How peoples' ratings of dental implant treatment change over time?

OBJECTIVES: Dental implant treatment (DIT) improves peoples' oral health-related quality of life (OHQoL). Assessment of longitudinal changes in OHRQoL may be undermined by response shift (RS). RS is the process by which quality of life changes, independent of health status as a result recalibration, reprioritization or reconceptualization. Thus, this study aimed to describe RS in the OHRQoL and perceived oral health of individuals receiving DIT and to compare the then-test, a self-anchored scale and the classification and regression trees (CRT) approaches for assessing RS. METHODS: OHRQoL was assessed in 100 patients receiving DIT using the OHIP-Edent (n = 100) and a self-anchored scale (n = 45) before placement of the final restoration and 3 to 6 months after treatment was completed. The OHIP-Edent was also used as a retrospective assessment at follow-up. CRT examined changes in the OHIP-Edent total score as a dependent variable with global changes in oral health and each OHIP-Edent subscale score as independent variables. RESULTS: OHRQoL and perceived oral health improved after treatment. The OHIP-Edent score decreased from 36.4 at baseline to 12.7 after treatment. On average, participants recalibrated their internal standard downwards (- 4.0 OHIP-Edent points). CRT detected downwards recalibration in 5% of participants and upwards in 15%. Reprioritization was observed in the social disability and psychological discomfort aspects of OHRQoL. CONCLUSIONS: RS affects longitudinal assessments of OHRQoL in DIT, reducing the apparent magnitude of change. The then-test and CRT are valid and complementary methods to assess RS.

Maxillary Implant-Supported Overdentures: Mechanical Behavior Comparing Individual Axial and Bar Retention Systems. A Cohort Study of Edentulous Patients.

Background and objectives: To compare the medium- to long-term mechanical behavior of overdentures with two different retention systems: overdentures with Locator® axial retention, and vertical insertion overdentures with bar retention, used to rehabilitate edentulous maxillar. Material and Methods: This prospective study assessed patients presenting complete maxillary edentulism, rehabilitated by means of implant-supported overdentures (n = 20), 10 with Locator® axial retention (ODA group) and 10 with overdentures on bars (ODB group). Patients also completed a questionnaire to determine their satisfaction with treatment. Results: The mean follow-up time in both groups was 11.4 years, with follow-up times in both groups ranging from 5 to 14 years. The ODA group suffered mechanical complications such as retention loss, need for nylon retention insert changes, resin fracture, and need for relining. In the ODB group, prosthetic dental wear, screw loosening, and complete prosthetic failure were more common. A total of 19 implants failed (23.8%); of these, 11 were in the ODA group (failure rate = 27.5%) and eight in the ODB group (failure rate = 20%). The patient satisfaction questionnaire obtained a mean score of 7.9 out of 10 in the ODA group, and 9.75 in the ODB group. Conclusions: in rehabilitations of edentulous maxillar by means of implant-supported overdentures, both the systems assessed were shown to be effective in the medium to long term. Patients expressed a high level of satisfaction with the treatments received.

Cultural constraints in the use of dental implants and orthodontic mini-implants in Benin City, Nigeria.

