KNOWLEDGE AND ATTITUDE OF PATIENTS REGARDING THE CHOICE OF SELECTION OF FPDS AND DENTAL IMPLANTS
Shahzeb Ansari1*, Abdulrahman Alhazmi2, Ali Alajmi2, Wail Asali2, Sultan Alkathiri2, Ziad Alrasheedi2
1Department of Preventive Dentistry, College of Dentistry, Riyadh Elm University, Riyadh, KSA. [email protected]
2Department of Internship Training Program, College of Dentistry, Riyadh Elm University, Riyadh, KSA.
https://doi.org/10.51847/Esn7bjMEN4
ABSTRACT
A patient's dental health is highly essential for social and psychological well-being, which is highly dependent on the presence of teeth in the oral cavity. Edentulous, a complete loss of all dentition, can be linked to caries, periodontal disease, or an injury, which affects aesthetics and function and, therefore, has a considerable impact on social and psychological well-being. A cross-section survey was used to collect the data through an online survey using the questionnaire among the Saudi population consisting of items evaluating the knowledge about implants and crowns. Findings reported that the majority of participants were female, comprising 62.6% of the total sample. 85.7% of participants were from the middle class, and the age group of 36-40 was 37.4%, followed by 40 above participants. 78.9% of participants were married, and a majority graduated. Information level about implants and crowns was poor, while the majority chose fixed partial dentures over implants. 67.6% were not sure about any complications related to it, while those who agreed thought broken or loose implants were the most common complication. Findings revealed the poor knowledge of participants about implants and crowns while preferred FPDs over implants. The reason for choosing implants and crowns was longevity and cost, while for not choosing it was cost and long treatment time.
Key words: Knowledge, Attitude, Fixed partial denture, Implants.
Introduction
A patient's dental health is highly essential for social and psychological well-being, which is highly dependent on the presence of teeth in the oral cavity [1-3]. Edentulism, a complete loss of all dentition, can be linked to caries, periodontal disease, or an injury, which affects aesthetics and function and, therefore, has a considerable impact on social and psychological well-being. Therefore, an imminent urge to restore the natural has taken precedence, and hence several alternative treatment methods, such as complete dentures, removable partial dentures (RPD), fixed partial dentures (FPD), and dental implants, have emerged [4, 5].
The substitution and repair of missing dentition with fixed prosthetics reinstate the configuration purpose and appearance, and it provides excellent satisfaction to the patient as well as the dentist. It can change an unhealthy and unsightly dentition into a properly occluded, healthy bite and aesthetically pleasing dentition [4, 6].
FPDs are “dental prostheses that are luted, screwed, or mechanically attached or otherwise securely retained to natural teeth, tooth roots, and/or dental implant abutments." FPDs or bridges have been used for missing dentition restoration for many years. They are more suitable for the replacement of root canal-treated teeth, however, as they are highly economical in comparison to implants, which makes this treatment modality more acceptable to patients. The fixed partial prosthesis is sensitive to various frequent problems, which include periodontal and periapical infections, traumatic occlusion, loss of tooth vitality, breakage of the prosthesis, etc. Additionally, in the case of bridges, the neighboring structures need to be compromised to restore a single tooth, which is a significant drawback [7].
With the advent and widespread usage of osseointegrated implants, many edentulous cases are now being replaced through implants rather than FPDs. A dental implant is a screw that is surgically embedded into the bone, mimicking the root to restore a single or more teeth or making a complete prosthesis taking support of these. It has more advantages as compared to FPDs in terms of aesthetics and replacement of missing teeth without compromising the natural teeth. However, some patients still prefer FPDs over implants due to a lack of awareness in terms of its added advantages as compared to FPDs, coupled with its high cost and a misconception that during implants, a major surgical procedure is involved [8].
Several studies have been conducted in various countries to examine patients' awareness of dental implants from this standpoint. According to some studies, the level of awareness ranges from 23.24 percent to 79%. In contrast, others report that the high cost was the main reason preventing patients from choosing implants in 86.5% of cases, combined with fear of surgery and longer treatment time in 68.6 % and 71% of cases, respectively [9].
