Bernhard Pommer Progress and trends in patients’ mindset

Werner Zechner
Georg Watzak
on dental implants. II: implant
Christian Ulm acceptance, patient-perceived costs and
Georg Watzek
Gabor Tepper patient satisfaction

Authors’ affiliations:
Bernhard Pommer, Werner Zechner, Georg Watzak,
Georg Watzek, Gabor Tepper, Department of Oral
Surgery, Bernhard Gottlieb School of Dentistry,
Medical University of Vienna, Vienna, Austria
Christian Ulm, Department of Periodontology,
Bernhard Gottlieb School of Dentistry, Medical
University of Vienna, Vienna, Austria
Corresponding author:
Dr Bernhard Pommer
Department of Oral Surgery
Bernhard Gottlieb School of Dentistry
Medical University Vienna
Waehringer Strasse 25a A-1090
Vienna
Austria
Tel.: þ 43 1 4277 67011
Fax: þ 43 1 4277 67019
e-mail: bernhard.pommer@meduniwien.ac.at
Key words: opinion poll, oral implants, patient-centered outcomes, public awareness,
representative survey
Abstract
Objectives: Compared with widespread investigations on dental implant survival and
biologic parameters, patient-based outcomes of implant dentistry have been neglected for
years and are now becoming more popular. The aim of this representative opinion poll was
to assess the up-to-date patients’ mindset on dental implants and draw comparisons with
the results published in 2003.
Material and methods: One thousand adults – representative for the Austrian population –
were presented with a total of 16 questionnaire items regarding acceptance and
subjectively perceived costs of dental implant treatment as well as patient satisfaction with
implant-supported rehabilitation.
Results: The implant acceptance rate was 56%, while 23% of the interviewees decidedly
rejected implant treatment (same rate as in 2003), especially those over 50 years of age.
Only 5% had themselves undergone implant treatment and 22% reported to know
someone fitted with implants. The estimated costs of implant treatment were significantly
higher than those in 2003, and three-quarters felt that the prize was too high and that the
sick fund or social security agencies should bear them. Satisfaction scores were significantly
higher among interviewees wearing implant-supported rehabilitations compared with
those with conventional fixed or removable dentures.
Conclusions: Little has changed in patients’ attitude toward dental implants compared
with the representative opinion poll in 2003. Neither implant acceptance nor implant
prevalence in the Austrian population demonstrated upward trends. Professional public
relations efforts are indicated to drop resentments and increase patient acceptance of
dental implants as a treatment modality.

Dental implantology is an increasingly nical complications (de Albuquerque et al.

Date:
Accepted 17 March 2010
To cite this article:
Pommer B, Zechner W, Watzak G, Ulm C, Watzek G,
Tepper G. Progress and trends in patients’ mindset on
dental implants. II: implant acceptance,
patient-perceived costs and patient satisfaction.
Clin. Oral Impl. Res. 22, 2011; 106–112.
doi: 10.1111/j.1600-0501.2010.01969.x
popular treatment modality that has shown
high levels of clinical success (Heydecke
et al. 2003). Treatment results with dental
implants are usually described in terms of
clinical and radiological aspects such as
fixture survival and marginal bone loss
(Stellingsma et al. 2003). The performance
of implant-supported dentures is evaluated
by measuring outcomes of chewing func-
tion, esthetics, longevity, as well as tech-
2000). When assessing the efficiency of
oral implant therapy, it is important to
consider both the clinicans’ as well as the
patients’ appraisals (Anderson 1998). How-
ever, important parameters such as patient
satisfaction are clearly underexposed in the
current literature (den Hartog et al. 2008).
Less than 2% of the publications on oral
implants deal with patient-centered issues
(Pjetursson et al. 2005). Information on

106 c 2010 John Wiley & Sons A/S



patient opinion of the treatment as well as
investigations of the psychological impact
following dental implant therapy are still
scarce (Vermylen et al. 2003; Abu Hantash
et al. 2006). The claim for patient-centered
outcomes of implant dentistry was reiter-
ated in the 4th European Workshop on
Periodontology (Lang et al. 2002).
Successful denture treatment requires
both functional and psychosocial adapta-
tion by patients (Sonoyama et al. 2002).
