Critical evaluation of patient responses to dental implant therapy
Identifieur interne : 002F97 ( Istex/Corpus ); précédent : 002F96; suivant : 002F98Critical evaluation of patient responses to dental implant therapy
Auteurs : Roman M. Cibirka ; Michael Razzoog ; Brien R. LangSource :
- The Journal of Prosthetic Dentistry [ 0022-3913 ] ; 1997.
English descriptors
- KwdEn :
- Acrylic resins, Adaptive response, Atrophic mandibles, Cibirka, Clinical investigations, Clinical trials, Clinician, Complete dentures, Content validity, Dent, Dental health, Dental implant therapy, Dental implant treatment, Dental therapy, Dentistry, Denture, Denture satisfaction, Denture success, Denture therapy, Domain, Edentulous patient, Esthetics, Evaluative analysis, Evaluative capacity, Experimental population, First questionnaire, Functional capacity, Hrql, Hrql questionnaires, Impacting quality, Implant, Implant experience, Implant therapy, Implant treatment, Interpersonal behavior, Lang, Lang table, Life benefits, Life measure, Life measures, Mandibular, Mandibular prosthesis, Masticatory efficiency, Maxillary, Maxillary dentures, Measurement session, Medical college, Patient responses, Patient satisfaction, Previous responses, Prosthesis, Prosthet, Prosthet dent, Prosthetic, Prosthetic dentistry, Prosthetic rehabilitation, Prosthodontic rehabilitation, Psychologic factors, Psychologic impact, Psychological variables, Psychosocial adaptation, Rank test, Rank test results, Rank values, Scientific evidence, Second questionnaire, Significant differences, Single quality, Staining solutions, Study subjects, Subjective feelings, Subjective patient responses, Subjective responses, Successive questionnaires, Synthetic saliva, Synthetic saliva coffee, Visual analog scale, Visual analogue scales, Wilcoxon.
- Teeft :
- Acrylic resins, Adaptive response, Atrophic mandibles, Cibirka, Clinical investigations, Clinical trials, Clinician, Complete dentures, Content validity, Dent, Dental health, Dental implant therapy, Dental implant treatment, Dental therapy, Dentistry, Denture, Denture satisfaction, Denture success, Denture therapy, Domain, Edentulous patient, Esthetics, Evaluative analysis, Evaluative capacity, Experimental population, First questionnaire, Functional capacity, Hrql, Hrql questionnaires, Impacting quality, Implant, Implant experience, Implant therapy, Implant treatment, Interpersonal behavior, Lang, Lang table, Life benefits, Life measure, Life measures, Mandibular, Mandibular prosthesis, Masticatory efficiency, Maxillary, Maxillary dentures, Measurement session, Medical college, Patient responses, Patient satisfaction, Previous responses, Prosthesis, Prosthet, Prosthet dent, Prosthetic, Prosthetic dentistry, Prosthetic rehabilitation, Prosthodontic rehabilitation, Psychologic factors, Psychologic impact, Psychological variables, Psychosocial adaptation, Rank test, Rank test results, Rank values, Scientific evidence, Second questionnaire, Significant differences, Single quality, Staining solutions, Study subjects, Subjective feelings, Subjective patient responses, Subjective responses, Successive questionnaires, Synthetic saliva, Synthetic saliva coffee, Visual analog scale, Visual analogue scales, Wilcoxon.
Abstract
Abstract: Statement of problem. Successful rehabilitation of the edentulous condition requires functional and psychosocial adaptation by the patient. Quality of life is markedly affected by the amount of satisfaction or dissatisfaction with their dental therapy. Patient concerns are primarily related to comfort, function, and esthetics. When these do not meet the patients expectations, anxiety, insecurity, diminished self-esteem, and introversion are typical psychosocial responses. Purpose. The objectives of the study were to assess the patient's subjective feelings about: (a) comfort, (b) function, (c) esthetics, (d) speech, (e) self-image, and (f) overall dental health with their existing complete dentures, and after implant therapy and prosthodontic rehabilitation. Material and methods. Two health-related quality of life (HRQL) questionnaires were developed to evaluate the effectiveness of dental implant therapy; one dealing with their feelings about their conventional complete dentures, and the second dealing with implant therapy. The first questionnaire was administered with supervision before receiving implant treatment. The second questionnaire was administered within 1 year after completion of prosthetic rehabilitation. Twenty-six patients who received implants to support a mandibular prosthesis and a new maxillary denture formed the experimental population. Results. Discriminative and evaluative analysis of subjective patient responses provided reliable, accurate, and reproducible results. Assessment of subject feelings before and after implant therapy and prosthodontic rehabilitation demonstrated significant differences when before treatment responses were compared with the responses after therapy. Conclusions. Significant differences for comfort, function, speech, esthetics, self-image, and dental health were demonstrated when conventional complete dentures and dental implant therapy were compared. HRQL data provided scientific evidence of an improved quality of life after dental implant therapy (p < 0.000). (J Prosthet Dent 1997;78:574)
Url:
DOI: 10.1016/S0022-3913(97)70008-8
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ISTEX:617C9A62F1C20F4B6D06965CC61CFD459357B675Le document en format XML
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Lang</name><affiliation><mods:affiliation>Medical College of Georgia, Augusta, Ga., and University of Michigan, Ann Arbor, Mich</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:617C9A62F1C20F4B6D06965CC61CFD459357B675</idno><date when="1997" year="1997">1997</date><idno type="doi">10.1016/S0022-3913(97)70008-8</idno><idno type="url">https://api.istex.fr/document/617C9A62F1C20F4B6D06965CC61CFD459357B675/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">002F97</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">002F97</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Critical evaluation of patient responses to dental implant therapy</title><author><name sortKey="Cibirka, Roman M" sort="Cibirka, Roman M" uniqKey="Cibirka R" first="Roman M." last="Cibirka">Roman M. Cibirka</name><affiliation><mods:affiliation>Medical College of Georgia, Augusta, Ga., and University of Michigan, Ann Arbor, Mich</mods:affiliation></affiliation></author><author><name sortKey="Razzoog, Michael" sort="Razzoog, Michael" uniqKey="Razzoog M" first="Michael" last="Razzoog">Michael Razzoog</name><affiliation><mods:affiliation>Medical College of Georgia, Augusta, Ga., and University of Michigan, Ann Arbor, Mich</mods:affiliation></affiliation></author><author><name sortKey="Lang, Brien R" sort="Lang, Brien R" uniqKey="Lang B" first="Brien R." last="Lang">Brien R. Lang</name><affiliation><mods:affiliation>Medical College of Georgia, Augusta, Ga., and University of Michigan, Ann Arbor, Mich</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">The Journal of Prosthetic Dentistry</title><title level="j" type="abbrev">YMPR</title><idno type="ISSN">0022-3913</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1997">1997</date><biblScope unit="volume">78</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="574">574</biblScope><biblScope unit="page" to="581">581</biblScope></imprint><idno type="ISSN">0022-3913</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-3913</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Acrylic resins</term><term>Adaptive response</term><term>Atrophic mandibles</term><term>Cibirka</term><term>Clinical investigations</term><term>Clinical 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prosthesis</term><term>Masticatory efficiency</term><term>Maxillary</term><term>Maxillary dentures</term><term>Measurement session</term><term>Medical college</term><term>Patient responses</term><term>Patient satisfaction</term><term>Previous responses</term><term>Prosthesis</term><term>Prosthet</term><term>Prosthet dent</term><term>Prosthetic</term><term>Prosthetic dentistry</term><term>Prosthetic rehabilitation</term><term>Prosthodontic rehabilitation</term><term>Psychologic factors</term><term>Psychologic impact</term><term>Psychological variables</term><term>Psychosocial adaptation</term><term>Rank test</term><term>Rank test results</term><term>Rank values</term><term>Scientific evidence</term><term>Second questionnaire</term><term>Significant differences</term><term>Single quality</term><term>Staining solutions</term><term>Study subjects</term><term>Subjective feelings</term><term>Subjective patient responses</term><term>Subjective responses</term><term>Successive questionnaires</term><term>Synthetic saliva</term><term>Synthetic saliva coffee</term><term>Visual analog scale</term><term>Visual analogue scales</term><term>Wilcoxon</term></keywords><keywords scheme="Teeft" xml:lang="en"><term>Acrylic resins</term><term>Adaptive response</term><term>Atrophic mandibles</term><term>Cibirka</term><term>Clinical investigations</term><term>Clinical trials</term><term>Clinician</term><term>Complete dentures</term><term>Content validity</term><term>Dent</term><term>Dental health</term><term>Dental implant therapy</term><term>Dental implant treatment</term><term>Dental therapy</term><term>Dentistry</term><term>Denture</term><term>Denture satisfaction</term><term>Denture success</term><term>Denture therapy</term><term>Domain</term><term>Edentulous patient</term><term>Esthetics</term><term>Evaluative analysis</term><term>Evaluative capacity</term><term>Experimental population</term><term>First questionnaire</term><term>Functional capacity</term><term>Hrql</term><term>Hrql