10.59987/ads/2010.3-4.2-8
Aim. This pilot study evaluated patients’ experience of oral surgical and prosthetic procedures as well as their opinions regarding function, aesthetics, comfort, and satisfaction with treatment outcomes.
Materials and methods. Forty-nine subjects treated with oral implants completed questionnaires comprising 44 questions. Three questionnaires were used related to implant-supported single-tooth, fixed implant-supported prostheses and implant-retained overdentures. The questions related to demographic data (age, sex, employment, marital status and educational level), the source of information, the reason they underwent implant treatment, the discomfort related to all phases of treatment, and their functional and aesthetic satisfaction.
Results. Most of the patients (53.8%) were employed and had received a high school certificate or a university diploma. Patients heard about implants from various sources, including referring dentists (55.8%), relatives and friends (23.1%), and television, radio and the Internet (17.3%). The main reasons for choosing implant treatment were restoring lost teeth (35,5%), following dentist’s advice (33,3%), improving stability of the removable denture (15.4%), eating habits (13.5%) and aesthetics (1.9%). Most patients considered that the procedure took a long time (44.2%) but was not traumatic (62.5%). Pain was almost absent in most cases (64.5%) and swelling, when present, was generally moderate (48.1%) and seldom was marked (17.3%). Patients were very satisfied about the aesthetics (82.7%) and function (94.2%), and considered the implant prosthesis to be part of themselves (84.6%). Most of the patients considered the implant prostheses to be easy to clean (73.1%), and would repeat the treatment if necessary (86.5%) and recommend it to other people (94.2%).
Conclusions. Although the present study is limited by the small sample, the outcomes suggest that oral implant rehabilitation meets patients’ needs and aesthetic demands.
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1971-1441
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M. P. Cristalli
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Annali di stomatologia
aesthetics
Patient satisfaction with oral implant rehabilitation: evaluation of responses to a questionnaire
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Ann Stomatol (Roma)
M. P. Cristalli
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aesthetics
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Patient satisfaction with oral implant rehabilitation: evaluation of responses to a questionnaire
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1
    Patient satisfaction with oral implant rehabilitation:
    evaluation of responses to a questionnaire




                                                                                                     i
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    Susanna Annibali, MD, DDS1                                     (64.5%) and swelling, when present, was generally mod-
    Anna Rita Vestri, MD2                                          erate (48.1%) and seldom was marked (17.3%). Patients
    Annalisa Pilotto, DDS1                                         were very satisfied about the aesthetics (82.7%) and
    Gerardo La Monaca, DDS, PhD1                                   function (94.2%), and considered the implant prosthe-
    Stefano Di Carlo MD, DDS3                                      sis to be part of themselves (84.6%). Most of the patients




                                                                                               zi
    Maria Paola Cristalli, DDS, PhD1                               considered the implant prostheses to be easy to clean
                                                                   (73.1%), and would repeat the treatment if necessary
                                                                   (86.5%) and recommend it to other people (94.2%).
                                                                   Conclusions. Although the present study is limited by




                                                                       na
    “Sapienza” University of Rome, Rome, Italy
    1 Department of Odontostomatological
                                                                   the small sample, the outcomes suggest that oral im-
                                                                   plant rehabilitation meets patients’ needs and aesthetic
    and Maxillofacial Sciences, Oral Surgery Unit                  demands.
    2 Department of Experimental Medicine
    3 Department of Odontostomatological and Maxillofacial
                                                                   Key words: patient opinion, oral implants, patient satis-




                                                                     er
    Sciences, Prosthetic Rehabilitation Unit                       faction, function, aesthetics.


