye JA, Ajayi YO, Akeredolu PA. Awareness, knowledge, and attitude of dental practitioners to the one-stage protocol of dental implant loading: A sub-Saharan African perspective.J Dent Implant 2019;9:53-59

How to cite this URL:
Obagbemiro K, Adeoye JA, Ajayi YO, Akeredolu PA. Awareness, knowledge, and attitude of dental practitioners to the one-stage protocol of dental implant loading: A sub-Saharan African perspective. J Dent Implant [serial online] 2019 [cited 2020 Feb 29 ];9:53-59
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Endo-osseous, osseointegrated dental implants are artificial tooth roots inserted into the jaw bones to support either a prosthetic tooth or other restorations such as conventional bridges, complete dentures, and maxillofacial prostheses.[1],[2] There is no doubt that this rehabilitative treatment modality is becoming increasingly important and popular among dentists and patients alike.[3],[4] In fact, majority of the patients with high dental awareness opt for dental implant/implant-supported therapy from the onset of dental visitation.[3] While dental surgeons and implantologists have cited high success rate and the predictability of treatment as reasons for choosing the implant therapy treatment option,[5] most patients treated have reported improvements in their self-confidence and psychosocial behaviors.[6],[7] Moreover, the conservation of adjacent tooth structure, which is not offered by tooth replacement procedures such as the conventional fixed bridges, has been an important patient- and operator-related factor considered, which has resulted in the increasing acceptance of dental implant therapy.[8]

Conventionally, endo-osseous dental implant placements were advocated only for alveolar ridges and healed extraction sockets; however, with further advancements in the biologic principles of bone healing around dental implants, placement in fresh extraction sockets has been attempted with a high degree of success reported, and are described as immediate implants.[9] Further expanding on the concept of immediate placement of implant following tooth extraction led to the introduction of modern implant designs that allow for immediate loading of the implants at the time of placement with provisional restorations,[10] thus circumventing the two-stage protocol which advocates for a load-free period between 3 and 6 months between placement and loading. Although the one-stage protocol offers instant rehabilitation in addition to better esthetics and self-confidence, factors known to influence clinical success and longevity of the implants and implant restorations include overall health status of the patient, site of implant placement, type of superstructure to be employed, implant biomechanical considerations and occlusal loads,[11] and oral hygiene maintenance,[12] which may mean that the protocol is not suitable for all implant therapy patients.

It is hypothesized that the immediate placement and loading protocol is quite uncommon in the sub-Saharan Africa and as general dentists have been reported to be the primary providers of information regarding dental implant treatment modality and stages to patients,[13] there is a need to first determine their current knowledge and attitude toward the immediate loading of osseointegrated dental implants.[12],[14] In addition to the low level of substantial evidence in literature regarding the aforementioned subject matter which our findings are meant to address, this study aims to evaluate the knowledge and attitude of dental surgeons to the immediate loading of dental implants in Nigeria, so as to ascertain the need for awareness of the protocol among dentists and improve its use when indicated.

 Materials and Methods

This is a descriptive, cross-sectional survey conducted among Nigerian dentists. The sample size was calculated using the appropriate statistical formula for qualitative variables, and a total of 250 participants were recruited into the study. All the participants were recruited at once at a national dental conference using the simple random sampling technique. Individuals were included into the study based on the premise that they were employed as a dentists in a public or private establishment regardless of their cadre or years of experience. However, practitioners who were identified as trained implantologists were excluded from the study. Ethical approval to conduct the survey was obtained from the Ethics Research Committee of the Nigerian Dental Association – organizers of the event where data collection tools were administered.

Data was collected using self-administered, pretested questionnaires designed in printed formats. The questionnaires were carefully and thoroughly explained to all the respondents individually, and informed consent was obtained from them before being administered. The questionnaire comprised three sections:

Section A – Sociodemographic informationSection B – Indicators of the knowledge of dentists regarding immediate loading of dental implantsSection C – Indicators of the attitude of dentists toward immediate loading of dental implants.

