Questions/Answers

Currently, the oral diseases have increasingly been found in all ages and particularly in the elderly. One of the treatment methods for the elderly who lose their teeth is the dental implant treatment. In 2006, Ministry of Science and Technology (now Ministry of Higher Education, Science, Research and Innovation) was able to locally produced standard-quality dental implant to use to avoid using the high-price imported ones; consequently, the dental implant cost is dramatically lower. In 2007, the local-made implant was provided to enhance the elderly’s ability in mastication nationwide. With the cooperation of 203 voluntary service institutions nationwide, the project has served general patients to the elderly for 12 years. We had learned that the elderly people participating in the project were happy. The quality of their life was improved: they could eat more, thus, they had better physical and mental health. We can save expenses on imported dental implant for more than 2,000 million baht from using the locally made equipment in the project. The dental implant for the elderly project is a part of the national plan for the aging society. The project, therefore, expands the initiatives of His Majesty the late King Bhumibol Adulyadej, who was deeply concerned for the less privileged citizens who do not have an access to the dental implant, in particular, the elderly who lose teeth. As His Majesty’s royal speech, saying that “when there is no teeth, food is not as delicious, and it leads to unhappiness, then discomfort mind and body”. Objectives To improve quality of life in the elderly and to reduce inequality in all regions of the country. To innovate a low-cost dental implant, utilizing domestic technology rather than relying on imports.

The project is in concordance with the award type 1, “services for all”. TCELS notices the significance of an increasingly aging population in Thailand. The dental implant for the elderly project involves nationwide voluntary units performing dental implants to replace natural back tooth loss for patients aged 60 and older, in order to increase the efficiency in mastication and consequently to better living conditions for the elderly. The purpose of this project is in accordance with the plan of the Department of the Dental Care for the Elderly, 2015-2022 to increase the accessibility of otherwise costly dental implant services.

The project is in concordance with the main purposes of SDGs number 3 in building good quality of life and enhancing welfare for people of all ages, and number 3.8 to achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. When standard ISO 13485-compliant implants could be produced domestically, these domestically-made dental implants have been developed for commercial use and have reduced the cost of the implant by more than half. General public, in particular the elderly, can have the treatment at a reasonable price. The National Health Security Office (NHSO) is working on getting the implant on the universal coverage scheme list.

To compound the high costs of importing implants, experts in the field are scarce, as implant technology is relatively new in Thailand. The dentist team of this project was put together of staff who have been involved in dental implant development since 2003. The country can now rely less on imported technology. Consequently, the cost of the dental implant has halved and more people with all ranges of age can have the good dental implant standard treatment.

Ten years ago, the cost of dental implant was high (70,000-120,000 Baht) using the imported parts. After Thailand has successfully produced her own dental implant parts, the cost is lower (35,000 – 70,000 baht) and we import less. The benefit that the government received from this project is the increasing in staff potential from the training sessions and workshops. More dentists and assistants become knowledgeable in dental implant and could expand their services in more areas at the lower cost, due to the local made parts. There are also dentists from Cambodia and Myanmar coming to observe, understudy and exchange knowledge in the project.

The patient screening criteria has no gender boundary. The elderly and the less privileged citizens can equally receive the treatment free of charge.

After having the dental implant, patients who are older than 60 and have lost molar teeth, and patients older than 60 with full denture that are coming loose, have better living conditions. They are able to attain proper mastication and thus eat a more complete diet, leading to better physical and mental health, including socializing more confidently without the embarrassment of dental problems.

Phase 1, 2007-2011, according to a survey, it was found that some elders with complete denture coming loose because there was mandibular bone resorption. The best way to solve this problem is to put 2 dental implants in the mandibular bone. Ministry of Science and Technology (now the Ministry of Higher Education, Science, Research, and Innovation) had researched and developed the dental implant and could produce the parts with lower cost. Hence, the project could provide the treatment to the elderly and the underprivileged free of charge, altogether 10,008 cases, or the total of 20,016 implants. After Phase 1 of the project, it was found that there were many elders who needed such treatment. Phase 2 of the project has begun aiming to treat 8,400 elders, or 16,800 implants, between 2012-2016. Phase 3 through the project entitled Single tooth Implant restoration for the Elderly with a target of providing dental implant treatments to 10,000 cases, 20,000 implants, for 5 years, starting from 2018. But the budget is allocated for 700 cases, or 1,400 implants, a year. There is no charge to the patients. the budget is for the project management, equipment, materials, medical supplies, laboratory expenses, and dental staff training expenses. With the limited budget, the project cannot be provided in every province in the country. There are only 32 voluntary service units. In 2018 and 2019, 92% of elders were satisfied with the service. Then the project was made into a national policy, the Oral Health Plan for the Thai Elderly 2015-2022. The project involves several aspects from dental implant and equipment producing plan, delivering the items to the units, setting criteria and screening the patients, having workshops for dentists and assistants, following up every 6 and 12 months, and evaluating the progress of all service units.

While the project was running, the budget was cut down and limited. We had been able to manage the constrain of the project, and the cost was lower. To solve the problems of having very few specialists and most of the few specialists are live in big cities. Also, the implant technology is quite new to Thailand and there is not enough service units nationwide, workshops for Super GP and assistants are continually offered.

The dental implant is regarded as an innovative medical device that has been researched and developed for so many years. The research was carried out between 2003 and 2006, and then it was successfully manufactured under ISO13485. The implant received product certification, making Thailand the first country in ASEAN that can rely less on imported technology and products. This process has increased knowledge and expertise in manufacturing processes. Consequently, Thailand is able to lower her trade deficit. This increase equality in access to dental implant treatment for the elderly and the less privileged.

