Immediate loading vs. early/conventional loading of immediately placed implants in partially edentulous patients from the patients' perspective: A systematic review.

OBJECTIVES: This systematic review aimed at answering the following PICO question: In patients receiving immediate (Type 1) implant placement, how does immediate compare to early or conventional loading in terms of Patient-Reported Outcome Measures (PROMs)? MATERIAL AND METHODS: Following search strategy development, the OVID, PubMed, EMBASE, and Cochrane Database of Systematic Reviews databases were search for the relevant literature. All levels of evidence including randomized controlled trials, prospective and retrospective cohort studies, and case series of at least five patients were considered for possible inclusion. An additional manual search was performed by screening the reference lists of relevant studies and systematic reviews published up to May 2017. The intervention considered was the placement of immediate implant. Study selection and data extraction were performed independently by two reviewers. RESULTS: The search yielded a list of 1,102 references, of which nine were included in this systematic review. The limited number of studies included and the heterogeneity of the data identified prevented the performance of a meta-analysis. Three studies, one of which was a randomized controlled trial, allowed the extraction of comparative data specific to the aim of the present systematic review. The remaining studies allowed only data extraction for one single treatment modality and were viewed as single cohort studies. Overall, irrespective of the PROMs chosen, patients' satisfaction was overall high with little difference between the two loading protocols. Moreover, studies indicated a positive impact on oral health-related quality of life following immediate implant placement and loading. CONCLUSIONS: Within the limitations of the present systematic review, immediate implant placement and loading in single tooth edentulous space seems to be a well-accepted treatment modality from the patients' perspective and is worthy of consideration in clinical practice. However, the paucity of comparative data limits any definitive conclusions as to which loading protocol; immediate or early/conventional, should be given preference based on PROMs.

Periodontal prosthesis in contemporary dentistry.

In the last 5 decades, the developments of osseointegrated titanium implants (since 1965) have led to the success of contemporary dentistry. Endosseous implant-supported restorations delivered in accordance with the traditional Branemark protocol have proven to be highly predictable. Today, implants are becoming increasingly common in dental care and provide more therapeutic options, but treatment planning and the sequencing of therapy are critical in implant-assisted and implant-supported cases. Implant prostheses give patients and dentists more options in treatment planning, but also present challenging decisions regarding implant surgery. In essence, the emerging thought is that teeth are expendable, as we now have implants to solve these problems. The fact that peri-implantitis is no simple problem to treat does not seem to affect many who hold that thought. In this article, the authors explain how to properly apply the periodontal prosthesis philosophy, concepts, principles, and techniques in contemporary dentistry. (This article is an update from the article was published in 2005) [1].

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.

Patient-Centered Perspectives and Understanding of Peri-Implantitis.

BACKGROUND: Patients undergoing dental treatment have an uncertain understanding about dental implant therapy and its complications. Therefore, the aims of this study assess the following: 1) level of knowledge, awareness, and attitudes about peri-implantitis; 2) information provided by dentists/specialists who perform the treatment; and 3) perceptions, level of satisfaction, and impact on patient quality of life (QoL). METHODS: Patients with implant restorative therapy currently undergoing peri-implant maintenance therapy were recruited. Participants completed an anonymous questionnaire that included general aspects of prognosis, including the following: 1) peri-implantitis; 2) etiology; 3) awareness; 4) attitudes; 5) treatment; 6) prevention; 7) risk factors; 8) quality of information; 9) level of patient satisfaction; and 10) QoL. Associations among questionnaire data were identified using univariate and multivariate analyses. RESULTS: Overall, 411 implants were included from 135 patients with implants. Frequency of peri-implantitis in the survey was 17.8% at the participant level, with 70% of them reporting high level of post-surgical satisfaction. Worry and concern were frequent findings among patients with peri-implantitis (64%), and 32% reported that living with the disease was terrible. The vast majority of patients (74.1%) did not have knowledge about peri-implant pathology. Patients with peri-implantitis showed statistically significantly better understanding of implant therapy (P <0.001) and also higher average concern (P = 0.004). CONCLUSIONS: Patients generally have a poor understanding and perception of peri-implantitis and its impact. QoL was impaired by the presence of peri-implantitis with high level of concern and low level of therapeutic satisfaction. Therefore, it is important to develop standardized information brochures to educate patients on risk factors and indicators of the disease to assist in the prevention of peri-implantitis.

