Knowledge and awareness about dental implant as an option for replacement of teeth: a survey among saudi adults

Abstract

AimIt is important to evaluate the level of knowledge among the laypersons towards dental implants because it allows patients to select the proper options for teeth replacement. The aim of this study was to evaluate the knowledge and awareness of dental implants among a group of the Saudi population.MethodsThis was a cross-sectional survey conducted in 2017 among a group of the Saudi population. An electronic questionnaire was distributed using social media. This questionnaire was adapted from the literature. The data were collected in the form of an Excel file and then it was coded, entered and analyzed using SPSS software program.ResultsMedia was the most common source of information reported by 37.2% followed by dentists. Although most of both genders reported the fixed bridge as the first choice, there was a statistically significant difference in percentages. There was a significant difference in responses according to the age group while no significant difference was found between the different education levels for the same question. However, a significant difference was found between the education levels in response to the self-evaluation of the treatment with dental implants.ConclusionApproximately 80% of the study respondents had some knowledge about dental implant. This result was similar to that reported by many other studies where the reported level of knowledge ranged from 70% and 77%. The knowledge about dental implant has been improved in the last decades. Only 9% of respondents chose fixed prosthesis as a better option for replacement. This reflects the high level of awareness among participants about fixed prosthesis as a better solution because of its advantages over the removable prosthesis. Conclusion: The level of awareness about dental implant is high but the detailed information is missing. The study also showed the need for a more organized program to correct and to provide more information about treatment with dental implants.

Keywords

Introduction

Prosthodontic rehabilitation of missing teeth has been greatly evolved especially with the introduction of dental implants. Efficacy of dental implants, since its introduction in 1982, has been successfully confirmed by many of long-term clinical studies.^1-2 Its first use was for edentulousness as it was placed in the mandible to hold a denture which presented improvement in retention, stability, and support, as well as the patient’s quality of life was clearly improved.^1-5 In the present time, dental implants are being used widely for both partially and completely edentulousness. This makes the dental implants well known in the dental community and even becomes a part of the dental curriculum and academic education.^6-9 Moreover, treatment of partially or completely edentulous patients with conventional removable dentures becomes less popular or less preferred because of the undesirable complications of these dentures. In addition, treatment with dental implants particularly in the esthetic zone becomes the first choice from biologic and esthetic points of view.^10-12 On the other hand, knowledge and awareness about dental implants among people increased significantly. This increase, however, varies considerably between different countries. In Saudi Arabia, Al-Johany el al. ¹³ found 66% of Saudi population is aware about dental implants. Salonen el al. ¹⁴ reported that the awareness of dental implants among the target population was only 29% while, Best ¹⁵ reported 64% of awareness among the questioned people. Tepper el al.,¹⁶ however, reported a higher percentage with 72% of awareness. Fortunately, it has been reported that the acceptance and attitude of patients toward dental implants increased after increasing the knowledge and awareness among those patients about dental implants and the various available treatment options with dental implants.^16-19 Therefore, it is of a great importance to evaluate the level of knowledge among the laypersons towards dental implants and hence, the aim of this study was to evaluate the knowledge of dental implants among a group of the Saudi population.

Materials and Methods

This was a cross-sectional survey conducted in the period from May to August 2017 among a group of Saudi population. An electronic questionnaire was distributed as web-based questionnaires. This questionnaire was adapted from some previous studies.^13,20 It consisted of two sections; the first one related to the demographic information including gender, age group, and education level. The remaining questions related to the knowledge of dental implants. One question related to the presence or absence of missing teeth among the questioned people, one question was whether the participant had an implant and another question related to the source of information about dental implants. The sample size was calculated using equation of proportion estimation at 0.95 confidence interval and 0.05 error of estimation. The data were collected in the form of an Excel file and then it was coded, entered and analyzed using SPSS software program. The demographic data were presented in the form of frequency and percentage. Chisquared test was utilized to test the significance of responses among participants according to their gender, age, and education. A p-value less than 0.05 was considered significant

