A qualitative analysis on participants’ perspectives on oral implants

Patient-reported outcomes for bone regenerative procedures

Evidence-based dentistry used for decision-making and assessment of treatment includes three components: evidence from the literature, clinical expertise, and patient expectations. Patient satisfaction embraces affability, availability, and ability and can be examined using questionnaires or structured questions to the patient to evaluate patient perception of the treatment. The questions can be quantified using dichotomous, point, or visual analog scales. This would be a straightforward patient-reported outcome measure (PROM). Validated and specific oral health-related quality of life (OHRQoL) questionnaires such as the oral health impact profile (OHIP), oral impact on daily performance (OIDP), or the dental impact on daily living (DIDL) can be used as PROMs, and these measures are appropriate for population studies, where you can measure changes over time and differences between treatment groups. PROMs have shown to enhance patient engagement when integrated into clinical care. PROMs for bone regenerative procedures are mainly used as secondary outcome and are concentrating on the prosthetic outcome more than the pain, discomfort, anxiety, and cost of the surgical procedures. Surprisingly, most patients are satisfied and willing to have the procedures performed again. Whether this is recall bias or not and how the information's from the dentist and the team influence the patients answers to PROMs questionnaires are discussed. The importance of patient perspectives in bone regeneration procedures is obvious and combined with clinical outcome measures, it increases our ability to provide better care. Studies using PROMs as a primary outcome variable are required.

Patients' preferences in dental care: A discrete-choice experiment and an analysis of willingness-to-pay

INTRODUCTION

Dental diseases are a major problem worldwide. Costs are a burden on healthcare systems and patients. Missed treatments can have health and financial consequences. Compared to other health services, dental treatments are only covered in parts by statutory health insurance (SHI). Using the example of dental crowns for a cost-intensive treatment, our study aims to investigate whether (1) certain treatment attributes determine patients' treatment choice, and (2) out-of-pocket payments represent a barrier to access dental care.

METHODS

We conducted a discrete-choice-experiment by mailing questionnaires to 10,752 people in Germany. In presented scenarios the participants could choose between treatment options (A, B, or none) composed of treatment attribute levels (e.g., color of teeth) for posterior (PT) and anterior teeth (AT). Considering interaction effects, we used a D-efficient fractional factorial design. Choice analysis was performed using different models. Furthermore, we analyzed willingness-to-pay (WTP), preference of choosing no and SHI standard care treatment, and influence of socioeconomic characteristics on individual WTP.

RESULTS

Out of n = 762 returned questionnaires (response rate of r = 7.1), n = 380 were included in the analysis. Most of the participants are in age group "50 to 59 years" (n = 103, 27.1%) and female (n = 249, 65.5%). The participants' benefit allocations varied across treatment attributes. Aesthetics and durability of dental crowns play most important roles in decision-making. WTP regarding natural color teeth is higher than standard SHI out-of-pocket payment. Estimations for AT dominate. For both tooth areas, "no treatment" was a frequent choice (PT: 25.7%, AT: 37.2%). Especially for AT, treatment beyond SHI standard care was often chosen (49.8%, PT: 31.3%). Age, gender, and incentive measures (bonus booklet) influenced WTP per participant.

CONCLUSION

This study provides important insights into patient preferences for dental crown treatment in Germany. For our participants, aesthetic for AT and PT as well as out-of-pocket payments for PT play an important role in decision-making. Overall, they are willing to pay more than the current out-of-pockt payments for what they consider to be better crown treatments. Findings may be valuable for policy makers in developing measures that better match patient preferences.

Understanding the Lived Experience of North American Dental Patients With a Single-Tooth Implant in the Upper Front Region of the Mouth: Protocol for a Qualitative Study

BACKGROUND

Assessment of the subjective experiences of individuals with maxillary anterior (ie, the upper front region of the mouth) single-tooth implants is limited mainly to quantitative measurements of satisfaction with appearance. Interestingly, there is unexplained variability in the relationship between satisfaction and appearance.

OBJECTIVE

This qualitative study protocol aims to explore and better understand the satisfaction with appearance and function in a Canadian population with maxillary anterior single-tooth implants treated at a postgraduate university clinic. Thus, we aim to obtain diversity among participants relating to the identification of esthetically pleasing and displeasing cases from a clinician perspective.

METHODS

A qualitative research design using interpretative phenomenology analysis (IPA) will provide an adaptable inductive research approach. The participants will be recruited, and consent documents, photographs, digital intraoral scans, and self-administered questionnaire responses will be obtained from them. The transcribed verbatim data from audio-recorded, in-depth, semistructured, one-to-one interviews of the participants will be managed, coded, and analyzed thematically with computer-assisted qualitative data analysis software. The IPA will consider the COnsolidated criteria for REporting Qualitative (COREQ) guidelines when applicable.