Four basic parameters have been described
to affect the outcome of restorative dentis-
try (Anderson 1998): biologic and physio-
logic parameters (health of oral structures,
chewing ability, esthetics), longevity and
survival (of teeth, implants, restorations),
psychosocial parameters (treatment satis-
faction, self-esteem, body image, quality of
life) and economic parameters (cost of fab-
rication and maintenance, patient prefer-
ences such as treatment time). For the
clinician, implant survival, prosthesis long-
evity and the frequency of complications
are the most significant parameters. On
the other hand, the social and psychologic
impact of the treatment, cost-effectiveness,
benefit and utility are more important from
the patient’s view (Zitzmann & Marinello
2000). Evaluations of treatment outcomes
by dentists do not necessarily correspond to
the patients’ own judgment (Sonoyama
et al. 2002). The degree of patient satisfac-
tion was found to correlate neither to
increased masticatory function nor to clin-
ical parameters (Buch et al. 2002). As
quality of life (HRQL) is markedly affected
by the amount of satisfaction or dissatisfac-
tion with their dental therapy (Cibirka
et al. 1997), patient-centered approaches
to the assessment of treatment efficiency
are highly relevant (Stellingsma et al.
2003). The attitude of patients toward im-
plant therapy is influenced not only by the
expected longevity of the reconstructions
but also by prospective morbidity (Nkenke
et al. 2007). Economic parameters will
finally be decisive for the preference of a
particular choice of prosthetic rehabilita-
tion (Palmqvist et al. 1991; Zitzmann
et al. 2006).
Dental implants have revolutionized re-
storative dentistry and have afforded many
benefits for patient care (Moberg et al.
2001). New technologies may not only
provide advanced possibilities of prosthetic
rehabilitation but also increase the expecta-
c 2010 John Wiley & Sons A/S
 107 |
Pommer et al  Progress and trends in patients’ mindset on dental implants
tions of the patients (Buch et al. 2002). As
dental implants gain more acceptance and
feature prominently in the media, many
patients have come to expressly request
fixed implant-supported dentures (Vasak
et al. 2007). Most implant-related publica-
tions rightfully emphasize quality assur-
ance based on extensive basic research,
yet what the public thinks about dental
implants has largely been neglected (Strass-
burger et al. 2004). However, medical re-
sponsibility as well as economic interests
necessitate an appraisal of the role accorded
to implants by the public by analysing
patient feedback. A representative opinion
poll on dental implants in the Austrian
population was published in 2003 (Tepper
et al. 2003a, 2003b) to shed light on this
topic. By repeating the poll 7 years later,
the present investigation aims to assess the
up-to-date patients’ mindset on dental im-
plants and evaluate recent progress and
trends. Part II of this representative patient
survey addresses the following topics: im-
plant acceptance in the population of Aus-
tria, patient-perceived cost of implant
treatment and patient satisfaction with
implant-supported rehabilitation.
Material and methods
This survey was commissioned by the
Department of Oral Surgery (Bernhard
Gottlieb School of Dentistry, Medical Uni-
versity of Vienna, Austria, Head: ao.Univ.
Prof. DDr Georg Watzek) and conducted by
the Austrian Gallup Institute (Dr Karma-
sin Institute for Market Research, Inter-
view Division). The study protocol was
approved by the local ethics committee.
The methods used were reported in part I
of the article and are summarized briefly:
1000 adults over 14 years of age – repre-
sentative for the Austrian population –
were presented with a total of 35 question-
naire items. The data collected are reported
in two parts. Part II deals with 16 items on
patient acceptance of dental implants, pa-
tient-perceived cost of implant treatment
and patient satisfaction with implant treat-
ment. The survey was conducted nation-
wide using pre-stratified multi-tiered
cluster sampling (random sampling). The
opinion poll was based on face-to-face in-
terviews backed by questionnaires in pri-
vate households. The demographic data of
the sample, polling period, polling method,
follow-up mechanisms and statistical ana-
lyses are identical to those reported in Part
I.
Results
Implant acceptance
The overall implant acceptance rate was
56% (Table 1). Twenty-three percent of
those who were familiar with implants
(n ¼ 788) decidedly rejected implant treat-
ment (same rate as in 2003). Implant
acceptance varied significantly between
the age groups (Po0.001): the highest im-
plant refusal rate was recorded for those
over 50 years of age (64%). Compared with
2003, lesser interviewees thought that
everybody could afford implants or that
implants were good for everyone, yet the
differences were insignificant. Sixty-one
percent of the total sample felt that missing
teeth should be replaced in any case, while
33% thought that closing a gap was only
necessary if it was visible. Interviewees
with higher professional qualifications
were significantly more affirmative about
the need of prosthodontic rehabilitation
(P ¼ 0.013). Compared with 2003, a signif-
icantly higher percentage would replace
missing teeth only if the gap was visible
(Po0.001).
Asked whether they had already lost at
least one tooth or more, 36% answered
‘‘no.’’ This was a significantly lower per-
centage than in 2003 (P ¼ 0.024), particu-
larly the group with four or five missing
teeth had increased in the last years. Four
percent of those questioned were edentu-
lous. Tooth loss was significantly corre-
lated to age (R ¼ 0.611, Po0.001),
professional qualification (R ¼  0.199,
Po0.001), net monthly income (R ¼
 0.183, Po0.001) and size of residence
(R ¼  0.099, Po0.01). Tooth loss had a
significant effect on the level of informa-
tion on dental implants (Po0.01) as well as
on other treatment alternatives (Po0.001).