Results

A total of 634 questionnaires were electronically received. Female participants were much higher than males (83.3% and 16.7%, respectively). Participants from the age group 21 - 40 years were the most prevalent (75.2%) followed by participants from the age group > 40 years (20.5%), and only 4.3% of the participants were from the age group < 20 years. Most participants were at the university level (70.7%), followed by secondary level participants (23.8%), and only 35 participants (5.5%) were postgraduate (Table 1). More than half of the participants (53%) had missing teeth while 47% reported they had no missing teeth. The majority of participants (93.4%) reported that they had no dental implants while only 6.6% reported they had dental implants (Figure 1). Media was the most common source of information reported by 37.2% followed by dentists (31.9%) and friends (30.9%) (Figure 2). Regarding the opinion of the questioned participants for the replacement of the missing teeth, there was a significant difference (P < 0.05) between genders. Although most of both genders reported the fixed bridge as the first choice there was a statistically significant difference in proportions of males and females regarding this question. Similarly, there was a significant difference in responses according to the age group while no significant difference (P > 0.05) was found between the different education levels for the same question. However, a significant difference was found between the education levels in response to the self-evaluation of the treatment with dental implants. Most of those who had dental implants reported that the treatment was successful. Difference between responses according to age groups was found in relation to the question “Where the dental implants are placed?” Most of respondents from the age groups < 20 years and 21 – 40 years reported the gum as the site where the implant is placed (44.4% and 43.8%, respectively) while most respondents (34.6%) from the age group > 40 years selected the bone as the place for dental implants (Table 2).
Responses to the self-evaluation of dental implant success rate were significantly different among age groups. A 5-year success rate of the implant was reported by 40% of those who aged < 20 years. Additionally, there were significant differences between the different age groups in responses to the question “What is your attitude about dental implant?” Although most responses were reported as agree, there was a significant difference between different age groups (54.3%, 43.2%, and 58.5% for the age groups < 20 years, 21 – 40 years, and > 40 years, respectively). Factors reported that prevent respondents to have implants were reported as follows: high cost (reported by 40%) followed by fear of surgery (reported by 26%), and 10% of respondents reported both factors. About 24% of respondents said that they do not know why dental implant is preferred than fixed and removable prostheses while 13% reported that dental implant is more comfortable, 11% reported that dental implant is more esthetic, and 10% reported that dental implant is useful in oral rehabilitation. In relation to the question about cleaning dental implants, there was a significant difference between both genders. Most of the male participants reported that dental implants require cleaning similar to the natural teeth while most responses of females were that dental implants require cleaning more than natural teeth. Participants with different educational level were significantly different regarding the question of dental implants whether cleaning is required similar to the natural teeth. No significant difference was found in relation to age groups. The remaining knowledge questions revealed no significant difference between all participants. More details about responses are presented in Table 2.

Discussion

The present study was carried out to assess the knowledge among Saudi people. Our target population was randomly selected. An electronic version of the questionnaire was used to share it with more people especially by using the new technology of social media. Although the vast majority of respondents in the current study had no dental implants, about half of the subjects had heard about dental implant and nearly one third know about it. This means that approximately 80% of subjects have some knowledge about dental implant. This result seems to be similar to that reported by Zimmer at al.,²¹ in which the level of knowledge was 77%. Also, the result of this study is similar to that reported by Tepper el al. ¹⁶ and Berge ²² where the reported level of knowledge was 72% and 70%, respectively. However, the level of knowledge in this study is higher than that reported by Al-Johany el al. ¹³ which was conducted among Saudi population in 2010 and the level of knowledge was 66%. This confirms that the knowledge about dental implant has increased significantly in the recent years. Only 9% of respondents chose removable prosthesis for the replacement of one or more missing teeth, while most respondents chose fixed partial denture (bridge) as a better option for replacement. This reflects the high level of awareness among participants about fixed prosthesis as a better solution because of its advantages over the removable prosthesis. This result comes in the same line with that reported by Tepper el al.,¹⁶ Zimmer el al.,²¹ and Al-Johany el al.,¹³ in which fixed prosthesis was more preferred more esthetically pleasant by the study subjects. In the current study, the media was the main source of information about dental implant followed by dentists and finally, by the friends and relatives. This result contrasts with the finding of Al-Jahory el al. study,¹³ in which friends and relatives were the main source of information followed by dentists and finally, by the media and internet. However, the finding of the present study is comparable with that reported by Zimmer el al. ²¹ who found the media as the main source of information. Also, our result is similar to that of Berge,²² Akagawa el al.,²³ and Best ¹⁵ who reported the media as the main source of information about dental implant. The difference between our result and that of Al-Jahory might be related to advancement and new technology of media. Despite it was found that the study subjects have a high level of knowledge about dental implant, their awareness about site of implant was low. About 42% of respondents chose the gum as the site where dental implant is placed followed 33.6% who chose bone while 21.3% reported that they do not know where the dental implant should be placed. About 24% of subjects reported that they do not know about the advantages of dental implant. This result refers to the shortage of information and the need for more detailed information. Dentists as well as media (via public programs) play an important role in this regard. High cost and fear of surgery were the most of the reasons reported by subjects whichprevent them to have dental implants. This result is in agreement with that reported by Tepper el al. ¹⁶ and Kent.²⁴
However, some limitation of our study should be noted. The electronic version of the questionnaire can only be accessed by those who can use the new technology and/or social media and those who can read and write. On the other hand, there is still a high number of illiterate people who cannot reach such technology. Face to face interview with those subjects maybe useful. Therefore, future studies among a larger sample with variant characteristics are highly recommended.

