Investigating patients' expectations from dental implant therapy

Abstract

Aims: To investigate the origins of patients’ expectations before implant treatment and their healing experiences after implant surgery. In addition, to identify the underlying determinants of expectations that may lead to unrealistic perceptions. Methods: (1) A systematic review following PRISMA guidelines was conducted; (2) A theoretical model was constructed and an instrument to assess patients’ expectations was developed; (3) The developed instrument was utilized to investigate patients’ initial information level, perceptions, as well as expectations of the implant therapy; (4) Finally, patients healing experiences were investigated following five different procedures of dento-alveolar surgery, including implant surgery and guided bone regeneration. Result: (1) The review identified that patients’ expectations of implant treatment is scarcely studied and the relationship between expectations prior to treatment and satisfaction with treatment outcome is poorly understood. There is a large degree of heterogeneity among studies in terms of assessment and no standard instrument is available. Expectations with respect to aesthetics and function are key attributes considered. (2) The conceptual model identified five domains through factor analysis. Test-retest reliability was high (ICC=0.924). SEM further simplified the instrument to 16 items and all indexes suggested adequate fit to data (CHI/DF=1.694; GFI=0.934; AGFI=0.906; RMSEA=0.05). Forty-three percent of the variance of patients’ expectations was explained by the proposed factors; however, outcome expectations themselves could not predict unrealistic components (r=0.01; P=0.92). Psychosocial factors of norm value, attitude and cognitive perceptions had a direct impact on unrealistic components (r=0.331; P=0.002). (3) The instrument was delivered to 277 patients from Hong Kong and Mainland China. The main information source about implant therapy was from the dentist or hygienist (N=113, 42%). Most of participants (N=174, 62.8%) reported to receive general information of implant, but only 17.7% felt confident with the information they received. Approximate a third reported misperceptions about dental implants. Expectations of treatment outcome were generally high. Overall, younger subjects (<45 years old) and those with higher education level (Bachelor and Postgraduate) tended to present more realistic perceptions and lower outcome expectations. (4) An sample of 339 subjects was recruited for assessing the post-surgical healing based on patient-centered outcomes measurement. The first-3-days Area-Under-the-Curve (AUC) analyses identified implant placement with guided bone regeneration (GBR) resulted in significant higher level of swelling (AUC: Mean=9.1) and bruising (Mean=4.2), and highest use of painkillers. Healing outcomes of straightforward implant placement were comparable to that of a simple extraction. Experiences over a two-week period observed that the symptoms quickly subsided for all groups. Conclusion: The systematic review identified the growing interest in patients’ expectations of implant dentistry. However, there is a lack of standardized approach to assess their expectations. A theoretical framework and instrument were developed to assess patients’ expectations and it demonstrated acceptable validity and reliability. Although the proposed model could not adequately predict unrealistic perceptions, it highlights the influences from patients’ psychosocial factors, and draws attention to clinically relevant parameters. Healing procedure from implant surgery was comparable to other types of dento-alveolar surgery with most sequelae subsiding in the first few days post-surgery.