According to a study conducted by Salim et al. (2021), 34% of patients preferred implants [10]. In one study regarding awareness of dental prosthesis types, 60% had a piece of good knowledge about fixed prosthesis, compared to 47.5% about removable partial dentures and 57% about dental implants. Another study reported that due to the time length and the fact that the implant is a surgical treatment, about 48% of patients believe that FPD is less time demanding than the implant [11].
Benefits of the study
The findings of this study may help determine the treatment plan for patients with their input and reasons.
Scope of the study
This study is going to focus mainly on Saudi patients visiting REU clinics.
Study hypotheses
Patients showed a positive attitude towards FPDs as compared to Implants.
Aims of the study
Materials and Methods
Study design
This is a cross-sectional study conducted among Saudi patients using an online survey.
Study sample
398 patients visiting various campuses of REU were utilized in this study.
Study instrument
The online questionnaire consisted of questions related to demographic data followed by questions including knowledge and attitude towards the choice of various fixed prostheses and reasons associated with them.
Instrument validity and reliability
A pilot study was conducted by sending the survey to 20 participants. The data was inserted in SPSS version 22 to determine the reliability using Chronbach’s coefficient alpha (value: 0.725). The validity of the questionnaire was tested by sending it to experienced researchers in REU, but no changes were made.
Statistical analysis
Collected data were analyzed using SPSS version 22, where descriptive and inferential statistics were conducted. Comparisons between groups will be made with the value of significance kept under 0.05 using the Chi-square test.
Results and Discussion
In the present study, based on the knowledge and attitude of patients regarding the choice of selection of FPDs and dental implants, the frequency table revealed that the majority of participants were female, comprising 62.6% of the total sample (Table 1). 85.7% of participants were from the middle class, and the age group of 36-40 was 37.4%, followed by 40 above participants. 78.9% of participants were married, and the majority were graduates. Information level about implants and crowns was poor, while the majority chose fixed partial dentures over implants. The reason for choosing implants was longevity, and the high cost was not to choose them. The source of information was friends and family. 67.6% were not sure about any complications related to it, while those who agreed thought broken or loose implants were the most common complication. When it comes to crowns/bridges, minute differences exist between choosing it due to cost and would not choose it. The reason for not choosing it was also its high cost for the majority, and the source of information was friends and family, same as implants. The majority thought no complications were associated with crowns, while those who agreed thought bad odor was the most common complication. The majority agreed they needed more information about implants and crowns/bridges. In Table 2, we explored the non-significant gender differences, and the findings revealed that the majority of both groups were from the middle class, married, and graduated. Females were from the 36-40 years age group while the males were more from the 40-above group. Both groups have poor information about implants and crowns/bridges and choose FPDs over implants. Longevity was the reason for choosing and the high cost for not choosing implants for both groups. Friends and family were a source of information for males while social media was for females. Both groups were unsure of any complications, while the remaining thought broken implants were the most common ones. In crowns/bridges, the majority did not choose crowns, and the reason was its cost. Information source was friends and family for males while dentists for females. Most of them were not sure about any complications, while those who agreed thought bad odor was the most common. Both groups think they need more information about implants and bridges.
