Sung-Hee Oh Younhee Kim Joo-Yeon Park Yea Ji Jung Seong-Kyun Kim Sun-Young Park
Authors’ affiliations: Sung-Hee Oh, Younhee Kim, Joo-Yeon Park, Yea Ji Jung, Seong-Kyun Kim, Sun-Young Park, National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea Sung-Hee Oh, College of Pharmacy, Yonsei University, Incheon, Korea Younhee Kim, Institute of Health and Environment, School of Public Health, Seoul National University, Seoul, Korea Seong-Kyun Kim, Department of Prosthodontics and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea Sun-Young Park, School of Pharmacy, Sungkyunkwan University, Suwon, Korea
Comparison of fixed implant-supported prostheses, removable implant-supported prostheses, and complete dentures: patient satisfaction and oral health-related quality of life
Key words: complete dentures, fixed implant-supported prostheses, OHIP-14, oral health-
related quality of life, patient satisfaction, removable implant-supported prostheses Abstract Objectives: The purpose of this study was to compare patient satisfaction and oral health-related quality of life (OHRQoL) among fully edentulous patients treated with either fixed implantsupported prostheses (FP), removable implant-supported prostheses (RP), or complete dentures (CD). Material and Methods: Eighty-six patients – 29 FP, 27 RP, and 30 CD patients – participated in this study. The survey was conducted using face-to-face interviews with a questionnaire that included a patient satisfaction scale and Oral Health Impact Profile (OHIP-14). We measured patient satisfaction after prosthetic treatments and OHRQoL before and after the treatments.
Corresponding author: Sun-Young Park, MPharm School of Pharmacy Sungkyunkwan University 2066 Seobu-ro, Jangan-gu, Suwon Gyeonggi-do 440-746 Korea Tel.: +82 31 296 4380 Fax: +82 31 299 4379 e-mail: [email protected]
Results: After prosthetic treatments, OHRQoL increased in all three groups (P < 0.05). The FP and RP groups showed no significant difference in patient satisfaction and OHRQoL, and both groups showed greater improvement compared with the CD group. Specifically, the OHRQoL dimensions of functional limitation, physical pain, psychological discomfort, and psychological disability in the FP group, and functional limitation in the RP group, improved greatly in comparison with the CD group (P < 0.05). Conclusions: Although further research is still needed, prosthetic treatments may provide superior OHRQoL for fully edentulous patients. In particular, both the FP and RP treatments provided significantly greater improvement of OHRQoL and patient satisfaction than the CD treatment. Reliable information of OHRQoL and patient satisfaction helps experts and patients choose the best prosthetic treatment option.
Date: Accepted 28 September 2014 To cite this article: Oh S-H, Kim Y, Park J-Y, Jung YJ, Kim S-K, Park S-Y. Comparison of fixed implant-supported prostheses, removable implant-supported prostheses, and complete dentures: patient satisfaction and oral health-related quality of life. Clin. Oral Impl. Res. 00, 2014, 1–7. doi: 10.1111/clr.12514
While the prevalence of total tooth loss is decreasing, transition to edentulousness is occurring at a later stage in patients’ lives because of increased life expectancy (Allen et al. 2001b; Preciado et al. 2012). It is known that edentulousness can cause functional problems such as diminished chewing efficiency, nutritional imbalance, disability, handicap, and reducing quality of life (QoL) (Allen et al. 2001b; Locker et al. 2002; Richmond et al. 2007). To solve these problems, different types of prostheses such as fixed implant-supported prostheses (FP), removable implant-supported prostheses (RP), and complete dentures (CD) have been developed for fully edentulous patients (Locker et al. 2002; Fillion et al. 2013; Preciado et al. 2013; Emami et al. 2014).
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Clinical studies on patient satisfaction or QoL after prosthetic treatments have shown successful results (Fillion et al. 2013; Preciado et al. 2013; Emami et al. 2014). Singlearm studies have showed improvement in oral health-related quality of life (OHRQoL) in the FP (Berretin-Felix et al. 2008), RP (MacEntee et al. 2005), and CD (John et al. 2007) groups. Some studies also compared either patient satisfaction or OHRQoL between two of the three groups (Heydecke et al. 2003b; Kim 2008; Brennan et al. 2010). When dentists and patients choose a prosthetic treatment option for full edentulism, they should have inferred the comparative effectiveness on patient satisfaction and OHRQoL among FP, RP, and CD groups indirectly based on several previous literature
1
Oh et al OHRQoL in fully edentulous patients treated with prostheses
sources. This is because there were few studies that have compared the results of the three treatment options in fully edentulous patients. Therefore, the purpose of this study was to compare patient satisfaction and OHRQoL in fully edentulous patients who received FP, RP, or CD.
