Ridwaan Omar, BSc, BDS, LDS, MSc, FRACDS,

FDSRCSEda
Sentiments Expressed in Relation Esam Tashkandi, BDS, MS, FDSRCSEd, PhDb
Tariq Abduljabbar, BDS, MS, PhDb
to Tooth Loss: A Qualitative Study Mohamed Aleem Abdullah, BDS, MDSc
Among Edentulous Saudis Riyadh F. Akeel, BDS, MS, PhDc

Purpose: The objective was to explore and gain insight into the sentiments surrounding
tooth loss in a group of edentulous Saudis. Materials and Methods: Using a qualitative
methodology, 44 edentulous patients who were receiving complete denture treatment
were interviewed in private, in the Arabic language. Interviews were tape recorded and
semistructured, following a list of predetermined and piloted topics, but dialogue also
took place, with the freedom for both interviewer and interviewee to explore areas of
interest. All recordings were transcribed, translated into English, and interpreted
independently by two members of the team to identify the core themes associated with
tooth loss. Results: The mean age of participants was 58.9 years (range 35 to 72 years),
and they had been edentulous for a mean of 7.1 years (range 3 months to 22 years). The
main themes related to tooth loss were unqualified acceptance, inevitability with old age,
behavior changes with respect to eating comfort, aged appearance, self-responsibility,
positively perceived benefits, high prosthetic expectations and reduced level of denture
satisfaction, and some need for privacy. Conclusion: The lack of any outward indication
that participants experienced bereavement suggests that outlook on life can influence the
impact of tooth loss. Participants’ unqualified acceptance of their edentulous fate, yet
their clear need to “normalize” oral function, reflects a degree of pragmatism toward life
events. The strong influence of religion in Saudi society is a possible factor in the
sentiments expressed. Int J Prosthodont 2003;16:515–520.

T he impact poor oral health can have on quality of

life is well-recognized.1–3 It is also known that nei-
ther oral ill health nor an individual’s perceived oral
status depend solely on clinical factors. Many social
and functional factors, which may or may not be af-
fected by the presence of disease, are important in-
tervening variables in determining oral health–re-
lated quality of life.4–6 Specifically, the loss of teeth
results in significant disabilities, which can pro-
foundly disrupt social activities.7 Tooth loss is very
traumatic and upsetting and is regarded as a serious
aProfessor, Department of Prosthetic Dental Sciences, College of
Dentistry, King Saud University, Riyadh, Saudi Arabia.
bAssistant Professor, Department of Prosthetic Dental Sciences,
College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
cAssociate Professor, Department of Prosthetic Dental Sciences,
College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
Reprint requests: Dr R. Omar, Department of Prosthetic Dental
Sciences, College of Dentistry, King Saud University, PO Box
60169, Riyadh 11545, Saudi Arabia. Fax: + 966 1 488 5241. e-mail:
romar.ksa@zajil.net
life event8 that requires significant social and psy-
chologic readjustment.
Edentulous and partially dentate people harbor a
wide range of long-term feelings about tooth loss.7,9,10
Underlying feelings of loss can, in part, explain
chronic dissatisfaction with complete dentures, and
the observation that even those who appear to be
coping well with dentures retain similar depths of
feeling suggests that the impact of tooth loss should
not be misjudged.7,9,11
Cultural traditions and lifestyle play an important
role in shaping attitudes and values. For example, re-
gardless of age and gender, Chinese people believe
that they are susceptible to dental disease, that one
should expect to lose teeth in older age, and that noth-
ing can be done to prevent it.12 Cross-cultural differ-
ences in the range and intensity of feelings expressed
about tooth loss have been reported. Although groups
of edentulous people from Britain and Hong Kong ex-
pressed similar difficulties in coming to terms with
tooth loss, Hong Kong Chinese generally felt more
handicapped in their daily activities, as well as less

