1. Introduction
ental implants are among the best treatment methods to restore function and beauty. The long-term success of implants depends on the follow-up sessions [1]. In the first year after treatment, regular visits should be at intervals of 3 months, then determined according to the individual’s needs [2]. Dental implants are prone to mechanical problems and plaque-related inflammatory changes over time [3].
Various methods have been used to assess the health of the implant during follow-up [2, 4]. Soft tissue and implant prosthesis should be examined. Intraoral radiography should be also provided [7, 6, 5].
As the demand for patients for implants has dramatically increased, dentists must increase their knowledge and awareness. Therefore, this study aimed to investigate the knowledge and attitude of general dentists about follow-up implants to adjust the appropriate program and educational content.
2. Materials and Methods
The present study analytical and cross-sectional study was conducted in Arak City, Iran, in 2019. The questions were organized into 3 sections, as follows: demographic, awareness, and attitude. To design the questions, the opinions of experts in the fields of the prosthesis, radiology, and periodontology, as well as using reference books were used [8, 9]. The first part of the questionnaire concerned demographic characteristics.
The second part was related to the dentist’s knowledge of follow-up of implant treatment. The third section included questions about the dentist’s attitude toward implant follow-up. To determine validity and reliability, 40 questionnaires were completed. The validity and reliability of the questionnaire were confirmed by calculating Cronbach’s alpha coefficient of 90%. The validity and reliability of this questionnaire were measured to be 75% and 86%, respectively.
In the questions section, the correct answers were given a score of 1. The maximum score in this section equaled 19. In the attitude questions section, the low answer was given 1 score, the average answer was given 2 scores and the high answer was given 3 scores; thus, the maximum score was equal to 21. Statistical analysis was performed using the Chi-squared test and Independent Samples t-test. 
3. Results
Among the 98 active dentists in Arak who participated in the study; 41 were female and 57 were male. In total, 26.8% had 1-3 years of work experience, 13.2% had 3-5 years work experience, 42.8% had 5-10 years work experience, and 17.4% had 10 years or more work experience. From the maximum score of 19 in the knowledge section, the mean obtained scores were measured as 10.8; in the attitude section, of the maximum score of 21, the mean scores equaled 12.8. The number of years of work experience did not significantly affect the examined dentists’ knowledge and attitude about the follow-up of implant treatment (P>0.05).
There was a statistically significant difference in the mean knowledge and attitude values of dentists who underwent implant treatment and those who did not (Tables 1 and 2).




Dentists who performed implant treatment were significantly more aware of implant treatment follow-up in all areas of knowledge (dental prostheses, radiology, & periodontology). Moreover, in the attitude questions section, dentists who performed implant treatment received 14.5 points; dentists who did not perform implant treatment received 11.1 points. There was no significant gender-wise difference in the mean scores of knowledge and attitude (P>0.05). Dentists achieved the highest knowledge score in periodontology; they obtained the lowest knowledge in prosthetics. However, this difference was not statistically significant (P>0.05).
4. Discussion and Conclusion
The present study data indicated that the level of knowledge and attitude of general dentists about dental implant follow-ups was low. In the study of haghighat et al., the average score of knowledge obtained was far from the full score [10]. This finding indicated the inadequacy of implant education in the entire dental education system. In a study by Jayachandran et al., 77% of general dentists were trained in only theoretical aspect of implant [11].
The results revealed that dentists who had performed implant treatment had awareness and attitude toward implants follow-up higher than those of the dentists who did not perform dental implant treatment. According to Gibson’s study, general dentists believed that implant treatment should be performed by a specialist dentist [12].
Levin et al. found that 80% of general dentists feel the need for implant training courses [13]. Nagpal stated that general dentists presented the most negative attitude concerning implant treatments [14]. According to the obtained results, there was a slight difference in knowledge and attitude between dentists who had different years of work, i.e., not statistically significant. Dentists with 3-5 years of work experience had the best knowledge and the most positive attitude towards implant treatment, i.e., consistent with Nagpal’s study [14].
The study suggested that gender had no significant effect on dentists’ knowledge and attitude. According to Trovic, age, gender, and place of work of the dentist had no effect on their decision regarding the edentulous patient [13]. The current research results indicated the lack of knowledge and attitude of general dentists about the follow-up of dental implants. It is necessary to present further implant training classes for students and retraining classes for general dentists.

Ethical Considerations
Compliance with ethical guidelines
This article was approved by the Ethics Committee of Arak University of Medical Sciences (Code: IR.ARAKMU.REC.1397.283).