questionnaires</term><term>Impacting quality</term><term>Implant</term><term>Implant experience</term><term>Implant therapy</term><term>Implant treatment</term><term>Interpersonal behavior</term><term>Lang</term><term>Lang table</term><term>Life benefits</term><term>Life measure</term><term>Life measures</term><term>Mandibular</term><term>Mandibular prosthesis</term><term>Masticatory efficiency</term><term>Maxillary</term><term>Maxillary dentures</term><term>Measurement session</term><term>Medical college</term><term>Patient responses</term><term>Patient satisfaction</term><term>Previous responses</term><term>Prosthesis</term><term>Prosthet</term><term>Prosthet dent</term><term>Prosthetic</term><term>Prosthetic dentistry</term><term>Prosthetic rehabilitation</term><term>Prosthodontic rehabilitation</term><term>Psychologic factors</term><term>Psychologic impact</term><term>Psychological variables</term><term>Psychosocial adaptation</term><term>Rank test</term><term>Rank test results</term><term>Rank values</term><term>Scientific evidence</term><term>Second questionnaire</term><term>Significant differences</term><term>Single quality</term><term>Staining solutions</term><term>Study subjects</term><term>Subjective feelings</term><term>Subjective patient responses</term><term>Subjective responses</term><term>Successive questionnaires</term><term>Synthetic saliva</term><term>Synthetic saliva coffee</term><term>Visual analog scale</term><term>Visual analogue scales</term><term>Wilcoxon</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Abstract: Statement of problem. Successful rehabilitation of the edentulous condition requires functional and psychosocial adaptation by the patient. Quality of life is markedly affected by the amount of satisfaction or dissatisfaction with their dental therapy. Patient concerns are primarily related to comfort, function, and esthetics. When these do not meet the patients expectations, anxiety, insecurity, diminished self-esteem, and introversion are typical psychosocial responses. Purpose. The objectives of the study were to assess the patient's subjective feelings about: (a) comfort, (b) function, (c) esthetics, (d) speech, (e) self-image, and (f) overall dental health with their existing complete dentures, and after implant therapy and prosthodontic rehabilitation. Material and methods. Two health-related quality of life (HRQL) questionnaires were developed to evaluate the effectiveness of dental implant therapy; one dealing with their feelings about their conventional complete dentures, and the second dealing with implant therapy. The first questionnaire was administered with supervision before receiving implant treatment. The second questionnaire was administered within 1 year after completion of prosthetic rehabilitation. Twenty-six patients who received implants to support a mandibular prosthesis and a new maxillary denture formed the experimental population. Results. Discriminative and evaluative analysis of subjective patient responses provided reliable, accurate, and reproducible results. Assessment of subject feelings before and after implant therapy and prosthodontic rehabilitation demonstrated significant differences when before treatment responses were compared with the responses after therapy. Conclusions. Significant differences for comfort, function, speech, esthetics, self-image, and dental health were demonstrated when conventional complete dentures and dental implant therapy were compared. HRQL data provided scientific evidence of an improved quality of life after dental implant therapy (p < 0.000). (J Prosthet Dent 1997;78:574)</div></front></TEI><istex><corpusName>elsevier</corpusName><keywords><teeft><json:string>denture</json:string><json:string>prosthesis</json:string><json:string>mandibular</json:string><json:string>implant</json:string><json:string>maxillary</json:string><json:string>prosthetic</json:string><json:string>implant therapy</json:string><json:string>significant differences</json:string><json:string>prosthet</json:string><json:string>prosthet dent</json:string><json:string>complete dentures</json:string><json:string>dental implant therapy</json:string><json:string>hrql</json:string><json:string>mandibular prosthesis</json:string><json:string>wilcoxon</json:string><json:string>clinician</json:string><json:string>cibirka</json:string><json:string>dentistry</json:string><json:string>prosthetic rehabilitation</json:string><json:string>dental health</json:string><json:string>patient responses</json:string><json:string>subjective patient responses</json:string><json:string>prosthetic dentistry</json:string><json:string>prosthodontic rehabilitation</json:string><json:string>dental implant treatment</json:string><json:string>rank test</json:string><json:string>previous responses</json:string><json:string>dent</json:string><json:string>first questionnaire</json:string><json:string>synthetic saliva</json:string><json:string>implant treatment</json:string><json:string>lang</json:string><json:string>measurement session</json:string><json:string>subjective feelings</json:string><json:string>rank values</json:string><json:string>denture satisfaction</json:string><json:string>patient satisfaction</json:string><json:string>acrylic resins</json:string><json:string>content validity</json:string><json:string>domain</json:string><json:string>esthetics</json:string><json:string>masticatory efficiency</json:string><json:string>scientific evidence</json:string><json:string>clinical investigations</json:string><json:string>evaluative capacity</json:string><json:string>second questionnaire</json:string><json:string>psychosocial adaptation</json:string><json:string>visual analog scale</json:string><json:string>study subjects</json:string><json:string>denture therapy</json:string><json:string>life measures</json:string><json:string>subjective responses</json:string><json:string>successive questionnaires</json:string><json:string>hrql questionnaires</json:string><json:string>psychologic impact</json:string><json:string>lang table</json:string><json:string>edentulous patient</json:string><json:string>experimental population</json:string><json:string>maxillary dentures</json:string><json:string>single quality</json:string><json:string>life measure</json:string><json:string>evaluative analysis</json:string><json:string>impacting quality</json:string><json:string>dental therapy</json:string><json:string>implant experience</json:string><json:string>rank test results</json:string><json:string>interpersonal behavior</json:string><json:string>life benefits</json:string><json:string>synthetic saliva coffee</json:string><json:string>atrophic mandibles</json:string><json:string>psychological variables</json:string><json:string>psychologic factors</json:string><json:string>adaptive response</json:string><json:string>denture success</json:string><json:string>visual analogue scales</json:string><json:string>medical college</json:string><json:string>staining solutions</json:string><json:string>functional capacity</json:string><json:string>clinical trials</json:string></teeft></keywords><author><json:item><name>Roman M. Cibirka DDS, MS a</name><affiliations><json:string>Medical College of Georgia, Augusta, Ga., and University of Michigan, Ann Arbor, Mich</json:string></affiliations></json:item><json:item><name>Michael Razzoog DDS, MS, MPH b</name><affiliations><json:string>Medical College of Georgia, Augusta, Ga., and University of Michigan, Ann Arbor, Mich</json:string></affiliations></json:item><json:item><name>Brien R. Lang DDS, MSc</name><affiliations><json:string>Medical College of Georgia, Augusta, Ga., and University of Michigan, Ann Arbor, Mich</json:string></affiliations></json:item></author><arkIstex>ark:/67375/6H6-RTBPMK37-Q</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><abstract>Abstract: Statement of problem. Successful rehabilitation of the edentulous condition requires functional and psychosocial adaptation by the patient. Quality of life is markedly affected by the amount of satisfaction or dissatisfaction with their dental therapy. Patient concerns are primarily related to comfort, function, and esthetics. When these do not meet the patients expectations, anxiety, insecurity, diminished self-esteem, and introversion are typical psychosocial responses. Purpose. The objectives of the study were to assess the patient's subjective feelings about: (a) comfort, (b) function, (c) esthetics, (d) speech, (e) self-image, and (f) overall dental health with their existing complete dentures, and after implant therapy and prosthodontic rehabilitation. Material and methods. Two health-related quality of life (HRQL) questionnaires were developed to evaluate the effectiveness of dental implant therapy; one dealing with their feelings about their conventional complete dentures, and the second dealing with implant therapy. The first questionnaire was administered with supervision before receiving implant treatment. The second questionnaire was administered within 1 year after completion of prosthetic rehabilitation. Twenty-six patients who received implants to support a mandibular prosthesis and a new maxillary denture formed the experimental population. Results. Discriminative and evaluative analysis of subjective patient responses provided reliable, accurate, and reproducible results. Assessment of subject feelings before and after implant therapy and prosthodontic rehabilitation demonstrated significant differences when before treatment responses were compared with the responses after therapy. Conclusions. Significant differences for comfort, function, speech, esthetics, self-image, and dental health were demonstrated when conventional complete dentures and dental implant therapy were