Sixty-six percent of those who had already
lost one or more teeth (n ¼ 610), claimed to
have had their missing teeth replaced. Only
32% of the sample had at least one gap
without any replacement. Compared with
the percentage recorded in 2003 (30%)
the number of unrestored gaps has not
increased significantly (P ¼ 0.349). Gaps
Clin. Oral Impl. Res. 22, 2011 / 106–112
Pommer et al  Progress and trends in patients’ mindset on dental implants

Table 1. Questions on dental implant acceptance 23% said up to h1500, 15% said up to
Present investigation Tepper et al. (2003a, 2003b) h2000 and 17% said more than h2000
What do you personally think of implants? (%) (Table 2). The estimated prize was signifi-
Would have made them 56 61 cantly higher compared with the results in
if needed the year 2003 (Po0.001). Seventy-six per-
Would not have any 23 23
cent felt the prize they had estimated was
Implants are not good 36 40
for everyone too high, 10% found it fair and only 2%
Implants are good for 29 37 thought that it was favorable. Significantly
everyone more interviewees with a low net family
Implants are expensive, 52 61
only for the rich
income felt that this was too expensive
Everyone can afford 14 21 (P ¼ 0.009). No significant difference to
implants the survey in 2003 could be found
Do you think missing teeth should be replaced? (%) (P ¼ 0.086). The interviewees were also
Yes, definitely 61 72n
Yes, if the gap is visible 33 25n asked how much – in their view – a dentist
No 3 3 himself would have to pay for purchasing
Have you lost one or more teeth in the past? (%) an implant. Nine percent thought up to
No 36 41n
h100, 18% up to h200, 23% up to h350,
1–3 teeth 27 26
4–5 teeth 15 8n 17% up to h700, 7% up to h1000 and 7%
6–10 teeth 7 7 more than h1000. A significant correlation
More than 10 teeth 4 4 could be found between low net income
Almost all teeth 4 5
and below-average prize estimation of h100
All teeth 4 6
Did you have your missing at most (P ¼ 0.030). The estimated prize
teeth replaced? (%) was significantly higher compared with the
Yes 66 70 results in the year 2003 (Po0.001).
No 32 30
Fifty-eight percent of the sample attrib-
If you had your missing teeth replaced, what with? (%)
Implant supported 9 7 uted the costs of implant treatment to the
reconstructions dentists, 24% to the lab technicians, 14%
Removable partial 16 13 to the manufacturers, 13% to the taxes and
dentures
Removable complete 18 18
12% to the dealers. Of those participants in
dentures the highest income bracket, 70% thought
Fixed partial dentures 63 34n the dentists were responsible for the price,
Have you yourself or any one you know ever had implants? (%) compared with 60% of those from the
Yes, I have 5 4
Yes, someone I know 22 25 lowest income bracket, yet the difference
No 63 74n was not significant (P ¼ 0.058). The results
Before you had your implants put in, did you have removable dentures? (%) did not differ significantly from the inves-
Yes 28 10n
tigation in 2003 (P ¼ 0.053). Asked who
No 68 90n
should pay for implant treatment, 73%
n
Significant differences between the studies. said the sick fund or social security agen-
cies, 25% said private insurers and only
12% felt that the patient should bear the
without replacement were significan- implant-supported restorations was signifi- costs. No significant difference was found
tly more frequent in male participants cantly correlated to high monthly income regarding the net monthly income of the
(P ¼ 0.015) and correlated to age (P ¼ 0.036) as well as to age (P40.001). In interviewees (P ¼ 0.871). The results did
(Po0.001). Of those who had their missing the group of implanted patients (n ¼ 54), not differ significantly from the investiga-
teeth replaced (n ¼ 402), 16% wore remo- 28% had worn removable dentures before tion in 2003 (P ¼ 0.097).