BACKGROUND: Dental implants and orthodontic mini implants or temporary anchorage devices (TAD) have been used for tooth replacement and as adjuncts to orthodontic treatment in anchorage control and retraction of segments of teeth respectively. They are manufactured from various materials with titanium being the currently used material. The patients in our environment have diverse cultural acceptances and constraints with some prohibiting the use of certain materials in their oral cavity. AIM: The aim of this study therefore was to determine the existence of cultural constraints in the use of dental or orthodontic min-implants and compare them in the management of patients. MATERIALS AND METHODS: Four groups of dental patients were selected to determine if cultural constraints exist. Groups 1 and 2 were patients with either anterior or posterior missing teeth requiring replacement with dental implants (implant group) or partial dentures (denture group), respectively. Group 3 were orthodontic patients requiring TAD (orthodontic group) and group 4 were patients with other dental problems and served as the control (normal group). Associations between frequencies, gender, educational, and cultural differences were evaluated with the Chi-square test. Significant values of P < 0.05 were applied where applicable. RESULTS: A total number of 192 participants were recruited for the study. Group 1 had the highest number of culturally constrained participants (n = 21, 10.9%). A significantly higher number from the group was seen (n = 11, 52.4%) among the African Traditional worshippers (ATR). Although a total number of 58 (30.2%) patients replaced their missing teeth, 37 (19.3%) utilized partial dentures in group 2 with no cultural constraints. Orthodontic implants were not rejected (n = 0, 0%) by all the four groups. Group 4 demonstrated a low level of constraints (n = 7, 4.2%). Of the four religious groups identified, ATR demonstrated the highest level of constraints with Christians and Muslims showing fewer constraints to the use of implants (n = 7, 33.3%) and (n = 2, 9.5%), respectively. Participants with the highest educational levels and social classes were more culturally constrained in the use of dental implants. CONCLUSION: Cultural constraints exist in the use of dental implants in our environment among African Traditional religion worshippers. There was, however, no cultural constraint to the use of orthodontic implants by any of the religious groups.

Provision of information on dental implant treatment: Patients' thoughts and experiences.

OBJECTIVES: To explore patients' thoughts and perceptions of information provision regarding dental implant treatment. METHODS: This generic qualitative study involved 38 semi-structured face-to-face and telephone interviews with 34 participants, who were at different stages of dental implant treatment. The interviews were transcribed verbatim. The data collection and coding process followed the principles of qualitative thematic analysis. RESULTS: Clinical sources of information were generally trusted by patients; however, patients clearly lacked information relative to their own specific situation, concerns and preferences, and this may lead to patients' reliance on other general sources of information. Crucial information on the long-term prosthesis needs was requested by patients at all treatment stages. Issues concerning the longevity and functional capability of the implant restoration and the long-term maintenance including optimisation of hygiene practice were questioned by patients and required greater explanation. CONCLUSION: With growing patient interest in implants for replacement of missing teeth, complete and accurate knowledge and understanding of implants should be established with patients. This should be undertaken with more reliance on reliable clinically based sources of implant information.

Patients' perceptions of implant placement surgery, the post-surgical healing and the transitional implant prostheses: a qualitative study.

OBJECTIVES: This study aimed to explore patients' thoughts, feelings about, and experiences of, implant placement surgery (IPS), the post-surgical healing stage and the immediate post-surgical transitional implant prosthesis (TIP) (fixed and removable). METHODS: A qualitative study design was chosen and 38 semi-structured telephone and face-to-face interviews were conducted with 34 patients at different stages of implant treatment. The interviews were transcribed verbatim; the data collection and coding process followed the principles of thematic analysis, which was facilitated through the use of NVivo10. RESULTS: Patients anticipated that surgery would be painful and unpleasant but were prepared to accept this temporary discomfort for the expected benefits of implant treatment. However, a key finding was that patients felt they had overestimated the trauma of surgery but underestimated the discomfort and difficulties of the healing phase. A number of difficulties were also identified with the TIP phase following implant surgery. CONCLUSION: Existing research has tended to focus on the longer term benefits of dental implant treatment. This qualitative study has investigated in-depth patients' perceptions of dental implant surgery, including their experiences related to sedation, and of transitional implant restoration. While patients felt their concerns were overestimated in relation to the implant surgery, they experienced greater morbidity than they expected in the healing phase. Recommendations are made for relatively small changes in care provision which might improve the overall patient experience. Partial dentate patients treated with a fixed transitional prosthesis experienced advantages more quickly than patients with an overdenture.

Patient-centered and clinical outcomes of mandibular overdentures retained with the locator system: A prospective observational study.

