Patient expectations of implant therapy are high

Key Points

In brief

• Patients requesting dental implants report significant functional limitations with conventional complete dentures.

• Expectations of implant therapy are high — this could influence satisfaction with outcome and should be carefully assessed.

• Self-completed questionnaires may complement clinical assessment when planning implant therapy.

Abstract

Statement of problem The loss of the natural dentition leads to severe functional impairment in many edentulous adults. A prosthesis retained and supported by osseointegrated dental implants may provide a satisfactory solution for people who have lost all their natural teeth. However, little information is available as to what patients requesting implants expect of implant-retained prostheses.

Aim The aim of this study was to assess the expectations of a group of edentulous patients requesting implant therapy.

Method The study included two groups: (1) a group of edentulous adults who requested implant therapy ('implant group'); and (2) an edentulous control group, of similar age and gender distribution as the implant group, receiving conventional complete dentures. Following a clinical and radiographic examination of the patients, data were collected using validated questionnaires. Both groups made a subjective assessment of current dentures. The implant group also completed a questionnaire which assessed expectations of implant-retained prostheses.

Results Baseline satisfaction with current dentures was low in both groups, with the implant group being significantly less satisfied with comfort and stability of their mandibular dentures. Perceived ability of the implant group to chew hard foods was less than the control group. The implant group's expectations of an implant-retained prosthesis were significantly greater than for a conventional denture.

Conclusion Careful assessment of patient expectation of implant therapy is essential to determine appropriate treatment need, and to highlight unrealistic expectations.

Main

Patient expectations of oral implant-retained prostheses in a UK dental hospital Allen P F, McMillan A S and Walshaw D Br Dent J 1999; 186: 80–84

Comment

This study is of interest to all practitioners, whether private or hospital-based, working with implants. It looks at a most difficult area of implant provision, which is the expectations of patients. Demand for implant therapy is likely to increase as the public become more aware of this treatment option although, as the authors point out in this study, information regarding patient's expectation of implant therapy is sparse.

The authors looked at two groups of patients, those requesting implants to retain a complete prosthesis and a control group of patients requesting replacement dentures by conventional means. The patients were given a questionnaire which covered an assessment of their present dentures and their expectations of an implant-retained denture. The control group were asked about their expectations of the conventional treatment they were about to receive. It was found that implant patients are more dissatisfied with their existing dentures. In particular, the implant group found eating particular foods such as apple, bacon and nuts more difficult. The implant group had high expectations of their forthcoming treatment with regard to retention, stability, comfort, speech and appearance.

There is no doubt that implant patients expect a major improvement in oral function following implant therapy. They perceive that they will be either totally or very satisfied with their implant-retained prosthesis when compared with natural teeth. The authors point out that such expectations may be unrealistic and discuss the consequences of this clinically. If expectations are unrealistic then implant patients may become disappointed with the outcome with the real possibility of dissatisfaction with the treatment. Patients should be informed of the nature of the procedure, the aftercare required and the possibility of fixture failures. There are different methods of modifying patients expectations prior to treatment. The use of a questionnaire similar to the one in the study will help to screen out patients with unrealistic expectations and data derived will influence the type of treatment that should be undertaken.

The authors should be congratulated on their study which will assist clinicians in their implant assessment and it is a useful reminder that the provision of implants is a challenging treatment option. This study captures the nature of functional complaints but the authors are well aware of the psychological and social problems that are also present in denture wearers. The authors will be tackling this in a follow-up study and contributing more essential knowledge to the literature.