Table 1. Frequency Percentages of the variables
Variable |
Frequency Percentage |
Gender Male Female |
149(37.4%) 249(62.6%) |
Socio-economic status Low SES Middle SES High SES |
32(8%) 341(85.7%) 25(6.3%) |
Age 20-25 26-30 31-35 36-40 40 above |
42(10.6%) 30(7.5%) 77(19.3%) 149(37.4%) 100(25.1%) |
Marital status Single Married Widow Divorced |
58(14.6%) 314(78.9%) 18(4.5%) 08(02%) |
Education Level High school or below Graduation Post-Graduation |
96(24.1%) 252(63.3%) 50(12.6%) |
Level of information regarding implants? Excellent Very good Good Poor Do not know |
16(04%) 13(3.3%) 55(13.8%) 222(55.8%) 92(23.1%) |
Level of information regarding crowns/bridges? Excellent Very good Good Poor Do not know |
15(3.8%) 18(4.5%) 61(15.3%) 194(48.7%) 110(27.6%) |
Which prosthesis to choose? Fixed Partial Dentures Implants |
253(63.6%) 145(36.4%) |
Reason to choose implants? Cost Longevity Convenience Would not choose |
54(13.6%) 225(56.5%) 33(8.3%) 86(21.6%) |
Reason not to choose implants High cost Long treatment time Need surgery Lack of information |
185(53.3%) 46(13.3%) 82(23.6%) 34(9.8%) |
Source of information Friends and Family Social Media Dentist Other |
126(31.7%) 120(30.2%) 102(25.6%) 50(12.6%) |
Are there any complications associated with implants? Yes No Not sure |
14(21.5%) 129(32.4%) 269(67.6%) |
If yes, which complication is the most common? Broken or loose implants Gingival bleeding Bad Odor Swelling |
75(28.8%) 59(22.7%) 58(22.3%) 68(26.2%) |
Reason to choose crowns/bridges? Cost Longevity Convenience Would not choose |
124(31.2%) 62(15.6%) 86(21.6%) 126(31.7%) |
Reason not to choose crowns/bridges? High cost Long treatment Need surgery Lack of information |
135(33.9%) 105(26.4%) 46(11.6%) 112(28.1%) |
Source of information? Friends and family Social media Dentist Other |
136(34.2%) 88(22.1%) 101(25.4%) 73(18.3%) |
Is there any complication associated with crowns/bridges? Yes No Not sure |
143(35.9%) 55(13.8%) 200(50.3%) |
If yes, which complication is more common? Broken crown/bridge Gingival bleeding Bad odor Swelling Sensitivity |
54(19.2%) 48(17.1%) 132(47%) 26(9.3%) 21(7.5%) |
Do you think you need more information on implants? Yes No May be |
332(83.4%) 43(10.8%) 23(5.8%) |
Do you think you need more information about crowns/bridges? Yes No May be |
318(79.9%) 53(13.3%) 27(6.8%) |
Table 2. Differences across gender
Variable |
Male |
Female |
P-value |
Level of information regarding implants? Excellent Very good Good Poor Do not know |
2.7% 5.4% 12.1% 54.4% 25.5% |
4.8% 2% 14.9% 56.6% 21.7% |
.242 |
Level of information regarding crowns/bridges? Excellent Very good Good Poor Do not know |
2% 5.4% 12.8% 45.6% 34.2% |
4.8% 4% 16.7% 50.6% 23.7% |
.109 |
Which prosthesis to choose? Fixed Partial Dentures Implants |
59.1% 40.9% |
66.3% 33.7% |
.148 |
Reason to choose implants? Cost Longevity Convenience Would not choose |
18.1% 53.7% 6% 22.1% |
10.8% 58.2% 9.6% 21.3% |
.141 |
Reason not to choose implants High cost Long treatment time Need surgery Lack of information |
48.4% 16.8% 14.2% 11.4% |
45.4% 8.4% 24.5% 6.8% |
.006 |
Source of information Friends and Family Social Media Dentist Other |
38.1% 25.5% 21.5% 14.8% |
27.7% 32.9% 28.1% 11.2% |
.058 |
Are there any complications associated with implants? Yes No Not sure |
29.5% 12.1% 58.4% |
34.1% 9.6% 56.2% |
.545 |
If yes, which complication is the most common? Broken or loose implants Gingival bleeding Bad Odor Swelling |
28.1% 27.1% 20.8% 23.9% |
19.3% 13.3% 15.3% 18.1% |
.626 |
Reason to choose crowns/bridges? Cost Longevity Convenience Would not choose |
32.2% 14.8% 19.5% 33.6% |
30.5% 16.1% 22.9% 30.5% |
.810 |
Reason not to choose crowns/bridges? High cost Long treatment Need surgery Lack of information |
34.9% 27.5% 10.1% 27.5% |
33.3% 25.7% 12.4% 28.5% |
.879 |
Source of information? Friends and family Social media Dentist Other |
44.3% 16.8% 20.1% 18.8% |
28.1% 25.3% 28.5% 18.1% |
.005 |
Is there any complication associated with crowns/bridges? Yes No Not sure |
27.5% 16.8% 55.7% |
40.9% 13% 47% |
.022 |