STATEMENT OF PROBLEM: Whether clinical or demographic variables affect the perception of treatment in terms of quality of life and satisfaction is unknown. PURPOSE: The purpose of this prospective study was to make an evidence-based assessment of the treatment outcomes (patient- and clinically based) of locator-retained mandibular overdentures. MATERIAL AND METHODS: This prospective observational study assessed patients with edentulism who had worn mandibular overdentures supported by 2 implants and retained by the locator system for at least 1 year of functional life (N=80). Medical histories were reviewed, and patients underwent oral examinations. Prosthetic clinical outcomes and patient well-being were registered using the Oral Health Impact Profile 20 (OHIP-20) and Oral Satisfaction Scale (OSS). RESULTS: Patient well-being scored an overall OHIP-20 score of 19.0 ±14.0 of 80 (the higher the score, the greater the impact and the worse the oral health-related quality of life); overall oral satisfaction was 8.3 ±1.7 of 10. Women suffered greater social impact (0.8 ±1.0) and disability (0.4 ±0.8) than men (0.4 ±0.7 versus 0.2 ±0.4, respectively). Impact on well-being was inversely proportional to both patient age and the age of the prosthesis (r=-0.25; P<.01). Implants had been placed on average 73.6 ±39.2 months previously, showing a survival rate of 82.5%. Most of the overdentures had been functioning for over 60 months. Relining (46.3%), readjustments (82.5%), and changes of nylon retention (1.5 ±1.8 per patient over 60 months of use) devices negatively influenced well-being. CONCLUSIONS: Mandibular overdentures produced good results with regard to quality of life and oral satisfaction, but attention should be paid to factors affecting clinical outcomes and patient well-being.

Facilitators and barriers influencing the readiness to receive dental implants in a geriatric institutionalised population-A randomized non-invasive interventional study.

OBJECTIVE: Although elderly people have many serious dental issues and are in need of prosthesis, few opt for dental implants. The aim of this study was to investigate barriers that prevent elderly people from receiving dental implants. Specifically, we examined (i) whether the message was delivered before or after the interview had an impact, and (ii) whether it did matter who delivered the message. MATERIALS AND METHODS: Sixty-six residents from seven residential homes in the Canton of Grisons, Switzerland were included. The sample was randomized to a treatment group that received comprehensive education about dental implants before the interview and a control group that received education after completing the questionnaire. RESULTS: The sample consisted of 54 women (81.8%) and 12 males (18.2%) with an average age of 86.2 years. Education before the interview did not show any impact on the attitude towards dental implants. Main reasons for a negative attitude towards implants were old age and high costs. Participants who received information about implants from their relatives and their own dentist and not from the study dentist were significantly more willing to receive implants. CONCLUSION: Providing an adequate education about benefits and risks of receiving dental implants does not change the attitude towards dental implants. The source of information/messenger does influence attitudes towards implants. If the person delivering the education and information is a relative or a known medical person, the person's attitude is more likely to change as compared to people receiving the information from an unrelated person.

Implants for the aged patient: biological, clinical and sociological considerations.

Until recently, age, particularly old age, was considered a contraindication to the placement of dental implants. However, this was based largely on anecdotal dogma rather than on empirical information. This review considers the biological, clinical and socio-economic implications of implants placed in the aged population. Aging has been shown to have an influence on the biological aspects of soft- and hard-tissue wound healing and tissue remodeling, which may influence the establishment and maintenance of implant integration. However, information to date indicates that age should not be an a priori contraindication for implant placement and there is good evidence to indicate that dental implants can be placed successfully in the elderly with good clinical and socio-economic outcomes.

A qualitative analysis on participants' perspectives on oral implants.

BACKGROUND: Quantitative research methods provide clinicians with information about the effectiveness of interventions and determined causal-effect relationships, whereas qualitative research investigates other aspects of clinical implant practice, particularly the participants' perspectives and expectations. The aim of the qualitative study was to understand the experience of participants with immediate single molar implants. METHODS: In-depth, audiorecorded, semistructured interviews were conducted with 15 participants who had participated in a controlled clinical trial of immediate molar implants. Participants were aged 36-77 years. Nine participants received single implants in mandibular molar fresh extraction sockets while the remaining participants had their implants in healed sites. The interviews that assessed participants' perspectives of the pre-operative, operative, and postoperative phases of therapy were transcribed verbatim and analysed using inductive and content analysis. RESULTS: Participants took part in the clinical trial mainly because it offered oral implant therapy at a reduced cost. The affordability of implant treatment was the main factor in determining restorative options. Minimal differences were found between male and female participants of different age groups in terms of their perceptions of function and aesthetics. However, single molar implants did not have an impact on aesthetics and self-esteem. Participants' expectations regarding the longevity of oral implants were not realistic and their knowledge about future maintenance needs was not adequate. CONCLUSIONS: Using face-to-face verbal conversation more frequently may improve communication between clinicians and participants and minimize misunderstanding about the procedures of different treatment modalities. Special emphasis should be placed on understanding the importance of maintenance by spending more time with the participants to identify any future barriers to maintaining good outcomes of oral implants.