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 Sentiments Regarding Tooth Loss Among Saudis
inhibited by denture wearing, than their British equiv-
alents.13
Strongly held religious beliefs and cultural tradi-
tions play a similarly important role14 and have been
shown to be important predictors of oral health be-
havior and oral health.15 The Kingdom of Saudi
Arabia has a wholly Muslim indigenous population.
In spite of its participation in almost unparalleled de-
velopment programs and exposure to Western cul-
ture, Saudi society’s religious underpinning has
remained uniformly strong. In this context, it is hypo-
thesized that religious beliefs may be a characteris-
tic of society that potentially influences emotional re-
actions to tooth loss. This qualitative study therefore
sought to gain insight into such emotions, if any, in
a group of edentulous Saudis.
Materials and Methods
This exploratory investigation aimed to gain an un-
derstanding of a range of attitudes, values, and feelings
of the target group, so a qualitative approach was con-
sidered optimal.16 The method entailed one-to-one, in-
depth interviews conducted in private and tape re-
corded, as previously described.7 The preliminary list
of topics to be covered in the interviews was based in
principle on that previously described, but modified ac-
cording to the team’s knowledge and perceptions of
local traditions and influences. This list was tested on
seven people who were recruited in the same manner
as those in the main study (data not included). Aside
from allowing fine tuning of the initial topic list, the pilot
study oriented interviewers to the free style required and
ensured uniformity of technique through independent
interpretation of the transcribed pilot interviews.
Forty-four edentulous patients undergoing com-
plete denture treatment in the undergraduate clinic at
the College of Dentistry, King Saud University, Riyadh,
Saudi Arabia, during the 2001 to 2002 academic year
participated in the study. Twenty-five were women
and 19 were men, with a mean age of 58.9 years
(range 35 to 72 years), and the mean length of eden-
tulism was 7.1 years (range 3 months to 22 years).
Having been screened as suitable for treatment by stu-
dents in their first complete denture course, patients
could all be deemed successful complete denture
wearers. At an appropriate time during a treatment ses-
sion, patients were consecutively approached by one
of two members of the team who had been assigned
as interviewers. All patients who were asked agreed
to participate and were provided with a brief statement
of confidentiality and informed consent.
One interviewer conducted 25 interviews, and the
other the remaining 19. Each was fluent in both the
local Arabic dialect and cultural nuances. The mean
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Omar et al
duration of the interviews was 24 minutes (range 15 to
44 minutes). All recordings were transcribed and trans-
lated into English by the third bilingual member of the
team. Each transcription was independently interpreted
by two examiners not involved in the particular inter-
view, with a view to identifying common themes re-
lated to the impact tooth loss had on the group.
Although they were, strictly speaking, unstructured
to encourage spontaneity in the responses, the inter-
views followed the predetermined list of topics as a
guide:
• Knowledge/perception of reasons for tooth loss at
time of loss
• Feelings at time of tooth loss
• Changes in feelings with time
• Preparedness for tooth loss and its effects
• Effects of tooth loss on self-confidence, appear-
ance, eating, and social behavior
• Perceptions of the benefits of dentures prior to
tooth loss
• Subsequent satisfaction with dentures
• Factors that could have made dealing with tooth
loss any easier
In spite of this list, a degree of freedom for both the
interviewer and interviewee was allowed for explo-
ration of areas of interest if, and as, they arose.
Because of the possible sensitive nature of the topic,
interviewers were allowed discretion on the wording
of questions, their timing, and some informality when
deemed necessary.
Results
Content analysis of the interviews revealed several
main themes. These are described in more detail,
using selected quotes to highlight the feelings ex-
pressed by the group. Issues that evoked negative re-
actions, as well as those treated dismissively by the
group, were documented. Although quotes are spe-
cific to an individual, they embody recurring themes,
except when stated otherwise.
Unqualified Acceptance
The over-riding and unhesitating response by almost
all participants was that their edentulous state was the
will of God. As such, it was not something to be ques-
tioned, or even explained, but rather wholly accepted.
With few exceptions, there was no outward indication
that patients were experiencing, or had ever experi-
enced, the recognized intervening stages of bereave-
ment—denial, anger, depression, and bargaining—
before acceptance.17 Two participants used the
516 Volume 16, Number 5, 2003
 Omar et al
expression “by the grace of God” on no fewer than 12
and 14 occasions, respectively, during the course of
their interviews.
“Nothing about losing my teeth upset me at all. It
was God’s will, and who am I to question that?”
“Are you not a believer, my son? You know that
all Muslims should accept the will of God.”
When there was a reference to unhappiness or
bargaining (as observed with two 45-year-old women
and a 57-year-old man), it was still tempered by an
acknowledgement of divine will:
“It is, of course, His will, but it does upset me to
be without my own teeth at such a young age.”
Inevitability
In reply to the question “Why were your teeth lost?”
subjects generally indicated that it was the result of
oral diseases, and in some cases “weak” teeth, or sys-
temic disease. However, responses reflected a belief
in the inevitability of tooth loss with increasing age,
and that nothing could be done to prevent it.
“My teeth were decayed. But when people get
older, they have to lose their teeth anyway. What
can you do about it, and what should one say?
. . . Except to accept one’s fate.”
“I am a diabetic, and my doctor told me that’s
why I had to lose my teeth.”
Behavior Change
Complaints about the need to change behavior were rel-
atively infrequent, with the notable exceptions of choice
of food and eating enjoyment, which were common.
“Nothing changed, except my eating. I have to
eat soft foods all the time.”
“It did affect my speech, although I don’t feel so
unhappy about it because I can still talk, thank