Conclusion

Within the limitation of the present study it can be concluded that the level of awareness about dental implant is high but the detailed information is missing. The study also showed the need for more organized program to correct and to provide more information about treatment with dental implants.

Declarations

References

1. Adell R, Lekholm U, Rockler B, Brånemark PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg. 1981;10(6):387-416. doi:10.1016/s0300-9785(81)80077-4
   Article · PubMed · Google Scholar
2. Adell R, Eriksson B, Lekholm U, Brånemark PI, Jemt T. Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws. Int J Oral Maxillofac Implants. 1990;5(4):347-359.
   PubMed · Google Scholar
3. Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants. 1986;1(1):11-25.
   PubMed · Google Scholar
4. Anner R, Grossmann Y, Anner Y, Levin L. Smoking, diabetes mellitus, periodontitis, and supportive periodontal treatment as factors associated with dental implant survival: a long-term retrospective evaluation of patients followed for up to 10 years. Implant Dent. 2010;19(1):57-64. doi:10.1097/id.0b013e3181bb8f6c
   Article · PubMed · Google Scholar
5. Bonde MJ, Stokholm R, Isidor F, Schou S. Outcome of implant-supported single-tooth replacements performed by dental students: a 10-year clinical and radiographic retrospective study. Eur J Oral Implantol. 2010;3(1):37-46.
   PubMed · Google Scholar
6. Bavitz JB. Dental implantology in US dental schools. J Dent Educ. 1990;53(3):205-206. doi:10.1002/j.0022-0337.1990.54.3.tb02402.x
   Article · PubMed · Google Scholar
7. De Bruyn H, Koole S, Mattheos N, Lang NP. A survey on undergraduate implant dentistry education in Europe. Eur J Dent Educ. 2009;13(suppl 1):3-9. doi:10.1111/j.1600-0579.2008.00557.x
   Article · PubMed · Google Scholar
8. Parrish L, Hunter R, Kimmes N, Wilcox C, Nunn M, Miyamoto T. Predoctoral dental implant education at Creighton University School of Dentistry. J Dent Educ. 2013;77(5):576-580. doi:10.1002/j.0022-0337.2013.77.5.tb05505.x
   Article · PubMed · Google Scholar
9. Mattheos N, De Bruyn H, Hultin M, Jepsen S, Klinge B, Koole S, et al. Developing implant dentistry education in Europe: the continuum from undergraduate to postgraduate education and continuing professional development. Eur J Dent Educ. 2014;18(suppl 1):3-10. doi:10.1111/eje.12075
   Article · PubMed · Google Scholar
10. Cheung MC, Kao P, Lee N, Sivathasan D, Vong CW, Zhu J, et al. Interest in dental implantology and preferences for implant therapy: a survey of Victorian dentists. Aust Dent J. 2016;61(4):455-463. doi:10.1111/adj.12411
    Article · PubMed · Google Scholar
11. Chiapasco M, Abati S, Romeo E, Vogel G. Implant-retained mandibular overdentures with Brånemark System MKII implants: a prospective comparative study between delayed and immediate loading. Int J Oral Maxillofac Implants. 2001;16(4):537-546.
    PubMed · Google Scholar
12. Jung RE, Pjetursson BE, Glauser R, Zembic A, Zwahlen M, Lang NP. A systematic review of the 5-year survival and complication rates of implant-supported single crowns. Clin Oral Implants Res. 2008;19(2):119-130. doi:10.1111/j.1600-0501.2007.01453.x
    Article · PubMed · Google Scholar