compared. HRQL data provided scientific evidence of an improved quality of life after dental implant therapy (p > 0.000). (J Prosthet Dent 1997;78:574)</abstract><qualityIndicators><score>10</score><pdfWordCount>5123</pdfWordCount><pdfCharCount>32786</pdfCharCount><pdfVersion>1.3</pdfVersion><pdfPageCount>8</pdfPageCount><pdfPageSize>612 x 828 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractWordCount>271</abstractWordCount><abstractCharCount>2084</abstractCharCount><keywordCount>0</keywordCount></qualityIndicators><title>Critical evaluation of patient responses to dental implant therapy</title><pmid><json:string>9421786</json:string></pmid><pii><json:string>S0022-3913(97)70008-8</json:string></pii><genre><json:string>research-article</json:string></genre><host><title>The Journal of Prosthetic Dentistry</title><language><json:string>unknown</json:string></language><publicationDate>1997</publicationDate><issn><json:string>0022-3913</json:string></issn><pii><json:string>S0022-3913(05)X7047-0</json:string></pii><volume>78</volume><issue>6</issue><pages><first>574</first><last>581</last></pages><genre><json:string>journal</json:string></genre></host><namedEntities><unitex><date><json:string>1997</json:string></date><geogName></geogName><orgName><json:string>University of Michigan</json:string><json:string>Research Assistant, Department of Prosthodontics, University of Michigan, Ann Arbor, Mich</json:string><json:string>Department of Prosthodontics, School of Dentistry, University of Michigan</json:string><json:string>Research Associate I, and Beth E</json:string><json:string>Department of Oral Rehabilitation, School of Dentistry, Medical College of Georgia</json:string></orgName><orgName_funder></orgName_funder><orgName_provider></orgName_provider><persName><json:string>College</json:string><json:string>Q. Group</json:string><json:string>R. Lang</json:string><json:string>Ann Arbor</json:string><json:string>Michael Razzoog</json:string></persName><placeName></placeName><ref_url></ref_url><ref_bibl><json:string>Guyatt et al</json:string></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/6H6-RTBPMK37-Q</json:string></ark><categories><wos><json:string>1 - science</json:string><json:string>2 - dentistry, oral surgery & medicine</json:string></wos><scienceMetrix><json:string>1 - health sciences</json:string><json:string>2 - clinical medicine</json:string><json:string>3 - dentistry</json:string></scienceMetrix><scopus><json:string>1 - Health Sciences</json:string><json:string>2 - Dentistry</json:string><json:string>3 - Oral Surgery</json:string></scopus><inist><json:string>1 - sciences appliquees, technologies et medecines</json:string><json:string>2 - sciences biologiques et medicales</json:string><json:string>3 - sciences medicales</json:string><json:string>4 - chirurgie (generalites). transplantations, greffes d'organes et de tissus. pathologie des greffons</json:string></inist></categories><publicationDate>1997</publicationDate><copyrightDate>1997</copyrightDate><doi><json:string>10.1016/S0022-3913(97)70008-8</json:string></doi><id>617C9A62F1C20F4B6D06965CC61CFD459357B675</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/617C9A62F1C20F4B6D06965CC61CFD459357B675/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/617C9A62F1C20F4B6D06965CC61CFD459357B675/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/617C9A62F1C20F4B6D06965CC61CFD459357B675/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Critical evaluation of patient responses to dental implant therapy</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>©1997 Editorial Council of The Journal of Prosthetic Dentistry</p></availability><date>1997</date></publicationStmt><notesStmt><note>Reprint requests to: Dr. Roman M. Cibirka School of Dentistry Medical College of Georgia Augusta, GA 30912-1260.</note><note>10/1/84809</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Critical evaluation of patient responses to dental implant therapy</title><author xml:id="author-0000"><persName><forename type="first">Roman M.</forename><surname>Cibirka</surname></persName><roleName type="degree">DDS, MS a</roleName><affiliation>Medical College of Georgia, Augusta, Ga., and University of Michigan, Ann Arbor, Mich</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Michael</forename><surname>Razzoog</surname></persName><roleName type="degree">DDS, MS, MPH b</roleName><affiliation>Medical College of Georgia, Augusta, Ga., and University of Michigan, Ann Arbor, Mich</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Brien R.</forename><surname>Lang</surname></persName><roleName type="degree">DDS, MSc</roleName><affiliation>Medical College of Georgia, Augusta, Ga., and University of Michigan, Ann Arbor, Mich</affiliation></author><idno type="istex">617C9A62F1C20F4B6D06965CC61CFD459357B675</idno><idno type="DOI">10.1016/S0022-3913(97)70008-8</idno><idno type="PII">S0022-3913(97)70008-8</idno></analytic><monogr><title level="j">The Journal of Prosthetic Dentistry</title><title level="j" type="abbrev">YMPR</title><idno type="pISSN">0022-3913</idno><idno type="PII">S0022-3913(05)X7047-0</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1997"></date><biblScope unit="volume">78</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="574">574</biblScope><biblScope unit="page" to="581">581</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1997</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Statement of problem. Successful rehabilitation of the edentulous condition requires functional and psychosocial adaptation by the patient. Quality of life is markedly affected by the amount of satisfaction or dissatisfaction with their dental therapy. Patient concerns are primarily related to comfort, function, and esthetics. When these do not meet the patients expectations, anxiety, insecurity, diminished self-esteem, and introversion are typical psychosocial responses. Purpose. The objectives of the study were to assess the patient's subjective feelings about: (a) comfort, (b) function, (c) esthetics, (d) speech, (e) self-image, and (f) overall dental health with their existing complete dentures, and after implant therapy and prosthodontic rehabilitation. Material and methods. Two health-related quality of life (HRQL) questionnaires were developed to evaluate the effectiveness of dental implant therapy; one dealing with their feelings about their conventional complete dentures, and the second dealing with implant therapy. The first questionnaire was administered with supervision before receiving implant treatment. The second questionnaire was administered within 1 year after completion of prosthetic rehabilitation. Twenty-six patients who received implants to support a mandibular prosthesis and a new maxillary denture formed the experimental population. Results. Discriminative and evaluative analysis of subjective patient responses provided reliable, accurate, and reproducible results. Assessment of subject feelings before and after implant therapy and prosthodontic rehabilitation demonstrated significant differences when before treatment responses were compared with the responses after therapy. Conclusions. Significant differences for comfort, function, speech, esthetics, self-image, and dental health were demonstrated when conventional complete dentures and dental implant therapy were compared. HRQL data provided scientific evidence of an improved quality of life after dental implant therapy (p < 0.000). (J Prosthet Dent 1997;78:574)</p></abstract></profileDesc><revisionDesc><change when="1997">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/617C9A62F1C20F4B6D06965CC61CFD459357B675/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier doc found" wicri:toSee="Elsevier, no converted or simple article"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 5.0.1//EN//XML" URI="art501.dtd" name="istex:docType"><istex:entity SYSTEM="gr1" NDATA="IMAGE" name="gr1"></istex:entity><istex:entity SYSTEM="gr2" NDATA="IMAGE" name="gr2"></istex:entity></istex:docType><istex:document><article docsubtype="fla" xml:lang="en"><item-info><jid>YMPR</jid><aid>84809</aid><ce:pii>S0022-3913(97)70008-8</ce:pii><ce:doi>10.1016/S0022-3913(97)70008-8</ce:doi><ce:copyright type="other" year="1997">Editorial Council of The Journal of Prosthetic Dentistry</ce:copyright></item-info><head><ce:article-footnote><ce:label>☆</ce:label><ce:note-para>Reprint requests to: Dr. Roman M. Cibirka School of Dentistry Medical College of Georgia Augusta, GA 30912-1260.</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>☆☆</ce:label><ce:note-para><ce:bold>10/1/84809</ce:bold></ce:note-para></ce:article-footnote><ce:title>Critical evaluation of patient responses to dental implant therapy</ce:title><ce:author-group><ce:author><ce:given-name>Roman M.</ce:given-name><ce:surname>Cibirka</ce:surname><ce:degrees>DDS, MS <ce:sup>a</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>Michael</ce:given-name><ce:surname>Razzoog</ce:surname><ce:degrees>DDS, MS, MPH <ce:sup>b</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>Brien R.</ce:given-name><ce:surname>Lang</ce:surname><ce:degrees>DDS, MSc</ce:degrees></ce:author><ce:affiliation><ce:textfn>Medical College of Georgia, Augusta, Ga., and University of Michigan, Ann Arbor, Mich</ce:textfn></ce:affiliation></ce:author-group><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para><ce:bold>Statement of problem.</ce:bold> Successful rehabilitation of the edentulous condition requires functional and psychosocial adaptation by the patient. Quality of life is markedly affected by the amount of satisfaction or dissatisfaction with their dental therapy. Patient concerns are primarily related to comfort, function, and esthetics. When these do not meet the patients expectations, anxiety, insecurity, diminished self-esteem, and introversion are typical psychosocial responses.