Material and methods Study design and subjects
This study was approved by the Institutional Review Board (IRB) at the National Evidencebased healthcare Collaborating Agency (No. NECAIRB11-014-1). We included patients who were aged 40–69 years; were fully edentulous and treated with FP, RP, or CD for edentulous maxilla, mandible, or both; provided voluntary consent to participate in this survey; and received prosthetic treatment at a dental clinic or hospital at least 6 months prior to the survey date. The sample size was determined using standard statistical criteria (alpha = 0.05, power = 0.80) based on the primary outcome, which was OHRQoL measured on visual analog scales (VAS) before and after treatment in the previous studies (Awad et al. 2003; Heydecke et al. 2003a). The minimum sample size calculated was 26 patients per group. The quota sampling was used to select the representative sample, with quotas related to the main characteristics of the target population (Moser 1952; Aday & Cornelius 2006). Samples were extracted in a quantity proportional to the population distribution according to the age based on the forth Korea National Health and Nutrition Examination Survey (Kim et al. 2011). This survey was conducted from September 1, 2011 to October 26, 2011. The face-to-face interview method was used to decrease possible bias by respondents and increase response rates (Aday & Cornelius 2006). Interviewers were extensively trained using the instruction sheet on each prosthetic treatment definition with accompanying figures and questionnaire items. Questionnaire
A draft of the questionnaire was prepared based on a literature review and expert opinions. It was pilot-tested on 10 patients, each of whom received one of the prosthetic treatments. An in-depth interview of five patients that received prosthetic treatments at hospitals located in Seoul, Korea, was performed to identify any questions that required revision. The final version of the questionnaire was developed reflecting the oral health
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Clin. Oral Impl. Res. 0, 2014 / 1–7
context of Korea, and it was divided into three parts: (1) Characteristics of subjects including oral health and dental management; (2) Patient satisfaction; and (3) OHRQoL using the Korean version of the 14-item Oral Health Impact Profile (OHIP-14) (Bae et al. 2007). Previous studies have shown that functional aspects, social aspects, and overall satisfaction were important factors in the evaluation of patient satisfaction (Zitzmann & Marinello 2000; Heydecke et al. 2003a). Based on these articles, patient satisfaction after prosthetic treatments was measured through three domains containing a total of 14 items – five items in chewing function, six items in social function, and three items in overall satisfaction. Responses were measured by a five-point Likert scale ranging from 0 (“not at all satisfied”) to 4 (“totally satisfied”). Patient satisfaction was calculated by totaling each item score – the scores ranged from 0 to 56. The higher scores indicated progressively greater satisfaction with the prosthetic treatment. OHIP-14 is one of the most commonly used instruments for measuring OHRQoL. It was derived from the original extended version, OHIP-49, which was developed in 1994 (Slade & Spencer 1994; Montero-Martin et al. 2009). Even though it is the short form, it has proven to be reliable and valid in several languages including Korean (Slade 1997; Allen et al. 2001a; Locker et al. 2004; Lee et al. 2005; Bae et al. 2007). The self-reported questionnaire consisted of 14-items divided into seven dimensions – functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. For these items, subjects were asked to evaluate how often they felt and experienced an impacts on oral health during the 12-month period prior to prosthetic treatment and during the period after the treatment using a five-point Likert scale coded 0 (“never”), 1 (“hardly”), 2 (“occasionally”), 3 (“fairly often”), and 4 (“very often”). Total OHIP-14 scores ranged from 0 to 56 and subtotal scores for each dimension were calculated by adding together each item score; higher scores indicated worse OHRQoL. Data analyses
Statistical analyses were performed using Stata/SE 11.1 (StataCorp LP, College Station, TX, USA) at a significance level of 0.05. Data were analyzed using descriptive statistics for representing frequencies of subject characteristics. The characteristics of the three groups were compared using the chi-square test or
Fisher’s exact test for categorical variables. For patient satisfaction after prosthetic treatments, the median scores were compared using a nonparametric Kruskal–Wallis test because data were not normally distributed according to the Shapiro–Wilk test. In addition, changes in OHRQoL were calculated as the difference between OHIP-14 median scores before and after treatment. After using the Shapiro–Wilk test of normality, the Wilcoxon signed-rank test was used to test the statistical significance between changes in OHRQoL before and after treatment, within each group. Among the groups, changes in OHIP-14 median scores were compared using the Kruskal–Wallis test; a post hoc pairwise comparisons that used the Wilcoxon ranksum tests with Bonferroni’s correction (P < 0.017; Bonferroni-corrected P value threshold) were also performed.
