June 22, 2018
Patient-reported outcome measures in implant dentistry
Assessing patients’ perceptions regarding the outcomes of implant treatment is of increasing interest to researchers. However, well-designed controlled studies are scarce, and most have been conducted in the past several years. The primary objective of this systematic review was to provide an update on the use of patient-reported outcome measures (PROMs) in implant dentistry. The study’s secondary objective was to compare PROMs for prostheses supported by 1 or more implants with those for alternative treatments. The study was published in a supplement to the September 2015 issue of Clinical Oral Implants Research.
The researchers conducted an electronic search of the dental literature through December 31, 2014, using the PubMed database. They limited their search to English-language controlled studies consisting of at least 10 patients who underwent straightforward implant treatment. Of the 300 articles published in the preceding 6 years, only 84 used PROMS in the context of treatment with implant-supported prostheses compared with alternative treatments or a healthy dentition.
Of the 84 studies, 39 were conducted in fully edentulous patients who received a mandibular (n = 33) or maxillary (n = 6) implant overdenture (IOD), and 9 were performed in fully edentulous patients treated with a fixed implant prosthesis (FIP), the authors wrote. Of the 33 studies of mandibular IODs in fully edentulous patients, 15 involved follow-up of less than 1 year, and 18 involved follow-up of 1 through 10 years.
The evidence from these well-controlled studies shows a high level of patient satisfaction with mandibular IODs compared with conventional dentures (CDs). These findings likely reflect improved comfort, chewing ability, and stability or retention, the authors wrote. Moreover, patient satisfaction did not appear to be associated with implant type, number of implants, or the connection or attachment system used. With regard to speech, esthetics, and cleaning ability, the systematic review results were comparable for IODs and CDs.
The literature contains few studies pertaining to patient satisfaction with maxillary IODs, and the results have been mixed, the authors wrote. Investigators in 1 study reported that patients who received an IOD after having been treated with a CD experienced no improvement in masticatory ability, speech, stability, comfort, or function.
Similarly, few controlled trials of PROMs have been conducted in partially edentulous patients. In patients with single implants (n = 16 studies), the timing of implant placement (early versus delayed) did not seem to affect patient satisfaction, the authors wrote.
Regarding the researchers’ primary objective, only 84 of 300 studies published in the 6 years preceding this systematic review were controlled trials, and most focused on patient satisfaction with mandibular IODs. Many PROM studies in the literature used nonstandardized questions and various scoring methods (such as visual analog scales, open questions, and the Oral Health Impact Profile), making comparisons between studies difficult, if not impossible.
Consequently, the authors stress the need for standardized reporting of PROMs in implant dentistry. In particular, a standardized assessment tool is needed for partially edentulous patients with FIPs or single implants because OHIP questionnaires and other instruments have been validated only for completely edentulous patients.
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Consulting Editor: Clark M. Stanford, DDS, PhD
Distinguished Professor and Dean
University of Illinois at Chicago College of Dentistry
Vice President, Academy of Osseointegration Board of Directors
Patient-centered and clinically based outcomes of Locator-retained mandibular overdentures
Edentulous patients experience functional and esthetic limitations that can affect their quality of life. However, few studies have assessed the treatment outcomes of mandibular overdentures retained by the Locator system (Zest Dental Solutions). In this prospective observational study, researchers conducted an evidence-based assessment of patient-based and clinically based outcomes of Locator-retained mandibular overdentures. The study was published in the March 2017 issue of Journal of Prosthetic Dentistry.
Participants included 80 edentulous patients (48 women, 32 men) who had undergone treatment by staff and students at the University of Valencia in Spain. Patients had worn mandibular overdentures supported by 2 implants and retained by the Locator system for a minimum of 1 year of functional life.
The researchers performed basic oral examinations and reviewed patients’ dental records annually. They assessed the following clinical variables: implant size, angulation, and survival (including attachment loosening, fracture, or wear); changes in nylon retention elements and problems with attachments; prosthetic fracture, relining, or adjustment; state of soft tissues; and the influence of time.
To assess factors related to patient well-being, the researchers administered the Oral Health Impact Profile v20 Spanish version (OHIP-20-sp) and the Oral Satisfaction Scale (OSS). The OHIP-20-sp is a 20-item questionnaire that focuses on 7 dimensions of impact (functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap). Participants reported the frequency of impact on a 5-point Likert scale (0 = never, 4 = very often) using a 12-month recall period, the authors wrote. The OSS is a visual analog scale (scores ranging from 0-10) that allows respondents to weight their perceived oral satisfaction.
The mean (standard deviation [SD]) age of participants was 69.6 (9.1) years. Most had little or no formal education, and 59% were retired. Oral hygiene consisted of once- or twice-daily toothbrushing, and 70% of participants had visited a dentist within the previous 2 years. In addition, 80% of participants were either never smokers or former smokers, the authors wrote.
Implants had been placed, on average, 73.6 (39.2) months previously, with a survival rate of 82.5%. Most of the overdentures had metal reinforcements and had been in function for more than 60 months. Data regarding clinical outcomes showed that 82.5% of overdentures needed postinsertion readjustments (mean [SD], 1.8 [1.2] readjustments). In addition, 46.3% of overdentures had been relined, and 12.5% had been replaced because of fracture.