</ce:simple-para><ce:simple-para><ce:bold>Purpose.</ce:bold> The objectives of the study were to assess the patient's subjective feelings about: (a) comfort, (b) function, (c) esthetics, (d) speech, (e) self-image, and (f) overall dental health with their existing complete dentures, and after implant therapy and prosthodontic rehabilitation. <ce:bold>Material and methods.</ce:bold> Two health-related quality of life (HRQL) questionnaires were developed to evaluate the effectiveness of dental implant therapy; one dealing with their feelings about their conventional complete dentures, and the second dealing with implant therapy. The first questionnaire was administered with supervision before receiving implant treatment. The second questionnaire was administered within 1 year after completion of prosthetic rehabilitation. Twenty-six patients who received implants to support a mandibular prosthesis and a new maxillary denture formed the experimental population. <ce:bold>Results.</ce:bold> Discriminative and evaluative analysis of subjective patient responses provided reliable, accurate, and reproducible results. Assessment of subject feelings before and after implant therapy and prosthodontic rehabilitation demonstrated significant differences when before treatment responses were compared with the responses after therapy. <ce:bold>Conclusions.</ce:bold> Significant differences for comfort, function, speech, esthetics, self-image, and dental health were demonstrated when conventional complete dentures and dental implant therapy were compared. HRQL data provided scientific evidence of an improved quality of life after dental implant therapy (<ce:italic>p</ce:italic> < 0.000). (J Prosthet Dent 1997;78:574)</ce:simple-para></ce:abstract-sec></ce:abstract></head><body><ce:sections><ce:para><ce:display><ce:textbox><ce:textbox-body><ce:sections><ce:para><ce:italic>The clinical findings in this study support the use of dental implants to manage the dissatisfied conventional complete denture patient. However, additional health-related quality of life (HRQL) questionnaires need to be administered over 2-year and 4-year evaluation periods to provide meaningful longitudinal measures of patient responses to dental implant therapy and prosthodontic rehabilitation.</ce:italic></ce:para></ce:sections></ce:textbox-body></ce:textbox></ce:display></ce:para><ce:para>Acceptance of artificial replacements for missing natural teeth and thus successful complete denture therapy requires both functional and psychosocial adaptation by the patient. Despite excellent prosthetic replacement, the loss of teeth may cause emotional responses that can directly impact one's quality of life. For the edentulous patient who suffers from both a disability and a handicap, the quality of life is markedly affected by the amount of satisfaction or dissatisfaction with their complete dentures. Unfortunately, it seems that judgments about denture quality and satisfaction by clinicians correlates quite poorly with the patients' own judgments, possibly because the patients concerns are more related to comfort, function, and esthetics, which are factors that are extremely difficult for the clinician to measure.<ce:cross-refs refid="bib1 bib2"><ce:sup>1,2</ce:sup></ce:cross-refs> When these factors do not fully meet the patient's level of expectation, anxiety, insecurity, diminished self-esteem, and introversion are typical psychosocial responses after denture therapy.<ce:cross-refs refid="bib3 bib4 bib5 bib6 bib7"><ce:sup>3-7</ce:sup></ce:cross-refs></ce:para><ce:para>Many authors have discussed denture satisfaction in terms of psychological variables<ce:cross-refs refid="bib3 bib8 bib13 bib14"><ce:sup>.3,8,13,14</ce:sup></ce:cross-refs> Application of personality trait measures has been suggested to identify patients with a propensity for adaptive difficulties.<ce:cross-refs refid="bib3 bib8 bib13 bib14"><ce:sup>3,8,13,14</ce:sup></ce:cross-refs> Few controlled studies have examined the predictive value of information related to patient perceptions, expectations, and prior experiences.<ce:cross-refs refid="bib1 bib4 bib17 bib18 bib19 bib20"><ce:sup>1,4,17-20</ce:sup></ce:cross-refs> Patients at risk for conventional treatment failure may be evaluated by two approaches that have appeared in the literature: (a) psychometric inventories to assess various measures of personality such as emotionality, neuroticism, and locus of control; or (b) questionnaires designed to elicit pertinent information related to the patients' prior experiences, perceptions, and expectations of the dental treatment.<ce:cross-ref refid="bib10"><ce:sup>10</ce:sup></ce:cross-ref> These previous investigations have provided inconsistent results.<ce:cross-refs refid="bib3 bib8 bib9 bib13 bib14"><ce:sup>3,8,9,13,14</ce:sup></ce:cross-refs></ce:para><ce:para>Health-related quality of life (HRQL) questionnaires have been used to evaluate aspects of life that are not generally considered as “health” and include interpersonal relationships, self-esteem, and confidence. Health, in this sense, can be applied to the effectiveness of dental therapy in controlled clinical trials. Although the treatment modalities being assessed may be considered by some to be distant from health, their impact on one's life can become health-related. For example, HRQL questions that address the effectiveness of dental implant therapy, when answered by patients, can produce responses that range from negatively valued responses before implant therapy (dissatisfied with denture retention), to more positively valued functional status after implant treatment and prosthetic rehabilitation (much better ability to chew). The patient responses to these HRQL questions provide clinicians and researchers with valuable information about the effectiveness of implant therapy on functional capacity and well-being, areas in which patients are most interested and familiar. Physiologic measures from chewing tests are commonly used to determine masticatory efficiency, but these data correlate poorly with functional capacity and well-being.</ce:para><ce:para>Another observation with the use of HRQL questionnaires in clinical trials is the phenomena that two patients with the same clinical situation often give dramatically different responses when questioned. For example, two patients with the same degree of looseness to their dentures may have very different emotional reactions. Although some of the patients may wear their dentures and interact with other persons in public, others will become introverted and avoid personal contacts. Such reactions by patients explain why clinicians, researchers, and healthcare administrators are interested in the HRQL questionnaires that measure the effects of different therapies.</ce:para><ce:para>HRQL questionnaires consist of a number of interrelated questions that form a domain, or the experience being measured. The number of questions within a domain is limited for clinical investigations that use this method. Questions asked, such as (1) does chewing loosen the mandibular prosthesis, (2) have your eating habits changed, and (3) are there foods so difficult to chew that you avoid them, may constitute a domain on function. The value assigned to each of the questions may be weighted relative to others, or equally weighted, which assumes that the value of each question is equal.</ce:para><ce:para>HRQL questionnaires are administered by trained interviewers or are self-administered. The former method is resource intensive, but assures compliance, decreased errors, and missing items. The latter approach is much less expensive, however, the number of errors and missing responses are increased. A compromise between the two is to have the questionnaires completed with supervision. HRQL questionnaires are designed to (1) differentiate between people who have a better HRQL response, and those who do not, or a discriminative capability, and (2) measure how much HRQL has changed, or the evaluative capacity of the questionnaire.</ce:para><ce:para>If the questionnaire is to be considered reliable, it must be accurate and reproducible. Reproducibility means having a high signal-to-noise ratio, and the way of quantifying the signal-to-noise ratio is to determine the reliability of the questionnaire. If the variability in scores between patients is much greater than the variability within patients, the questionnaire will be deemed reliable. Accuracy indicates whether the questionnaire is really measuring what it was intended to measure.</ce:para><ce:para>The evaluative capacity of a questionnaire is its ability to measure change within patients during a specified time period. Responsiveness is the signal-to-noise ratio determined during the measurement session, or the ability of a questionnaire to detect change. It is directly related to the degree of the difference in scores in patients who have improved or deteriorated and the extent to which patients who have not changed (the signal) to record the same or similar scores (the noise). When no “standard” exists as the criterion against which the HRQL measure can be compared, face and content validity must be considered. Face validity determines whether a questionnaire is measuring what it is intended to measure, and content validity establishes the extent to which the domain of interest is examined by the questions. Quantitative testing of face and content validity are rarely attempted.