Oral health-related quality of life of patients rehabilitated with fixed and removable implant-supported dental prostheses

Abstract

Dental implants have become a mainstream treatment approach in daily practice, and because of their high survival rates over time, they have become the preferred treatment option for prosthetic rehabilitation in many situations. Despite the relatively high predictability of implant therapy and high costs to patients, patient perceptions of success and patient-reported outcome measures have become increasingly significant in implant dentistry. Increasing numbers of publications deal with oral health-related quality of life and/or patient-reported outcome measures. The aim of this paper was to provide an overview of the available evidence on oral health-related quality of life of fully and partially dentate patients rehabilitated with fixed and removable implant-supported dental prostheses. A comprehensive electronic search was performed on publications in English up to 2021. A selection of standardized questionnaires and scales used for the evaluation of oral health-related quality of life were analyzed and explained. The analysis encompassed three aspects: a functional evaluation of oral health-related quality of life, an esthetic assessment of oral health-related quality of life, and a cost-related evaluation of oral health-related quality of life for rehabilitation with dental implants. The data demonstrated that the preoperative expectations of patients markedly affected the outcomes perceived by the patients. As expected, reconstructions supported by implants substantially improved the stability of conventional dentures and allowed improved function and patient satisfaction. However, from a patient's perspective, oral health-related quality of life was not significantly greater for dental implants compared with conventional tooth-supported prostheses. The connection of the implants to the prostheses with locators or balls indicated high oral health-related quality of life. The data also suggest that patient expectation is not a good predictor of treatment outcome. In terms of esthetic outcomes, the data clearly indicate that patients' perceptions and clinicians' assessments differed, with those of clinicians yielding higher standards. There were no significant differences found between the esthetic oral health-related quality of life ratings for soft tissue-level implants compared with those for bone-level implants. Comparison of all-ceramic and metal-ceramic restorations showed no significant differences in patients' perceptions in terms of esthetic outcomes. Depending on the choice of outcome measure and financial marginal value, supporting a conventional removable partial denture with implants is cost-effective when the patient is willing to invest more to achieve a higher oral health-related quality of life. In conclusion, the oral health-related quality of life of patients rehabilitated with implant-supported dental prostheses did not show overall superiority over conventional prosthetics. Clinicians' and patients' evaluations, especially of esthetic outcomes, are, in the majority of cases, incongruent. Nevertheless, patient-reported outcomes are important in the evaluation of function, esthetics, and the cost-effectiveness of treatment with implant-supported dental prostheses, and should be taken into consideration in daily practice.

Keywords: dental implants; esthetics; patient satisfaction; patient-reported outcome measures; quality of life.

FIGURE 1

Clinical view at baseline (ie, before steps 1 and 2 of periodontal therapy)

FIGURE 2

Radiographic view at baseline (ie, before steps 1 and 2 of periodontal therapy) depicting severe horizontal and vertical bone loss

FIGURE 3

Periodontal chart at baseline (ie, steps 1 and 2 of periodontal therapy) after extraction of tooth 46

FIGURE 4

Clinical view at 3 months following nonsurgical periodontal therapy (ie, step 2 of periodontal therapy)

FIGURE 5

Periodontal chart after nonsurgical periodontal therapy (ie, step 2 of periodontal therapy, after 3 months)

FIGURE 6

Cone beam computed tomography planning for implant placement in the area of 46

FIGURE 7

Intraoperative situation depicting implant placement

FIGURE 8

Final situation after delivery of the screw‐retained single unit crown

FIGURE 9

Radiographic images depicting the baseline situation and after implant placement and prosthetic restoration

FIGURE 10

Clinical situation after periodontal therapy, implant placement, and prosthetic restoration

FIGURE 11

Radiographic view after periodontal therapy, implant placement, and prosthetic restoration indicating healthy periodontal and peri‐implant conditions

FIGURE 12

Periodontal chart after periodontal therapy, implant placement, and prosthetic restoration indicating healthy periodontal and peri‐implant conditions

FIGURE 13

Clinical view at baseline (ie, before steps 1 and 2 of periodontal therapy)

FIGURE 14

Radiographic images at baseline (ie, before steps 1 and 2 of periodontal therapy)

FIGURE 15

Radiographic planning for implant placement in the area of 46

FIGURE 16

Intraoperative situation depicting implant placement, healing phase and delivery of the prosthetic restoration

FIGURE 17

Radiographic view after periodontal therapy, implant placement, and prosthetic restoration indicating healthy periodontal and peri‐implant conditions

FIGURE 18

Clinical situation after periodontal therapy, implant placement, and prosthetic restoration

FIGURE 19

Periodontal chart at baseline (ie, before steps 1 and 2 of periodontal therapy) before extraction of tooth 46

FIGURE 20

Periodontal chart after periodontal therapy, implant placement, and prosthetic restoration indicating healthy periodontal and peri‐implant conditions