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.

Altered expectations on dental implant therapy; views of patients referred for treatment of peri-implantitis.

AIM: The aim was to explore patients' reactions on being diagnosed with peri-implantitis, their opinions on dental implant therapy and expectations on treatment of the disease. MATERIAL AND METHODS: The study subjects were patients referred to a specialist clinic for treatment of peri-implantitis. The method of grounded theory was used in collecting and analyzing data. Audiotaped, thematized open-ended interviews were conducted. The interviews were transcribed verbatim and consecutively analyzed in hierarchical coding processes that continued until saturation was met (n = 15). RESULTS: In the analysis, a conceptual model was generated that illuminated a process among patients. From having very high initial expectations on dental implant therapy as a permanent solution of oral/dental problems, patients realized that dental implants, such as teeth, require continuous care and that there is no guarantee for that dental implants provides a treatment alternative free from future problems. The core concept of the model "altered expectations on dental implant therapy" was composed of three main categories: "initial expectations on dental implant therapy and living with dental implants", "being referred to periodontist and become diagnosed with peri-implantitis" and "investing again in an expensive therapy with no guarantee for the future". CONCLUSION: Patients may have unrealistically high expectations on dental implant therapy. The results illuminate the importance of patient-centered communication in dentistry and that treatment decisions should be based not only on professional expertise but also on expectations, abilities, wishes and life circumstances of the individual patient.

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.

The effect of denture installation at mandibular rest position on unsteady motion of the centre of pressure in postural sway.

Wearing dentures has been believed to decrease the instability of the postural sway using the total length of centre of pressure (CoP) trajectory or the magnitude of its variability. However, the physical aspects of the postural sway have not been taken into account while evaluating the CoP in patients who wear dentures. The CoP fluctuations are found to show a random walk process. Therefore, changes in the random movement of CoP caused by wearing dentures should be examined by nonlinear dynamics that enables analysis of the characteristics found in the random movement. We evaluated the effect of complete denture installation on CoP sway for twenty-six edentulous patients by performing the following steps. First, we excluded subjects who did not show crossover in spectral analyses. Then, we evaluated the spectral characteristics and phase shifts of the velocities of CoP sway for the subjects who showed crossover. We found that wearing complete dentures decreased the fluctuations in the high-frequency part of the power spectral density (PSD) and the phase shift in the mediolateral direction. On the other hand, we also found that the use of complete dentures decreased the fluctuations of PSD amplitude in the anteroposterior direction. From the point of view of the kinetic energy of the musculoskeletal system, we suggested that the use of complete dentures could reduce the energy consumption for the standing posture.

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.

Relationship between implantation of missing anterior teeth and oral health-related quality of life.

PURPOSE: The aim of the present study was to investigate the relationship between anterior teeth implantation and oral health-related quality of life (OHRQoL). METHODS: Participants completed the Chinese version of the Oral Health Impact Profile-14 (OHIP-14) prior to implantation and at 6 months following crown restoration. Participant demographic information was recorded. Six months following implant crown restoration, participants were asked to self-assess their overall oral health and implant restoration. A Kruskal-Wallis test and Spearman correlation test were used for statistical analyses. A p value <0.05 was considered statistically significant. RESULTS: A total of 238 patients (133 women and 105 men) completed the study. OHP-14 scores were negatively correlated with self-assessment of both overall oral health (r = -0.788, p < 0.001) and implant restoration (r = -0.739, p < 0.001) after implant crown restoration. There were no significant differences between qualitative reasons for dissatisfaction or between quantity of reasons given for dissatisfaction (p = 0.845). Six months following crown restoration, the overall OHIP-14 scores and the four common factors (disability, psychological discomfort, functional limitation, pain, and discomfort) decreased significantly compared to preimplantation scores (p < 0.001). From the paired differences between genders before and after implantation, significant differences were observed in overall quality (p = 0.044) and disability (p = 0.029). Patients with a higher education level scored significantly higher on overall quality of life (p = 0.031) and psychological discomfort (p = 0.002) following crown restoration. CONCLUSIONS: Our findings indicate that the implantation of anterior missing teeth could significantly improve patient OHRQoL. Gender and education level were shown to affect implantation results.