<ce:cross-ref refid="bib15"><ce:sup>15</ce:sup></ce:cross-ref></ce:para><ce:para>For discriminative purposes or interpretability, the scores for the questions should indicate whether mild, moderate, or severe changes have occurred. The changes may represent trivial, small, moderate, or large improvement or deterioration. Patient responses to questions can be assessed on a graduated scale, sometimes with as few as two divisions, for example, satisfactory and unsatisfactory, or the divisions may be as many as five. Such methods are simple to use but do not discriminate well when there are few divisions, and subjects tend to choose the central section when scales with an odd number of choices are used.</ce:para><ce:para>Alternatively, a visual analog scale (VAS) can be used.<ce:cross-ref refid="bib11"><ce:sup>11</ce:sup></ce:cross-ref> The VAS consists of a line 10 cm in length representing a spectrum of feeling between extremes identified by end-phrases. The end-phrases provide subjects with meaningful limits to their feelings. For example, in response to the question, “do you feel discomfort with your mandibular prosthesis,” the left side of the line would represent the response “always,” whereas the right side would be “never.” The left end-phrase would be the zero point representing the measurement origin and the least favorable response or a percentage of zero. The right end-phrase would represent a 100% value and the most favorable response for the question. The patients could circle either end-phrase as a response, or place a vertical mark on the line at a point corresponding to their feelings at that time. The distance of the mark from the left-hand limit is divided by 100 or the length of the line and reported as a percentage. The magnitude of the percentage in the example would represent the degree of comfort.</ce:para><ce:para>When using questionnaires that report measurement of subjective states over time, investigators will usually not allow study subjects to see their prior responses (blind administration).<ce:cross-ref refid="bib16"><ce:sup>16</ce:sup></ce:cross-ref> The reasoning for this approach is that availability of previous responses may introduce bias.<ce:cross-refs refid="bib17 bib18 bib19 bib20"><ce:sup>17-20</ce:sup></ce:cross-refs> The biases postulated include: (a) subjects may repeat their prior answers, even when real change has occurred; or (b) they may exaggerate changes to please the investigator or clinician. However, there is no data to demonstrate that these biases actually occur.<ce:cross-ref refid="bib16"><ce:sup>16</ce:sup></ce:cross-ref> Guyatt et al.<ce:cross-ref refid="bib16"><ce:sup>16</ce:sup></ce:cross-ref> suggested allowing patients to see their previous responses because their clinical investigations on treatment and quality of life measures demonstrated significant improvement in the validity of the subjective responses by patients. In another study, Guyatt et at.<ce:cross-ref refid="bib16"><ce:sup>16</ce:sup></ce:cross-ref> demonstrated that patients who were aware of their earlier responses used the response options in a consistent manner from measurement session to measurement session. Informing patients of their previous responses acted as a method of calibration, which is extremely important in areas where subjective evaluation is required and patients may not be familiar or comfortable with trying to quantify their internal experience.</ce:para><ce:para>Implant therapy has been suggested as a treatment approach to satisfying the edentulous patient having difficulties adapting to complete dentures.<ce:cross-refs refid="bib21 bib22 bib23 bib24 bib25 bib26 bib27 bib28"><ce:sup>21-28</ce:sup></ce:cross-refs> Several studies have shown that oral function is significantly improved in edentulous patients after implant treatment.<ce:cross-refs refid="bib24 bib25"><ce:sup>24,25</ce:sup></ce:cross-refs> Blomberg<ce:cross-ref refid="bib26"><ce:sup>26</ce:sup></ce:cross-ref> also indicated that patients consider the osseointegrated prostheses to be an integrated part of their bodies, leading to obvious improvement in their life situation. Kiyak et al.<ce:cross-ref refid="bib29"><ce:sup>29</ce:sup></ce:cross-ref> found significant improvements were not limited to the teeth, but the face, mouth, and overall self-image. However, the paucity of information reporting the influence of implant therapy on quality of life and overall health-related factors prompted investigators to initiate an HRQL longitudinal study on the impact of implant therapy.</ce:para><ce:para>The objectives of the study were to assess the patient's subjective feelings about (a) comfort, (b) function, (c) esthetics, (d) speech, (e) self-image, and (f) their overall dental health after receiving implant therapy and prosthodontic rehabilitation within 1 year after treatment. Successive questionnaires are planned for years 2 and 4 for the long-term evaluation of therapy and quality of life.</ce:para><ce:section><ce:section-title>Material and methods</ce:section-title><ce:para>The HRQL questionnaires were developed by the authors specifically for this investigation. The questionnaires were administered by members of the Michigan Osseointegration Implant Study Club to patients in their practices.</ce:para><ce:para>Twenty-six patients who met the specific criteria of the study were selected. The inclusion criteria for selection were an experienced conventional complete denture wearer of several years duration (>1 year duration) who was treatment planned for a mandibular fixed implant-supported prosthesis opposing a maxillary conventional complete denture. Patients should not have undergone second-stage surgery before the administration of the first questionnaire. The exclusion criteria included patients who were not of legal age to sign an advised consent statement.</ce:para><ce:para>The prospective nature of this investigation required the first questionnaire to be administered as early as possible before psychologic impact of the dental implant therapy. Questionnaire 2 was administered at approximately 1-year after completion of the implant reconstruction. Successive questionnaires are planned for years 2 and 4 for the long-term evaluation of therapy and quality of life.</ce:para><ce:section><ce:section-title>The HRQL questionnaires</ce:section-title><ce:para>Two questionnaires were developed to address HRQL measures; one dealing with conventional complete dentures and the second dealing with implant therapy. The questionnaires contained demographic and odontologic history data, followed by 48 questions on six domains. Eight questions dealt with comfort, 13 with function, 15 with esthetics, 3 with speech, 7 with self-image, and 2 with dental health. Patient responses were recorded by placement of vertical marks on a visual analog scale as previously described.</ce:para><ce:para>The first questionnaire was administered with supervision before the patients received implant treatment. The second questionnaire was administered within 1 year after completion of the prosthetic rehabilitation. Before questionnaire 2 was completed, each patient was allowed to review their responses in questionnaire 1.</ce:para></ce:section></ce:section><ce:section><ce:section-title>Results</ce:section-title><ce:para>Analysis of the demographic data for the 26 patients demonstrated an experimental population consisting of 80% women and 20% men. The distribution of patients by age ranged from 40 to 72 years. The patients had been edentulous in the maxillary and mandibular arches from 1 year to more than 20 years. The length of time wearing a maxillary complete denture also ranged from 1 year to more than 20 years. The length of time for wearing a mandibular complete denture ranged from 1 year to more than 15 years, but less than 20 years, which indicated that some patients did not wear their mandibular denture for various reasons. The majority of patients had been wearing conventional complete dentures for more than 2 to 5 years.</ce:para><ce:para>The VAS was subdivided into three sections: 0% to 33%, 34% to 66%, and 67% to 100%. Each subdivision was assigned a value from 1 to 3 for analysis using nonparametric tests. The number of patients whose response as determined by the VAS to fall within each subdivision for each of the 48 questions were then tabulated. The patient totals within each subdivision were divided by the total number of patients (26) to determine the percentage with similar feelings. The questions were then grouped together for each of the six domains.</ce:para><ce:para>The data for questionnaire 1 were compared with questionnaire 2 with the Wilcoxon signed rank test. The domains are identified in Table I.
<ce:display><ce:table colsep="0" rowsep="0" frame="topbot"><ce:label>Table I</ce:label><ce:caption><ce:simple-para>Six interrelated areas identified as health-related quality of life domains</ce:simple-para></ce:caption><tgroup cols="2"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><tbody><row rowsep="1"><entry>Q. Group 1<ce:hsp sp="1.0"></ce:hsp><ce:hsp sp="1.0"></ce:hsp></entry><entry>Comfort</entry></row><row rowsep="1"><entry>Q. Group 2<ce:hsp sp="1.0"></ce:hsp><ce:hsp sp="1.0"></ce:hsp></entry><entry>Function</entry></row><row rowsep="1"><entry>Q. Group 3<ce:hsp sp="1.0"></ce:hsp><ce:hsp sp="1.0"></ce:hsp></entry><entry>Speech</entry></row><row rowsep="1"><entry>Q. Group 4<ce:hsp sp="1.0"></ce:hsp><ce:hsp sp="1.0"></ce:hsp></entry><entry>Esthetics</entry></row><row rowsep="1"><entry>Q. Group 5<ce:hsp sp="1.0"></ce:hsp><ce:hsp sp="1.0"></ce:hsp></entry><entry>Self-image</entry></row><row><entry>Q. Group 6<ce:hsp sp="1.0"></ce:hsp><ce:hsp sp="1.0"></ce:hsp></entry><entry>Dental health</entry></row></tbody></tgroup></ce:table></ce:display>The <ce:italic>p</ce:italic> values for each question by domain are presented in Table II with significant differences at the 0.05% level of confidence.