RESULTS

For the qualitative interview, we plan to include at least eight patients to conduct up to 1.5 hours of open-ended interviews with each participant aided by an interview guide. Ethical approval was granted by the University of British Columbia Behavioral Research Ethics Board (H19-00107) in May 2019. Two American dental foundations funded this study.

CONCLUSIONS

The analysis in this study will elucidate the aspects (including their value) that influence participant satisfaction at different dental implant treatment stages. This will be the first qualitative study on this group of the population to explore and obtain a better understanding of their satisfaction with appearance and function, as well as any other patient-reported outcome measures that could be identified.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/25767.

Comprehension and recall of information about factors associated with peri-implantitis: A randomized controlled trial

BACKGROUND

To evaluate the effect of different communication strategies on comprehension and recall of information about factors associated to peri-implantitis.

MATERIALS

A prospective, randomized controlled trial was conducted in consecutive patients diagnosed with peri-implantitis. The sample was divided into three groups according to the communication strategy used: Test group 1-Written communication via leaflet with visual aids (L-VA); Test group 2-Written communication via leaflet with no visual aids (L-NVA); and control group-only verbal communication with no leaflet (NL). A questionnaire assessing comprehension at baseline (T0) and recall at 3 months (T1) and 6 months (T2) was administered following the fuzzy trace theory with a combination of 11 "gist" and seven "verbatim" items. The "health belief model" dimensions were further examined to test the influence of the communication strategy upon perceived severity, susceptibility, benefits, barriers, self-efficacy, and behavioral intentions.

RESULTS

Ninety-nine patients that fulfilled the eligibility criteria were included. Gist and verbatim comprehension of the control, risk factors, and preventive measures for peri-implantitis overall was significantly greater in the test groups, in particular in L-VA at T0 (n = 99). Nevertheless, recall was not influenced by the communication strategy at T1 (n = 85) or T2 (n = 78). No significant differences were noted between groups or as a function of time for any of the "health belief model" constructs with the sole exception of perceived barriers (P = 0.045), which proved lower in the test groups.

CONCLUSION

The comprehension of information about factors associated to peri-implantitis can be efficiently improved by using written communicative strategies, in particular when supplemented with visual aids. Nevertheless, this approach failed to show effectiveness in modulating recall or in changing behavioral intentions over follow-up (NCT04543604).

A critical review of qualitative research publications in dental implants from 2006 to 2020

OBJECTIVES

This critical review is aimed to investigate the current status of qualitative research in dental implant research and to explore the quality of available information.

MATERIAL AND METHODS

A systematic search was done on the journal databases to identify dental implant research articles that used qualitative methodology during 2006 and 2020. The resulting articles were appraised against the checklist offered by the Critical Appraisal Skills programme (CASP) tool. Also, the theories evolved from the research were reviewed to understand the value of this methodology in dental implant research.

RESULTS

Twenty-five (25) articles out of the 8,421 original results were identified as using qualitative methodology. The researchers have sought to identify the views of patients about tooth loss, dental implants, and the information they receive from dental professionals, and views of the dentists about dental implant practice. The review found that there were few inconsistencies in the quality of such research especially the qualitative data analysis.

CONCLUSIONS

The quantity of qualitative research in dental implants remains low; however, the quality has improved in the past two decades. Despite these improvements, there is still a lack of research in understanding both patients' and dentists' views on dental implant procedures and management.

Aesthetic Parameters and Patient-Perspective Assessment Tools for Maxillary Anterior Single Implants

Background

This review aimed to concisely describe the current aesthetic objective indices for a single-implant maxillary anterior crown. The secondary aim was to propose introducing a unified, standardized questionnaire for adequately collecting patient-reported outcome measures (PROMs) in implant dentistry.

Materials and Methods

A literature review was conducted using both EMBASE/Ovid and MEDLINE/PubMed databases by combining keywords and Emtree/Mesh terms related to “Esthetics,” “Self-Assessment or Surveys and Questionnaires,” and “Single-Tooth Dental Implants.”