[Use of metabolic drugs and psychotherapy in dental implantation in elderly patients].

The estimation of efficiency of metabolic drugs and psychotherapy in dental implantation in the elderly was carried out. On the basis of the study results an important pathogenetic significance of use of metabolic drug cytoflavin and cognitive therapy in the treatment of partially adentia at elderly patients was justified. It was proved that the optimization of the internal picture of health by means of the implementation of information and regulatory functions, and emotional reinforcement of the therapeutic process in patients receiving cytoflavin and cognitive therapy would improve the effectiveness of the treatment, to increase "survival" performance of implants and to approach to understanding the underlying mechanisms of forming health in elderly patients with partial adentia.

Factors shaping demand for prostethic dentistry treatment with special focus on implant dentistry.

AIM: The main aim of this thesis was to investigate how attitudes influence the latent and manifest need, desire, demand, and utilization for dental implant treatment, considering the gatekeeping process between need and demand, and between demand and utilization of dental treatment. MATERIAL AND METHODS: A conceptual analysis of the need and demand concept from the literature was a first step in the study. A second step was to examine changes in attitudes toward desire for implant treatment over time, also in relation to dental status, in a population of middle aged and older individuals in Sweden based on two questionnaire studies, one in 1989 and the other in 1999 among the same 3000 participants. The individuals who responded both in 1989 and 1999 constituted a panel of 56% of the 1989 survey sample. Logistic regression models were done with desire of implant treatment as dependent variable. In paper V, a qualitative study using grounded theory was done on the treated patients' subjective perspective on receiving a fixed implant-supported denture. RESULTS: An emancipatory perspective with the patient-dentist dialogue was regarded as central for an optimal treatment result in the prosthetic treatment decision-making process. A main finding was that need is established only in a communicative dialogue with mutual respect between the profession and the patient. The study implied that the gatekeeping concept relates to a complex process rendering great differences between demand and actual utilization. The main result from the questionnaires was the huge increase in interest for implant-treatment from 1989 to 1999. In 1999 almost all (94%) of the study population expressed desire for implant treatment; as many as 92 % percent of those who did not express a desire for implants in 1989 had changed their mind 10 years later. The regression analysis showed that older people, non-city residents, and those with one or several missing and unreplaced teeth, changed desire for implant treatment between the study years. Effects of age, residence, and better dental status disappeared during the ten year study period. Those edentulous and those with removable dentures expressed less desire than those with all teeth remaining, or only one or a few teeth missing, in 1989. High income significantly increased the probability to desire implant treatment for the study panel at both study occasions. The qualitative study, using the method for grounded theory, gave as core category and main finding the importance of the patients' trust and confidence in the dentist and his/her staff, in the process of transforming desire for dental implant treatment into manifest demand, and also making it more likely for the patients' to become satisfied with the treatment result regardless of complications. CONCLUSION: There is no objective need in prosthodontic treatment. Manifest need and demand change over time, and are influenced by the patients' attitude and situation, and by the dentist's practice profile. True need can only be identified in a dialogue between the professional and the patient. Income and dental status, but not age, place of residence, nor concern for dental appearance, influence desire for implant treatment at the end of the studied 10-year period. Individuals with removable dentures, or those being edentulous in one or both jaws have a lower probability to desire implant treatment than those with all teeth remaining, or with missing teeth replaced by fixed partial dentures. The qualitative study underlined the importance of the relationship between the professional and the patient. The patients' trust and confidence in the dentist and his/her staff were decisive in the process of making a demand for implant treatment manifest and turning it into actual utilization. The informants from this study described their confidence and trust as dependent on a communicative dialogue with mutual respect between the patient and the professional.

Residents' perceptions of implant surgical training in advanced education in prosthodontic programs.