    Corresponding author:
    Dott. Gerardo La Monaca
    Department of Odontostomatological
    and Maxillofacial Sciences
                                                             nt    Introduction

                                                                   Prosthetic rehabilitation of people with missing teeth is one
                                                   iI
    “Sapienza” University of Rome                                  of the most complex topics in dentistry due to its gnatho-
    Via Caserta, 6 - 00161 Rome, Italy                             logical, psychosocial, aesthetic and functional implications.
    Phone: +39-06-49976651                                         The loss of teeth can represent a severe handicap that di-
    E-mail: gerrylamonaca@tiscali.it
                                      on

                                                                   rectly impacts on the quality of life. Teeth serve both as part
                                                                   of the masticatory system and also greatly contribute to
                                                                   phonetics, functions and aesthetics (1).
    Summary                                                        In the past, the psychological reactions of people to tooth
    Patient satisfaction with oral implant rehabilitation: eval-   loss generated little concern, with most of them adapting
                             i


    uation of responses to a questionnaire.                        to replacement prostheses such as crowns, bridges and
                          iz



                                                                   dentures (2). Nowadays attitudes are different; for psy-
    Aim. This pilot study evaluated patients’ experience of        chological and functional reasons, many patients prefer an
    oral surgical and prosthetic procedures as well as their       implant restorative procedure. Implants improve retention
           Ed




    opinions regarding function, aesthetics, comfort, and          and stability of the complete dentures, thereby providing
    satisfaction with treatment outcomes.                          functional, psychological and social advantages, and
    Materials and methods. Forty-nine subjects treated with        partial fixed reconstructions avoid the need to prepare in-
    oral implants completed questionnaires comprising 44           tact adjacent teeth (3,4). Additional positive factors are pre-
    questions. Three questionnaires were used related to im-       venting continuous alveolar bone resorption, preserving
    plant-supported single-tooth, fixed implant-supported          ridge heigh and width, and improving aesthetics, especially
    prostheses and implant-retained overdentures. The              in anterior regions (5,6).
IC




    questions related to demographic data (age, sex, em-           Most of the recent studies have focused on the clinical
    ployment, marital status and educational level), the           aspects of osseointegration (7,9,11) without considering
    source of information, the reason they underwent im-           patients’ attitudes toward implant treatment and their opi-
    plant treatment, the discomfort related to all phases of       nions about aesthetics, function, comfort and satisfaction.
C




    treatment, and their functional and aesthetic satisfaction.
                                                                   The present pilot study evaluated patients’ experiences of
    Results. Most of the patients (53.8%) were employed and
                                                                   surgical and prosthetic procedures as well as their opinions
    had received a high school certificate or a university
                                                                   regarding function, aesthetics, comfort, and satisfaction with
    diploma. Patients heard about implants from various
    sources, including referring dentists (55.8%), relatives       treatment outcomes.
©




    and friends (23.1%), and television, radio and the Inter-
    net (17.3%). The main reasons for choosing implant
    treatment were restoring lost teeth (35,5%), following         Materials and methods
    dentist’s advice (33,3%), improving stability of the re-
    movable denture (15.4%), eating habits (13.5%) and aes-        At the Oral Surgery Unit of the Odontostomatological and
    thetics (1.9%). Most patients considered that the              Maxillofacial Department - “Sapienza” University of Rome
    procedure took a long time (44.2%) but was not trau-           from September 2008 to September 2009, 49 patients (with
    matic (62.5%). Pain was almost absent in most cases            128 implants) were selected for implants procedures; they

    2                                                                                     Annali di Stomatologia 2010; I (3-4): 2-8
    Patient satisfaction with oral implant rehabilitation: evaluation of responses to a questionnaire




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    Figure 1 - Distribution of patients by age.


    underwent first stage surgery to insert one or more im-          assessed chewing function. Questions 39 to 44 of the im-
    plants. After about 5 months they underwent second sta-          plant-supported overdenture questionnaire assessed pro-
    ge of surgery to insert abutments and to take impressions.
    Prosthesis took about one month to be completed. After
    about four mounths prosthetic treatment was completed,
                                                               nt    sthesis stability and phonetics.
                                                                     The relatively small sample made it impossible to valida-
                                                                     te the questionnaires. The standard statistical and data ma-
                                                     iI
    they were asked to fill in a questionnaires on their opinions    nagement package SPSS (version 16.0 for Windows XP)
    about the effectiveness of the implant restorative proce-        was used for descriptive statistical analysis. Mean and stan-
    dure, overall satisfaction and oral function outcome.            dard deviation (SD) values were calculated. The outcomes
                                          on