God.”
A 62-year-old man was one of the few who was de-
jected about his compromised situation:
“I feel lost amongst people, and inferior to them.”
Only one man, 71 years old, ventured a flippant re-
mark about personal relationships:
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Sentiments Regarding Tooth Loss Among Saudis
“The only problem is that now I cannot take a new
bride, because she would not have me like this.”
Appearance
Generally, changes in appearance were attributed to
the effects of aging, rather than the direct or indirect
effects of tooth loss.
“My daughters always wanted me to have my
teeth removed because I complained a lot about
pain. And they actually like the way I look now.”
A few people felt differently, and a 45-year-old
woman admitted to unhappiness with her appearance:
“Yes, it changed the way I talk, the way I eat, and
I suffered a lot of headache. I felt embarrassed
meeting people because I look older than I am.
But I had to face it.”
Self-Responsibility
There was no attribution of blame to any third party,
such as the clinician for not providing adequate ad-
vice or care, or the health care service for being in-
accessible.
“I do not feel angry because it was my own fault.
I neglected my teeth, so I should accept the con-
sequences.”
However, there was also some remorse about not
having taken greater care of their teeth:
“After I lost my teeth, and understood why I lost
them, I tried to tell my sisters to brush their teeth
and not to just have them extracted, if they can
avoid it.”
Perceived Benefits
For many people, the anticipated benefits of having
their teeth extracted were generally realized. Relief
from dental pain was the main dividend, and this was
seen as a reasonable tradeoff against the disadvan-
tages of being edentulous.
“All the pain and discomfort I suffered for so long
are gone, thank God.”
Prosthetic Expectation and Satisfaction
Most peoples’ expectations about prosthetics were
high, although their subsequent levels of denture
517 The International Journal of Prosthodontics
 Sentiments Regarding Tooth Loss Among Saudis
satisfaction were more varied.
“Losing teeth is not like losing other parts of our
body, especially since, with the help of dentists,
we can easily replace them.”
“As long as we can replace our teeth with com-
fortable dentures, being without my own teeth
does not really upset me. But dentures are not
at all like one’s own teeth.”
The 45-year-old woman cited earlier was more
openly critical of dentures:
“I was upset firstly about losing my teeth, and sec-
ondly at not being able to chew with the dentures.”
Privacy
This aspect is reported because most responses to the
question about privacy’s importance were rather dis-
missive. The only person who admitted to a need for
secrecy and a feeling of shame about her edentu-
lousness was the previously cited 45-year-old
woman. A small number of other women in the same
age range expressed their need for privacy, albeit in-
directly.
“The only ones I ever spoke to about it were my
sisters. I told them how sad I was to lose my
teeth. And losing one’s teeth is worse than los-
ing a friend because you can never really replace
them, but you can replace a friend.”
Discussion
The findings of this study should be viewed in the light
that qualitative research aims to define the issues that
are relevant to a subject and explore them in depth. It
has little role in examining the extent and distribution
of views held by the target population, and is not an
alternative to quantitative research. Instead, qualitative
research facilitates examination of the complexity of
situations and the inter-relationships between different
dimensions of those situations.16 The size and location
of the sampled group are therefore of little relevance
to the internal validity of the findings.18 Although the
sample was drawn from a prosthetic teaching clinic,
which is sometimes thought of as attended by typically
“difficult” denture patients, all participants in the study
were being treated in an undergraduate first complete
denture course. Partially dentate individuals were not
included at this preliminary stage, since our purpose
was to gain insight into the reactions to tooth loss as
explicitly as possible.
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Omar et al
The responses obtained in the pilot interviews
were remarkably consistent, suggestive of homo-
geneity of culture, and thus conformity of behavior.
A similar trend was observed in the study sample. The
most striking finding was that the response to tooth
loss in edentulous Saudis was, in general, one of im-
mediate and unequivocal acceptance of their con-
dition as divine will. This belief was underscored by
apparent irritation on the part of some participants
when pressed for even a small concession to feeling
grief over their condition. A recognized systematic
error of the interview approach is that we rely on re-
ports, not observations, of behavioral patterns. These,
in turn, depend on the respondent’s candor, under-
standing of the question, ability to recall past events
accurately, and stability of opinions and attitudes.16
Respondents may tend to give socially acceptable an-
swers to sensitive questions, but the regularity with
which participants stated their acceptance of their fate
makes this unlikely.
In Islam, tolerance in the face of extreme hardship
is closely linked to the central tenets of submission to
the will of God and acceptance of the predetermina-
tion of His will.19 Subjects may have been suffering
pain and indignity over their condition, but a possi-
ble element of stoicism could not be known in an in-
vestigation of this nature. A few of the younger par-
ticipants (⬍ 45 years) expressed a less acquiescent
attitude to their tooth loss. This may have arisen for
two reasons: the greater exposure of younger indi-
viduals to modern lifestyles and values, and the pos-
sibly greater disability that had to be endured in the
face of edentulousness at a young age. On the other
hand, most participants stated the cause of their tooth
loss as oral diseases. A number of participants ac-
knowledged a lack of adequate care of their teeth. The
role of oral cleanliness in controlling the two most
common infective processes that afflict the dental
and supporting tissues is undisputed.20 The impor-
tance of oral cleanliness by use of the miswak (a
chewing stick21) is abundantly described in the Islamic
literature, and for many Muslims miswak serves not
only as a personal hygiene aid, but also a spiritual tra-
dition.22 It may seem paradoxic that people could in-