Patient-based outcomes following surgical implant placements.

OBJECTIVES: To assess the postoperative oral health-related quality of life (OHRQoL), pain and swelling after surgical implant placement and to investigate their association with socio-demographic and clinical variables. MATERIALS AND METHODS: A total of 85 partial edentulous patients requiring implant-supported fixed prostheses were enrolled. Standard surgical practice for implant placement was employed. Interviews were conducted to assess the OHRQoL based on the oral impact on daily performances (OIDP) index preoperatively as well as 2 weeks and 1 month postoperatively in addition to the degree of pain and swelling at 2 weeks postoperatively. The socio-demographic and clinical variables of interest were also assessed. RESULTS: Patient's OHRQoL was reduced at 2 weeks followed by a return to baseline levels 1 month postoperatively. The median OIDP scores were 5.0, 12.0 and 3.5 preoperatively, 2 weeks and 1 month postoperatively, respectively. Eating and teeth cleaning were affected after surgery. Overall, 50.6% of the patients perceived no to mild pain, whereas 36.5%, 49.4% and 14.1% reported no, localized or extensive facial swelling, respectively. No association was found between pain and any variable, but anterior implantation and bone augmentation were more commonly associated with facial swelling. Oral health-related quality of life worsened in patients with more pain or facial swelling as well as in cases involving multiple implant placement or bone augmentation procedures. CONCLUSIONS: Oral health-related quality of life deteriorated shortly after surgery based on eating and teeth cleaning difficulties. A high degree of pain, extensive swelling, multiple implant placement and bone augmentation procedures were all associated with oral impacts.

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.

Systemic Trans- and Postoperative Evaluations of Patients Undergoing Dental Implant Surgery.

OBJECTIVE: The aims of this study were to examine the trans- and postoperative systemic characteristics of patients undergoing dental implant surgery and to investigate the relationship between pre- and post- surgery anxiety levels. MATERIAL AND METHODS: Thirty-nine patients were analyzed in 3 call centers to determine anxiety levels, pain levels, and preoperative and postoperative histories using the State-Trait (STAI) questionnaire. RESULTS: A total of 93 dental implants were installed, with a success rate of 100%. The most frequently reported systemic disease was hypertension. There was a significantly higher rate of effective clamping (torque) to the mandibular bone than to the maxillary bone. The association between postoperative surgical complications and longer operative time was not significant, but there was a significant correlation between the alteration of mouth opening and daily routine activities and a significant decrease in anxiety levels between the day of surgery and the postoperative time point (p =0.006). CONCLUSION: A longer surgical time was associated with surgery-related complications and with a higher anxiety index on the preoperative evaluation.

Systemic Trans- and Postoperative Evaluations of Patients Undergoing Dental Implant Surgery

OBJECTIVE: The aims of this study were to examine the trans- and postoperative systemic characteristics of patients undergoing dental implant surgery and to investigate the relationship between pre- and post- surgery anxiety levels. MATERIAL AND METHODS: Thirty-nine patients were analyzed in 3 call centers to determine anxiety levels, pain levels, and preoperative and postoperative histories using the State-Trait (STAI) questionnaire. RESULTS: A total of 93 dental implants were installed, with a success rate of 100%. The most frequently reported systemic disease was hypertension. There was a significantly higher rate of effective clamping (torque) to the mandibular bone than to the maxillary bone. The association between postoperative surgical complications and longer operative time was not significant, but there was a significant correlation between the alteration of mouth opening and daily routine activities and a significant decrease in anxiety levels between the day of surgery and the postoperative time point (p =0.006). CONCLUSION: A longer surgical time was associated with surgery-related complications and with a higher anxiety index on the preoperative evaluation.

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 perceived burden of implant placement compared to surgical tooth removal and apicectomy.