Results General characteristics
Eighty-six subjects – 29 FP, 27 RP, and 30 CD – took part in this study. The general characteristics of the three groups are shown in Table 1. The majority of general characteristics were similar in each group (P > 0.05). The survey included 34 (39.5%) male and 52 (60.5%) female subjects. The mean age of the patients was 55.1 years (SD = 7.1). The variables “subjective economic status”, “subjective health status”, and “presence of chronic disease” showed statistically significant differences among the three groups (P < 0.05). In subjective economic status, all subjects of the CD group responded as being below the middle class, while 17.2% of the FP group and 3.7% of the RP group responded as being above the upper middle class. The FP group reported better subjective health status, and the CD group reported more chronic diseases than the other groups. Oral health and dental management-related characteristics
Oral health and dental management-related characteristics of the three groups are shown in Table 2. 69.8% of the subjects were examined 1–3 years after receiving new prostheses. Among the subjects, 64.0% reported their subjective oral health status as either fair or good, 66.3% did not have oral diseases, and 14.0% received treatment due to side effects after prosthetic treatment. There were statistically significant differences among the three groups in the variables “treatment location”, “subjective treatment costs”, and “dental checkups” (all variables, P < 0.05).
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Oh et al OHRQoL in fully edentulous patients treated with prostheses
Table 1. General characteristics according to the type of prosthetic treatment
Variables
Fixed implantsupported prostheses (N = 29)
Age, Mean (SD) 54.4 (6.9) Gender, n (%) Male 12 (41.4) Female 17 (58.6) Residential area, n (%) Metropolitan area 26 (89.7) Urban area 2 (6.9) Rural area 1 (3.5) Monthly household income (USD)§, n (%) 0.017, Bonferroni; see Table 6).
Discussion The results of this study confirm that prosthetic treatments can provide better OHRQoL for fully edentulous patients and the FP and RP treatments may improve OHRQoL and patient satisfaction better than CD
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Clin. Oral Impl. Res. 0, 2014 / 1–7
Oh et al OHRQoL in fully edentulous patients treated with prostheses
Table 2. Oral health and dental management-related characteristics according to the type of prosthetic treatment Fixed implantsupported prostheses (N = 29)
Variables
Treatment period, n (%)
Authors’ affiliations: Sung-Hee Oh, Younhee Kim, Joo-Yeon Park, Yea Ji Jung, Seong-Kyun Kim, Sun-Young Park, National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea Sung-Hee Oh, College of Pharmacy, Yonsei University, Incheon, Korea Younhee Kim, Institute of Health and Environment, School of Public Health, Seoul National University, Seoul, Korea Seong-Kyun Kim, Department of Prosthodontics and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea Sun-Young Park, School of Pharmacy, Sungkyunkwan University, Suwon, Korea
Comparison of fixed implant-supported prostheses, removable implant-supported prostheses, and complete dentures: patient satisfaction and oral health-related quality of life
Key words: complete dentures, fixed implant-supported prostheses, OHIP-14, oral health-
related quality of life, patient satisfaction, removable implant-supported prostheses Abstract Objectives: The purpose of this study was to compare patient satisfaction and oral health-related quality of life (OHRQoL) among fully edentulous patients treated with either fixed implantsupported prostheses (FP), removable implant-supported prostheses (RP), or complete dentures (CD). Material and Methods: Eighty-six patients – 29 FP, 27 RP, and 30 CD patients – participated in this study. The survey was conducted using face-to-face interviews with a questionnaire that included a patient satisfaction scale and Oral Health Impact Profile (OHIP-14). We measured patient satisfaction after prosthetic treatments and OHRQoL before and after the treatments.
Corresponding author: Sun-Young Park, MPharm School of Pharmacy Sungkyunkwan University 2066 Seobu-ro, Jangan-gu, Suwon Gyeonggi-do 440-746 Korea Tel.: +82 31 296 4380 Fax: +82 31 299 4379 e-mail: [email protected]
Results: After prosthetic treatments, OHRQoL increased in all three groups (P < 0.05). The FP and RP groups showed no significant difference in patient satisfaction and OHRQoL, and both groups showed greater improvement compared with the CD group. Specifically, the OHRQoL dimensions of functional limitation, physical pain, psychological discomfort, and psychological disability in the FP group, and functional limitation in the RP group, improved greatly in comparison with the CD group (P < 0.05). Conclusions: Although further research is still needed, prosthetic treatments may provide superior OHRQoL for fully edentulous patients. In particular, both the FP and RP treatments provided significantly greater improvement of OHRQoL and patient satisfaction than the CD treatment. Reliable information of OHRQoL and patient satisfaction helps experts and patients choose the best prosthetic treatment option.