    Three questionnaires were used related to implant-sup-           are represented here on pie charts and histograms pro-
    ported single-tooth implants, fixed implant-supported            duced with Microsoft Excel.
    prostheses and implant-retained overdentures. Three of
    the 49 patients completed two questionnaires (one for each
    type of treatment), giving a total of 52 completed que-          Results
                                i


    stionnaires. The questions were formulated by the authors
                             iz



    based on outcomes of related studies and on topics of re-        The survival rate of 128 implants installed in 49 patients
    levance to clinicians. To assess parameters, questions had       was 97,65%. Only three implants did not osseointegrate,
    multiple choice as mode of answers. The patients filled the      all of which were successfully inserted again. The follow-
            Ed




    questionnaires at the recall examination under supervi-          up period after the prosthetic reconstruction ranged from
    sion of one of the authors not involved in the treatment         6 to 24 months with a mean of 14 months.
    so as to avoid bias and the effects of interpersonal re-         The 52 collected questionnaires were distributed as follows:
    actions.                                                         24 on single-tooth implants, 21 on implant-supported fixed
    Each questionnaire comprised 44 questions, with questions        prostheses and 7 on implant-retained overdenture.
    1 to 38 being the same in each questionnaire, and que-           Percentages of questions from 1 to 7 are based on the
    stions 39 to 44 varying with the specific treatment. The first   number of patients (n.49) and from 8 to 44 on the num-
IC




    five questions related to demographic data: age, sex, em-        ber of questionnaires (n.52).
    ployment, marital status and educational level. In questions     The 49 patients comprised 27 (55.1%) women and 22
    6 and 7, patients explained where they had obtained in-          (44.9%) men who ranged in age from 29 to 72 years, with
    formation about the implant treatment and why they de-           a mean age of 51.16 years (SD=13.6 years). The deca-
C




    cided to undergo it. Questions 8 to 23 asked patients about      de between 61 and 70 years comprised the largest num-
    the discomfort related to implant surgery and abutment sur-      ber of patients (26.9%) (Fig. 1).
    gery or associated with impression-taking and prosthetic         Most of the patients were employed (53.8%) and retired
    procedures, as well as their overall experience of the tre-      (28,8%); 75% of them had received a high school certifi-
©




    atment. Questions 24 to 38 evaluated functional and ae-          cate or a university diploma, 15,4% attended only medium
    sthetic satisfaction, oral hygiene, cost-effectiveness, ac-      school and 7,7% elementary school; patients had heard
    ceptance of implant-supported prostheses, and willingness        about implants from various sources, including referring
    to repeat treatment or to recommend it to other people.          dentists (55.8%), relatives and friends (23.1%), television,
    Questions 39 to 43 were identical for the implant-supported      radio and the Internet (17.3%), newspapers (1.9%), and
    single tooth and for the fixed prosthesis, while question 44     medical doctors (1.9%).
    of the single-tooth-implant questionnaire assessed ae-           Patients who were partially or completely edentulous and
    sthetics in anterior segments and that of the fixed prosthesis   who missed one anterior tooth considered it particularly

    Annali di Stomatologia 2010; I (3-4): 2-8                                                                                   3
    S. Annibali et al.




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    Figure 2 - Did you experience pain and/or swelling after implant insertion procedure?


    necessary to restore lost teeth (34.6%). Other reasons for           cases. Pain was absent in 64.5% of the subjects, and only
    choosing implant treatment were the advice of a dentist
    (32.7%), improving the stability of the denture (15.4%), ea-
    ting habits (13.5%) and aesthetics (1.9%).
    The time to complete the treatment was consider enough
                                                                 nt      5.8% experienced severe pain. Swelling was moderate and
                                                                         marked in 48.1% and 17.3% of the patients, respective-
                                                                         ly, with this often being correlated with the procedure com-
                                                                         plexity (Fig. 2).
                                                      iI
    long and long by 44.2% and 19.2% of our respondents,                 Abutment surgery was assessed positively by 76.9% of the
    respectively. However, almost all (90,3%) of them consi-             subject: swelling and pain, which were often (Fig. 3).
    dered that the procedures were not traumatic.                        The prosthetic procedure was evaluated as not unpleasant
                                        on