OBJECTIVE: To assess how patients actually perceive implant placement, to evaluate whether patients' perceived burdens are related to specific stages during implant placement, and to compare patients' perceptions during implant placement with other surgical procedures. METHODS: A sample of 287 patients was consecutively recruited. Only patients with implantations (n=45), surgical tooth removal (n=147), or apicectomies (n=95) were included. Patients' perceptions during oral surgery and implantation were assessed using the Burdens in Oral Surgery Questionnaire (BiOS-Q). Effects of treatment on BiOS-Q total and domain scores were assessed using multivariate linear regression analyses, and effect sizes (Cohen's d) were computed. RESULTS: Overall, patients' perceived burdens during oral surgery were low indicated by a mean BiOS-Q total score of 28.5 points, with lowest scores for Side effects (19.4) and highest scores for Anesthesia (34.1). Among treatment groups, implantation was perceived least unpleasant. This was related to lower burdens during Bone and soft tissue manipulation during implantation than during surgical tooth removal (difference: 14.8 points; d=0.8) or apicectomy (difference: 13.1 points; d=0.7). CONCLUSIONS: Implantation has a low overall perceived burden and is significantly less burdensome during bone and soft tissue manipulation than surgical tooth removal or apicectomy. CLINICAL SIGNIFICANCE: Patients can be informed that implant placement is less unpleasing than other commonly performed oral surgery procedures.

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.

Degree of patient pain, complications, and satisfaction after root canal treatment or a single implant: a preliminary prospective investigation.

INTRODUCTION: Dentists often face the choice between tooth retention with root canal treatment and tooth replacement with implant treatment. To date, there has not been a prospective clinical trial directly comparing nonsurgical root canal treatment and single delayed implant therapy with regard to the degree of preoperative and postoperative pain, complications, and patient satisfaction. METHODS: Twenty-four patients had initial nonsurgical root canal treatment, and another 24 had single implant treatment in healed sites. Questionnaires were given at pretreatment, 7 days, 3 months, 6 months, and 12 months. RESULTS: All patients completed the 12-month follow-up period. No significant difference in pain, complications, or overall satisfaction was noted between the 2 groups at any of the time points (P > .05). However, there were differences within each group between the time points. There was more pain at pretreatment for root canal treatment and 7-day post-treatment point for single implant treatment than any other time point. For complications, more were reported at the 7-day post-treatment point than any other time point for both groups. With overall satisfaction, there was no difference from any time point for either group. CONCLUSIONS: The results of this study suggest that patients perceive both treatments with high degrees of satisfaction with minimal pain and discomfort. Differences were found at different time points of treatment and were related to the nature of the treatment itself. This information is useful to help patients with treatment decisions.

Patients' experiences of dental implant placement for treatment of partial edentulism in a student clinic setting.

The aim of this study was to evaluate patients' experiences of oral implant surgery when performed in a student clinic setting and the potential impact on patients'daily life. Patient selection was carried out during a round, to which undergraduate students in semester 9 and 10 could bring patients that they considered eligible for one or two implants. Partial edentulous patients that fulfilled the inclusion criteria for implant installation at the student's clinic were consequently enrolled to implant surgery with either Astra Tech or 3i implants. The same surgeon accomplished all implant installations and the students were involved in the treatment, initially by assisting during the surgery and subsequently by performing the prosthetic restoration. After the surgery, a study-specific questionnaire was sent to patients for evaluation of discomfort, pain during the surgical procedure and postoperative symptoms. Thirty-six patients were included in the study, 30 patients answered the questionnaire (response rate 83%). When retrospectively assessed, more than half of the patients (60%) perceived discomfort in the course of the implant surgery and 29% reported pain during the surgical procedure. Impact on daily living and postoperative symptoms were rarely reported (most common were pain, swelling and difficulties with chewing) and had a short duration when they occurred. Based on the results of this study conducted at a student's clinic, the impact of implant surgery on daily living appears to be small. However, it is noteworthy that the perception of discomfort and pain during the surgical procedure was frequently reported. Continued research is recommended to expose the patient's experiences of implant surgery in an educational context as well as in general dental practice.

Patients' preferences towards minimally invasive treatment alternatives for implant rehabilitation of edentulous jaws.