Date: Accepted 28 September 2014 To cite this article: Oh S-H, Kim Y, Park J-Y, Jung YJ, Kim S-K, Park S-Y. Comparison of fixed implant-supported prostheses, removable implant-supported prostheses, and complete dentures: patient satisfaction and oral health-related quality of life. Clin. Oral Impl. Res. 00, 2014, 1–7. doi: 10.1111/clr.12514
While the prevalence of total tooth loss is decreasing, transition to edentulousness is occurring at a later stage in patients’ lives because of increased life expectancy (Allen et al. 2001b; Preciado et al. 2012). It is known that edentulousness can cause functional problems such as diminished chewing efficiency, nutritional imbalance, disability, handicap, and reducing quality of life (QoL) (Allen et al. 2001b; Locker et al. 2002; Richmond et al. 2007). To solve these problems, different types of prostheses such as fixed implant-supported prostheses (FP), removable implant-supported prostheses (RP), and complete dentures (CD) have been developed for fully edentulous patients (Locker et al. 2002; Fillion et al. 2013; Preciado et al. 2013; Emami et al. 2014).
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Clinical studies on patient satisfaction or QoL after prosthetic treatments have shown successful results (Fillion et al. 2013; Preciado et al. 2013; Emami et al. 2014). Singlearm studies have showed improvement in oral health-related quality of life (OHRQoL) in the FP (Berretin-Felix et al. 2008), RP (MacEntee et al. 2005), and CD (John et al. 2007) groups. Some studies also compared either patient satisfaction or OHRQoL between two of the three groups (Heydecke et al. 2003b; Kim 2008; Brennan et al. 2010). When dentists and patients choose a prosthetic treatment option for full edentulism, they should have inferred the comparative effectiveness on patient satisfaction and OHRQoL among FP, RP, and CD groups indirectly based on several previous literature
1
Oh et al OHRQoL in fully edentulous patients treated with prostheses
sources. This is because there were few studies that have compared the results of the three treatment options in fully edentulous patients. Therefore, the purpose of this study was to compare patient satisfaction and OHRQoL in fully edentulous patients who received FP, RP, or CD.
Material and methods Study design and subjects
This study was approved by the Institutional Review Board (IRB) at the National Evidencebased healthcare Collaborating Agency (No. NECAIRB11-014-1). We included patients who were aged 40–69 years; were fully edentulous and treated with FP, RP, or CD for edentulous maxilla, mandible, or both; provided voluntary consent to participate in this survey; and received prosthetic treatment at a dental clinic or hospital at least 6 months prior to the survey date. The sample size was determined using standard statistical criteria (alpha = 0.05, power = 0.80) based on the primary outcome, which was OHRQoL measured on visual analog scales (VAS) before and after treatment in the previous studies (Awad et al. 2003; Heydecke et al. 2003a). The minimum sample size calculated was 26 patients per group. The quota sampling was used to select the representative sample, with quotas related to the main characteristics of the target population (Moser 1952; Aday & Cornelius 2006). Samples were extracted in a quantity proportional to the population distribution according to the age based on the forth Korea National Health and Nutrition Examination Survey (Kim et al. 2011). This survey was conducted from September 1, 2011 to October 26, 2011. The face-to-face interview method was used to decrease possible bias by respondents and increase response rates (Aday & Cornelius 2006). Interviewers were extensively trained using the instruction sheet on each prosthetic treatment definition with accompanying figures and questionnaire items. Questionnaire
A draft of the questionnaire was prepared based on a literature review and expert opinions. It was pilot-tested on 10 patients, each of whom received one of the prosthetic treatments. An in-depth interview of five patients that received prosthetic treatments at hospitals located in Seoul, Korea, was performed to identify any questions that required revision. The final version of the questionnaire was developed reflecting the oral health
2 |
Clin. Oral Impl. Res. 0, 2014 / 1–7