PURPOSE: The purpose of this study was to assess residents' perspectives on their implant surgical training in Advanced Education in Prosthodontic programs in the United States. MATERIALS AND METHODS: Questionnaires were distributed to all prosthodontic residents (N = 442). The 27 questions assessed the subjective and objective aspects of implant surgical training from the view of prosthodontic residents. The data were compiled and reported as frequencies. Descriptive statistics were used to analyze the data. RESULTS: One hundred and ninety-eight responses (44.8%) were received and analyzed. Forty-seven percent (94) of the respondents felt that the philosophy of their programs regarding implant placement in prosthodontics was "optional but encouraged," whereas 30% (60) felt that it was "mandatory." The majority of the respondents (73%, 144) stated that their programs allowed them to place implants for their own patients. For those respondents who placed their own implants, 40% (58) of them indicated that the level of their clinical training was "competent." Almost half of the respondents expressed that they would like to have a proficient level of clinical training in implant surgery by the completion of their residency programs. Forty-four percent (87) of the respondents felt their residency training adequately prepared them for implant surgery, whereas the other 37% (73) did not. For those who did not, 74% (55) felt their residency programs should have prepared them for implant surgical training. CONCLUSION: The current generation of prosthodontic residents has an opportunity to place implants in their programs and would like to be trained in surgical aspects of implant dentistry at the level of competency or higher.

Patients' knowledge and expectations regarding dental implants: assessment by questionnaire.

Today, modern implant dentistry appeals to a wide population, but the decision for and the success of implants depend on the knowledge and expectations of patients. The aim of this study was, with the help of a questionnaire, to evaluate the level of patient knowledge before a professional consultation was performed, and hence to be better prepared in the interests of patient awareness. Fifty-eight percent of 315 patients questioned thought that implants require the same care as natural teeth, 61% expected an additional payment of 2000 Euro or less, 80% held the function of an implant-supported overdenture as very important and 54% attached great importance to the aesthetics. The expectations that patients have for an implant-supported set are high in contrast to their willingness to make additional payments. There are still misconceptions regarding costs, and these must be resolved individually in practice.

Hypnosis as a Valuable Tool for Surgical Procedures in the Oral and Maxillofacial Area.

Hypnosis is a valuable tool in the management of patients who undergo surgical procedures in the maxillofacial complex, particularly in reducing and eliminating pain during surgery and aiding patients who have dental fear and are allergic to anesthesia. This case report demonstrates the efficacy of hypnosis in mitigating anxiety, bleeding, and pain during dental surgery without anesthesia during implant placement of tooth 14, the upper left first molar.

Changes in oral health-related quality of life during implant treatment in partially edentulous patients: A prospective study.

PURPOSE: The aim of this prospective study was to evaluate the changes in oral health-related quality of life (OHRQoL) during implant treatment for partially edentulous patients, and to evaluate the influence of the type of partially edentulous arch. METHODS: Twenty patients with a small number of lost teeth (fewer than 4 teeth) who underwent implant treatment were selected. Chronological QOL change during implant treatment was measured. The subjects completed the shortened Japanese version of the Oral Health Impact Profile (OHIP-J14) before the surgery (T0), 1 week after the surgery (T1), 1 week after interim prosthesis placement (T2), and 1 week after definitive prosthesis placement (T3). Complete data of the twenty subjects were analyzed with the Wilcoxon signed-rank test. RESULTS: The total OHIP-J14 score was significantly reduced only at T3 (P<0.05). "Physical pain" and "Physical disability" scores significantly decreased at T3, and "Psychological discomfort" scores also significantly dropped at T2. However, "Functional limitation" scores significantly increased at T1. "Psychological disability", "Social disability", and "Handicap" scores remained the same. On the other hand, in the comparison depending on the type of partially edentulous arch, the total OHIP-J14 score significantly decreased at T3 in the unilateral free-end edentulous space, whereas no significant difference was observed in the bounded edentulous space. CONCLUSION: Although there is a temporary functional limitation after implant placement in overall OHRQoL improvement was observed after the definitive prosthesis placement. Moreover, implant treatment was more effective in the unilateral free-end edentulous space.