voke both fate as well as controllable diseases as the
cause of their tooth loss.
The absence of bereavement, even if it might have
been, to a degree, self-conditioned, is in stark con-
trast with that noted in other edentulous popula-
tions. 7,9,13,23 The relative emotional adjustment
needed when teeth are lost compared to other life
events is also significant.8,24 Regarding the impacts
of tooth loss on daily living, greater restrictions on eat-
ing and socializing patterns, as well as less inhibited
denture-wearing habits, have been expressed by
518 Volume 16, Number 5, 2003
 Omar et al
Hong Kong Chinese than British people.13 Such a
functionally oriented outlook appeared, more or less,
to be the case among our group of Saudis, and sup-
ports the contention that cultural, religious, and tra-
ditional factors are influential in reacting to, and cop-
ing with, life events. This contradicts the suggestion
that responses to life events transcend differences in
cultural background, religion, or race,25 and that
20th century cultures have the over-riding influence
on attitudes.26
The inevitability of tooth loss in later life was con-
sistently expressed by our group, similar to attitudes
reported in Chinese12 and Malaysian people.27 The
expectation and acceptance of tooth loss in later
life may be partly responsible for the openness with
which these groups were prepared to talk about their
edentulousness. The need for secrecy that Western
equivalents attach to their condition, and its taboo
status in the public domain, seems less frequent
among non-Western groups. However, the role of
education, and perhaps newer cultural influences, in
changing the perception of tooth loss from a natural
part of aging to a state of negative subjective well-
being needs to be considered.28 Among our group,
there was a general resignation that their teeth could
not have been saved anyway, and that the elimina-
tion of dental pain was worth it. No subjects as-
signed blame to any third party for failing to either
save their teeth or properly prepare them for the ef-
fects of tooth loss. Such a willingness to accept re-
sponsibility for their condition may be a further re-
flection of the introspection derived from their
religious beliefs.
The effects of tooth loss on daily living are impor-
tant.1,29,30 The most significant impact felt by our
group was related to daily living activities, especially
eating. While harboring few outward signs of bitter-
ness about their condition, subjects clearly desired to
return to all aspects of functional “normality,” in par-
ticular eating, appearance, and social interaction.
This was regarded as both a legitimate and attainable
aspiration through prosthodontic treatment. Such an
apparently forward-looking approach to problem
solving may reflect the strength of their acceptance
of their condition.
There was a positive anticipation of the benefits of
prosthetic care, even though the outcome in terms
of denture satisfaction was less certain. On the basis
of clinical criteria, all of our group had been judged
successful denture wearers, so it is fair to speculate
on the reasons for their apparently high level of eat-
ing dissatisfaction. One reason is the emphasis
Saudis place on social occasions, which routinely
include feasting; the traditional cuisine of a steamed
whole lamb with rice requires considerable
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Sentiments Regarding Tooth Loss Among Saudis
chewing ability. Another reason could be the wide-
spread knowledge of the benefits of implant-retained
prostheses among the local population. The growing
availability of such services in the highly subsidized
public health service means that patient expectations
may be growing. Failure to receive the preferred
treatment option could negatively affect the level of
satisfaction with treatment.31 Whether this, in turn,
could negatively influence feelings about tooth loss
is open to speculation.
The participants’ apparently unquestioning ac-
ceptance of the loss of their teeth, and desire to focus
instead on the practical aspects of daily living, con-
trasts strongly with the lingering feelings of loss re-
ported in Western societies. An essential require-
ment of Muslims is to show tolerance in the face of
distressing life events, and to find solace in being
close to God. The inherently religious nature of
Saudis, especially among the older generation, sug-
gests that a strongly held spiritual belief can signifi-
cantly soften the impact of serious life events.
References
1. Locker D. The burden of oral disorders in a population of older
adults. Community Dent Health 1992;9:109–124.
2. Slade GD, Spencer AJ. Development and evaluation of the oral
health impact profile. Community Dent Health 1994;11:3–11.
3. Leao A, Sheiham A. The development of a socio-dental measure
of dental impacts on daily living. Community Dent Health 1995;
13:22–26.
4. Rosenoer LM, Sheiham A. Dental impacts on daily life and sat-
isfaction with teeth in relation to dental status in adults. J Oral
Rehabil 1995;22:469–480.
5. Steele JG, Ayatollahi SMT, Walls AWG, Murray JJ. Clinical fac-
tors related to reported satisfaction with oral function amongst
dentate older adults in England. Community Dent Oral Epidemiol
1997;25:143–149.
6. Locker D, Slade G. Association between clinical and subjective
indicators of oral health status in an older adult population.
Gerodontology 1994;11:108–114.
7. Fiske J, Davis DM, Frances C, Gelbier S. The emotional effects
of tooth loss in edentulous people. Br Dent J 1998;184:90–93.
8. Bergendal B. The relative importance of tooth loss and denture
wearing in Swedish adults. Community Dent Health 1989;6:
103–111.
9. Davis DM, Fiske J, Scott B, Radford DR. The emotional effects of
tooth loss: A preliminary quantitative study. Br Dent J 2000;188:
503–506.
10. Davis DM, Fiske J, Scott B, Radford DR. The emotional effects
of tooth loss in a group of partially dentate people: A quantita-
tive study. Eur J Prosthodont Restorative Dent 2001;9:53–57.
11. Carlsson GE. Clinical morbidity and sequelae of treatment with
complete dentures. J Prosthet Dent 1998;79:17–23.
12. Kwan SYL, Williams SA. Dental beliefs, knowledge and behav-
iour of Chinese people in the UK. Community Dent Health 1999;
16:33–39.
13. Scott BJJ, Leung KCM, McMillan AS, Davis DM, Fiske J. A tran-
scultural perspective on the emotional effect of tooth loss in com-
plete denture wearers. Int J Prosthodont 2001;14:461–465.
519 The International Journal of Prosthodontics
 Sentiments Regarding Tooth Loss Among Saudis Omar et al