<ce:display><ce:table colsep="0" rowsep="0" frame="topbot"><ce:label>Table II</ce:label><ce:caption><ce:simple-para>Levels of significance for each question by domain</ce:simple-para></ce:caption><tgroup cols="3"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><tbody><row rowsep="1"><entry><ce:bold>Domain</ce:bold></entry><entry align="center"><ce:bold>Number of questions in domain</ce:bold></entry><entry align="center"><ce:bold><ce:italic>p</ce:italic>-value*</ce:bold></entry></row><row rowsep="1"><entry>#1 - Comfort</entry><entry align="center">1</entry><entry align="center">0.109</entry></row><row rowsep="1"><entry></entry><entry align="center">2</entry><entry align="center">0.345</entry></row><row rowsep="1"><entry></entry><entry align="center">3</entry><entry align="center">0.059</entry></row><row rowsep="1"><entry></entry><entry align="center">4</entry><entry align="center"><0.0001</entry></row><row rowsep="1"><entry></entry><entry align="center">5</entry><entry align="center">0.779</entry></row><row rowsep="1"><entry></entry><entry align="center">6</entry><entry align="center">0.000</entry></row><row rowsep="1"><entry></entry><entry align="center">7</entry><entry align="center">0.610</entry></row><row rowsep="1"><entry></entry><entry align="center">8</entry><entry align="center">0.000</entry></row><row rowsep="1"><entry>#2 - Function</entry><entry align="center">1</entry><entry align="center">0.003</entry></row><row rowsep="1"><entry></entry><entry align="center">2</entry><entry align="center">0.002</entry></row><row rowsep="1"><entry></entry><entry align="center">3</entry><entry align="center">0.001</entry></row><row rowsep="1"><entry></entry><entry align="center">4</entry><entry align="center">0.002</entry></row><row rowsep="1"><entry></entry><entry align="center">5</entry><entry align="center">0.790</entry></row><row rowsep="1"><entry></entry><entry align="center">6</entry><entry align="center">0.051</entry></row><row rowsep="1"><entry></entry><entry align="center">7</entry><entry align="center">0.000</entry></row><row rowsep="1"><entry></entry><entry align="center">8</entry><entry align="center">0.496</entry></row><row rowsep="1"><entry></entry><entry align="center">9</entry><entry align="center">0.807</entry></row><row rowsep="1"><entry></entry><entry align="center">10</entry><entry align="center"><0.0001</entry></row><row rowsep="1"><entry></entry><entry align="center">11</entry><entry align="center">0.019</entry></row><row rowsep="1"><entry></entry><entry align="center">12</entry><entry align="center">0.638</entry></row><row rowsep="1"><entry></entry><entry align="center">13</entry><entry align="center">0.000</entry></row><row rowsep="1"><entry>#3 - Speech</entry><entry align="center">1</entry><entry align="center">0.109</entry></row><row rowsep="1"><entry></entry><entry align="center">2</entry><entry align="center">0.051</entry></row><row rowsep="1"><entry></entry><entry align="center">3</entry><entry align="center">0.008</entry></row><row rowsep="1"><entry>#4 Esthetics</entry><entry align="center">1</entry><entry align="center">0.345</entry></row><row rowsep="1"><entry></entry><entry align="center">2</entry><entry align="center">0.208</entry></row><row rowsep="1"><entry></entry><entry align="center">3</entry><entry align="center">0.008</entry></row><row rowsep="1"><entry></entry><entry align="center">4</entry><entry align="center">0.009</entry></row><row rowsep="1"><entry></entry><entry align="center">5</entry><entry align="center">0.715</entry></row><row rowsep="1"><entry></entry><entry align="center">6</entry><entry align="center">0.139</entry></row><row rowsep="1"><entry></entry><entry align="center">7</entry><entry align="center">0.660</entry></row><row rowsep="1"><entry></entry><entry align="center">8</entry><entry align="center">0.018</entry></row><row rowsep="1"><entry></entry><entry align="center">9</entry><entry align="center">0.138</entry></row><row rowsep="1"><entry></entry><entry align="center">10</entry><entry align="center">0.028</entry></row><row rowsep="1"><entry></entry><entry align="center">11</entry><entry align="center">0.445</entry></row><row rowsep="1"><entry></entry><entry align="center">12</entry><entry align="center">0.445</entry></row><row rowsep="1"><entry></entry><entry align="center">13</entry><entry align="center">0.033</entry></row><row rowsep="1"><entry></entry><entry align="center">14</entry><entry align="center">0.050</entry></row><row rowsep="1"><entry></entry><entry align="center">15</entry><entry align="center">0.477</entry></row><row rowsep="1"><entry>#5 - Self-image</entry><entry align="center">1</entry><entry align="center">0.178</entry></row><row rowsep="1"><entry></entry><entry align="center">2</entry><entry align="center">0.018</entry></row><row rowsep="1"><entry></entry><entry align="center">3</entry><entry align="center">0.655</entry></row><row rowsep="1"><entry></entry><entry align="center">4</entry><entry align="center">0.009</entry></row><row rowsep="1"><entry></entry><entry align="center">6</entry><entry align="center">0.023</entry></row><row rowsep="1"><entry></entry><entry align="center">7</entry><entry align="center">0.012</entry></row><row rowsep="1"><entry>#6 - Dental health</entry><entry align="center">1</entry><entry align="center">0.002</entry></row><row rowsep="1"><entry></entry><entry align="center">2</entry><entry align="center">0.000</entry></row><row><entry namest="col1" nameend="col3"></entry></row></tbody></tgroup><ce:legend><ce:simple-para>*<ce:italic>p</ce:italic>-value of Wilcoxon signed rank test.</ce:simple-para></ce:legend></ce:table></ce:display>A number of questions demonstrated significant differences between the two questionnaires. All questions within a domain were further analyzed for the two questionnaires. Significant differences were found in all six domains (<ce:italic>p</ce:italic> < 0.001).</ce:para><ce:para>All questions within a domain were further subdivided into those dealing with the maxillary or the mandibular prosthesis for further analysis. The mean rank value of the summation of the questions within the domain as related to the particular arch are listed in Table III.
<ce:display><ce:table colsep="0" rowsep="0" frame="topbot"><ce:label>Table III</ce:label><ce:caption><ce:simple-para>Mean rank values for all questions in a domain for the maxillary and mandibular prosthesis</ce:simple-para></ce:caption><tgroup cols="5"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><colspec colname="col5" colsep="0"></colspec><tbody><row rowsep="1"><entry></entry><entry align="center"></entry><entry namest="col3" nameend="col4" align="center"><ce:bold>Mean rank</ce:bold></entry><entry colname="col5" align="center"></entry></row><row rowsep="1"><entry><ce:bold>Prosthesis</ce:bold> </entry><entry align="center"><ce:bold>Domain</ce:bold></entry><entry align="center"><ce:bold>Before</ce:bold></entry><entry align="center"><ce:bold> After</ce:bold></entry><entry align="center"><ce:bold><ce:italic>p</ce:italic>-value*</ce:bold></entry></row><row rowsep="1"><entry>Maxillary</entry><entry align="center">Q. Group 1</entry><entry align="center">16.98</entry><entry align="center">17.04</entry><entry align="center">0.2918</entry></row><row rowsep="1"><entry>Maxillary</entry><entry align="center">Q. Group 2</entry><entry align="center">6.00</entry><entry align="center">8.17</entry><entry align="center">0.8068</entry></row><row rowsep="1"><entry>Maxillary</entry><entry align="center">Q. Group 3</entry><entry align="center">6.11</entry><entry align="center">5.50</entry><entry align="center">0.0505</entry></row><row rowsep="1"><entry>Maxillary</entry><entry align="center">Q. Group 4</entry><entry align="center">30.33</entry><entry align="center">28.14</entry><entry align="center">0.0671</entry></row><row rowsep="1"><entry>Maxillary</entry><entry align="center">Q. Group 5</entry><entry align="center">3.13</entry><entry align="center">2.50</entry><entry align="center">0.1775</entry></row><row rowsep="1"><entry>Mandibular</entry><entry align="center">Q. Group 1</entry><entry align="center">32.91</entry><entry align="center">35.75</entry><entry align="center"><0.0001</entry></row><row rowsep="1"><entry>Mandibular</entry><entry align="center">Q. Group 2</entry><entry align="center">11.00</entry><entry align="center">—</entry><entry align="center"><0.0001</entry></row><row rowsep="1"><entry>Mandibular</entry><entry align="center">Q. Group 3</entry><entry align="center">9.19</entry><entry align="center">5.50</entry><entry align="center">0.0077</entry></row><row rowsep="1"><entry>Mandibular</entry><entry align="center">Q. Group 4</entry><entry align="center">27.45</entry><entry align="center">27.64</entry><entry align="center">0.0022</entry></row><row rowsep="1"><entry>Mandibular</entry><entry align="center">Q. Group 5</entry><entry align="center">4.00</entry><entry align="center">—</entry><entry align="center">0.0180</entry></row><row><entry namest="col1" nameend="col5"></entry></row></tbody></tgroup><ce:legend><ce:simple-para>*<ce:italic>p</ce:italic>-value of Wilcoxon signed rank test.</ce:simple-para></ce:legend></ce:table></ce:display>The <ce:italic>p</ce:italic> values for each domain as subdivided by prosthesis are listed in Table III with significant differences at the 0.05% level of confidence when comparing the mandibular conventional prosthesis to the implant prosthesis. Although significant differences were not found in all six domains for the maxillary dentures, several indicated a tendency in this direction.</ce:para><ce:para>In addition, the data for all six domains were grouped together and subdivided by prosthesis. These data were analyzed, and significant differences were found in comparing the mandibular complete denture to the implant prosthesis (<ce:italic>p</ce:italic> < 0.0001) as shown in Table IV.