vable partial dentures, 18% removable implant installation. This is a significant
complete dentures and 63% fixed partial increase of 18% compared with 2003
Patient satisfaction with implant
dentures. The percentage of those wear- (Po0.001). The recorded percentage was treatment
ing implant-supported replacements in- higher for female participants (37%) com- Interviewees wearing conventional fixed or
creased insignificantly from 7% to 9% pared with males (11%), yet the difference removable dentures (n ¼ 402) were asked
(P ¼ 0.304), while the percentage of fixed was insignificant (P ¼ 0.358). how satisfied they were with the way in
partial restorations has grown significantly which their teeth were replaced. Thirty-
(Po0.001). seven percent of this sample said that they
Patient-perceived cost of implant
Twenty-two percent of the total sample treatment were very satisfied and 43% claimed to be
reported to know someone fitted with im- Asked to estimate what a single implant satisfied, irrespective of the type of
plants, while 5% had themselves under- without suprastructure would cost, 9% prosthodontic work (Table 3). The mean
gone implant treatment. The frequency of said up to h750, 23% said up to h1000, satisfaction score was significantly higher

108 | Clin. Oral Impl. Res. 22, 2011 / 106–112 c 2010 John Wiley & Sons A/S

 Pommer et al  Progress and trends in patients’ mindset on dental implants

Table 2. Questions on patient-perceived costs of dental implant treatment the esthetic appearance and 69% were very
Present investigation Tepper et al. (2003a, 2003b) satisfied with the function of their im-
How much do you think a patient has to pay for an implant in Austria without a crown, i.e. plants. Not a single patient in this sample
just for the post? (%) claimed to be ‘‘not so satisfied’’ or ‘‘un-
Up to h750 9 18n satisfied.’’ Compared with the implanted
Up to h1000 23 26
patients in 2003, the satisfaction score did
Up to h1500 24 20n
Up to h2000 15 11n not improve significantly (P ¼ 0.576). In-
More than h2000 17 16 terviewees with implant-treated friends or
Do you think this is . . . (%) acquaintances (n ¼ 219) reported that 33%
Favorable 2 1
Fair 10 12
of them were very satisfied and 50% were
Too much 76 78 satisfied. The results did not differ from the
How much do you think a dentist has to pay for purchasing an implant from the answers given by the implanted intervie-
manufacturer/dealer? (%) wees themselves, neither regarding im-
Up to h100 9 9
Up to h200 18 26n plant esthetics (P ¼ 0.404) nor implant
Up to h350 23 34n function (P ¼ 0.543).
Up to h700 17 14
Up to h1000 7 2n
More than h1000 7 1n
Who/what is mainly responsible for the final price? (%) Discussion
Dentist 58 62
Lab technician 24 21 Population surveys of adult dental health
Manufacturer 14 15
indicate that levels of total tooth loss are
Dealer 12 9n
Taxes 13 15 decreasing worldwide (Bradnock et al.
Who should pay for the implant? (%) 2001). The transition to edentulousness is
Patient 12 14 occurring later in patient lives because of
Sick fund/social security 73 72
increased life expectancy and lower levels
Private insurer 25 21
of dental disease in the younger population
n
Significant differences between the studies. (Allen et al. 2001). The percentage of
edentulous patients below the age of 74
Table 3. Questions on patient satisfaction with dental implant treatment years dropped from 19% in 1975 to 3%
Present investigation Tepper et al. (2003a, 2003b) shortly before the turn of the millennium
How satisfied are you with your current replacement (conventional fixed or removable
(Osterberg et al. 2000). Ninety percent of
dentures)? (%) those below 84 years can be expected to be
Very satisfied 37 41 more or less dentate by 2015 (Tepper et al.
Satisfied 43 37n 2003b). This trend was also observed in the
Fair to middling 15 17
Not so satisfied 2 4 present survey. Compared with 2003, sig-
Unsatisfied 1 1 nificantly less interviewees had already
How satisfied are you with the esthetics of your implant(s)? (%) experienced tooth loss. Missing posterior
Very satisfied 70 62
teeth were less important from a subjective
Satisfied 19 29
Fair to middling 7 4 aspect, one-third of the total sample even
Not so satisfied 0 0 felt that closing a gap was only necessary if
Unsatisfied 0 0 it was visible (significant increase com-
How satisfied are you with the function of your implant(s)? (%)
pared with 2003). This confirms that es-
Very satisfied 69 51
Satisfied 18 31 thetics are more important than function
Fair to middling 11 0n for a great majority of patients (Elias &
Not so satisfied 0 0 Sheiham 1998). Dental care providers
Unsatisfied 0 6
should make a greater effort to sensitize
If you know someone with implants, how satisfied is he/she with the implant(s)? (%)
Very satisfied 33 29 their patients to the complex consequences
Satisfied 50 36n of intermediate or terminal gaps left unat-
Fair to middling 11 10 tended for the entire masticatory system,
Not so satisfied 1 3
Unsatisfied 1 6n
lest they neglect their obligation to provide
information on late sequels (Tepper et al.
n
Significant differences between the studies. 2003b). Patients seeking implant treat-
ment reported that tooth loss had a much
for male participants than for women plant-supported dentures (n ¼ 54), the sa- greater impact on their quality of life than
(P ¼ 0.039). The results did not differ sig- tisfaction score was significantly higher patients seeking conventional dentures
nificantly compared with the survey of (Po0.001). Seventy percent of the im- (Allen & McMillan 2003). The subjective
2003 (P ¼ 0.190). Among those with im- planted patients were very satisfied with need for tooth replacement is also influ-

c 2010 John Wiley & Sons A/S

 109 | Clin. Oral Impl. Res. 22, 2011 / 106–112
Pommer et al  Progress and trends in patients’ mindset on dental implants
enced by certain socio-demographic fac-
tors. In the present investigation, intervie-
wees with high professional qualification
as well as pupils and students were most
affirmative about the need of prosthodontic
rehabilitation.