14. McGrath C, Liu KS, Lam CW. Physiognomy and teeth: An ethno-
graphic study among young and middle-aged Hong Kong adults.
Br Dent J 2002;192:522–525.
15. Bedi R. Ethnic indicators of dental health for young Asian school-
children resident in areas of multiple deprivation. Br Dent J
1989;166:331–334.
16. Singleton RA, Straits BC. Approaches to Social Research, ed 3.
New York: Oxford University Press, 1999:254–256.
17. Kubler-Ross E. On Death and Dying. New York: Macmillan, 1969.
18. Kay EJ, Blinkhorn AS. A qualitative investigation of factors governing
dentists’ treatment philosophies. Br Dent J 1996;180:171–176.
19. Sarwar G. Islam: Beliefs and Teachings, ed 3. London: Muslim
Education Trust, 1984.
20. Axelsson P, Lindhe J. Effect of controlled oral hygiene procedures
on caries and periodontal disease in adults. J Clin Periodontol
1981;8:239–248.
21. Al-Khateeb TL, O’Mullane DN, Whelton H, Sulaiman MI.
Periodontal treatment needs among Saudi Arabian adults and
their relationship to the use of the miswak. Community Dent
Health 1991;8:323–328.
22. Bos G. The miswak, an aspect of dental care in Islam. Med Hist
1993;37:68–79.
23. Likeman P, Fiske J, Davis DM. Use of the internet as a research
method in a study of the emotional effects of tooth loss in
Poland. Eur J Prosthodont Restorative Dent 2002;10:33–35.
24. Haugejorden O, Rise J, Klock KS. Norwegian adults’ perceived
need for coping skills to adjust to dental and non-dental life
events. Community Dent Oral Epidemiol 1993;21:57–61.
25. Holmes TH, Rahe RH. The Social Readjustment Rating Scale. J
Psychosom Res 1967;11:213–218.
26. Rahe RH. Multi-cultural correlations of life change scaling.
America, Japan, Denmark and Sweden. J Psychosom Res 1969;13:
191–195.
27. Razak IA, Jaafar N, Jalalludin RL, Esa R. Patients’ preference for
exodontia versus preservation in Malaysia. Community Dent
Oral Epidemiol 1990;18:131–132.
28. Unell L, Söderfeldt B, Halling A, Paulander J, Birkhed D. Oral dis-
ease, impairment, and illness: Congruence between clinical and
questionnaire findings. Acta Odontol Scand 1997;55:127–132.
29. Smith JM, Sheiham A. How dental conditions handicap the el-
derly. Community Dent Oral Epidemiol 1979;7:305–310.
30. Atchison KA, Dolan T. Development of the geriatric oral health
assessment index. J Dent Educ 1990;54:680–687.
31. Allen PF, McMillan AS, Locker D. An assessment of sensitivity
to change of the Oral Health Impact Profile in a clinical trial.
Community Dent Oral Epidemiol 2001;29:175–182.