Patient satisfaction 8-14 years after dental implant therapy - a questionnaire study.

OBJECTIVE: The aim of this questionnaire study was to investigate patient satisfaction 8-14 years after dental implant therapy and complications influencing the degree of satisfaction. MATERIALS AND METHODS: A questionnaire was sent by post to 587 patients at a specialist clinic of periodontology. The questionnaire consisted of 19 statements or questions such as the degree of satisfaction with the implants and knowledge of complications. In nine of the questions, respondents were asked to grade the extent of their agreement with a statement by selecting from fixed answers. Three of the questions were designed to be answered using a visual analog scale. RESULTS: In total, 400 individuals (81%) responded to the questionnaire. The mean time elapsed since implant installation was 10 years. A great majority (81%) experienced a high chewing comfort and was satisfied or sufficiently satisfied (94%) with the aesthetic aspects of their implant restorations, while 32% of the individuals had experienced problems with their implant reconstructions. The disadvantage that patients remarked on was the cost of the treatment. Those who had experienced problems with their implant reconstructions were also less satisfied with the treatment. CONCLUSION: A great majority of the patients expressed a high degree of satisfaction with their dental implants 8-14 years after the treatment. Patients were less satisfied if they had experience of problems with their implant reconstructions and in cases when the clinicians were unable to resolve their complications.

Analysis of the Factors Affecting Surgical Success of Implants Placed in Iranian Warfare Victims.

OBJECTIVE: The aim was to evaluate the survival time and success rates of dental implants in warfare victims and factors that affect implant success. SUBJECTS AND METHODS: This retrospective study involved 250 Iranian warfare victims who received dental implants from 2003 to 2013. Patients' demographic characteristics, as well as the brand, diameter, length, location and failure rate of the implants were retrieved from patients' dental records and radiographs. The associations between these data and the survival rate were analyzed. Statistical analysis was carried out with χ2 and log-rank tests. RESULTS: Overall, out of the 1,533 dental implants, 61 (4%) failed. The maxillary canine area had the highest failure rate [9 of 132 implants (6.8%)], while the mandibular incisor region had the least number of failures [3 of 147 implants (2.0%)] and the longest survival time (approximately 3,182 days). Maxillary canine areas had the shortest survival (about 2,996 days). The longest survival time was observed in implants with 11 mm length (3,179.72 ± 30.139 days) and 3.75-4 mm diameter (3,131.161 ± 35.96 days), and the shortest survival was found in implants with 11.5 mm length (2,317.79 ± 18.71 days) and 6.5 mm diameter (2,241.45 ± 182.21 days). Moreover, implants with 10 mm length (10.7%) and 5.5-6 mm diameter (22.2%) had the highest failure rate; however, the least failure rate occurred when the implants were 11.5 mm in length (1.9%) and 3-3.5 mm in diameter (3.1%). CONCLUSIONS: The brand, length and diameter of implants affected the survival time, failure rate and time to failure. The location of the implant was not statistically significant regarding the mentioned factors, although it has clinical significance.

Dental implant treatment following trauma: An investigation into the failure to complete Accident Compensation Corporation funded care.