PURPOSE: To evaluate patient satisfaction, oral health-related quality of life, and patients' preferences towards minimally invasive treatment options for graftless rehabilitation of complete edentulism by means of dental implants. MATERIAL AND METHODS: A MEDLINE search of literature in the English language up to the year 2013 was performed to summarise current evidence from the patient's perspective. The final selection included 37 studies reporting on minimally invasive implant treatment of 648 edentulous maxillae and 791 edentulous mandibles in 1328 patients, via a total of 5766 implants. RESULTS: Patient satisfaction averaged 91% with flapless implant placement (range: 77 to 100%), 89% with short implants, 87% with narrow-diameter implants (range: 80 to 93%), 90% with a reduced number of implants (range: 77 to 100%), 94% with tilted implant placement (range: 58 to 100%), and 83% with zygomatic fixtures (range: 50 to 97%). Indirect comparison yielded patient preference towards tilted implant placement compared to a reduced number of implants (P = 0.036), as well as to zygomatic implants (P = 0.001). CONCLUSIONS: While little evidence on patients' preferences towards minimally invasive treatment alternatives vs. bone augmentation surgery could be identified from within-study comparison, it may be concluded that patient satisfaction with graftless solutions for implant rehabilitation of completely edentulous jaws is generally high. Comparative effectiveness research is needed to substantiate their positive appeal to potential implant patients and possible reduction of the indication span for invasive bone graft surgery.

Patient-reported outcomes of immediate versus conventional loading with fixed full-arch prostheses in the maxilla: a nonrandomized controlled prospective study.

PURPOSE: To compare patient satisfaction and postoperative pain and swelling for immediate versus conventional loading in partially edentulous patients requiring extraction of the remaining maxillary dentition and rehabilitation with fixed full-arch prostheses. MATERIALS AND METHODS: This prospective, controlled, nonrandomized study with 12-month follow-up included 30 consecutive patients scheduled for fixed full-arch implant-supported maxillary rehabilitation. Fifteen patients were treated with conventional loading (control group) and the next 15 with immediate loading (test group). Ten-centimeter visual analog scales were used as assessment tools. Patient overall satisfaction and specific satisfaction with esthetics, chewing, speaking, comfort, self-esteem, ease of cleaning, and treatment duration were assessed preoperatively and at 3 and 12 months postoperatively. Postoperative pain and swelling levels were recorded daily during the first week. Statistical analysis was performed using Mann-Whitney and Wilcoxon rank sum tests, α = .05. RESULTS: One test group patient was excluded, so the final sample included 29 patients. Between baseline and 3 months, in the test group general satisfaction and all specific satisfactions increased significantly with the exception of speech; in the control group overall satisfaction and self-esteem did not change, satisfaction with esthetics increased significantly, and satisfaction with speech, chewing, and comfort decreased significantly. After 12 months, satisfaction was significantly higher in the test group with the exception of ease of cleaning. Between 3 and 12 months, satisfaction improved in both groups but to a greater degree in the control group. After 12 months, there were no differences in satisfaction. No differences were found in either mean postoperative pain/swelling or maximum pain/swelling at the studied time points. CONCLUSIONS: Patient satisfaction for immediate loading was significantly higher than for conventional loading during the osseointegration period. After 12 months, when final prosthetic rehabilitations had been in function for some time, differences had disappeared. No differences were found between loading protocols in postoperative pain or swelling.

An RCT comparing patient-centred outcome variables of guided surgery (bone or mucosa supported) with conventional implant placement.

AIM: To assess in a randomized study the patient-centred outcome of two guided surgery systems (mucosa or bone supported) compared to conventional implant placement, in fully edentulous patients. MATERIAL AND METHODS: Fifty-nine patients (72 jaws) with edentulous maxillas and/ or mandibles, were consecutively recruited and randomly assigned to one of the treatment groups. Outcome measures were the Dutch version of the McGill Pain Questionnaire (MPQ-DLV), the Health-related quality of life instrument (HRQOL), visual analogue scales (VAS), the duration of the procedure, and the analgesic doses taken each day. RESULTS: Three hundred and fourteen implants were placed successfully. No statistical differences could be shown between treatment groups on pain response (MPQ-DLV), treatment perception (VAS) or number or kind of pain killers. For the HRQOLI-instrument, a significant difference was found between the Materialise Mucosa and Materialise Bone group at day 1 (p = 0.02) and day 2 (p = 0.01). For the duration of the surgery, a statistical difference (p = 0.005) was found between the Materialise mucosa and the Mental group, in favour of the first. CONCLUSION: In this study little difference could be found in the patient outcome variables of the different treatment groups. However there was a tendency for patients treated with conventional flapped implant placement to experience the pain for a longer period of time.