The development of the dental implant in Thailand was inspired by His Majesty the late King Bhumibol Adulyadej’s royal speech, which included: “when there is no teeth, food is not as delicious, and it leads to unhappiness, then discomfort in mind and body”. His Majesty was tremendously satisfied with his implant. “Can the 30-baht scheme pay for this implant?”, His Majesty asked the dental team. The team then took on the idea and turned his question into action by researching and developing dental implants with the cooperation of several organizations, state and private sectors.

The project has run training sessions for dentists and assistants who are civil servants of the Ministry of Public Health, the Ministry of Defense, and the Dental Innovation Foundation under Royal Patronage. The workshops train dentists and assistants on the dental implant system, dental implant equipment, and the application. These dentists and assistants will be able to use the body of knowledge in research and development of dental implants, to treat patients with craniomaxillofacial deformities caused by accidents, tumor surgery, and congenital defects.

The latest project, TCELS makes an annual budget request under the Integration of the Elderly plan, through the project entitled Single tooth Implant restoration for the Elderly with a target of providing dental implant treatments to 2000 cases a year. The elderly people who meet the screening criteria will each receive dental implants for 2 teeth, free of charge. The budget is approximately 20 million baht a year for the project management, equipment, materials, medical supplies, laboratory expenses, and dental staff training expenses. The budget will keep the project running and developing continually and sustainably.

The Center of Advanced Dental Technology started the dental implant project to honor His Majesty King Bhumibol Adulyadej for his 80 anniversary on December 5th, 2007. The project aims to enhance the masticatory efficiency of the elderly and the less privileged by providing dental implants, with the cooperation of 203 offices: dental institutes, the Department of Medical Services, the Ministry of Health, and public hospitals nationwide. The project emphasizes cooperation of every participant: dentists, assistants, hospital staff, provincial public health officers, sub district and provincial administration organizations, community leaders, schools, and the elderly.

Yes

There was an evaluation of the impact of the project which was presented to the Thailand Center of Excellence for Life Sciences for review. It was found that the two projects Dental Implants to Honor His Majesty and Dental Implants for the Elderly had treated 20,096 patients (40,192 teeth), saving 52,250 baht per tooth. The project was evaluated to have an economic impact as the project had saved the state budget 2,000,032,000 baht.

There was a survey of the cost of dental implants by public and private units. The result was compared with the cost of the treatment provided by the project. The project was divided into 3 phases, and all together 20,096 patients (40,192 teeth) were treated, saving 52,250 baht per tooth. The project was evaluated to have a significant economic impact as the project has saved the state budget 2,000,032,000 baht.

The project, which is proposed for the award, has a concrete impact on both economy and society. The project has saved over 2,000 million baht from importing parts and technology, and the project has enhanced the elderly’s oral health, resulting in better mastication and better living conditions.

The Advanced Medical Devices Technology & Medical Robotics program under Thailand Center of Excellence for Life Sciences (TCELS) is responsible for the project as part of its mission in seeking service units and hospitals in affiliation with the Ministry of Health that are willing to take part in the project, training dental personnel on dental implants, providing and quality controlling the materials and implant tools utilized in the project, seeking private dental laboratories that are willing to support the project with a limited budget, working with all service units to solve problems, making a monthly report on the number of patients and monitoring the project to accomplish the target cases as the budget allows. The project involves several sectors: public hospitals under the Ministry of Public Health, faculties of dentistry of various universities under the Ministry of Defense and under the Royal Thai Police Headquarters and Dental Innovation Foundation under Royal Patronage. All the sectors participating in this dental implants for the elderly project must sign the Memorandum of Understanding (MOU) for the project. The Thailand Center of Excellence for Life Sciences is responsible for providing the budget for medical materials, payments, dental implant and implant tools.

In order for the project to be sustainable, the project is systematically run with the cooperation of all sectors, starting from the policy level. In order to receive adequate financial support for the target cases, the project was put in the action plan Strategy 2 for the Elderly, on Equality and Narrowing the Gap of the Department of Older Persons, Ministry of Social Development and Human Security and the Elderly Oral Health Plan 2005-2022 under the Department of Health, Ministry of Public Health. The project must operate in every province in the country. The local dentists and assistants must be trained on the dental implant innovation. The head office of each involved sector should provide additional support on the parts that are not covered by the requested budget. In order to further develop the dental implant innovation and the sustainability of the project, project evaluation was conducted Feedback from the elderly is a part of the evaluation to improve the project. The elderly are invited to take part in the project and treatment right accessing for reimbursement of dental implants from the National Health Security Office (NHSO).

From beginning dental implants in 2007 to the dental implant for the elderly project in 2019, all together 12 years, we have learned that the elderly people participating in the project are happy. The quality of their life is improved: they can eat more, thus, they have better physical and mental health. Using the domestically-produced innovation in the project shows that domestically-made products actually work. The constant support from the government is an important factor in the development of the dental implant and the treatment. The medical equipment in the project also has economic values at the regional level. The expenses of the dental implant treatment can be lowered for the government sector and the public if there is a policy for public hospitals to use medical equipment produced domestically according to international standards as there is a price control over domestically-produced medical equipment. This project can be further developed by including dental implant treatment rights to the list of the National Health Security Office (NHSO), along with campaigning to protect oral health by collecting big data on dental health for budget planning.