<ce:display><ce:table colsep="0" rowsep="0" frame="topbot"><ce:label>Table IV</ce:label><ce:caption><ce:simple-para>Mean rank values for all domains combined for the maxillary and mandibular prosthesis</ce:simple-para></ce:caption><tgroup cols="5"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><colspec colname="col5" colsep="0"></colspec><tbody><row rowsep="1"><entry></entry><entry align="center"></entry><entry namest="col3" nameend="col4" align="center"><ce:bold>Mean rank</ce:bold></entry><entry colname="col5" align="center"></entry></row><row rowsep="1"><entry><ce:bold>Prosthesis</ce:bold></entry><entry align="center"><ce:bold>Domain</ce:bold></entry><entry align="center"><ce:bold>Before</ce:bold></entry><entry align="center"><ce:bold> After</ce:bold></entry><entry align="center"><ce:bold><ce:italic>p</ce:italic>-value*</ce:bold></entry></row><row rowsep="1"><entry>Maxillary</entry><entry align="center">All</entry><entry align="center">60.68</entry><entry align="center">60.18</entry><entry align="center">0.010</entry></row><row rowsep="1"><entry>Mandibular</entry><entry align="center">All</entry><entry align="center">82.89</entry><entry align="center">75.24</entry><entry align="center"><0.0001</entry></row><row><entry namest="col1" nameend="col5"></entry></row></tbody></tgroup><ce:legend><ce:simple-para>*<ce:italic>p</ce:italic>-value of Wilcoxon signed rank test.</ce:simple-para></ce:legend></ce:table></ce:display>Significant differences were found in comparing the maxillary dentures for the two time periods (<ce:italic>p</ce:italic> = 0.01).</ce:para><ce:para>Finally, the data for all six domains for the maxillary and mandibular prostheses were grouped together and analyzed as a single quality of life measure (Table V).
<ce:display><ce:table colsep="0" rowsep="0" frame="topbot"><ce:label>Table V</ce:label><ce:caption><ce:simple-para>Mean rank values for all questions in a domain for combined maxillary and mandibular prostheses</ce:simple-para></ce:caption><tgroup cols="5"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><colspec colname="col5" colsep="0"></colspec><tbody><row rowsep="1"><entry></entry><entry align="center"></entry><entry namest="col3" nameend="col4" align="center"><ce:bold>Mean rank</ce:bold></entry><entry colname="col5" align="center"></entry></row><row rowsep="1"><entry><ce:bold>Prosthesis</ce:bold></entry><entry align="center"><ce:bold>Domain</ce:bold></entry><entry align="center"><ce:bold>Before</ce:bold></entry><entry align="center"><ce:bold> After</ce:bold></entry><entry align="center"><ce:bold><ce:italic>p</ce:italic>-value*</ce:bold></entry></row><row rowsep="1"><entry><ce:bold>Maxillary and mandibular</ce:bold></entry><entry align="center"><ce:bold>All</ce:bold></entry><entry align="center"><ce:bold>280.05</ce:bold></entry><entry align="center"><ce:bold>244.46</ce:bold></entry><entry align="center"><ce:bold><0.0001</ce:bold></entry></row><row rowsep="1"><entry></entry><entry align="center">Q. Group 1</entry><entry align="center">50.62</entry><entry align="center">43.30</entry><entry align="center"><0.0001</entry></row><row rowsep="1"><entry></entry><entry align="center">Q. Group 2</entry><entry align="center">98.40</entry><entry align="center">87.00</entry><entry align="center"><0.0001</entry></row><row rowsep="1"><entry></entry><entry align="center">Q. Group 3</entry><entry align="center">16.20</entry><entry align="center">12.00</entry><entry align="center">0.000</entry></row><row rowsep="1"><entry></entry><entry align="center">Q. Group 4</entry><entry align="center">68.62</entry><entry align="center">68.26</entry><entry align="center">0.001</entry></row><row rowsep="1"><entry></entry><entry align="center">Q. Group 5</entry><entry align="center">29.84</entry><entry align="center">21.50</entry><entry align="center"><0.0001</entry></row><row rowsep="1"><entry></entry><entry align="center">Q. Group 6</entry><entry align="center">17.27</entry><entry align="center">8.50</entry><entry align="center"><0.0001</entry></row><row><entry namest="col1" nameend="col5"></entry></row></tbody></tgroup><ce:legend><ce:simple-para>*<ce:italic>p</ce:italic>-value of Wilcoxon signed rank test.</ce:simple-para></ce:legend></ce:table></ce:display>Significant differences were found when conventional complete dentures were compared with a mandibular implant-supported prosthesis (<ce:italic>p</ce:italic> < 0.0001).</ce:para></ce:section><ce:section><ce:section-title>Discussion</ce:section-title><ce:para>The purpose of this study was to assess the effect of dental implant therapy on patients' subjective feelings about the domains of comfort, function, esthetics, speech, self-image, and overall dental health. These parameters afforded evaluation of health-related factors and quality of life. Evaluation was interpreted by patient responses to several questions related to the six domains.</ce:para><ce:para>The functional and psychosocial disability experienced by the nonadaptive denture patient may be greatly improved by the use of dental implant therapy and prosthetic rehabilitation.<ce:cross-refs refid="bib24 bib25 bib28"><ce:sup>24,25,28</ce:sup></ce:cross-refs> The adverse emotional responses directly impacting quality of life measures by the maladaptive denture patient may be significantly improved through dental implant treatment.</ce:para><ce:para>To date, functional and psychosocial evaluations of dental handicaps have been retrospective studies with various techniques that primarily use questionnaires for subjective patient responses.<ce:cross-refs refid="bib1 bib3 bib8 bib9 bib12 bib17 bib18 bib19 bib20"><ce:sup>1,3,8,9,12,17-20</ce:sup></ce:cross-refs> This study provided a prospective evaluation of subjective patient responses to dental implant treatment and prosthetic rehabilitation. The patients were experienced, complete denture wearers with differing degrees of adaptation. Questionnaire 1 was administered before surgery to reduce the psychologic impact of the implant therapy from the study outcome.</ce:para><ce:para>Health-related quality of life (HRQL) questionnaires have been used to assess parameters of life not considered bodily, although directly impacting one's quality of life. The questionnaires used in this study consisted of demographic and odontologic questions. The randomly positioned questions relating to the implant experience were equally weighted and formed domains when categorized for evaluation.</ce:para><ce:para>The HRQL questionnaires provided discriminative and evaluative analysis of the subjective patient responses with seemingly reliable, accurate, and reproducible results. No quantitative data indicating blind administration of questionnaires to reduce bias have been published. The validity of the subjective measures in this study by allowing the patients to evaluate their responses from questionnaire 1 before completing questionnaire 2 is supported by Guyatt et al.<ce:cross-refs refid="bib15 bib16"><ce:sup>15,16</ce:sup></ce:cross-refs> Awareness of previous responses allowed for consistency and served as a method of calibration for the response of the implant experience by the patient. The author suggested that this method, when applied to smaller populations, approached an anticipated global response rate.</ce:para><ce:para>The calculation of the percentage of patient feelings about a question and assigning this value to a specific subdivision of (1) 0% to 33%; (2) 34% to 66%; and (3) 67% to 100%, clearly separated feelings about the subject of the question into three categories of worse, the same, or better. The change in each subdivision within a domain between questionnaires 1 and 2 can be seen in Figure 1.
