Knowledge and Patient Expectations on Dental Implants

Introduction

The use of Implant-supported were viable and the osseointegration reality was a significant positive impact magnitude of psychosocial aspect of the patient, as demonstrated by a study by Adell, et al. [1]. Low self-esteem, social interaction difficulties, decreased quality of life, among other issues, are problems that can be related with tooth loss, as well as losses in the masticatory function and consequently the stomatognathic system of the patient [2].

Despite that, still exists a large number of people who don’t have enough knowledge about the possibilities of replacement of the lost tooth. Such information would be valuable in making decisions about the choice of a removable prosthesis or implant-supported [3]. Like most of the important decisions, the choice of way of treatment increases expectations that generally aren’t linear with reality and can’t be mitigated by any known treatment. These high expectations are direct connected to poor quality of information obtained from sources without scientific relevance. Most part of patients hope the dental implants last at least twenty years or for hole life, and some still expect a good implant has the appearance of a natural tooth, and apply the same chewing [4, 5, 6].

In a study by Pommer, et al. [7] which they used a questionnaire to assess the knowledge and expectations of patients regarding dental implants in Austria. 1000 respondents, 79% cited implants as first choice when asked about the replacement of missing teeth. This study pointed a significant increase level of knowledge in the population regarding the research conducted by Tepper et al. [8] and also demonstrated that most of the knowledge obtained is provided by the dental surgeon. However, it is necessary the improvement of communication strategies between dentist- patient so that the information that the professional pass to the patient become more understandable.

The correct professional approach, good understanding of the patient and the expectations created by both before procedures are extremely important conditions to conquer the patient’s awareness and thus be able to overcome psychological and social problems that can impacts negatively the terapêutic success [9]. Many patients feel well informed about dental implants, but few feel comfortable about this kind of treatment. The dental surgeon is considered most reliable source [9, 10, 11].

It is noticeable that dental implants are increasingly accepted by society, although there is little dissemination of specialized information regarding treatment. The high figure for this treatment is an important factor that sometimes makes the patient decline in such a therapeutic modality, as they aren’t oriented reliably relative to the cost of the material used and all professional fees which will be dedicated to carrying out the necessary procedures. However, when patients are informed about these process, they understand that the cost-benefit of such therapeutic modality is excellent and feel able to choose it [12, 13, 14, 15, 16, 17]. Therefore, knowledge of perspective that led patients to choose this kind of treatment is essential for the dental surgeon enhance the ability to assist the patient in adapting to a new situation and the correct treatment planning, helping to improve bond of trust with the patient and the treatment success.

Methods

This was an observational cross-sectional study. For this process, was selected 70 patients who underwent rehabilitation treatment through dental implants in a specialization course in implantology in the city of Juiz de Fora/MG. First of all it was filled out a health record containing identification data and patient age. Then a modified questionnaire was filled proposed by Pommer et al. [7, 11], containing data involving socioeconomic status and monthly income, as well as rehabilitation-related data with dental implants such as self-awareness, goals and expectations.

The inclusion criteria were selected patients who are in process of treatment for rehabilitation with implants and dentures on implants in the arch top and/or bottom, unitary or multiple. Patients who didn’t consent to participate in the study were excluded by not signing the free and informed consent. This study was approved by the Research Ethics Committee of the Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA/JF - report number 1.867.336).

Results

Initially were interviewed 70 patients, 58 were selected as met the inclusion and exclusion criteria. A total of 12 were excluded as they didn’t fill the data correctly and/or didn’t agree with the Informed Consent Form. 39 (67.24%) were female and 19 (32.75%) were male (Chart 1). The mean age was 52.1 years, ranging from 23 to 79 years, and most patients (38 / 65.51%) were in the age group 50-69 years (Chart 2).

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Chart 1: Division of patients by gender.

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Chart 2: Division of patients by age.