If yes, which complication is more common? Broken crown/bridge Gingival bleeding Bad odor Swelling Sensitivity |
8.7% 12.8% 33.6% 6% 4.7% |
16.5% 11.6% 32.9% 6.8% 5.6% |
.435 |
Do you think you need more information on implants? Yes No May be |
83.9% 10.7% 5.4% |
83.1% 10.8% 6% |
.962 |
Do you think you need more information about crowns/bridges? Yes No May be |
82.6% 11.4% 6% |
78.3% 14.5% 7.2% |
.590 |
In Table 3, we explored the differences across socioeconomic status and fining reported non-significant differences. The majority of lower SES were from the age group of 31-35, the middle class was 36-40, and the higher were from 36 to 40 above age group. The majority of all three groups were married and graduated. The level of information was poor for all groups for implants and crowns and chose FPDs over implants. The reason for choosing implants was longevity for the 2nd and 3rd groups while the cost for the 1st group. The reason for not choosing it was the high cost for the first 2 groups while longevity and need surgery for the later group. The source of information was social media for the first, friends for 2nd and dentists for 3rd group. Higher SES think complications are associated with implants, and the most common one is gingival bleeding, while for other two are bad odor and broken implant, respectively. The reason for choosing bridges was the cost for lower and middle SES, while the higher class would not choose it. The source of information was friends for the lower and middle class while other sources were for the higher class. The complication associated with bridges is a bad odor, according to all groups. All groups think they need more information about implants and bridges.
Table 3. The difference across Socioeconomic status
Variable |
Low SES |
Middle SES |
High SES |
P-value |
Level of information regarding implants? Excellent Very good Good Poor Do not know |
3.1% 3.1% 15.6% 46.9% 31.3% |
3.8% 2.9% 12.9% 56.9% 23.5% |
8% 8% 24% 52% 8% |
.336 |
Level of information regarding crowns/bridges? Excellent Very good Good Poor Do not know |
3.1% 12.5% 9.4% 43.8% 31.3% |
3.5% 3.8% 15.2% 49.6% 27.9% |
8% 4% 24% 44% 20% |
.329 |
Which prosthesis to choose? Fixed Partial Dentures Implants |
46.9% 53.1% |
64.5% 35.5% |
72% 28% |
.093 |
Reason to choose implants? Cost Longevity Convenience Would not choose |
40.6% 31.3% 9.4% 18.8% |
11.4% 58.1% 8.5% 22% |
8% 68% 4% 20% |
.043 |
Reason not to choose implants High cost Long treatment time Need surgery Lack of information |
62.5% 6.3% 9.4% 15.6% |
46.6% 10.9% 21.1% 8.2% |
28.6% 33% 33% 4.8% |
.013 |
Source of information Friends and Family Social Media Dentist Other |
25% 50% 18.8% 6.2% |
32.8% 29% 25.8% 12.3% |
24% 20% 32% 24% |
.093 |
Are there any complications associated with implants? Yes No Not sure |
25% 21.9% 53.1% |
31.1% 9.3% 59.5% |
60% 12% 28% |
.004 |
If yes, which complication is the most common? Broken or loose implants Gingival bleeding Bad Odor Swelling |
18.8% 18.8% 28.1% 6.3% |
18.5% 13.2% 13.9% 18.2% |
24% 32% 8% 16% |
.089 |
Reason to choose crowns/bridges? Cost Longevity Convenience Would not choose |
50% 6.2% 21.9% 21.9% |
31.1% 16.1% 21.7% 31.1% |
8% 20% 20% 52% |
.025 |
Reason does not choose crown/bridges? High cost Long treatment Need surgery Lack of information |
50% 28.1% 9.4% 12.5% |
33.1% 24.9% 11.7% 30.2% |
24% 44% 12% 20% |
.105 |
Source of information? Friends and family Social media Dentist Other |
43.8% 28.1% 15.6% 12.5% |
34% 21.4% 27% 17.5% |
24% 24% 16% 36% |
.142 |
Is there any complication associated with crowns/bridges? Yes No Not sure |
28.1% 25% 46.9% |
35.5% 13.2% 51.3% |
52% 8% 40% |
.157 |
If yes, which complication is more common? Broken crown/bridge Gingival bleeding Bad odor Swelling Sensitivity |
21.9% 15.6% 28.1% 3.1% 3.1% |
12.6% 12.3% 32.6% 6.7% 5.9% |
16% 4% 48% 8% 00% |
.471 |
Do you think you need more information on implants? Yes No May be |
72% 19% 9% |
84.8% 10% 5.2% |
80% 12% 8% |
.431 |
Do you think you need more information about crowns/bridges? Yes No May be |
69% 15.5% 15.5% |
80.4% 13.5% 6.2% |
88% 8% 4% |
.236 |