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.

Dental phobia is no contraindication for oral implant therapy.

OBJECTIVES: Dental phobia is a psychological disease and a possible contraindication for implant therapy. The study aimed to show that implant therapy in dental-phobic patients (DP, test group) after adequate psychological and dental pretreatment (PDPT) is successfully possible and results in a similar implant prognosis as in nonfearful patients (NF, control group). METHOD AND MATERIALS: 15 DP with PDPT and 15 NF were treated with dental implants and were re-evaluated 2 to 4 years after denture-mounting regarding: alteration of dental anxiety (Hierarchical Anxiety Questionnaire [HAQ], Visual Analog Scale [VAS]), patient satisfaction and compliance, implant success, and peri-implant health. Statistical tests of non-inferiority DP versus NF were performed with Hodges-Lehmann estimators and respective one-sided 97.5% confidence intervals of Moses, and pairwise testings with Mann-Whitney test. RESULTS: The DP test group rated its anxiety significantly lower at follow- up than at baseline (PHAQ < .001). However, at follow-up, anxiety was still higher in DP than in NF (PHAQ = .046; PVAS < .001). Implant success at follow-up was 100%. Oral health was equally good in DP and NF patients. At follow-up, all patients were satisfied with implant therapy, but compliance was better for NF (100%) than for DP (73% dental checkup; 67% dental hygienist). CONCLUSION: Implant therapy can be successfully performed in DP patients with PDPT as phobia is not negatively influenced by the invasive implant therapy. However, motivation for professional maintenance programs remains challenging.

Assessment of pain and anxiety following surgical placement of dental implants.

PURPOSE: To investigate the change in 89 patients' pain and anxiety following implant surgery and to evaluate the correlation among anxiety, pain, and influencing factors. MATERIALS AND METHODS: Eighty-nine patients were included in this study. Subjective factors influencing pain perception included anxiety from the overall dental treatment (scored on the Dental Anxiety Scale [DAS]) and anxiety relative to the time from implant surgery. Objective factors were sex, age, and implant location and number. Patients completed questionnaires just before surgery (T0), immediately after surgery (T1), 1 day after surgery (T2), and 1 week after surgery (T3). RESULTS: The average pain perception was highest at T2, followed by T1 and T3. Pain perception at T1 was significantly higher in women and for a larger number of implant placements. Pain perception at T2 was significantly higher in women and when DAS and anxiety scores were high. The pain score at T3 was significantly higher in women and when anxiety scores were high. The results from multiple linear regression analysis showed that pain perception was significantly higher at T1 in women and for a larger number of implant placements, and at T3 when the dental anxiety score was high. CONCLUSION: Within the limitations of this study, a patient's anxiety represented by dental anxiety score and state of anxiety scores affected pain intensity 1 day after implant surgery. Sex and the number of implants affected pain intensity immediately after implant surgery. Patients who have high pain intensity 1 week after implant surgery showed high pain intensity at each time point.

A qualitative study of patients' motivations and expectations for dental implants.

OBJECTIVE: To explore patients' motivations and expectations for dental implants. DESIGN: Single-setting, qualitative interview study. SUBJECTS, SETTING AND METHOD: Semi-structured, telephone interviews were conducted with nine patients who had consulted a restorative dental practitioner with an interest in implantology about the possibility of replacing their missing teeth with dental implants. OUTCOME MEASURE: Interview transcripts were subjected to thematic analysis to identify relevant themes. RESULTS: The main theme to emerge was 'normality'. Participants expected implants to restore their oral-related quality of life to 'normal'. However, individual definitions of normality differed; some were appearance focused, while others were more concerned with functioning. Several participants who had completed implant treatment regarded their new prostheses as 'just like natural teeth'. CONCLUSIONS: Patients' belief that dental implants are just like natural teeth could be cause for concern if it leads them to treat them as such, and thereby not follow the recommended specialist care they require. The findings emphasise the importance of good dental practitioner-patient communication in assessing expectations of treatment and outcomes. Further studies should explore the expectations of patients of different ages and socioeconomic backgrounds and consider ways of eliciting patients' beliefs about implants before treatment takes place.