13. Al-Johany S, Al Zoman HA, Al Juhaini M, Al Refeai M. Dental patients’ awareness and knowledge in using dental implants as an option in replacing missing teeth: a survey in Riyadh, Saudi Arabia. Saudi Dent J. 2010;22(4):183-188. doi:10.1016/j.sdentj.2010.07.006
    Article · PubMed · Google Scholar
14. Salonen MA. Assessment of states of dentures and interest in implant-retained prosthetic treatment in 55-year-old edentulous Finns. Community Dent Oral Epidemiol. 1994;22(2):130-135. doi:10.1111/j.1600-0528.1994.tb01588.x
    Article · PubMed · Google Scholar
15. Best HA. Awareness and needs of dental implants by patients in New South Wales. Aust Prosthodont J. 1993;7:9-12.
    PubMed · Google Scholar
16. Tepper G, Haas R, Mailath G, Teller C, Bernhart T, Monov G, et al. Representative marketing-oriented study on implants in the Austrian population. II. Implant acceptance, patient-perceived cost and patient satisfaction. Clin Oral Implants Res. 2003;14(5):634-642. doi:10.1034/j.1600-0501.2003.00917.x
    Article · PubMed · Google Scholar
17. Vohra F, Habib R. Knowledge and attitude of dentists toward implant-retained restorations in Saudi Arabia. Niger J Clin Pract. 2015;18(3):312-317. doi:10.4103/1119-3077.151788
    Article · PubMed · Google Scholar
18. Ong CT, Ivanovski S, Needleman IG, Retzepi M, Moles DR, Tonetti MS, et al. Systematic review of implant outcomes in treated periodontitis subjects. J Clin Periodontol. 2008;35(5):438-462. doi:10.1111/j.1600-051x.2008.01207.x
    Article · PubMed · Google Scholar
19. Murray CM, Leichter JW. Dental implant use in New Zealand: a 10-year update. N Z Dent J. 2016;112(2):49-54.
    PubMed · Google Scholar
20. Tepper G, Haas R, Mailath G, Teller C, Zechner W, Watzak G, et al. Representative marketing-oriented study on implants in the Austrian population. I. Level of information, sources of information and need for patient information. Clin Oral Implants Res. 2003;14(5):621-633. doi:10.1034/j.1600-0501.2003.00916.x
    Article · PubMed · Google Scholar
21. Zimmer CM, Zimmer WM, Williams J, Liesener J. Public awareness and acceptance of dental implants. Int J Oral Maxillofac Implants. 1992;7(2):228-232.
    PubMed · Google Scholar
22. Berge TI. Public awareness, information sources and evaluation of oral implant treatment in Norway. Clin Oral Implants Res. 2000;11(5):401-408. doi:10.1034/j.1600-0501.2000.011005401.x
    Article · PubMed · Google Scholar
23. Akagawa Y, Rachi Y, Matsumoto T, Tsuru H. Attitudes of removable denture patients toward dental implants. J Prosthet Dent. 1988;60(3):362-364. doi:10.1016/0022-3913(88)90286-7
    Article · PubMed · Google Scholar
24. Kent G. Effects of osseointegrated implants on psychological and social well-being: a literature review. J Prosthet Dent. 1992;68(3):515-518. doi:10.1016/0022-3913(92)90421-6
    Article · PubMed · Google Scholar

Tables

Additional Information

Publisher’s Note
Bayrakol MP remains neutral with regard to jurisdictional and institutional claims.

Rights and Permissions

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0). To view a copy of the license, visit https://creativecommons.org/licenses/by-nc/4.0/

View full license details →