Considering that no less than one-third
of the sample had at least one missing
tooth that was not replaced, the market
potential for restorative dentistry, both im-
plant supported and conventional, is all but
fully exhausted. Dental anxiety is consid-
ered one major barrier to seeking implant
rehabilitation (Schwartz-Arad et al. 2007)
affecting a substantial portion of the general
population. In the present investigation, no
o23% of the sample rejected dental im-
plants. No upward trend could be observed
in the last 7 years. Resentments about oral
implant treatment have been shown to
vary considerably by gender and age (Berge
2000). This is confirmed by the finding
that implant acceptance was particularly
low in the age group of over 50 years in the
present sample. The overall percentage of
those in the Austrian population fitted
with implant-supported restorations has
increased insignificantly from 4% to 5%
in the past 7 years. No upward trend could
be observed in the prevalence of dental
implants in the Austrian population com-
pared with the survey of 2003.
Implant treatment leads to greater im-
provements in dental health outcomes, but
also requires substantially higher initial
costs (Zitzmann et al. 2006). In the present
survey, over the half of the interviewees
were convinced that dental implants were
only for the rich without, however, being
aware of the actual costs. One-third of
those questioned estimated that a single
implant without suprastructure would cost
more than h1500. The estimated prize was
significantly higher compared with the
results in the year 2003. With regard to
subjectively perceived prices, it should be
noted that consumers of implants can at
best give limited estimates of what im-
plants are worth. Both the complex nature
of the product and the service input needed
make it extremely difficult for them to put
a figure to the expected benefits (Tepper et
al. 2003b). Emphasizing the special advan-
tages of the product as well as giving con-
sumers an idea of what implant dentists
have to spend on investments, mainte-
nance and continuing education should
110 | Clin. Oral Impl. Res. 22, 2011 / 106–112
have a positive impact on what patients
subjectively think about the cost of im-
plant treatment. Compared with the
survey of 2003, significantly more inter-
viewees complained about treatment costs,
which were rated as the major disadvantage
of implant dentistry. Three-quarters felt
that current prices billed to the end user
unfavorable, while only 10% of the sample
accepted the increased financial expenses.
Both in the lower as well as in the higher
income groups, implant treatment was
reported to be too expensive. Interviewees
with first-hand experience with dental im-
plants tended to have a less negative opi-
nion about cost to benefit. This compares
with 81–93% of implanted patients that
deemed implant treatment costs to be
reasonable (Kaptein et al. 1998; Vermylen
et al. 2003).
In the patients’ perspective, the dentist is
mainly responsible for the final implant
price. More than the half of the current
sample attributed the costs of implant
treatment to the dentist. More information
about the investments needed for research,
training and implant production could help
to make the patients accept the expenses
incurred by implant treatment more readily
(Tepper et al. 2003b). Three-quarters of
those interviewed thought that social se-
curity agencies or the sick fund should pay
for implants, while only 12% would want
the patients themselves to pay for them.
Initial surgical and prosthetic treatment as
well as time costs represent the largest part
of the costs for dental implants, while the
proportion of maintenance and time costs
represents no more than 13% (Zitzmann et
al. 2006). However, little is known about
the long-term cost-effectiveness (i.e. im-
provements in perceived chewing ability) of
implant prostheses, yet the time horizon of
economic evaluation may have a substan-
tial influence. Single-tooth implant recon-
struction demonstrated a more favorable
cost-effectiveness ratio, when compared
with conventional three-unit fixed partial
dentures (Brägger et al. 2005). When pa-
tients realize that implantology in many
respects touches upon the most complex
areas of state-of-the-art dentistry, they may
well be prepared to reconsider their views
about implant costs (Tepper et al. 2003b).
Compared with the opinion poll pub-
lished in 2003, no changes in patient sa-
tisfaction could be observed, neither with
conventional dentures nor with implant
dentures. Of those not fitted with dental
implants, 80% claimed to be satisfied with
their current replacements. Patients wear-
ing implant reconstructions were signifi-
cantly more satisfied (87–89%). High
satisfaction rates of 80–92% were noted
in several studies among implanted pa-
tients (Kaptein et al. 1998; Buch et al.