<ce:display><ce:figure id="fig1"><ce:label>Fig. 1</ce:label><ce:caption><ce:simple-para>Wilcoxon signed rank test results before and after implant therapy. Responses are subdivided into worse, same, and better categories. For domains of comfort, function, speech, esthetics, self-image, and conclusion increases in number of responses “better” after implant therapy are quite evident.</ce:simple-para></ce:caption> <ce:link locator="gr1"></ce:link></ce:figure></ce:display>The greatest changes were seen in the domains of comfort, function, self-image, and dental health, with significant differences of <ce:italic>p</ce:italic> < 0.0001.</ce:para><ce:para>The domain of comfort indicated two questions had the greatest impact on the shift in responses by patients. The questions, “how good a fit is your mandibular prosthesis” and “do you feel the mandibular prosthesis is ‘foreign' in your mouth or part of yourself,” were responsible for the significant shift in the 67% to 100% zone in <ce:cross-ref refid="fig1">Figure 1</ce:cross-ref>. The corresponding decrease in the other zones support the improvement in subjective patient responses attributed to the dental implant treatment. The attribute of comfort, a factor difficult for the clinician to measure irrespective of the excellence of the prosthesis, may be predictive of successful prosthetic management. Clearly, implant treatment and prosthodontic rehabilitation appeared to have a positive impact on this domain.</ce:para><ce:para>Function, a domain related to masticatory efficiency and confidence, had the most impact by three questions, “does chewing loosen the mandibular prosthesis,” “have your eating habits changed,” and “are there foods so difficult to chew that you avoid them.” The responses by patients afforded the percentage shift illustrated by the change in the area of the 67% to 100% zone and diminution of the 0% to 33% zone (<ce:cross-ref refid="fig1">Fig. 1</ce:cross-ref>). The minimal change in the 34% to 66% zone, or no change zone, may be attributed to the habitual diet of patients and lack of motivation to change irrespective of functional ability.</ce:para><ce:para>Self-image as related to denture satisfaction has been documented in the literature.<ce:cross-refs refid="bib1 bib3 bib8 bib9 bib10 bib12"><ce:sup>1,3,8-10,12</ce:sup></ce:cross-refs> Questions related to confidence, self-esteem, and psychosocial behavior were asked of the patients. The three questions producing the most significant effect on the comparison between questionnaires 1 and 2 were “has your self-confidence improved because of your upper denture,” “do you avoid smiling,” and “does wearing a lower prosthesis cause you any nervousness.” The dramatic reduction in the 0% to 33% zone, or worsened effect from treatment and corresponding increase in area of the 67% to 100% zone would support the enhancement of self-image characteristics experienced by patients. The improved confidence and security provided through dental implant treatment may have allowed patients to reduce their anxieties related to conventional removable prostheses while improving interpersonal behavior and psychosocial interactions.</ce:para><ce:para>The domains of speech and esthetics produced less dramatic increases in satisfaction levels associated with the dental implant treatment. The percentage increases in the areas of the 67% to 100% zone related to these domains are evidenced in <ce:cross-ref refid="fig1">Figure 1</ce:cross-ref>. Interestingly, the greatest influence on the response change in the esthetic domain was related to the question, “do the (maxillary) teeth look natural?” This question produced the significant difference (<ce:italic>p</ce:italic> = 0.01) for the maxillary prosthesis when all questions in all domains were grouped together and subdivided by prostheses. Again, it may be speculated that the improved confidence and reduced tendency for introversion may be related to this finding.</ce:para><ce:para>The conclusion, or overall dental health domain, produced the most dramatic response shift by patients between questionnaires 1 and 2. The area of the 67% to 100% zone demonstrated a large area increase with a total elimination of the 0% to 33% zone, or worse response zone. The impact of this dramatic shift was produced by two questions, “are you happier with your dental health” and “has your life or lifestyle changed because you wear a maxillary and mandibular prosthesis?” Satisfaction or dissatisfaction with oral prostheses markedly effect quality of life and may be extremely difficult for quantitative measurement. Quality of life measures may not be entirely related to “health” factors and are strongly impacted on by interpersonal behavior, security, and levels of expectation that are difficult for clinicians to measure.</ce:para><ce:para>From the HRQL instrument, combination of all questions in all six domains, as defined by patient response shifts between questionnaires 1 and 2, produced a single quality of life measure. The changes in all three zones of interpretation of improvement or deterioration can be seen (Fig. 2).
<ce:display><ce:figure><ce:label>Fig. 2</ce:label><ce:caption><ce:simple-para>Wilcoxon signed rank test results before and after implant therapy when combining all questions in all six domains. Improvement in quality of life is evident by number of “better” responses after implant therapy.</ce:simple-para></ce:caption> <ce:link locator="gr2"></ce:link></ce:figure></ce:display>Significant changes in the 67% to 100% zone would indicate a demonstrative improvement in the quality of life experienced by a patient after dental implant treatment and prosthetic rehabilitation (<ce:italic>p</ce:italic> < 0.0001).</ce:para><ce:para>Despite excellent conventional complete denture therapy, the influence of the domains described in this article may not result in improvement of one's quality of life. The clinical significance of the findings in this study would support the use of dental implants to manage the dissatisfied conventional complete denture patient. However, additional HRQL questionnaires will need to be administered during the 2-year and 4-year evaluation periods to provide longitudinal measures of patient responses to dental implant therapy and prosthodontic rehabilitation. This information will lend insight to the long-term quality of life benefits from dental implant treatment. Other studies that evaluated conventional prosthetic replacement alone on the immediate and long-term influence on the patient's quality of life should also be conducted.</ce:para></ce:section><ce:section><ce:section-title>Conclusions</ce:section-title><ce:para>Within the limitations of this investigation, the following conclusions were drawn.
<ce:list><ce:list-item><ce:label>1.</ce:label><ce:para>Significant differences in subjective responses for the domains comfort, function, speech, esthetics, self-image, and dental health were demonstrated when comparing conventional complete denture and dental implant therapy.</ce:para></ce:list-item><ce:list-item><ce:label>2.</ce:label><ce:para>HRQL questionnaires that measure patient feelings about comfort, function, speech, esthetics, self-image, and dental health can provide scientific evidence of an improved quality of life after dental implant therapy (<ce:italic>p</ce:italic> < 0.0001).</ce:para></ce:list-item><ce:list-item><ce:label>3.</ce:label><ce:para>Further evaluation at the 2-year and 4-year intervals need compilation to provide an understanding of the long-term quality of life benefits from dental implant therapy.</ce:para></ce:list-item></ce:list></ce:para></ce:section></ce:sections><ce:acknowledgment><ce:section-title>Acknowledgements</ce:section-title><ce:para>We acknowledge the contributions of Rui-Feng Wang, BS, Research Associate I, and Beth E. 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Successful rehabilitation of the edentulous condition requires functional and psychosocial adaptation by the patient. Quality of life is markedly affected by the amount of satisfaction or dissatisfaction with their dental therapy. Patient concerns are primarily related to comfort, function, and esthetics. When these do not meet the patients expectations, anxiety, insecurity, diminished self-esteem, and introversion are typical psychosocial responses. Purpose. The objectives of the study were to assess the patient's subjective feelings about: (a) comfort, (b) function, (c) esthetics, (d) speech, (e) self-image, and (f) overall dental health with their existing complete dentures, and after implant therapy and prosthodontic rehabilitation. Material and methods. Two health-related quality of life (HRQL) questionnaires were developed to evaluate the effectiveness of dental implant therapy; one dealing with their feelings about their conventional complete dentures, and the second dealing with implant therapy. The first questionnaire was administered with supervision before receiving implant treatment. The second questionnaire was administered within 1 year after completion of prosthetic rehabilitation. Twenty-six patients who received implants to support a mandibular prosthesis and a new maxillary denture formed the experimental population. Results. Discriminative and evaluative analysis of subjective patient responses provided reliable, accurate, and reproducible results. Assessment of subject feelings before and after implant therapy and prosthodontic rehabilitation demonstrated significant differences when before treatment responses were compared with the responses after therapy. Conclusions. Significant differences for comfort, function, speech, esthetics, self-image, and dental health were demonstrated when conventional complete dentures and dental implant therapy were compared. HRQL data provided scientific evidence of an improved quality of life after dental implant therapy (p < 0.000). (J Prosthet Dent 1997;78:574)</abstract><note>Reprint requests to: Dr. Roman M. Cibirka School of Dentistry Medical College of Georgia Augusta, GA 30912-1260.</note><note>10/1/84809</note><relatedItem type="host"><titleInfo><title>The Journal of Prosthetic Dentistry</title></titleInfo><titleInfo type="abbreviated"><title>YMPR</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">199712</dateIssued></originInfo><identifier type="ISSN">0022-3913</identifier><identifier type="PII">S0022-3913(05)X7047-0</identifier><part><date>199712</date><detail type="volume"><number>78</number><caption>vol.</caption></detail><detail type="issue"><number>6</number><caption>no.</caption></detail><extent unit="issue-pages"><start>537</start><end>630</end></extent><extent unit="issue-pages"><start>A1</start></extent><extent unit="pages"><start>574</start><end>581</end></extent></part></relatedItem><identifier type="istex">617C9A62F1C20F4B6D06965CC61CFD459357B675</identifier><identifier type="ark">ark:/67375/6H6-RTBPMK37-Q</identifier><identifier type="DOI">10.1016/S0022-3913(97)70008-8</identifier><identifier type="PII">S0022-3913(97)70008-8</identifier><accessCondition type="use and reproduction" contentType="copyright">©1997 Editorial Council of The Journal of Prosthetic Dentistry</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-HKKZVM7B-M">elsevier</recordContentSource><recordOrigin>Editorial Council of The Journal of Prosthetic Dentistry, ©1997</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/document/617C9A62F1C20F4B6D06965CC61CFD459357B675/metadata/json</uri></json:item></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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