Literature Abstract

Implant surface roughness affects osteoblast gene expression.

The transcription factor Cbfa1 regulates osteoblast differentiation and expression of genes nec-
essary for the development of a mineralized phenotype. This study determined if Cbfa1 and
BSPII gene expression are influenced by implant surface microtopography. Osteoblasts (50,000
cells/10-µL dot) from a previously characterized UMR-106-01-BSP osteoblast model and a non-
transformed primary rat calvarial osteoblast model were cultured on 600-grit (grooved) or sand-
blasted (roughened) commercially pure titanium implant disks measuring 1.25 cm in diameter
and 4 mm in height. A nonmineralizing subclone of the parental UMR-BSP cell line, UMR-UI
cells, was used for the negative mineralization control. Mineralization was evaluated by alizarin-
red-S staining. Real-time PCR primer and probes were used for quantitative analysis of Cbfa1
and BSPII gene expression. Enhanced mineralization was seen in osteoblasts grown on rough-
ened implant surfaces relative to tissue culture plastic. Real-time PCR showed significant in-
creases in Cbfa1 gene expression grown on roughened, as compared with grooved, implant
surfaces. BSPII gene expression was also increased on rough surfaces in the UMR cells, but
was reduced in the rat calvarial osteoblast. Gene expression and mineralization are affected by
roughed implant microtopographies during osseointegration.

Schneider GB, Perinpanayagam H, Clegg M, et al. J Dent Res 2003;82:372–376. References: 24.
Reprints: Dr G. B. Schneider, N402, Dows Institute for Dental Research and the Department of Prosthodontics,
University of Iowa College of Dentistry, Iowa City, Iowa 52242. e-mail: galen-schneider@uiowa.edu—Tee-Khin
Neo, Singapore

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