The aesthetic and functional restoration in the case of partial edentulism in young patients.

The absence of teeth in youths can be due to congenital absence, traumas, caries and periodontitis. The loss of a tooth in growing patients can cause both aesthetic-functional and psychological problems, particularly if the teeth of the anterior region are involved. When there is the loss of a dental element in a teenager it is necessary to provide a quick suitable therapeutic solution, which will be different in comparison to an adult because of the changes related to the growth of the maxillary bones. The aim of this paper is the analysis of the several therapies which can be carried out on young patients with partial edentulism, paying particular attention to the conditions and the indications which allow an implant prosthesis restoration.

Assessment of anxiety in patients who undergo surgical procedures for tooth implants: a prospective study.

PURPOSE: The purpose of this study is to evaluate general anxiety using the State-Trait Anxiety Inventory (STAI) and dental anxiety using the Corah Dental Anxiety Scale (Corah-DAS) in patients who underwent surgical procedures for dental implants. METHODS: The study was performed with 55 patients who underwent implant surgery, of whom 37 were treated at a university and 18 were treated at a private office. General anxiety (STAI) and dental anxiety (Corah-DAS) were assessed at three different time points: appointment prior to clinical procedures (T1), day of procedures (just before the procedures; T2), and first post-procedure appointment (T3). The data were analyzed using analysis of variance followed by the Duncan test or Student's t-test. RESULTS: State anxiety increased on the day of surgery (T2), whereas trait anxiety was higher at T1 (both p < 0.05). Women (n = 41) presented higher state anxiety at T2 than men (n = 14). Patients who were treated at the university (n = 37) exhibited higher state anxiety at both T1 and T3 than patients who were treated in a private practice (n = 18). Individuals with lower dental anxiety at T1 were those who reported having good experiences with dental treatment. CONCLUSIONS: An increase in state anxiety was observed immediately before surgical procedures, and this increase was more pronounced in females. Although the Corah-DAS has been used as an indicator of dental anxiety, the STAI appears to be more sensitive for the measurement of anxiety. The application of appropriate methods is essential for ascertaining anxiety in patients, which should be considered in oral surgeries.

Patient knowledge and expectations prior to receiving implant-supported restorations.

PURPOSE: Implant dentistry has revolutionized the treatment of partially and completely edentulous patients. The aims of this study were to explore what made patients choose implant treatment and their prior knowledge and expectations of this treatment option. MATERIALS AND METHODS: A study population of 117 subjects was selected from 248 referred possible candidates for implant therapy. The subjects answered a questionnaire regarding implant dentistry prior to professional consultation at two hospital/university-based centers and one private implant center. RESULTS: In most cases, the choice of treatment was motivated by expectations of improved chewing/function (46.0%), appearance (19.5%), or both (18.6%). Improved chewing/function and improved appearance were rated "very important" by 96.5% and 86.1% of patients, respectively. Surprisingly, 57.4% reported that the cost of treatment did not play a role in their decision. Only 6.0% claimed to have much prior knowledge about the treatment and 33.6% had a realistic perception about the length of anticipated service. Patients first received implant-related information primarily (62.9%) from dentists, and 75.2% thought their dentist gave the most useful information. Significant positive associations were found between knowledge about the treatment, the need for periodic professional oral health maintenance, and expected treatment time. CONCLUSION: Patients seek implant therapy primarily to improve chewing function and esthetics, whereas cost seems to be less important. Prior to treatment, many patients lack precise information on the importance of necessary implant-related hygiene measures and implant longevity. The general dentist is the primary source of information.

Patients' experiences of dental implant treatment: A literature review of key qualitative studies.