    Implant insertion surgery was assessed negatively by only            by 76.9% of the respondents in the present study, while
    3.8% of those who completed questionnaires. This finding             28.8% of them considered impression-taking to be the
    could be attributable to the protocol used, because all the          worst part of the procedure. Most of the patients in the pre-
    patients received diazepam per os before surgery to ob-              sent study (61.5%) considered the time between implant
    tain conscious sedation, with consequent anterior amne-              insertion and prosthesis rehabilitation to be acceptable,
                              i


    sia of unpleasant remembrances.                                      even when a temporary replacement was absent (63.5%).
                           iz



    The post-operative period was free of complications in most          In remaining 36.5% of responders a removable provisio-
           Ed
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©




    Figure 3 - Did you experience pain and/or swelling in post-operative period after abutment insertion procedure?


    4                                                                                            Annali di Stomatologia 2010; I (3-4): 2-8
    Patient satisfaction with oral implant rehabilitation: evaluation of responses to a questionnaire




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    Figure 4 - Are you satisfied of the implant-supported prosthesis functionally?




                                                                             er
    nal was used. The temporary removable replacement was                 tural bite and that the construction was an integral part of
    viewed positively by the fully edentulous subjects and un-            their mouth (Fig. 5).
    pleasant by most of the subjects (63.5%) with implants re-
    storing single crowns and fixed partial prosthesis. The tem-
    porary removable replacement was worn by 55% of sub-
    jects both day and night, and by 35% of them only during
                                                                  nt      All the seven edentulous subjects in our study considered
                                                                          that the implant-supported overdenture provided improved
                                                                          stability and phonetics.
                                                                          Most of our sample (82.8%) was completely satisfied with
                                                       iI
    the day, while other subjects either did not wear it (5%) or          the aesthetic outcome, 15.4% were satisfied and only one
    only wore it when eating (5%). Almost half of the patients            person rated his implant-supported crown (upper lateral
    (47.4%) reported that the temporary rehabilitation fun-               incisor) as not being very aesthetic.
                                         on

    ctioned better after implant surgery. Almost all of the pa-           Most of our respondents got used to the implant-suppor-
    tients in the present study (94.2%) were satisfied with the           ted prostheses either immediately (30.8%) or soon
    chewing function (definitely in 44.2% of cases and adequate           (65.4%) after the placement procedure; most of our patients
    in 50% of cases) (Fig. 4).                                            (82.7%) were highly satisfied of the outcome of implant tre-
    Chewing ability increased in 84.6% of our patients, with              atment, 86.5% were willing to have the same treatment per-
                               i


    82.7% being able to chew every kind of food and 84.6%                 formed again and 94.2% were willing to recommend the
                            iz



    considering that the prosthesis was comparable to their na-           treatment to friends and relatives.
           Ed
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C
©




    Figure 5 - Do you feel the implant-supported prosthesis to be strange or as part of yourself?


    Annali di Stomatologia 2010; I (3-4): 2-8                                                                                       5
    S. Annibali et al.


    Most of our patients (69.2%) considered the cost of implant         considered the prosthetic procedures unpleasant: name-
    therapy to be reasonable.                                           ly, impression-taking, try-in and mounting of the crown.
    Most of our respondents (65.4%) experienced a major                 The temporary removable replacement was viewed posi-
    change in their oral hygiene habits after implant insertion,        tively by the fully edentulous subjects and unpleasant by
    and 73.1% found it easy to clean the implant reconstruc-            most of the subjects (63.5%) with implants restoring sin-




                                                                                                          i
    tions. In spite of this, only one-third of the patients increased   gle crowns and fixed partial prosthesis; infact the tempo-




                                                                                                        al
    their frequency of visiting a dentist for hygiene reasons and       rary removable replacement was worn by 55% of subjects
    follow-up.                                                          both day and night, and by 35% of them only during the
    In the comparison between conventional and implant-sup-             day, while other subjects either did not wear it (5%) or only
    ported prostheses, 42.2% of the subjects found the two pro-         wore it when eating (5%). Almost half of the patients