In Table 4, we explored differences across education levels and found reported non-significant differences. The high school was majority from the 31-35 age group while the graduates were 36-40 and postgraduates were from 36-40 above age category. The majority of all three groups were married and marked their information about implants and bridges as poor. Preferred FPDs over implants. The reason to choose them was longevity for postgraduate and graduate groups while the cost for high school. The reason not to choose was the cost for all groups. The source of information was social media for the first group, while the latter two were dentists. All three groups were unsure about complications, while those who agreed thought broken implants as the most common complication. Postgraduates did not choose bridges, while others chose them due to their cost. The reason behind not choosing it was its cost and long treatment for groups, respectively. The source of information was friends and family for all. They were not sure about any complications while bad odor was most common, according to them. All groups think they need more information about implants and bridges.
Table 4. The difference across education level
Variable |
High school or below |
Graduation |
Post-graduation |
P-value |
Level of information regarding implants? Excellent Very good Good Poor Do not know |
3.1% 3.1% 15.6% 46.9% 31.3% |
3.8% 2.9% 12.9% 56.9% 23.5% |
8% 8% 24% 52% 8% |
.336 |
Level of information regarding crowns/bridges? Excellent Very good Good Poor Do not know |
3.1% 13.5% 10.4% 42.8% 30.3% |
4.5% 2.8% 16.2% 48.6% 27.9% |
9% 3% 23% 45% 20% |
.329 |
Which prosthesis to choose? Fixed Partial Dentures Implants |
47.9% 52.1% |
65.5% 34.5% |
73% 27% |
.093 |
Reason to choose implants? Cost Longevity Convenience Would not choose |
41.6% 30.3% 9.4% 18.8% |
11.4% 58.1% 8.5% 22% |
8% 68% 4% 20% |
.012 |
Reason not to choose implants High cost Long treatment time Need surgery Lack of information |
63.5% 6.3% 8.4% 15.6% |
47.6% 10.9% 20.1% 8.2% |
33.6% 28% 33% 4.8% |
.013 |
Source of information Friends and Family Social Media Dentist Other |
20% 55% 18.8% 6.2% |
28.8% 25% 32.8% 12.3% |
24% 20% 32% 24% |
.093 |
Are there any complications associated with implants? Yes No Not sure |
25% 20.9% 54.1% |
31.1% 10.3% 58.5% |
40% 12% 48% |
.004 |
If yes, which complication is the most common? Broken or loose implants Gingival bleeding Bad Odor Swelling |
28.8% 18.8% 18.1% 6.3% |
19.5% 13.2% 12.9% 18.2% |
32 24% 8% 16% |
.089 |
Reason to choose crowns/bridges? Cost Longevity Convenience Would not choose |
50% 8.2% 20.9% 20.9% |
31.1% 18.1% 20.7% 30.1% |
8% 21% 21% 50% |
.025 |
Reason not to choose crowns/bridges? High cost Long treatment Need surgery Lack of information |
50% 28.1% 9.4% 12.5% |
33.1% 24.9% 11.7% 30.2% |
24% 44% 12% 20% |
.105 |
Source of information? Friends and family Social media Dentist Other |
44.8% 28.1% 14.6% 12.5% |
35% 20.4% 26% 18.5% |
36% 24% 16% 24% |
.142 |
Is there any complication associated with crowns/bridges? Yes No Not sure |
28.1% 25% 46.9% |
35.5% 13.2% 51.3% |
40% 8% 52% |
.157 |
If yes, which complication is more common? Broken crown/bridge Gingival bleeding Bad odor Swelling Sensitivity |
21.9% 15.6% 28.1% 3.1% 3.1% |
12.6% 12.3% 32.6% 6.7% 5.9% |
16% 4% 48% 8% 00% |
.471 |
Do you think you need more information on implants? Yes No May be |
72% 19% 9% |
84.8% 10% 5.2% |
80% 12% 8% |
.431 |
Do you think you need more information about crowns/bridges? Yes No May be |
69% 15.5% 15.5% |
80.4% 13.5% 6.2% |
88% 8% 4% |
.236 |