BACKGROUND AND OBJECTIVES: Among other restorative strategies, the Accident Compensation Corporation (ACC) provides benefits for dental implant treatment to replace teeth lost as a result of trauma. While ACC has funded over 15,000 dental implants since 2002, the outcomes of this treatment and patient perceptions of this treatment have not been investigated. The aim of this study was to investigate the perceptions of the dental implant treatment outcomes and reasons for failure to complete restorative treatment in patients who had undergone trauma-related implant surgery funded by ACC between February 2006 and September 2009, but had not completed the prosthetic component of the treatment. METHODS: A randomly selected sample of 399 patients, who had undergone dental implant surgery but not completed the crown restoration, was identified from the ACC database. These individuals were contacted by mail for expressions of interest and 181 clients were interviewed by telephone. Responses to open-ended questions were entered into an Excel spreadsheet and analysed using a general inductive technique. RESULTS: A common emergent theme was the high level of satisfaction expressed by participants with the implant process, however just under half of those responding felt they had been pushed into having implants and were given the impression that this was the only treatment ACC paid for. The cost of the prosthetic phase of the treatment and surgical complications were identified as the primary reasons why participants failed to complete the restorative phase of treatment, after completing the surgical phase. CONCLUSIONS: The results highlighted the need to better inform patients of their treatment options and to allow time for them to process this information before progressing with care. A patient decision tool may help to give greater ownership of the treatment options. Newly implemented protocols to assist dentists to better assess treatment needs may also assist in achieving improvements in perceived treatment outcomes for patients.

Reasons for not using Implants to retain Complete Denture: Patients' Survey.

OBJECTIVE: This study aimed to gain more information from complete denture (CD) wearers who did not receive dental implants, of the reasons preventing them from using implants to retain their CD in a selected sample of dental patients in Riyadh, Saudi Arabia. MATERIALS AND METHODS: A paper-and-pencil questionnaire containing 20 direct questions of the possible reasons preventing CD wearers from receiving implants to retain their dentures was distributed in three different places in Riyadh, Saudi Arabia. RESULTS: A total of 270 subjects were included in this survey. The results showed that 180 (66.7%) patients indicated that the fear of pain associated with implant placement was the main reason preventing them from receiving an implant treatment, followed by fear of the surgical procedure (175, 64.8%), fear of postoperative complications (166, 61.5%), information from other people about the various problems associated with implant treatment (154, 57%), and finally cost of the implant (141, 52.2%). CONCLUSION: Fear is the main reason preventing CD wearers from receiving implant treatment. Therefore, it is essential for dentists to be familiar with the reasons for implant refusal to overcome a common, yet an influential obstacle.

Influence of different prosthodontic rehabilitation options on oral health-related quality of life, orofacial esthetics and chewing function based on patient-reported outcomes.

PURPOSE: The aim was to assess influence of different prosthodontic rehabilitation options on improvement of orofacial esthetics, chewing function (CF) and oral health-related quality of life. METHODS: Patients treated with 70 conventional complete dentures (CDs), 38 implant-supported mandibular complete dentures opposed to maxillary CDs, 56 conventional removable partial dentures, 15 implant-supported removable partial dentures, 25 conventional fixed partial dentures (FPDs) and 59 implant-supported fixed partial dentures (IFPDs) were included. The survey was conducted using the three questionnaires: the OHIP-CRO14, the Orofacial Esthetic Scale (OES-CRO) and the Chewing Function Questionnaire (CFQ), and administrated twice: at the baseline prior the therapy and 3 months after prosthodontic rehabilitation had been finished. RESULTS: The after-treatment scores were significantly better than the baseline scores (p < 0.001) for the OES, OHIP14 and CF questionnaires in all types of treatments. The two-factor ANOVA showed no significant difference for the OES after-treatment scores between different rehabilitation options and implant presence, but the OHIP14 and CFQ after-treatment scores were significantly better in FPD and IFPDs than in removable implant and conventional denture wearers. The score change was significantly higher in all implant removable denture patients for the OES, OHIP and CFQ. The lowest score change was registered in the FPD wearers. (p < 0.01). CONCLUSIONS: Removable denture implant patients most benefited from implant support, but IFPD and FPD had the best after-treatment scores. The assessed clinical parameters may help dentists in choice of the best rehabilitation option with the highest treatment effect.

Implant counseling and information: questions, predictors, and decision-making of patients before implant therapy.