To assess the knowledge levels of the study participants, participants who provided acceptable answers to 75% of the total questionnaires' parameters were deemed to have good knowledge of the protocol, whereas participants that answered 50%–74% of the indicators appropriately were adduced to have a fair knowledge of the protocol. Poor knowledge on the aforementioned subject matter was indicated by providing appropriate answers to <50% of the indicators. The study participants based on their attitude toward the immediate implant loading (IIL) protocol were classified as having positive and negative reservations toward the protocol. Those with positive attitude answered more than 50% of the questions in Section C appropriately, whereas participants that answered <50% of these questions in an acceptable manner were categorized as having negative attitude toward the protocol.

Data derived from the study were analyzed using Statistical Package for the Social Sciences (IBM Corp, Armonk, NY, USA) for Windows version 20. Descriptive tabulations were employed for data presentation on findings from the respondents. The Pearson's Chi-square test was used to determine the statistical relationship between the categorical variables, and the Pearson's correlation coefficient (r) was employed to determine the linear relationship between the knowledge and attitude of the study participants. For all statistical comparisons, P < 0.05 was adopted as the criterion for establishing statistical significance.


Two hundred and thirty-seven dental practitioners were eventually recruited as valid respondents in this study (94.8% response rate). Descriptive statistics of the sociodemographic characteristics of the respondents revealed that most of them were females (n = 156, 65.8%) and within the age range of 35–39 years (n = 72, 30.8%). The average age (SD) of the participants in this study was 36.8 (14.64) years. Majority of the respondents had practiced the dental profession for at least 10 years (n = 189, 81.8%), with gainful employment of slightly more participants in the private (n = 123, 51.9%) than the public sector (n = 114, 48.1%) [Table 1].{Table 1}

Despite being dental professionals in general practice, a few participants (n = 12, 5.1%) attested to not having heard the term “immediate loading of dental implants” previously. In addition, only 87 respondents (36.7%) knew the appropriate definition as regards the right time for loading the superstructure in IIL. A slightly higher percentage of respondents (n = 129, 54.4%) believed that surgery-related factors influence the dental implantologist's decision to load immediately following embedment within the alveolar ridges, whereas a significant percentage (n = 159, 79.1%) attested to the influence of host-related factors in the decision to perform the procedure [Table 2]. In relation to relevant indications for the procedure, most respondents (n = 171, 72.2%) agreed that esthetic consideration is the main reason for employing the IIL protocol, whereas 113 respondents (47.7%) and 32 respondents (13.5%), respectively, cited comfort and the absence of anatomical constraints as special reasons for undertaking the protocol as opposed to the conventional technique. However, 76 participants (32.1%) were unaware of the specific indications for the protocol.{Table 2}

[Table 3] shows that 89 dental surgeons (37.6%) practiced their professions in centers where implant therapy is one of the utilized options for prosthetic rehabilitation of missing teeth, with all of these centers practicing the conventional type of implant loading. Only thirty respondents (12.6%) were affiliated to centers where the IIL protocol is being employed when indicated. Overall, most respondents (n = 108, 45.6%) had good knowledge of the immediate loading protocol of implant placement, whereas 66 (27.8%) and 63 (26.6%) participants had fair and poor knowledge on the subject, respectively, although this was not statistically significant (P > 0.05) [Table 4]. The analysis further revealed that most dental surgeons that had 10 years or more practicing experience were statistically significantly better informed about the IIL protocol than their counterparts with less experience (P < 0.05). Eighty-one percent (n = 192) of the respondents had negative reservations toward the protocol, with this being statistically significant (P < 0.05) [Table 5].{Table 3}{Table 4}{Table 5}

There was a statistically significant association between the knowledge and the attitude of the study participants toward this one-stage protocol [Table 6], and cross-tabulation showed that most dental practitioners regardless of their knowledge levels regarding the IIL protocol had reservations to its use. Bivariate correlation analysis revealed a weak, positive linear relationship between the knowledge of the general dental practitioners and their attitude toward the IIL protocol (P > 0.05).{Table 6}