The study findings showed that, overall, patients were satisfied with treatment outcomes. The mean (SD) total OHIP-20-sp score was 19.0 (14.0) of a possible 80.0 points. The higher the score, the greater the impact and the worse the oral health–related quality of life. The domains most affected were pain, functional limitation, and physical disability, the authors wrote. The mean (SD) OSS score was 8.3 (1.7), meaning that patients’ oral satisfaction was high.
Younger participants and older prostheses were associated with a reduced perception of the quality of life (r = 0.25; P < .01), the authors wrote. Regarding clinical outcome variables, patients whose prostheses had not been relined reported significantly higher satisfaction than those whose prostheses had been relined. In addition, participants whose prostheses had undergone readjustment reported experiencing more pain than those whose prostheses had not. Patients with complete prostheses in the antagonist arch experienced lower functional limitation than did those with other types of antagonist arches.
The authors concluded that mandibular overdentures produced good results with respect to patients’ quality of life and oral satisfaction. However, clinicians need to pay attention to factors that affect clinical outcomes and the well-being of edentulous patients.
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Assessing patient satisfaction with single-implant crowns
Patient satisfaction is increasingly recognized as an important treatment outcome. Nevertheless, few studies have evaluated patient-related outcomes with respect to dental implants. The objective of this prospective study was to evaluate patient satisfaction with single-implant crowns (SICs). The findings were published in the May/June 2017 issue of The International Journal of Oral & Maxillofacial Implants.
Study participants included patients who received 1 or more SICs from 2001 through 2014 in a private prosthodontic practice. Of the 207 patients enrolled sequentially in this prospective cohort study, 128 (61.8%) responded to the mailed questionnaire. Patients who had received restored or unrestored single implants before referral to the practice were excluded from the study.
Of the 128 respondents, 51 were male and 77 were female. Their mean (standard deviation) age at the time of treatment was 47.2 (16.5) years (range, 17-79 years). A total of 109 participants (85.2%) had received 1 SIC, and 19 (14.8%) had received SICs at more than 1 site. The SICs had been in situ for up to 14 years (median time, 5 years). Nonrespondents (n = 79) were significantly more likely (P = .013) than respondents to have received SICs at more than 1 site; however, the investigators believed that this finding likely was due to random chance.
The researchers used a modified version of a previously validated patient satisfaction questionnaire (PSQ) that consisted of 14 questions (12 were answered on a 100-millimeter visual analog scale [VAS] [converted to percentages], and 2 were answered “yes” or “no”). The objective of the PSQ was to determine patient satisfaction levels with respect to the appearance of the prosthesis, appearance of the soft tissues, cleansability, costs, and overall satisfaction.
Participants reported a high level of satisfaction regarding the appearance of the prosthesis. Median VAS scores for the 8 related questions ranged from 90.5% to 95.0%, the authors wrote. In addition, the median response to the 1 question about cleansability was 90.0%. Over time, satisfaction improved with respect to appearance in general (P = .023), contour appearance (P = .003), and mucosa (P = .049). However, patients’ satisfaction with crown color did not change significantly over time.
Regarding treatment costs, participants reported that they had a medium level of satisfaction (median response, 50%) at the time of prosthesis placement. However, “with the benefit of hindsight,” participants’ satisfaction with the costs of treatment improved significantly (median response, 75%).
Younger patients (17-29 years and 30-44 years) reported lower satisfaction initially with appearance (P = .004) and costs (P = .007) compared with older patients (44-64 years and 65-79 years), the authors wrote. Over time, satisfaction with appearance did not improve significantly in these age groups; however, improvements did occur when the age groups were combined (P = .023). Moreover, satisfaction with costs improved significantly over time in all 4 age groups (P < .001, P = .001, P < .001, and P = .016, respectively).
Finally, participants reported a high level of satisfaction with treatment overall (median VAS score, 93%). Moreover, all 128 respondents stated that they would undergo the same type of treatment again and would recommend it to a friend.
The researchers concluded that study participants were highly satisfied with the appearance and cleansability of their SICS, as reported on a validated PSQ. Although patients reported having been concerned about upfront treatment costs (especially younger patients), satisfaction with costs improved significantly in all age groups over time.
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Patient‐centered outcomes after 5 types of surgical procedures
Researchers and clinicians have become increasingly interested in patient perceptions of dental treatment outcomes. In this study, researchers compared patient-centered outcome assessments (POAs) and postoperative complications over a 2-week period in patients who underwent a dentoalveolar procedure. The study was published in the April 2017 issue of Clinical Oral Implants Research.
This prospective study was conducted from October 2013 through February 2015 in 1 clinical center in Hong Kong and 1 in Nanjing, China. The study cohort was composed of 339 patients who underwent 1 of the following procedures: simple tooth extraction (SE) (n = 42), transalveolar extraction (TE) (n = 132 [primarily third molars]), straightforward implant placement (I) (n = 63), implant placement with guided bone regeneration (IGBR) (n = 70), or periodontal surgery (P) (n = 32).