2002; Pjetursson et al. 2005). In a recent
investigation 10 years after implant inser-
tion, no o92% of the patients would
choose the same solution again (Quirynen
et al. 2005). Asked whether they would
recommend dental implant treatment to
friends and relatives based on their first-
hand experience, 68–100% of the im-
planted patients claimed that they would
do so (Kaptein et al. 1998; Buch et al. 2002;
Vermylen et al. 2003; Pjetursson et al.
2005; Nkenke et al. 2007). This corre-
sponds well with second-hand experiences
with dental implants investigated in the
present survey. When asked about im-
planted patients they knew, 83% of those
without first-hand experience said that
their friends and acquaintances were satis-
fied with implant treatment. In the survey
of 2003, only 65% rated their friends’
satisfaction as optimal (Tepper et al.
2003b) and an American study in 1992
found that only 10% of the non-implanted
interviewees thought their implanted ac-
quaintances were satisfied (Zimmer et al.
1992). This comparison would suggest that
the public image of implant dentistry –
which is predominantly based on second-
hand information – has improved over the
last years, although no changes in first-
hand patient satisfaction were found.
Evaluations of treatment outcomes by
clinicians do not necessarily correspond to
the patients’ own judgment (Sonoyama et
al. 2002). Patient concerns are primarily
related to function, comfort and esthetics
(Cibirka et al. 1997; Stellingsma et al.
2003). Of the implanted patients in the
present investigation, 89% reported to be
satisfied with the esthetics of their im-
plants. This compares with satisfaction
rates with implant esthetics of 96–97% in
the current literature (Vermylen et al.
2003; Pjetursson et al. 2005). Patient sa-
tisfaction with the esthetic outcome of
implant reconstructions proved to be
much higher than comparable ratings by
clinicians (de Bruyn et al. 1997; Vermylen
c 2010 John Wiley & Sons A/S


et al. 2003). Moreover, a comparison of
specialty groups revealed that prosthodon-
tists gave higher esthetic ratings compared
with implant surgeons (Fürhauser et al.
2005). However, what patients perceive as
important to their satisfaction with im-
plant esthetics may be quite different
from what the dentist believes. Esthetic
parameters important for the prosthodon-
tist like red–white esthetics apparently are
of secondary importance for the patient
(Tepper et al. 2003b). A within-subject
comparison of maxillary fixed and remova-
ble implant prosthesis produced the follow-
ing ranking of factors important to the
patient: (1) ability to speak, (2) ease of
cleaning, (3) general satisfaction and (4)
esthetics (Heydecke et al. 2003).
With regard to patient satisfaction with
implant function, 87% of the implanted
patients in the present opinion poll claimed
to be satisfied. In the current literature,
rates of patient satisfaction with chewing
and speaking of 87–97% are reported after
10 years of function (Pjetursson et al. 2005;
Quirynen et al. 2005). The degree of pa-
tient satisfaction appears to be correlated
neither to the technical quality of dentures
nor to clinical parameters of masticatory
References
Abu Hantash, R.O., Al-Omiri, M.K. & Al-Wa-
hadni, A.M. (2006) Psychological impact on im-
plant patients’ oral health-related quality of life.
Clinical Oral Implants Research 17: 116–123.
Al-Khabbaz, A.K., Griffin, T.J. & Al-Shammari,
K.F. (2007) Assessment of pain associated with
the surgical placement of dental implants. Journal
of Periodontology 78: 239–246.
Allen, P.F. & McMillan, A.S. (2003) A longitudinal
study of quality of life outcomes in older adults
requesting implant prostheses and complete re-
movable dentures. Clinical Oral Implants Re-
search 14: 173–179.
Allen, P.F., McMillan, A.S. & Walshaw, D. (2001)
A patient-based assessment of implant-stabilized
and conventional complete dentures. Journal of
Prosthetic Dentistry 85: 141–147.
Anderson, J.D. (1998) The need for criteria on
reporting treatment outcomes. Journal of Prosthe-
tic Dentistry 79: 49–55.
Berge, T.I. (2000) Public awareness, information
sources and evaluation of oral implant treatment
in Norway. Clinical Oral Implants Research 11:
401–408.
Bradnock, G., White, D.A., Nuttall, N.M., Morris,
A.J., Treasure, E.T. & Pine, C.M. (2001) Adult
dental health survey: dental attitudes and beha-
viours in 1998 and implications for the future.
British Dental Journal 190: 228–232.
c 2010 John Wiley & Sons A/S
 111 |
Pommer et al  Progress and trends in patients’ mindset on dental implants
function or age and gender distribution
(Buch et al. 2002; Allen & McMillan
2003). By contrast, satisfaction rates with
dental prostheses are affected by psycholo-
gical factors, i.e. the existence of certain
personality profiles. Neuroticism was
found to be the main predictor of the
patients’ oral health-related quality of life
(Abu Hantash et al. 2006). Satisfaction
ratings were also found to be affected by
the patient’s dental status (Pjetursson et al.