Discussion

Nowadays it’s estimated that about one million dental implants are performed worldwide, making Implantology an important rehabilitation treatment in dentistry [8]. There are several possibilities to obtain information on dental implants. The rise of digital media worldwide has their broader dissemination, performing an important role in raising awareness of the general population and demonstrating the importance of replacing the lost tooth. Especially good communication between the dentist and the patient is very important not only for quality information, but also to the success of treatment, and the professional analyze the motivations and expectations of those who seek this treatment, thus increasing the possibility of patient satisfaction [18, 19, 20].

In this study the mean age of the patients interviewed was 52 years, the majority of females (67.24%). Among the respondents, 53 (91%) also reported that fixed prostheses are most advantageous for the replacement tooth compared with removable, according to a survey by Tomruk O, et al. [3]. However they indicated that the major disadvantages of implant-supported prosthesis are high aggregate cost to the treatment and also the need for surgery, increasing numbers of 29 (50%) and 16 (28%) of the analyzed questionnaires. These results differ from those reported in other research20, where intercurrences were cited but the overall experience was positive. In a survey conducted by Pommer, et al. [7], Austria, in this study, 22 (38%) of the patients felt well informed therapy implants. In the research conducted by Simensen et al. [21] reported that only 6.0% of respondents said they had much prior knowledge of the treatment and 64.1% thought they had little knowledge of implant treatment. As applied in the evaluation by Yao et al. [10] the number of subjects who reported to be well informed reached 17.7% on this treatment modality.

The results of this research demonstrate the need for increased communication between the dentist and patient since about nine (16%) of the respondents reported not know where the implants are anchored in the oral cavity, a result similar to that found in research conducted by Tepper, et al. [8], where 29% reported not knowing where the implants are anchored. When asked where obtains information about implants, 24 (48%) of patients reported inquire directly with the dentist, followed by information through friends and acquaintances. In addition, 48 (89%) of respondents said they would like to have the dentist as the main source, corroborating the results found in other studies, where 62% said they seek information to dentists and 84% would like information with a dentist [7, 21].

In studies by Pommer, et al. [11, 17] 60% couldn’t report whether the last dentist with whom they performed any treatment performed implants, demonstrating an improvement when compared to a survey by Tepper, et al. [8], where it was found that 70% didn’t know how to answer. Despite the progress in obtaining this information, it is clear a failed professional-patient communication. Our study has also applied the same question, where it was found a quantity of 10% of respondents held no knowledge of this data. In the present research, 59% of the interviewees reported that their surgeons are updated, corroborating previous research [8, 11, 17].

In this study, 45 (78%) of respondents said they should replace lost teeth. Regarding the number of teeth lost by respondents, 22 (38%) reported having lost up to three teeth, and research conducted in other countries have found less impressive results, 26% 17 and 27% 8, compared to the same degree of loss. Among the means for substitution and

presented to the participants, the large majority indicated that opt to use implants and more than half of respondents have or know someone who has implants.

In this study, 63% of respondents said they received between 880 and 1760 reais. In another research performed5 this percentage remained similar, where 61% said receiving between 685 and 1148 reais, taking into account the conversion of the local currency (Jordanian dinar) for the Brazilian currency. Research by Pommer, et al. [7] depicts another reality, where participants have minimum income up to 900 euros (US $ 3,274).

Of the 58 patients interviewed, 33 (57%) had already installed prosthetic implants and responded to about masticatory function and aesthetics. 30 (94%) proved to be satisfied with the functionality obtained and 29 (91%) say they are satisfied or very satisfied with the result after the implant aesthetic installation. When asked how satisfied they were with the current replacement teeth, we come up with a result of 80% approval, corroborating with results found in other similar studies [17, 22, 23].

Conclusion

a) With the results obtained in this study we suggest that: b) Even with the rising of digital media, patients would like to get further information and other knowledge of the rehabilitation with dental implants directly with the dentist; c) The expectation of patients in the choice of implant treatment is the recovery of masticatory function and esthetics compared to other therapeutic possibilities. In the present study, patients with implants showed been rehabilitated be satisfied with the masticatory function and the aesthetic obtained;

The information to patients on dental implants can help in eliminating any negative image of the procedure which may have been caused due to lack of adequate information.