context of Korea, and it was divided into three parts: (1) Characteristics of subjects including oral health and dental management; (2) Patient satisfaction; and (3) OHRQoL using the Korean version of the 14-item Oral Health Impact Profile (OHIP-14) (Bae et al. 2007). Previous studies have shown that functional aspects, social aspects, and overall satisfaction were important factors in the evaluation of patient satisfaction (Zitzmann & Marinello 2000; Heydecke et al. 2003a). Based on these articles, patient satisfaction after prosthetic treatments was measured through three domains containing a total of 14 items – five items in chewing function, six items in social function, and three items in overall satisfaction. Responses were measured by a five-point Likert scale ranging from 0 (“not at all satisfied”) to 4 (“totally satisfied”). Patient satisfaction was calculated by totaling each item score – the scores ranged from 0 to 56. The higher scores indicated progressively greater satisfaction with the prosthetic treatment. OHIP-14 is one of the most commonly used instruments for measuring OHRQoL. It was derived from the original extended version, OHIP-49, which was developed in 1994 (Slade & Spencer 1994; Montero-Martin et al. 2009). Even though it is the short form, it has proven to be reliable and valid in several languages including Korean (Slade 1997; Allen et al. 2001a; Locker et al. 2004; Lee et al. 2005; Bae et al. 2007). The self-reported questionnaire consisted of 14-items divided into seven dimensions – functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. For these items, subjects were asked to evaluate how often they felt and experienced an impacts on oral health during the 12-month period prior to prosthetic treatment and during the period after the treatment using a five-point Likert scale coded 0 (“never”), 1 (“hardly”), 2 (“occasionally”), 3 (“fairly often”), and 4 (“very often”). Total OHIP-14 scores ranged from 0 to 56 and subtotal scores for each dimension were calculated by adding together each item score; higher scores indicated worse OHRQoL. Data analyses
Statistical analyses were performed using Stata/SE 11.1 (StataCorp LP, College Station, TX, USA) at a significance level of 0.05. Data were analyzed using descriptive statistics for representing frequencies of subject characteristics. The characteristics of the three groups were compared using the chi-square test or
Fisher’s exact test for categorical variables. For patient satisfaction after prosthetic treatments, the median scores were compared using a nonparametric Kruskal–Wallis test because data were not normally distributed according to the Shapiro–Wilk test. In addition, changes in OHRQoL were calculated as the difference between OHIP-14 median scores before and after treatment. After using the Shapiro–Wilk test of normality, the Wilcoxon signed-rank test was used to test the statistical significance between changes in OHRQoL before and after treatment, within each group. Among the groups, changes in OHIP-14 median scores were compared using the Kruskal–Wallis test; a post hoc pairwise comparisons that used the Wilcoxon ranksum tests with Bonferroni’s correction (P < 0.017; Bonferroni-corrected P value threshold) were also performed.
Results General characteristics
Eighty-six subjects – 29 FP, 27 RP, and 30 CD – took part in this study. The general characteristics of the three groups are shown in Table 1. The majority of general characteristics were similar in each group (P > 0.05). The survey included 34 (39.5%) male and 52 (60.5%) female subjects. The mean age of the patients was 55.1 years (SD = 7.1). The variables “subjective economic status”, “subjective health status”, and “presence of chronic disease” showed statistically significant differences among the three groups (P < 0.05). In subjective economic status, all subjects of the CD group responded as being below the middle class, while 17.2% of the FP group and 3.7% of the RP group responded as being above the upper middle class. The FP group reported better subjective health status, and the CD group reported more chronic diseases than the other groups. Oral health and dental management-related characteristics
Oral health and dental management-related characteristics of the three groups are shown in Table 2. 69.8% of the subjects were examined 1–3 years after receiving new prostheses. Among the subjects, 64.0% reported their subjective oral health status as either fair or good, 66.3% did not have oral diseases, and 14.0% received treatment due to side effects after prosthetic treatment. There were statistically significant differences among the three groups in the variables “treatment location”, “subjective treatment costs”, and “dental checkups” (all variables, P < 0.05).
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Oh et al OHRQoL in fully edentulous patients treated with prostheses
Table 1. General characteristics according to the type of prosthetic treatment
Variables
Fixed implantsupported prostheses (N = 29)
Age, Mean (SD) 54.4 (6.9) Gender, n (%) Male 12 (41.4) Female 17 (58.6) Residential area, n (%) Metropolitan area 26 (89.7) Urban area 2 (6.9) Rural area 1 (3.5) Monthly household income (USD)§, n (%) 0.017, Bonferroni; see Table 6).
Discussion The results of this study confirm that prosthetic treatments can provide better OHRQoL for fully edentulous patients and the FP and RP treatments may improve OHRQoL and patient satisfaction better than CD
3 |
Clin. Oral Impl. Res. 0, 2014 / 1–7
Oh et al OHRQoL in fully edentulous patients treated with prostheses
Table 2. Oral health and dental management-related characteristics according to the type of prosthetic treatment Fixed implantsupported prostheses (N = 29)
Variables
Treatment period, n (%)