The mean (standard deviation) age of patients was 43.2 (16.0) years, and 134 patients (39.5%) were male. A total of 174 procedures were performed in the Hong Kong clinical center, and 165 were performed in the Nanjing center.
The researchers asked patients to fill out a healing diary starting the day after surgery (day 1) and continuing every day for the next 6 days, and then again on day 14. The diary consisted of 4 visual analog scales (VAS) (0 = none, 10 = worst/very heavy) on which patients recorded their perceptions of bleeding, swelling, pain, and bruising. In addition, patients were asked whether they used painkillers and, if so, the type. Patients mailed their completed diaries to the surgical center or returned them directly to the dentists in charge.
Area-under-the-curve analyses for the first 3 postoperative days showed that patients who underwent TE experienced significantly greater overall bleeding (mean, 5.6; P < .001) and pain (mean, 7.5; P = .004) than patients in the other groups. However, IGBR resulted in significantly greater swelling (mean, 9.1; P < .001) and bruising (mean, 4.2; P < .001) than the other dental procedures.
The median VAS scores showed that all 4 POA parameters were generally low and decreased to 0 relatively early in the study period. On postoperative days 1 and 2, bleeding was significantly greater in the TE group (median VAS scores, 3 and 1, respectively) than in the other groups, the authors wrote. However, bleeding stopped on day 3 for all dentoalveolar procedures. Patients who underwent IGBR reported experiencing more swelling (median VAS, 3) and bruising (median VAS, 1) on day 1 than patients in the other 4 groups. Healing events for patients who underwent SE were similar to those for patients who underwent straightforward I.
The VAS scores for painkiller use also descended quickly in all groups. In the IGBR group, 71.4%, 50.0%, and 35.7% of patients reported that they took painkillers on days 1, 2, and 3, respectively. These percentages are higher than those in the other 4 groups, the authors wrote.
On postoperative day 7, the clinicians who performed the dental procedures conducted clinical examinations. The prevalence of complications was low in all groups (SE, 4.8%; TE, 1.5%; I, 12.7%; IGBR, 20.0%; and P, 15.6%). By day 14, all postoperative complications had resolved (median VAS, 0).
The study results provide valuable information about healing events from patients’ perspectives, the authors wrote. They concluded that the findings could be used to develop evidence-based and patient-centered advice for people contemplating dental procedures with which they may be unfamiliar.
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Implantology CE courses
At Implant Direct, we offer a diverse and comprehensive list of implant dentistry courses to meet all your learning and CE needs. Each class is designed to meet the specific needs of the modern implant marketplace. Featuring a variety of hands-on training sessions, interactive lectures, and live surgery observation classes, our classes are taught by some of the most respected names in the field. From introductory courses that cover the basic surgical principles and protocols, hybrid and full arch restoration cases to advanced courses covering the latest technological innovations and the future of implantology, we’re here to help each clinician reach their full potential. For more information, go to our Education Center.
Registration is now open for ‘Advances in Clinical Implant Dentistry’
Registration is now open for the Academy of Osseointegration’s (AO) Mid-Atlantic Regional Meeting, to be held in National Harbor, Maryland September 14-15, 2018.
“Advances in Clinical Implant Dentistry” will focus on various disciplines within implant dentistry, including the latest in surgical, restorative, and laboratory techniques.
Featuring AO member presenters from the mid-Atlantic region, the impressive 2-day program will include: Dr. Joseph Fiorellini from the University of Pennsylvania, and Tony Prestipino, a Washington, DC-area certified dental technician, who will facilitate hands-on clinics on September 14. The main program on September 15 will feature Drs. Eva Anadioti, Edgard El Chaar, Thomas Taylor and Maria Troulis, all from leading university programs along the east coast.
The Gaylord National Resort & Convention Center, one of the most elegant meeting facilities along the Eastern seaboard of the United States, will provide the backdrop with its picturesque views of Washington, D.C. and old-town Alexandria from the shores of the Potomac River.
Space is limited, so be sure to register early to guarantee your seat at this special event. Register here.
Grow base, improve patient care
Committed to increasing access to healthy smiles everywhere, Implant Direct empowers doctors at every stage of their implant practice. From single implant to full arch cases, we are committed to helping practices grow their base and improve patient care. Our ‘Welcome Box’ teaches practices about implant procedures and how to educate patients on their benefits, while the ‘Implant Direct Dental Implant Marketing Seminar Kit’ helps practices build marketing seminars to attract new implant patients. For more information, click here.
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JADA+ Specialty Scans and JADA+ Scans are quarterly newsletters updating dentists on the latest research in selected specialties and disciplines in dentistry. ADA Publishing and the consulting editors from the represented specialties and disciplines aggregate and summarize research from previously published materials, each item attributed to its publication of origin. JADA+ Scan specialties and disciplines include endodontics, oral pathology, orthodontics, pediatric dentistry, periodontics, prosthodontics, radiology, cosmetic/esthetic and osseointegration. The ADA has engaged the specialty organizations in these areas as well as its own Science Institute and Division of Legal Affairs to assist with these newsletters. View past issues here.
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