Results

The most meaningful aesthetic objective indices for single implants in the literature are the Pink Esthetic Score (PES), the Papilla Presence Index (PPI), Peri‐Implant and Crown Index (PICI), PES/White Esthetic Score (PES/WES), the Implant Crown Aesthetic Index (ICAI), and a modified version of the ICAI (mod-ICAI) index. Clearly, PES/WES is still the most widely accepted tool. It is encouraging to observe that there is an increasing tendency in recent years to report PROMs more frequently in the implant dentistry literature. We proposed the implementation of a unified, standardized questionnaire using a self-administered visual analogue scale (VAS) scoring system, which evaluates overall satisfaction, comfort, tooth appearance, gingival appearance, function, and hygiene complexity. This tool should be validated in the oral implantology research context for its regular implementation or further development.

Conclusions

Conducting qualitative studies among dental implant patients who received few implants or single-tooth implant reconstructions in the aesthetic zone may help dental researchers understand better how to efficiently develop and validate a quantitative instrument. This standard tool would reduce heterogeneity bias by providing comparable data between studies.

Clinical sequelae and patients' perception of dental implant removal: A cross-sectional study

BACKGROUND

A cross-sectional study was designed to shed light on the clinical sequelae and patient satisfaction after dental implant removal (IR).

METHODS

Patients undergoing ≥1 IRs were eligible. The reasons for implant failure, clinical and radiological parameters before and after IR, and the surgical and prosthetic treatments offered after IR was assessed. Patient satisfaction was recorded and the Oral Health Impact Profile (OHIP)-14 was used to document patient self-reported dysfunction and discomfort attributed to IR. Lastly, patient expectations after IR were also evaluated.

RESULTS

Thirty-one patients with 45 implants were analyzed. Peri-implantitis was the main reason for IR (64.5%). The average implant survival time before IR was 120.3 ± 88.2 months. Signs of infection (51.7%) and bleeding on probing (37.5%) were common signs detected at the time of IR. Guided bone regeneration was the intervention most commonly applied simultaneously to IR (74.1%). The reported degree of satisfaction was high, and the overall OHIP-14 score was low. However, a certain patient reluctance to undergo future implant placement in the same clinic or with the same professional was recorded, and a statistically significant increase in adherence to the implant maintenance routine was observed after IR.

CONCLUSIONS

Peri-implantitis is the leading cause for IR. Guided bone regeneration is commonly applied to attenuate the clinical sequelae of IR. Nonetheless, IR does not seem to affect patients' satisfaction nor their quality of life, though a certain patient reluctance to undergo future implant placement in the same clinic or with the same professional was reported.

The patient experience of dental implant surgery: a literature review of pertinent qualitative studies

This review aims to identify and summarise the findings of published qualitative studies relating to patients' experiences of dental implant surgery, by means of textual narrative synthesis. A comprehensive two-stage electronic and manual search of the literature identified relevant qualitative studies up to January 2020. Included primary studies (n = 15) used qualitative research methods including interviews and focus groups to investigate patients' experiences of dental implant treatment. They looked at the experience of tooth loss, the decision making process, the pre-implant experience, motivating factors and barriers for treatment and the post-implant experience with the prosthesis. There is a deficiency in the exploration of the patients' intraoperative dental surgical experience and the adjunctive effects of conscious sedation. The included studies give considerable insight into patients' experiences of the dental implant journey, which in the main, had overall positive consensus. The limited information available regarding patients' experience of the intra operative dental implant surgery with or without conscious sedation warrants further investigation. This information is a fundamental step to understanding the patients' preferences, needs and values and ultimately enhancing the quality of patient care.

Challenges in dental implant provision and its management in general dental practice

OBJECTIVES

Dental implants have become a well-publicised treatment modality in dentistry. Implants are generally placed in the private sector by dentists who have undertaken further learning. The continued maintenance of implants falls within the duty of care for the general dental practitioner. The objective of this qualitative study is to investigate the current status of dental implants in general dental practice, and to explore the dentists view on dental implant education at both undergraduate and postgraduate level.

METHODS

In-depth interviews as a qualitative methodology was used in the study. The participants were recruited through theoretical sampling guided by saturation of information. Based on this, 22 general dental practitioners practicing in the UK were interviewed. Transcribed interview data were coded with NVIVO software and then analysed using a thematic framework analysis method.

RESULTS

General dentists from different educational backgrounds, experience levels participated in the study. They highlighted that the guidelines and protocols when dealing with implants were unclear and expressed their unwillingness to treat patients who had their specialised dental treatment performed elsewhere.

CONCLUSION

Expensive dental implant treatment is not being followed up by the general dental practitioner due to a wide range of barriers. Unclear care paths will lead to a likely increase in problems following implant placement.

CLINICAL SIGNIFICANCE

General Dentists' views of dental implants in general practice and their expectations from education providers are explored and show the need for improved education.

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.