2005) and differences in treatment modal-
ities, i.e. need for augmentation procedures
(Kaptein et al. 1998), or transmucosal vs.
submucosal implant placement (Nkenke
et al. 2007). Patient satisfaction with fixed
implant bridges was higher compared with
removable implant dentures (Heydecke et
al. 2003; Quirynen et al. 2005), while no
differences could be found between implant
overdentures with vs. without palatal cov-
erage (de Albuquerque et al. 2000; Allen &
McMillan 2003).
This first comparison of changes in
patients’ mindset on dental implants over a
period of 7 years brought forth the following
conclusions: neither implant acceptance
rates nor the percentage of implanted
patients and restored gaps demonstrated
Brägger, U., Krenander, P. & Lang, N.P. (2005)
Economic aspects of single-tooth replacement.
Clinical Oral Implants Research 16: 335–341.
Buch, R.S., Weibrich, G., Wegener, J. & Wagner, W.
(2002) Patient satisfaction with dental implants.
Mund-, Kiefer- und Gesichtschirurgie 6: 433–
436.
Cibirka, R.M., Razzoog, M. & Lang, B.R. (1997)
Critical evaluation of patient responses to dental
implant therapy. Journal of Prosthetic Dentistry
78: 574–581.
de Albuquerque, R.F., Lund, J.P., Tang, L., Larivée,
J., de Grandmont, P., Gauthier, G. & Feine, J.S.
(2000) Within-subject comparison of maxillary
long-bar implant-retained prostheses with and
without palatal coverage: patient-based outcomes.
Clinical Oral Implants Research 11: 555–565.
de Bruyn, H., Collaert, B., Lindén, U. & Björn, AL.
(1997) Patient’s opinion and treatment outcome
of fixed rehabilitation on Brånemark implants. A
3-year follow-up study in private dental practices.
Clinical Oral Implants Research 8: 265–271.
den Hartog, L., Slater, J.J., Vissink, A., Meijer, H.J.
& Raghoebar, G.M. (2008) Treatment outcome of
immediate, early and conventional single-tooth
implants in the aesthetic zone: a systematic re-
view to survival, bone level, soft-tissue, aesthetics
and patient satisfaction. Journal of Clinical Perio-
dontology 35: 1073–1086.
upward trends compared with the represen-
tative opinion poll of 2003. Patient satis-
faction rates with dental implant treatment
provide a major challenge for the future.
First-hand experience with implant treat-
ment was a key factor underlying a positive
attitude toward dental implants (Berge
2000). Professional public relations efforts
and confidence-building tools are indicated
to drop patients’ resentments. Guidelines
for communication with prospective im-
plant patients should be established to
provide them with realistic expectations
(Al-Khabbaz et al. 2007). Improved com-
munication ultimately may lead to greater
patient acceptance of dental implants as a
treatment modality.
Acknowledgements: The present
report is based on a commissioned
opinion poll conducted by Dr Karmasin
Institute for Market Research –
Austrian Gallup Institute Interview
Division. This survey was funded by the
Department of Oral Surgery (Bernhard
Gottlieb School of Dentistry, Medical
University of Vienna, Austria, Head:
ao.Univ.Prof. DDr Georg Watzek).
Elias, A.C. & Sheiham, A. (1998) The relationship
between satisfaction with mouth and number and
position of teeth. Journal of Oral Rehabilitation
25: 649–661.
Fürhauser, R., Florescu, D., Benesch, T., Haas, R.,
Mailath, G. & Watzek, G. (2005) Evaluation of
soft tissue around single-tooth implant crowns:
the pink esthetic score. Clinical Oral Implants
Research 16: 639–644.
Heydecke, G., Boudrias, P., Awad, M.A., de Albu-
querque, R.F., Lund, J.P. & Feine, J.S. (2003)
Within-subject comparisons of maxillary fixed
and removable implant prostheses: patient satis-
faction and choice of prosthesis. Clinical Oral
Implants Research 14: 125–130.
Kaptein, M.L., Hoogstraten, J., de Putter, C.,
de Lange, G.L. & Blijdorp, P.A. (1998)
Dental implants in the atrophic maxilla: measure-
ments of patients’ satisfaction and treatment
experience. Clinical Oral Implants Research 9:
321–326.
Lang, N.P., Karring, T. & Meredith, N. (2002)
Group E summary 4th European Workshop on
Periodontology, periodontal practice. Journal of
Clinical Periodontology 29 (Suppl. 3): 232–233.