Implant therapy has become an integral part of today's daily dental practice. Appropriate knowledge of diagnostic and therapeutic options within the scope of dental implant therapy is, therefore, mandatory even for general dental practitioners.[1] This study showed that the knowledge of our participants about immediate dental implant therapy is relatively low, as evidenced by the percentage of participants with good knowledge in our study (45.6%). According to Aparicio et al.,[15] IIL has been defined as a restoration placed in the occlusion with the opposing dentition within 72 h of implant placement.[15] From our study, only 36.7% answered this correctly – further revealing the relatively low knowledge of immediate dental implants among Nigerian dental practitioners and underscoring the need to promote the knowledge of the protocol in this respect. In our study, the observed level of practitioners with good knowledge is lower than what was reported by Lang-Hua et al.[16] in a study involving 246 general dental practitioners in Hong Kong where 80% and 67% of the dental practitioners regarded the protocol as being superior in posterior and anterior tooth replacement, respectively. This may be attributed to the standard of dental training in the nigeria as a whole, when compared to Hong Kong, a special administrative region of China where dental practitioners are mostly trained by a single university's dental faculty widely acclaimed as a top training institution globally. Furthermore, this may mean that more recent advancement in treatment procedures (such as the IIL protocol) is typically not taught at the undergraduate level in Nigeria, with interested dental surgeons who aspire to obtain these knowledge having to seek it in developed parts of the world where it is being carried out on a more routine basis.

In contrast, the proportion of general dental practitioners with good knowledge in our study was higher than what was reported by Pournasrollah et al.[17] in a study among 272 dental practitioners in Iran where 19.9% of the respondents had good knowledge of implant therapy in general.[17] Maintenance of esthetics was regarded as the most common indication for the immediate loading protocol in the anterior region (72.2%) followed by provision of comfort to the patients (47.7%), which is similar to reports from a cross-sectional survey conducted by Keerthika and Jain among 100 dental students where 68% of the respondents also regarded esthetics as the most important factor for the one-stage protocol of implant placement.[18]

Majority of the general dental practitioners in this study (81%) had negative attitudes toward the one-stage implant protocol. This observation is in contrast with the recent reports of Nagpal et al. regarding the attitude of dental postgraduates and practitioners in Karnataka, India.[19] In their study conducted among 416 dental postgraduates as well as institution-based and general practitioners, 91.3% of the respondents had either positive attitude or no reservations toward dental implant therapy. The reason for the very high level of reservations in our region may be attributed to the low level of good knowledge available at the disposal of these dentists concerning this type of implant protocol as this study found a significant association between the knowledge of the general dental practitioners and their attitude toward the one-stage protocol, with more individuals with fair or poor knowledge having negative attitudes. In fact, some of those dentists with good knowledge may even be circumspect of the viability of immediate loading protocol, as little has been reported in literature concerning its suitability and survival rates as opposed to the overflowing research articles and systematic reviews focusing on the delayed loading protocol. While we found that 24.1% of the participants were previously trained on the protocol via lectures, seminars, and observational sessions, 64.6% expressed their willingness to attend conferences that would improve their knowledge in further understanding the indications and procedures related to it. Implant training is said to be an additional factor that improves the knowledge, attitude, and practice of practitioners regarding dental implant therapy[17] and as such, significant advancements are expected if more practitioners are trained on the immediate loading protocol.

Considering that the awareness regarding the use of dental implants has increased in Nigeria over the last few years, this study, however, found that only 37.6% of the respondents practiced in centers where implant therapy is utilized for the rehabilitation of partially edentulous patients. It might be said that the management of partially edentulous patients using dental implants has improved from 1.3% as reported by Akeredolu et al.[20] 11 years ago; still, there is a need to further intensify awareness in Africa to corroborate what is obtained in more developed countries and centers.


Overall, there is a slightly low knowledge and significantly preponderant negative attitude toward the immediate loading protocol of implant placement among Nigerian dentists, which may possibly reflect what is obtained in other sub-Saharan countries. As dental implant therapy is emerging in the sub-Saharan Africa, we recommend that awareness regarding the one-stage protocol be increased so as to allow dental practitioners offer extensive treatment options for patients regarding missing tooth rehabilitation using dental implants.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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