BACKGROUND: Implant counseling and information must enable the patient to make his/her own independent decision (informed consent). However, there are indications that patient counseling and information often provides incomplete information. METHODS: In 40 implant counseling and information sessions, all questions raised by the patients were documented during the session. The patient's decision for or against implant therapy was recorded 3 months later. The influence of the patient's age and gender, the type of insurance, the number of questions asked by the patient, the number of required implants, and the need for augmentation on the patient's decision were determined. RESULTS: Sixty-five percentage of the patients decided in favor of implant-prosthetic therapy. One significant factor influencing the patient's decision was the need for augmentation. Fifty-four percentage of the patients who decided in favor of the implant intervention needed augmentation. Eighty-six percentage of the patients who refused the intervention could have been treated only in conjunction with pre-implantological augmentation. The need for augmentation was associated with a higher mean number of questions per counseling and information session (3.7 vs. 2.3) (n.s.). Patients who had opted for implant treatment asked significantly fewer questions (2.5) than patients who refused the treatment (4.4). The patient's age and gender, the type of insurance, or the number of implants required had no influence on decision-making. CONCLUSION: Patients who ask many questions rather tend to refuse the implant treatment. The need for augmentation was also associated with a significantly higher percentage of implant refusal. These results suggest that patients with an indication of augmentation require particularly detailed and comprehensive counseling and information.

Knowledge, attitudes, and perceptions of undergraduate dental students toward dental implants--an all India survey.

PURPOSE: This study aims to gauge the knowledge and perceptions of undergraduate dental students or residents toward dental implants. MATERIALS AND METHODS: The dental colleges in India were divided into 5 zones, and by random selection method, 7 colleges were selected from each zone. Thus, a total of 35 dental institutions were selected, which included 2800 residents. A printed questionnaire consisting of 15 questions, which assessed the level and source of information regarding implants, was prepared and distributed. RESULTS: A total of 2800 questionnaires were posted of which 2041 responses were received (response rate was 72.89%). This study shows that 81.1% of the residents believed that they were not provided sufficient information and a whopping 91.7% of them coveted more information about implants in their undergraduate curriculum. CONCLUSION: This study concludes that a revision in the undergraduate dental curriculum is required to make the students better equipped with the technicalities of implant dentistry.

Impact Of Dental Anxiety On The Decision To Have Implant Treatment.

INTRODUCTION: Dental implants are increasingly used in modern dentistry as anchors for prosthetic restorations. Anxiety is a complex phenomenon which can become a risk factor for suppression of many functions of the body. AIM: The aim of this study was to investigate the effect dental anxiety exerts on the choice of method of treatment by patients wanting to have dental implants. MATERIALS AND METHODS: The study included 174 patients that were referred to us for dental implants placement because of partial or total loss of teeth. Their dental anxiety was measured using the Dental Anxiety Scale (DAS) proposed by Norman Corah. The patients decided to have or refused to have treatment with dental implants either because they had dental anxiety or gave other reasons. RESULTS: Distribution of patients by level of anxiety was as follows: 33% were anxiety free, in 34% the dental anxiety was moderate, 25% had severe anxiety, and 8% experienced an extremely severe anxiety. Dental fear was given as a reason for refusal of treatment by 24.1% of the patients wanting to have dental implants. Of the patients wanting to have dental implants, 40.8% decided to proceed with the treatment; these patients exhibited low dental anxiety. CONCLUSION: The decision to have dental treatment with implants is affected by the patient's level of dental anxiety. Only those with low level of dental anxiety decide to proceed with such a treatment. The mild anxiety some patients experience is beneficial as it eliminates a risk factor that may hinder the process of osseointegration.

Patients' expectations to dental implant: a systematic review of the literature.