Moberg, L.E., Köndell, P.A., Sagulin, G.B., Bolin,
A., Heimdahl, A. & Gynther, G.W. (2001) Bråne-
mark System and ITI Dental Implant System for
treatment of mandibular edentulism. A compara-
Clin. Oral Impl. Res. 22, 2011 / 106–112
Pommer et al  Progress and trends in patients’ mindset on dental implants
tive randomized study: 3-year follow-up. Clinical
Oral Implants Research 12: 450–461.
Nkenke, E., Eitner, S., Radespiel-Tröger, M., Vair-
aktaris, E., Neukam, F.W. & Fenner, M. (2007)
Patient-centred outcomes comparing transmuco-
sal implant placement with an open approach in
the maxilla: a prospective, non-randomized pilot
study. Clinical Oral Implants Research 18:
197–203.
Osterberg, T., Carlsson, G.E. & Sundh, V. (2000)
Trends and prognoses of dental status in the
Swedish population: analysis based on interviews
in 1975 to 1997 by Statistics Sweden. Acta
Odontologica Scandinavica 58: 177–182.
Palmqvist, S., Söderfeldt, B. & Arnbjerg, D. (1991)
Subjective need for implant dentistry in a Swedish
population aged 45–69 years. Clinical Oral Im-
plants Research 2: 99–102.
Pjetursson, B.E., Karoussis, I., Bürgin, W., Brägger,
U. & Lang, N.P. (2005) Patients’ satisfaction
following implant therapy. A 10-year prospective
cohort study. Clinical Oral Implants Research
16: 185–193.
Quirynen, M., Alsaadi, G., Pauwels, M., Haffajee,
A., van Steenberghe, D. & Naert, I. (2005) Micro-
biological and clinical outcomes and patient satis-
faction for two treatment options in the
edentulous lower jaw after 10 years of function.
Clinical Oral Implants Research 16: 277–287.
112 | Clin. Oral Impl. Res. 22, 2011 / 106–112
Schwartz-Arad, D., Bar-Tal, Y. & Eli, I. (2007) Effect
of stress on information processing in the dental
implant surgery setting. Clinical Oral Implants
Research 18: 9–12.
Sonoyama, W., Kuboki, T., Okamoto, S., Suzuki,
H., Arakawa, H., Kanyama, M., Yatani, H. &
Yamashita, A. (2002) Quality of life assessment in
patients with implant-supported and resin-bonded
fixed prosthesis for bounded edentulous spaces.
Clinical Oral Implants Research 13: 359–364.
Stellingsma, K., Bouma, J., Stegenga, B., Meijer, H.J.
& Raghoebar, G.M. (2003) Satisfaction and psy-
chosocial aspects of patients with an extremely
resorbed mandible treated with implant-retained
overdentures. A prospective, comparative study.
Clinical Oral Implants Research 14: 166–172.
Strassburger, C., Heydecke, G. & Kerschbaum, T.
(2004) Influence of prosthetic and implant therapy
on satisfaction and quality of life: a systematic
literature review. Part 1 characteristics of the
studies. International Journal of Prosthodontics
17: 83–93.
Tepper, G., Haas, R., Mailath, G., Teller, C., Zech-
ner, W., Watzak, G. & Watzek, G. (2003a) Re-
presentative marketing-oriented study on
implants in the Austrian population. I. Level of
information, sources of information and need for
patient information. Clinical Oral Implants Re-
search 14: 621–633.
Tepper, G., Haas, R., Mailath, G., Teller, C., Zech-
ner, W., Watzak, G. & Watzek, G. (2003b) Re-
presentative marketing-oriented study on
implants in the Austrian population. II. Implant
acceptance, patient-perceived costs and patient
satisfaction. Clinical Oral Implants Research
14: 634–642.
Vasak, C., Fiederer, R. & Watzek, G. (2007) Current
state of training for implant dentistry in Europe: a
questionnaire-based survey. Clinical Oral Im-
plants Research 18: xiii –xx.
Vermylen, K., Collaert, B., Lindén, U., Björn, A.L.
& De Bruyn, H. (2003) Patient satisfaction and
quality of single-tooth restorations. Clinical Oral
Implants Research 14: 119–124.
Zimmer, C.M., Zimmer, W.M., Williams, J.
& Liesener, J. (1992) Public awareness and
acceptance of dental implants. International
Journal of Oral & Maxillofacial Implants 7:
228–232.
Zitzmann, N.U. & Marinello, C.P. (2000) Treat-
ment outcomes of fixed or removable implant-
supported prostheses in the edentulous maxilla.
Part I: patients’ assessments. Journal of Prosthetic
Dentistry 83: 424–433.
Zitzmann, N.U., Marinello, C.P. & Sendi, P.
(2006) A cost-effectiveness analysis of implant
overdentures. Journal of Dental Research 85:
717–721.
c 2010 John Wiley & Sons A/S