Evaluation of the Impact on Quality of Life Associated with Dental Implant RehabilitationABSTRACT
Objective: To analyze the impact on quality of life before and after rehabilitation with implant-supported prostheses.
Material and Methods: Prospective longitudinal study, non-controlled intervention, of the “before and after” type, with an initial sample of 319 participants, and a final sample of 160 patients, who underwent treatment with implants, from November 2021 to March 2023, in postgraduate schools in implantology, in a metropolitan region of the Southeast region of Brazil. A sociodemographic questionnaire, the Oral Health Impact Profile (OHIP-14) instrument for measuring quality of life, and data collected from the patients' medical records were used. The Wilcoxon test was used to compare the impact at the second stage of the study in relation to the first. The IBM SPSS 20 statistical program was used for this analysis, with a significance level of 5%.
Results: The impact of partial or total edentulism on quality of life before implant treatment was declared by 216 (67.7%) patients, with the domains with the greatest impact being psychological discomfort (45.8%) and psychological disability (46.7%). Only 6 patients (3.8%) reported an impact on their quality of life after treatment. In the functional limitation, physical pain, social incapacity, and disability domains, 0.6% of patients reported an impact; the psychological discomfort domain had the highest number of patients with an impact (2.5%).
Conclusion: Patients undergoing rehabilitation with prostheses on implants showed a significant improvement in quality of life across all dimensions of the OHIP-14.
Keywords:
Quality of Life; Dental Implants; Dental Prosthesis; Implant-Supported.
Introduction
Dental implants are used for functional and aesthetic rehabilitation in patients with single, multiple, or total missing teeth. Implant installation is performed surgically and requires osseointegration, i.e., the stable and functional union between the bone and the implant surface [1-4].
The survival and osseointegration rates of implants, the absence of peri-implantitis and aesthetic results are not the only factors for evaluating success in implant dentistry; the degree of satisfaction and quality of life of individuals after rehabilitation, as well as long-term follow-up, should be part of the daily practice of professionals and should be considered when planning any oral rehabilitation, adapting to the different needs of each patient, since dental implant therapy is capable of having a major psychological impact on patients [5,6].
Analyzing quality of life and its relationship with oral health has important implications for clinical dental care, as well as for planning public health policies. Different types of instruments are used to measure this [7-9]. Among them is the Oral Health Impact Profile (OHIP-14), formulated by Spencer and Slade in 1994 in Australia, based on dental interviews [10]. It is an internationally used instrument that has been validated in various contexts and languages, including Brazilian Portuguese by Oliveira and Nadanovsky in 2005 [11]. It measures quality of life through the following 7 dimensions: functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap [11].
Prosthetic rehabilitation is related to reducing the impact on quality of life [12]. The degree of satisfaction with the results of procedures performed, as reported by patients, is increasingly used to evaluate treatments [13]. However, scientific production in dentistry relating oral rehabilitation with implants and quality of life is still scarce. Studies that use subjective indicators to evaluate treatment are important for planning actions to improve the population's quality of life. Based on the above, the aim of this study was to analyze the impact on patients' quality of life before and after rehabilitation with implant-supported prostheses.
Material and Methods
Study Design and Ethical Clearance
This is an analytical study with a prospective longitudinal design and a non-controlled intervention of the “before and after” type, evaluating the impact on the quality of life of patients who underwent implant treatment between November 2021 and March 2023. This study was approved by the Research Ethics Committee of the Health Sciences Center at the Federal University of Espírito Santo (Final approval report: 5.035.685).
Participants
The approximate target population of 1,000 patients seen in the six months prior to collection, the prevalence of the impact of oral problems of 35%, supported by a previous study carried out in the same region [15], a 95% confidence level, and a 5% margin of error were used as parameters for sample calculation. A minimum sample of 260 individuals was obtained. After adjusting for a 20% loss rate, 52 people were added, resulting in a sample of 312 patients. To calculate the final study sample, a 95% confidence interval was used; the proportion adopted was 15%, with a margin of error of 5%, yielding a total of 148 participants. Between 30 and 60 days after prosthetic rehabilitation on the installed implants, three attempts were made by telephone to reapply the OHIP-14, resulting in 160 participants being interviewed, exceeding the previous sample calculation.
At the first stage of the study, 319 patients aged 21 or over who were eligible for implant surgery and who sought care at postgraduate schools of implant dentistry in a metropolitan region in the southeast of Brazil were included.
The study was first carried out in person, with the administration of a structured questionnaire for sociodemographic and socioeconomic analysis and the Oral Health Impact Profile (OHIP-14) to assess patients' quality of life. Data on patient treatment were collected from patient records. Both questionnaires have been used in previous studies [14,15]. Data collection for the second stage of the study was carried out by telephone.
The participants' socioeconomic status was categorized according to the Brazilian Economic Classification Criterion, version 2019. This criterion operationalizes socioeconomic stratification using a composite score that combines ownership of durable consumer goods (such as household appliances, automobiles, and home infrastructure) and the head of household's level of education, an indicator of human capital. This system, which ranks economic classes from A to E, seeks to estimate families' purchasing power and standard of living [16]. The Oral Health Impact Profile (OHIP-14) was used to assess participants' quality of life before and after prosthetic implant rehabilitation. In this study, the OHIP-14 results were dichotomized, with "always" and "often" indicating with impact and "sometimes", "rarely", and "never" indicating without impact.