                                                                                                      on
    cedures to be similar in time and quality, 76.2% did not find       (47.4%) reported that the temporary rehabilitation fun-
    any difference between implants and teeth, and 70% could            ctioned better after implant surgery. These data did not sup-
    chew similarly with implants and teeth. Implants were per-          port the outcome of Schropp et al. (16), who in approxi-
    ceived as a part of oneself, which constituted a very im-           mately 60% of the cases of implant rehabilitation of inci-
                                                                        sors and canines decided—in concert with the patient—




                                                                                                    zi
    portant advantage for the respondents.
                                                                        to make a removable partial denture as a temporary so-
                                                                        lution in the edentulous period. They found that most of their
    Discussion                                                          patients either did not wear their denture or only used it




                                                                            na
                                                                        during the day. None of their patients considered that the
    Our results show that people who undergo implant tera-              denture function was influenced by insertion of the implant,
    py can be male or female, of every age, especially after            and in only a few cases was the function impaired after the
    50. Most of the patients were employed (53.8%) and 75%              abutment operation.




                                                                          er
    of them had received a high school certificate or a uni-            Almost all of the patients in the present study (94.2%)
    versity diploma. In accordance with other studies (9,10,11),        were satisfied with the chewing, chewing ability increa-
    patients had heard about implants from various sources,             sed in 84.6% of our patients, with 82.7% being able to
    especially referring dentists (55.8%) and relatives and             chew every kind of food and 84.6% considering that the
    friends (23.1%); television, radio and the Internet (17.3%),
    newspapers (1.9%) and medical doctors (1.9%) seem less
    important. Our outcomes were comparable with those of
    de Bruyn et al. (12). Those authors used a questionnai-
                                                                  nt    prosthesis was comparable to their natural bite and that
                                                                        the construction was an integral part of their mouth. The-
                                                                        se data are in accordance with Pjetursson et al. (17) fin-
                                                                        ding that more than 90% of patients treated with crowns
                                                       iI
    re to evaluate patients’ opinions on oral rehabilitation using      or implant-supported fixed partial denture were com-
    implants, and found that only 27% of patients considered            pletely satisfied. Those authors compared the chewing
    using additional types of information (brochures, slides or         function between natural teeth and implants, and found
                                        on

    models) important to supporting an oral explanation. For            that 72.1% of their patients perceived no difference, and
    60% of those who completed questionnaires, an oral ex-              7.7% of them preferred implants due to the adaptive ca-
    planation had the greatest influence on the decision to un-         pacity of the stomatognathic system following implant the-
    dergo treatment. This might be due to too much information          rapy (18).
    being difficult to handle and even leading to confusion or          This finding contrasted those of some other studies. Häm-
                               i


    fear, because, as non-professionals, the patients might             merle et al. (19) showed that patient tactile perception dif-
                            iz



    have difficulties in extrapolating information concerning           fered significantly between implant abutments and natu-
    their own oral condition. In contrast, a more client-centred        ral abutments, and Keller et al. (20) demonstrated that the
    approach appears to increase confidence in the proce-               threshold for tactile perception in implants was increased
           Ed




    dure.                                                               after 1 week of healing and remained unchanged there-
    Patients who were partially or completely edentulous and            after.
    who missed one anterior tooth considered it particularly            In accordance with other studies (21,22,23,24,25), the se-
    necessary to restore lost teeth (34.6%). The main reasons           ven edentulous subjects in our study considered that the
    for choosing implant treatment were the advice of a den-            implant-supported overdenture provided improved stabi-
    tist (32.7%), improving the stability of the denture (15.4%),       lity and phonetics. In an investigation of the differences in
    eating habits (13.5%) and aesthetics (1.9%). Analogous              patients’ psychological and psychosocial attitudes after re-
IC




    outcomes were reported by Grogono et al. (2), who as-               ceiving implant prostheses, Grogono et al. (2) found that
    sessed the attitudes of edentulous patients towards implant         many respondents improved their speaking ability. In ad-
    treatment, and by de Bruyn et al. (15).                             dition, most of the patients smiled more often and felt more
    Implant and abutment surgery were assessed positively               comfortable in their social contacts and in relationships with
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    by most of the subject: infact they were in most of the case        the opposite sex. Only a few respondents reported negative
    painless and without swelling. Similar results were found           changes in attitude, and even when the responses were
    in previous studies, such as by Schropp et al. (16) who used        not totally positive, patients perceived that their implant pro-
    VAS scores to assess implant surgery. Their survey paper            stheses were at least as satisfactory as their removable
©




