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.

Impact of mandibular implant prostheses on the oral health-related quality of life in partially and completely edentulous patients.

OBJECTIVE: To assess the oral health-related quality of life (OHRQoL) of patients provided with mandibular implant fixed partial prostheses (IFPP) for rehabilitation of two adjacent missing posterior teeth and complete denture patients provided with mandibular implant-supported overdenture (ISOD). The response to change in OHRQoL with implant prostheses was additionally compared. MATERIAL AND METHODS: In this prospective study, 20 IFPP (mean age 47.0; SD 12.9 years) and 28 ISOD (mean age 61.5; SD 9.1 years) patients received 2 mandibular implants. Metal ceramic nonsplinted fixed prostheses were provided in IFPP group, while in ISOD group, the mandibular overdentures were retained by nonsplinted attachments. Patients rated their oral health-related quality of life using OHIP-14 Malaysian version at baseline (T0), 2-3 months (T1) and 1 year (T2) postimplant treatment. Mean OHIP-14 for total and domain scores between groups and intervals was analysed using repeated-measures ANOVA and t-test. Mann-Whitney and Wilcoxon signed-rank tests were used for the comparison of mean score change and effect size, while the association between pre- and post-treatment scores was determined using multivariate linear regression modelling. RESULTS: The total OHIP and domain scores before implant treatment were significantly higher (lower OHRQoL) in IFPP than in ISOD groups, except for physical pain where this domain showed similar impact in both groups. Postimplant scores between groups at T1 and T2 showed no significant difference. The mean score changes at T0-T1 and T0-T2 for total OHIP-14 and domains were significantly greater in IFPP except in the domains of physical pain and disability which showed no difference. Large effect size (ES) was observed for total OHIP-14 in IFPP while moderate in ISOD. Improved OHRQoL was dependent on the treatment group and pretreatment score. CONCLUSION: Improvement in OHRQoL occurred following both mandibular implant-supported overdentures and implant fixed partial prostheses.

Introducing high-cost health care to patients: dentists' accounts of offering dental implant treatment.

OBJECTIVES: The decision-making process within health care has been widely researched, with shared decision-making, where both patients and clinicians share technical and personal information, often being cited as the ideal model. To date, much of this research has focused on systems where patients receive their care and treatment free at the point of contact (either in government-funded schemes or in insurance-based schemes). Oral health care often involves patients making direct payments for their care and treatment, and less is known about how this payment affects the decision-making process. It is clear that patient characteristics influence decision-making, but previous evidence suggests that clinicians may assume characteristics rather than eliciting them directly. The aim was to explore the influences on how dentists' engaged in the decision-making process surrounding a high-cost item of health care, dental implant treatments (DITs). METHODS: A qualitative study using semi-structured interviews was undertaken using a purposive sample of primary care dentists (n = 25). Thematic analysis was undertaken to reveal emerging key themes. RESULTS: There were differences in how dentists discussed and offered implants. Dentists made decisions about whether to offer implants based on business factors, professional and legal obligations and whether they perceived the patient to be motivated to have treatment and their ability to pay. There was evidence that assessment of these characteristics was often based on assumptions derived from elements such as the appearance of the patient, the state of the patient's mouth and demographic details. The data suggest that there is a conflict between three elements of acting as a healthcare professional: minimizing provision of unneeded treatment, trying to fully involve patients in shared decisions and acting as a business person with the potential for financial gain. CONCLUSIONS: It might be expected that in the context of a high-cost healthcare intervention for which patients pay the bill themselves, that decision-making would be closer to an informed than a paternalistic model. Our research suggests that paternalistic decision-making is still practised and is influenced by assumptions about patient characteristics. Better tools and training may be required to support clinicians in this area of practice.

Patient satisfaction with two designs of implant supported removable overdentures; ball attachment and magnets.

OBJECTIVE: The aim of this study was to compare ball and magnet attachments within implant-supported mandibular overdentures (ISMOD) using patient centred outcome measures. Our a priori hypothesis was that there is no difference in patient satisfaction between the two attachment types. MATERIAL AND METHODS: In this within-subject crossover randomised clinical trial, edentulous patients were recruited to the study and completed a denture satisfaction questionnaire before having two implants placed in the intraforaminal region of the mandible. They were randomly assigned to receive an ISMOD retained by either ball or magnetic attachment. After 3 months satisfaction questionnaires were repeated before attachments were changed to the alternative design. After a further 3 months patients completed final questionnaires. Patients were asked to choose their preferred prostheses and record the most influential factors in their final choice. The outcome variables of patient satisfaction were compared between baseline and the two attachment types using non-parametric two-related sample tests (Wilcoxon's signed rank). RESULTS AND DISCUSSION: Sixteen patients completed the study. Patient satisfaction improved significantly between baseline and the new prosthesis with each attachment type for all domains of satisfaction (P<0.05). Ball attachments provided greater satisfaction in the domains of general satisfaction, stability and ability to chew (P<0.05). Patients' general satisfaction with ball attachment retained overdentures was greater than that for magnetic attachments; however, both designs provide significantly greater satisfaction than conventional dentures. In this study, the majority preferred to retain the ball attachment although one-third of patients actively chose the magnetic attachment.