Data Analysis
Quality of life before and after implantation was compared using the Wilcoxon test. The IBM SPSS 20 statistical program was used for this analysis, with a 5% significance level. Fisher's Exact Test was used to assess possible differences in the sociodemographic profile of the sample before and after treatment.
Results
The sociodemographic profile of the initial sample was mostly female (69%), aged 51-69 years (69%), self-declared white or brown (89.4%), having studied for up to 13 years (48.3%), and with socioeconomic status C and D/E (84.7%). There were no statistically significant differences between the sociodemographic profile before and after implant treatment (p > 0.05), so the final sample was considered very similar to the initial one (Table 1).
Of the 160 patients interviewed at the final stage of the study, there were more patients who had not undergone immediate loading (58.7%). As for whether bone grafting had been carried out before or at the same time as surgery, the difference was small, with 51.9% not having undergone grafting. A total of 62.5% of patients did not have extractions carried out at the same time as the implants were installed. Regarding complications during surgery, 152 patients (95%) did not experience any type of complication. A total of 144 patients (90%) did not lose any implants after surgery (Table 2). Both patients who had had definitive prostheses installed (60.6%) and patients with temporary prostheses (39.4%) were considered for the second stage of the study.
The impact of partial or total edentulism on quality of life before implant treatment was declared by 67.7% of patients (Table 3), with the domains with the greatest impact being psychological discomfort (45.8%) and psychological disability (46.7%).
Impact of partial or total edentulism on patients’ quality of life before implant treatment.
Only 6 patients (3.8%) reported an impact on their quality of life after completing treatment (Table 4). In the functional limitation, physical pain, social incapacity, and disability domains, 0.6% of patients reported an impact; the psychological discomfort domain had the highest proportion (2.5%).
There was a significant reduction in the impact on patients' quality of life across all dimensions of the OHIP-14 following prosthetic implant rehabilitation. Before treatment, 67.7% of patients reported an impact on their quality of life. After treatment, only 3.8% of patients reported an impact (Table 5).
Discussion
The results show a reduction in the impact on patients' quality of life after rehabilitation with implant-supported prostheses, with only 3.8% of patients reporting an impact in all dimensions of the OHIP-14 instrument. These findings corroborate a similar study that found an improvement in quality of life when assessing quality of life before and six months after implant rehabilitation, using the OHIP-14, in totally edentulous patients rehabilitated with implant-supported prostheses. Other studies evaluating patients over the long term have shown patient satisfaction and an improvement in oral health-related quality of life after ten years of implant rehabilitation [6,17,18].
In 2020, Reich et al. [19] evaluated 30 patients who had undergone implant surgery using the OHIP-14 instrument at 4.5 years. The success rates ranged from 83% to 95%, demonstrating a reduction in the impact on quality of life after rehabilitation [19]. The installation of implant-supported prostheses is associated with a significant increase in quality of life in partially dentate and edentulous patients, compared to conventional prostheses, as it restores function, chewing, and improves social interaction [20].
When analyzing the characteristics of the surgeries and the prognosis of the implants, the variables "intercurrence during surgery" and "loss of implants" showed percentages of 5% and 10%, respectively, which may be linked to the safety of the surgical procedures currently performed. However, it is important to note that the study was conducted over a short period and did not assess the impact of losses and complications on patients, so these findings should be interpreted with caution. The association between implant loss and the impact on quality of life has been discussed in the literature. Schimunda et al. [21] observed this association, associated with various factors, such as low schooling.
Similarly, this study found that 48.10% of patients underwent bone grafting and 37.5% underwent tooth extraction at the same time as implant installation, suggesting a possible association for future research. A study that assessed the relationship between the level of satisfaction in patients undergoing bone grafting, tooth loss time, surgical and healing time, and time to completion of rehabilitation treatment with implants, found lower results for patient satisfaction in those undergoing bone grafting and with longer tooth loss, due to pain and longer healing time [22].
As for the sociodemographic variables, there was a predominance of female patients aged 51-60 years, of white and brown race/color, who had studied for up to 13 years, and who belonged to socioeconomic conditions C and D/E. These findings corroborate several studies [18,23-25]. Over the last few years, the adult population aged 35 to 44 has seen a reduction in tooth loss rates and greater access to restorative dental services [26]. This is an important result for the advancement of dentistry, which, for a long time, was based on mutilating procedures. On the other hand, the older age group still has missing teeth that need to be replaced to restore function, aesthetics, and quality of life [27].
The study's limitations include the incompleteness of the medical records filled out by postgraduate students, which led to difficulties in gathering data and may imply information bias. It's suggested that further research evaluating patients rehabilitated with prostheses on implants over the long term be conducte to determine whether changes in quality of life remain over time.
Conclusion
Patients undergoing rehabilitation treatment with prostheses on implants showed significant improvement in quality of life in all dimensions evaluated by the OHIP-14.
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Financial SupportNone.
Data Availability
The data used to support the findings of this study can be made available upon request to the corresponding author.
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Edited by
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Academic Editor: Alessandro Leite Cavalcanti