    reported that patients rated implant insertion significantly        ones.
    worse than the abutment operation, and considered                   These outcomes were similar to those found in the survey
    swelling but not pain to be a problem.                              of Zitmann et al. (5) of patients treated with fixed implant-
    The prosthetic procedure was evaluated as not unpleasant            supported prostheses in the maxilla. Those authors found
    by 76.9% of the respondents in the present study, while             significant improvements in aesthetics, eating comfort, pho-
    28.8% of them considered impression-taking to be the                netics and overall satisfaction. Equally, subjects intervie-
    worst part of the procedure. In contrast, Schropp et al. (16)       wed by Blomberg and Lindquist (11) perceived their pro-
    found that approximately one-fourth of their respondents            sthesis to be part of themselves, and provided improve-

    6                                                                                           Annali di Stomatologia 2010; I (3-4): 2-8
    Patient satisfaction with oral implant rehabilitation: evaluation of responses to a questionnaire


    ments in aesthetics, self-esteem and interpersonal rela-            References
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                                                                                                           i
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                                                                                                       on
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                                                                          er
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                                                                  nt        nal of Oral and Maxillofacial Implants 1990; 5(4): 347-359
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                            iz



    et al. (17) finding that the feasibility of and the time nee-
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                                                                        14. Tepper G, Haas R, Mailath G, Teller C, Zechner W, Watzak
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    The outcomes of the present study should be interpreted                 G, Watzek G. Representative marketing-oriented study on
    with caution because they are based on a relatively small               implants in the Austrian population. I. Level of information,
    sample and a relatively short observation time, although                sources of information and need for patient information. Cli-
    previous studies have found that the adaptation to masti-               nical Oral Implants Research 2003; 14(5): 621–633.
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    catory function with implant reconstructions tends to im-           15. de Bruyn H, Collaert B, Lindén U, Björn AL. Patient’s opi-
    prove with time after insertion. Furthermore, assessment                nion and treatment outcome of fixed rehabilitation on Brå-
                                                                            nemark implants. A 3-year follow-up study in private dental
    of the treatment procedures and experience of the eden-
                                                                            practices. Clinical Oral Implants Research 1997; 8(4): 265–
    tulous period can be influenced by memory and by the time
                                                                            271.
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    and money spent.
                                                                        16. Schropp L, Isidor F, Kostopoulos L, Wenzel A. Patient ex-
    In spite of these limitations, the present study shows that             perience of, and satisfaction with, delayed-immediate vs de-
    oral implant rehabilitation meets patients’ needs and de-               layed single-tooth implant placement. Clinical Oral Implants
    mands. This is because oral function, aesthetics and well-              Research 2004; 15(4): 498–503.
    being improve significantly with implant-supported pro-             17. Pjetursson BE, Karoussis I, Bürgin W, Brägger U, Lang NP.
    stheses, while surgical and prosthetic procedures are not               Patients’ satisfaction following implant therapy. A 10-year
    considered traumatic, even though they are long and com-                prospective cohort study. Clinical Oral Implants Research
    plex.                                                                   2005; 16(2): 185–193.


    Annali di Stomatologia 2010; I (3-4): 2-8                                                                                           7
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    18. Jakobs R, van Steenberghe D. Comparative evaluation of                overdentures. A comparison with new complete dentures
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        A , Joss A, Lang NP. Threshold of tactile sensitivity percei-         tion with overdentures supported by one-stage TPS im-




                                                                                                             i
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                                                                                                           al
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                                                                                                         on
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        Research 1996; 7(1): 48–54.                                           nal of Prosthodontics 2002; 15(6): 575–581.
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                                                                                                       zi
    22. Boerrigter EM, Stegenga B, Raghoebar GM, Boering G. Pa-         27.   Yi S-W, Carlsson GE, Ericsson I, Kim CK. Patient evaluation
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                                                                            na
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