Implant dentistry in Turkey: How does global change affect implant practice?
By Dr. Tolga Tozum,
Academy News Editorial Consultant
Turkey is a unique country bridging the continents of Europe and Asia. It is a democratic and secular republic with a diverse cultural heritage in Eurasia neighboring with eight countries and has direct connection to the Mediterranean Sea, Black Sea, and Aegean Sea. Based on its critical location, Turkey has a significant geostrategic importance since the 11th century when Selcuk Turks migrated to this region.
Health care in Turkey used to be dominated by a full governmental health coverage system including medical and dental services. It was recently modified with a health reform program aimed at increasing the ratio of private to governmental health provision.
I have practiced licensed dentistry in Turkey since 1998, and continued to serve Hacettepe University, Ankara, Turkey as a full-time teaching and practicing faculty since 2002, especially advanced implant surgeries with an interdisciplinary respect. I am currently working at the Department of Periodontics, University of Illinois at Chicago (UIC), and have the opportunity to work with Dr. Clark Stanford, who is a member of the AO Board of Directors and also the Dean of UIC.
Based on my teaching/practicing/researching implant dentistry experience and knowledge in Turkey, I offer the following explanation of the credentialing process in Turkey – After five years of education, including didactic/pre-clinical (three years) and practice courses/clinical practice with a high number of patient treatments (lasting two or more years), including basic implant dentistry education, and completing with a successful average, the candidate is given the ‘dentist’ title with a practicing license. Officially accepted advanced specialty educations in Turkey are Dento-Maxillofacial Radiology, Prosthodontics, Periodontics, Oral Surgery, Restorative Dentistry, Endodontics, Pediatric Dentistry and Orthodontics. Specialty training would continue between three to four years, and can only be provided by government or private universities, not any other hospital systems.
Teaching and practicing faculty members are appointed full-time, and part-time faculty teaching and practicing are not allowed after the recent change. In periodontics or oral surgery residency, graduate students are provided with advance surgical implant educations and practicing opportunities on an increased number of patients. Prosthodontic residents are also provided significant numbers of implant restorations, with a wide range of implant brands.
When endosseous implant dentistry started in the late 1980s, only periodontists and oral surgeons had the ability to perform implant surgeries in Turkey, and those implant used to be restored by prosthodontists and a few by general dentists. However, related to a recent global trend, including internet, organization of international meetings, invitation of keynote speakers, increased number of hands-on courses and involvement of implant companies in continuing education, general dentists and prosthodontists started to place dental implants and perform advanced implant procedures, including surgeries and restorations.
Due to Turkey’s diverse economic population, a regular implant placement used to have a patient cost of $1,000 to $3,500 around 25 years ago, supported by 102 major implant companies. However, with my best guess, during the past decade, over 100 companies now drive the implant market, including some implant and graft companies based in Turkey, to serve an increased number of practicing general dentists placing and restoring implants. This eventually resulted in a decrease in patient regular surgery cost ranging approximately between $400 and $1,500 in private practice. due to having many competing companies, the specialists and the general dentists have the tendency of choosing the best deal/discount offered to lower their costs, which is a similar world-wide issue.
As a conclusion, global issues are currently affecting many countries. Company oriented implant educations, university supported implant trainings with weekly educations, and short-term implant fellowship programs provided by universities (i.e., 6 to 12 months programs) are affecting almost every country in the world. Are we sure that these limited or short-term educations are good enough to replace the specialty educations provided by the universities? Are general dentists really satisfied with these kinds of educations and are they really confident enough to perform implant dentistry ‘by all means’?
I also wonder if the implant failures or peri-implantitis treatment ratios are increasing globally. If so, why? Can it be related to education standards? And how can we fix all of these concerns?
Acknowledgement: I am thankful to Dr. Ilker Cebeci (Chairman of Ankara City Dental Chamber, Turkey) for his input in the preparation of this article.