Funding
This study was supported by the Vice Chancellor for Research of Arak University of Medical Sciences.

Authors' contributions
All authors met the standard writing criteria based on the recommendations of the International Committee of Medical Journal Publishers (ICMJE).

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors thank the Arak University of Medical Sciences for its technical support in conducting this research study.


References

1. Rosen PS, Sahlin H, Seemann R, Rosen AS. A 1-7 year retrospective follow-up on consecutively placed 7-mm-long dental implants with an electrowetted surface. Int J Implant Dent. 2018; 4(1):24. [DOI:10.1186/s40729-018-0136-4][PMID][PMCID]
2. Kanathila H, Pangi A, Benakatti V, Patil S. Maintenance of dental implants: A way to long term success: A review. Int J Appl Dent Sci. 2018; 4(2):104-7. https://www.researchgate.net/publication/327594119_Maintenance_of_dental_implants_A_way_to_long_term_success-_A_review
3. De Angelis F, Papi P, Mencio F, Rosella D, Di Carlo S, Pompa G. Implant survival and success rates in patients with risk factors: Results from a long-term retrospective study with a 10 to 18 years follow-up. Eur Rev Med Pharmacol Sci. 2017; 21(3):433-7. [PMID]
4. Gulati M, Govila V, Anand V, Anand B. Implant maintenance: A clinical update. Int Sch Res Notices. 2014; 2014:908534.[DOI:10.1155/2014/908534] [PMID] [PMCID]
5. Etter TH, Håkanson I, Lang NP, Trejo PM, Caffesse RG. Healing after standardized clinical probing of the perlimplant soft tissue seal: A histomorphometric study in dogs. Clin Oral Implants Res. 2002; 13(6):571-80. [DOI:10.1034/j.1600-0501.2002.130601.x] [PMID]
6. Newman MG, Flemmig TF. Periodontal considerations of implants and implant associated microbiota. Int J Oral Implantol. 1988; 5(1):65-70. [PMID]
7. Mahdizadeh M, Fazaelipour M, Namdari A. [Evaluation of dentists¡¯ awareness of how to prescribe correct radiographs in Isfahan in 2010-2011 (Persian)]. Dent Res J (Isfahan). 2012; 7(5):637-42. http://jids.journalonweb.ir/index.php/jids/article/view/443
8. Newman MG, Takei HH, Klokkevold PR, Carranza FA. Carranza’s clinical periodontology. Philadelphia: Saunders Elsevier; 2015. https://books.google.com/books?id=LFTjAQAACAAJ&dq
9. Misch CE. Dental implant prosthetics. Maryland Heights: Elsevier Mosby; 2014. https://books.google.com/books?id=1iBtngEACAAJ&dq
10. Haghighat A, Bonakdarchian M, Ghafari SM. [Evaluation of Isfahan dental practitioner’s awareness about dental implants (Persian)]. Dent Res J (Isfahan). 2011; 6(4):493-9. https://jids.journalonweb.ir/index.php/jids/article/view/249
11. Jayachandran S, Bhandal BS, Hill KB, Walmsley AD. Maintaining dental implants--do general dental practitioners have the necessary knowledge? Br Dent J. 2015; 219(1):25-8. [DOI:10.1038/sj.bdj.2015.528][PMID]
12. Gibson RL, Barclay CW. Dental implantology education: A survey of opinion and experience of 106 general dental practitioners. Br Dent J. 2006; 201(6):367-70. [DOI:10.1038/sj.bdj.4814043] [PMID]
13. Pournasrollah A, Negahdari R, Vahid Pakdel SM. Evaluation of the knowledge of general dental practitioners in Tabriz about the implant treatment planning. Adv Biosci Clin Med. 2015; 3(3):24-31. http://www.journals.aiac.org.au/index.php/ABCMED/article/view/1546
14. Nagpal D, Prakash S, Kalra DD, Singh G. Knowledge, attitude, and practice of dental implants among dental postgraduates and practitioners in Davangere City, Karnataka: A cross-sectional study. Indian J Dent Res. 2018; 29(5):575-82. [DOI:10.4103/ijdr.IJDR_500_15] [PMID]
15. Candirli C, Korkmaz YT, Celikoglu M, Altintas SH, Coskun U, Memis S. Dentists’ knowledge of occlusal splint therapy for bruxism and temporomandibular joint disorders. Niger J Clin Pract. 2016; 19(4):496-501. [DOI:10.4103/1119-3077.183310] [PMID]