OBJECTIVE: To examine the current literature on the impact of patients' expectations on treatment outcomes or final patient satisfaction and to identify the theoretical frameworks, study designs and measurement instruments which have been employed to assess patients' expectations within implant dentistry. METHODS: A structured literature search of four databases Pubmed, Cochrane, Web of Science and PsychINFO was conducted following PRISMA guidelines. Any type of literature published in English discussing the topic of 'patients expectations' in oral health were identified and further screened. Studies reporting on expectations regarding dental implants were selected and a narrative review was conducted. RESULTS: The initial search yielded 16707 studies, out of which 1051 'potentially effective studies' were further assessed and final 41 'effective studies' were included [Kappa = 0.76]. Ten observational studies, published from 1999 to 2013, dealt specifically with expectations of dental implants. There was a large degree of heterogeneity among studies in terms of assessment instruments. Expectations relating to aesthetics and function were primarily considered. Among the 10 studies, 8 were classified as quantitative research and 2 as qualitative research. The STROBE quality of reporting scores of the studies ranged from 13.5 to 18.0. Three of the 8 quantitative studies employed a before/after study design (prospective studies) and used visual analogue scales (VAS) to measure patient expectations. CONCLUSIONS: There is a growing interest in patients' expectations of dental implants. Most studies are cross sectional in nature and the quality of reporting varies considerably. Expectations with respect to aesthetics and function are key attributes considered. The use of visual analogue scales (VAS) provides quantitative assessments of patients' expectations but the lack of standardization of measures prohibits meta- analyses.

Patients' perspectives on dental implant and bone graft surgery: questionnaire-based interview survey.

PURPOSE: To assess up-to-date expectations and preferences of patients seeking dental implants. MATERIAL AND METHODS: One hundred and fifty consecutive patients (66 male and 84 female interviewees) were asked to rank their concerns regarding implant therapy and answer a questionnaire on implant and bone graft surgery, cost and time considerations and second-opinion behaviour. RESULTS: Treatment predictability and avoidance of removable dentures were ranked high priority (compared with time and cost efficiency or avoidance of bone grafts). Patients' estimation of the 10-year implant success rate was 84%, and 59% of patients expected implants to last for a lifetime. Total treatment time was estimated to be 4 months on average, and only 12% would tolerate increased risk of implant failure for the sake of shortening treatment duration. 61% of interviewees accepted autologous bone grafts (the majority favouring the retromolar area), while only 23% were willing to undergo bone harvesting from the hip. 43% opted for bone substitute material to avoid donor site morbidity. 67% would accept the additional costs associated with computed tomography, software-based treatment planning and guided implant placement to avoid bone graft surgery. Motivation for second-opinion seeking was high (46-62%), especially in young and male patients. CONCLUSION: Patient expectations on implant success and predictability are high compared with their reluctance towards treatment costs and duration. Acceptance of treatment morbidity is high among patients reporting low denture satisfaction; however, minimally invasive treatment alternatives are generally preferred.

Smile attractiveness of patients treated for congenitally missing maxillary lateral incisors as rated by dentists, laypersons, and the patients themselves.

STATEMENT OF PROBLEM: Esthetic judgments can help dental professionals better understand how attentive people are to their own smiles and those of others. PURPOSE: The purpose of this study was to evaluate the smile attractiveness of patients treated for maxillary lateral incisor agenesis compared with that of individuals with a complete dentition. MATERIAL AND METHODS: Photographs were made of the smiles of patients with maxillary lateral incisor agenesis who were treated with space closure and teeth recontouring (n=26) or space opening and implants (n=20) and of a control group with a complete dentition (n=22). Both laypersons and dentists assessed smile attractiveness by using a visual analog scale. Patients and controls also assessed the level of satisfaction with their own smile. Assessments were performed twice, and the reliability of the method was determined with Cronbach α and intraclass correlation. Multifactorial and 1-way ANOVA were used to analyze smile attractiveness and participant satisfaction, followed by the Bonferroni post hoc test (α=.05). RESULTS: Attractiveness ratings by dentists and laypersons did not differ significantly among the study groups (P=.64). The ratings of male dentists and female laypersons differed significantly from those of other evaluators (P=.01). Patients with space closure and teeth recontouring were significantly more satisfied than controls (P=.002). No significant differences were found between the patients with implants and controls or between the patients with implants and those with space closure and teeth recontouring. CONCLUSIONS: The smiles of patients with maxillary lateral incisor agenesis were judged to be as attractive as those of the controls. Male dentists were the most critical raters, closely followed by female laypersons. All participants had high levels of satisfaction with their own smile; patients treated with space closure and teeth recontouring were the most satisfied.