OBJECTIVES: To identify and summarise the findings of previous qualitative studies relating to patients' experience of dental implant treatment (DIT) at various stages of their implant treatment, by means of textual narrative synthesis. DATA/SOURCES: Original articles reporting patients' experience with dental implant were included. A two-stage search of the literature, electronic and hand search identified relevant qualitative studies up to July 2014. An extensive electronic search was conducted of databases including PubMed, Embase, Scopus, Web of Knowledge, Cochrane Database and Google Scholar. STUDY SELECTION: Included primary studies (n=10) used qualitative research methods and qualitative analysis to investigate patients' experiences with dental implants treatment. CONCLUSIONS: While the growing interest in implant treatment for the replacement of missing dentition is evident, it is essential to investigate patients' perceptions of different aspects of implant treatment. This textual narrative synthesis conducted to review qualitative studies which provided insight into patients' experience of two types of implant prostheses namely ISOD (implant-supported overdenture) and FISP (fixed implant supported prostheses). Primary reviewed studies tended to include samples of older patients with more extensive tooth loss, and to focus on experiences prior to and post-treatment rather than on the treatment period itself. Findings across reviewed studies (n=10) suggested that patients with FISP thought of implant treatment as a process of 'normalisation'(1) and believed that such implant restorations could be similar to natural teeth, whereas patients with ISOD focused more on the functional and social advantages of their implant treatment. CLINICAL SIGNIFICANCE: The growing interest in qualitative research is evident in several branches of clinical dentistry and dental implantology is not an exception. Qualitative studies concerning the patients account of their experience of dental implants is however limited. The aim of this review is to firstly identify recent work within this field and to subsequently categorise it more consistently by means of textural narrative synthesis, thus highlighting similarities and differences and enabling identification of gaps in research knowledge thereby setting the direction of further research.

Intravenous sedation as an adjunct to advanced comprehensive dental implantology: the patient's perspective and operator satisfaction.

OBJECTIVES: The aim of this three-year study was to evaluate whether elective comprehensive dental implant procedures involving guided bone and soft tissue regeneration carried out under intravenous sedation (midazolam) would be influenced by patient self-reported pre-operative anxiety levels; age and gender; effect the level of sedation with respect to the amount of sedative administered and the time taken in the procedures; effect patient intra-operative cooperation, and post-operative levels of patient satisfaction; influence further acceptance of dental implant surgical procedures; effect intra-operative surgeon satisfaction and consequently his/her post-operative sense of achievement.Design Single centre general dental practice, open study as a clinical audit. METHOD: One hundred and seventy-three consecutive patients undergoing prolonged surgical procedures involving dental implantology with the adjunctive facility of intravenous sedation were monitored with respect to self-reported levels of anxiety. Vital signs of heart rate, mean systolic and diastolic blood pressure and arterial oxygen saturation were recorded and monitored pre-intra- and post-surgery. A post-operative questionnaire was completed as to the perceptions of the level of sedation. RESULTS: A distinct relationship between self-reported pre-operative anxiety levels, age and gender were recorded - the younger the age, the higher the anxiety, with females dominating. Females required more midazolam than males. However, the analysis of the data as a whole, incorporating both genders, revealed a non-significant correlation result. The correlation between the midazolam dosage and the Corah anxiety score produced a p value result of: r (161) = 0.008, p <0.01. Forty-four percent of the patients described themselves as having 'high anxiety and fear of the dentist', however, 99.4% of the patients answered 'yes' to having sedation again in the future. For the purpose of this study, detailed consideration was given to the gender specific results in order to reveal a wider understanding of who poses as a 'cooperative patient'. CONCLUSIONS: The results should prompt a rethink as to who a cooperative patient is, and whether the self-assessed level of anxiety will influence further acceptance of dental implant surgical procedures under intravenous sedation.

Controlled longitudinal study on the psychological effects of osseointegrated dental implants.

Forty-seven patients participated in a longitudinal study on the psychological effects of the Brånemark implant technique. They were asked to complete questionnaires measuring their psychological well-being and symptom level on two occasions. The first occasion was shortly after the initial prosthetic assessment. Although 29 patients were subsequently accepted for implant treatment, 18 were found to be unsuitable at the later surgical assessment. Both groups of patients were again given the questionnaires approximately 2 years later. The implants were associated with a clinically significant improvement on measures of symptoms and psychological distress, but there was no change in self-esteem. By contrast, the only change in the untreated comparison group was that their level of distress had risen.