In the present study, we explored the knowledge and attitude of patients regarding fixed dentures and implants. The cross-sectional survey design was used for the collection of data via simple random sampling, and results were computed using SPSS through chi-square as the primary analysis. At the same time, the literature reported that friends, the media (TV radio, newspaper, internet, etc.), and others were the most common sources of information about implants. The majority of the participants said that the high cost of dental implant procedures is a principal reason for people rejecting this form of therapy. When it comes to crowns/bridges, minute differences exist between choosing it due to cost and would not choose it. The reason for not choosing it was also its high cost for the majority and the source of information was friends and family same as implants. The majority thought no complications were associated with crowns, while those who agreed thought bad odor was the most common complication. The majority agreed they need more information about implants and crowns/bridges and the same was reported by other studies as well [12].
In Table 2, we explored the non-significant gender differences, and the findings revealed that the majority of both groups were from the middle class, married, and graduated. Both groups had poor information about implants and crowns/bridges and chose FPDs over implants, while the literature reports that females have lower mean scores than males [12]. Longevity was the reason for choosing, and the high cost of not choosing implants for both groups and literature also reported cost as a barrier to choosing it as a treatment option. Friends and family were a source of information for males while social media was for females. Both groups were not sure of any complications, while the remaining thought has broken implants as the most common one. In crowns/bridges, the majority did not choose crowns, and the reason was its cost. The literature reported that males have better knowledge about treatment procedures than females [12, 13].
In Table 3, we explored the differences across socioeconomic status and fining reported non-significant differences. The majority of lower SES were from the age group of 31-35, the middle class was 36-40, and the higher were from 36 to 40 above age group. The reason for choosing implants was longevity for the 2nd and 3rd groups while the cost for the 1st group. The reason for not choosing it was the high cost for the first 2 groups. The reason for choosing bridges was the cost for lower and middle SES, while the higher class would not choose it. The source of information was friends for the lower and middle class while other sources were for the higher class. Complications associated with bridges are bad odor, according to all groups. All groups think they need more information about implants and bridges, as reported by another similar study [13].
In Table 4, we explored differences across education levels and found reported non-significant differences. The majority preferred FPDs over implants and studies also reported the same results that the permanent prosthesis, according to the majority of patients, provides a better feeling in the mouth and seems more natural. The reason to choose them was longevity for postgraduate and graduate groups while the cost for high school. The reason not to choose was the cost for all groups Postgraduates did not choose bridges, while others chose them due to their cost. The reason behind not choosing it was its cost and long treatment for groups, respectively. The source of information was friends and family for all. They were not sure about any complications while bad odor was the most common, and similar findings were observed in another study [14].
Conclusion
The present study findings revealed the poor knowledge of participants about implants and crowns while preferring FPDs over implants. The reason for choosing implants and crowns was longevity and cost, while for not choosing it was cost and prolonged treatment time. Most participants were not sure about complications regarding implants and crowns. All participants agreed on having more information about both treatment options. Non-significant differences were reported across gender, SES, and educational levels.
Recommendations
Acknowledgments: We would like to acknowledge the support of the REU research center.
Conflict of interest: None
Financial support: None
Ethics statement: This study fulfills the ethical requirement of the REU ethical committee.
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