IJCRR

IJCRR - 13(16), August, 2021

Pages: 17-23

Date of Publication: 30-Aug-2021

Knowledge and Awareness on Dental Implants Among Dentate and Partially / Completely Edentulous Adults - A Comparative Assessment in Chennai, India

Author: Tadepalli A, Appukuttan D, Subramanian S, Jenefa J

Category: Healthcare

Abstract:Introduction: Dental implants (DI) are being widely used for replacing missing teeth and literature reports showed successful results of DI supported prostheses in partial and complete edentulous rehabilitations. However, knowledge and awareness pertaining to these treatment modalities among patients with and without missing teeth need to be evaluated. Objective: This Cross-sectional observational research aimed to assess and compare the knowledge and awareness on prosthetic rehabilitation with dental implants among dentate and partially / completely edentulous adults. Methods: Self-administeredstructured questionnaire was used to collect the information pertaining to the knowledge and awareness of DI from 500 adults (Group 1: Partially / completely edentulous subjects n=250, Group 2: Dentulous subjects n=250). Further their attitude towards replacement and restoration of missing teeth were also assessed. Responses were tabulated and data was analysed using Chi-Square test and Fisher's exact test. Result: 53.2 % of group 1subjects and 47.6% of group 2 were aware of dental implants (p>0.05). Nevertheless, the latter group had better knowledge and information on DI (surgical placement, DI failure) than the former group (P< 0.001). The majority of the dentulous subjects were willing for the DI procedure than the other group (P< 0.001). Conclusion: Within the limitations of the study, there is a need to disseminate better knowledge, raise awareness on DI and eliminate the associated misconceptions, thereby facilitating the general population to take maximum advantage of these novel biomaterials to serve the dual purpose of aesthetics and function.

Keywords: Awareness, Adults, Dental implants, Edentulous, Partially, Knowledge

Full Text:

Introduction

Newer biomaterials and technologies have radically altered the way dental treatment has been delivered for the past several decades. In this context, dental implants have taken a leading edge over conventional complete, fixed and removable partial dentures for replacement of missing teeth. Despite the fact that these treatment modalities serve the purpose, the advantage rendered by dental implants in terms of enhanced stability, retention, aesthetics, social and psychological comfort, better quality of life and improved self-confidence accentuate them as an excellent alternative treatment for missing teeth.^1,2,3,4 

Scientific adoption of a novel technology in any area of medicine requires evidence to convince the practitioner and substantial impartation of awareness and knowledge to the general public in order to clarify the benefits and misconceptions associated with that as well. Emerging systematic reviews and meta-analysis suggested excellent success and survival rates with reduced biological and technical complications associated with dental implant therapy.^5,6 The cumulative survival rate of dental implants up to 16 years was projected at 82.94% and the prevalence of biological and technical complications was 16.94% and 31.09% respectively according to Simonis P et al.⁷ Similarly, Mark-Steven Howe et al.⁸ and Van Velzen et al.⁹ observed that the 10 years survival rate for dental implants was 96.4% and 99.7% respectively. Globally, the market analysis of dental implants has shown an exponential increase over the last few years and a compound annual growth rate is expected to increase over the next few years, due to the higher prevalence of dental decay and periodontitis associated with dental loss, higher than before demand for cosmetic dental treatment and increased life expectancy.

Despite gaining popularity and hassle free amalgamation into dental practice, surveys carried globally in different countries have revealed conflicting details of knowledge, awareness, perceptions, expectations, outcomes and misconceptions about dental implants. Studies from countries such as the USA,¹⁰ Sweden,¹¹ Austria¹² and Norway¹³ have shown greater awareness among their population i.e. 77%, 76.2%, 63% and 70.1% respectively. Studies have shown that people have unrealistic expectations and are misinformed about the life span, maintenance and expertise required for placement of dental implants. These factors in turn may influence their choice of dental implant. Despite the availability of literature evidence from various parts of India, the existing results are more conflicting rather than convincing. Furthermore, no studies have compared the awareness on dental implants between dentate and partially/completely edentulous subjects. Hence, the present study was carried out to compare the knowledge and awareness on dental implants between dentulous and partially or completely edentulous adults in Chennai city. 

Material and Methods

This cross sectional analytical observational study was approved by Institutional Ethical Committee and Review Board (SRMDC/IRB/2019/11) and the research was carried out in the outpatient Department of Periodontics, SRM Dental College and Hospital, Chennai. The study period was from May 2019 to February 2020 which was approximately 10 months. Convenience sampling was followed and the subjects fulfilling the selection criteria were recruited for the study. The purpose of the study was explained and written informed consent was obtained from each subject.

A self-explanatory questionnaire was prepared on the basis of previous studies in both English and Tamil languages. A bilingual expert in both English and Tamil languages checked the questionnaire and checked for equivalence in terms of content and meaning. Comprehensibility of the questionnaire was evaluated by randomly administering the questionnaire to 15 patients and their suggestions for improvement were included. Consistency and reliability were evaluated by twice administering the questionnaire to 20 subjects over a period of one week, and Cronbach's alpha of 0.8 was obtained, indicating acceptable internal consistency. 

The questionnaire was administered to the patients during their routine visit, those presenting with pain and those not able to read English or Tamil were not included. The study sample included dentulous and partially or completely edentulous adults who were willing to participate in the study. A structured questionnaire was framed, which consisted of the demographic details, responses towards replacement and restoration of missing teeth and their knowledge and awareness on Dental implants (DI).  Further their knowledge and awareness towards other replacements were also assessed. The questions were closed ended and the options covered the esthetic as well as the functional aspects of DI. The English or Tamil questionnaires were distributed to the respective subjects who are comfortable in the specific language. Any clarifications or assistance for completing the forms, if needed, were available at all times through trained interns. 

A total of 533 subjects received questionnaires and any form with incomplete responses was not included for assessment. In the end, 500 forms with complete responses were considered for the analysis. The received forms were categorized into two groups as responses from edentulous groups and responses from dentulous groups with 250 forms in each group. Responses were entered in the excel sheet and then submitted to a statistical analysis.

Statistical Methods 

To analyse the data SPSS (IBM SPSS Statistics for Windows, Version 25.0, Armonk, NY: IBM Corp. Released 2017) was used. Descriptive statistics like, percentage, mean standard deviation, minimum maximum were calculated. To compare proportions between groups, the Pearson Chi-Square test was applied. The significance level is fixed as 5% (α = 0.05).

Results

The demographic details of the study population were shown in Table 1. The study population consisted of a total of 500 subjects, including 250 participants with partial/complete edentulousness (116 males and 134 females) and 250 subjects without any missing teeth (124 males and 126 females). The mean age of group I subjects is 39.9±16.43 years and the mean age of group 2 subjects is 32.9±13.73 years. The majority of the participants in the study were graduates and employed in both groups.

Table 2  depicted the perception of study population towards replacement and restoration of missing teeth. It was observed that a significantly greater percentage of partial / complete edentulous subjects had dental problems than dentulous subjects. However, group 2 subjects significantly believed that missing teeth have to be replaced and loss teeth affect various vital functions such as mastication, speech and appearance.

Table 3 showed the comparison of knowledge and awareness of dental implants in the study population. There were no statistically significant differences in the awareness of dental implants among the study groups. Significant differences were noted with respect to the source of information on dental implants, the nature of implant surgery and the likelihood of complications among the study participants. Most of the study participants felt that cost was the main disadvantage factor associated with dental implant therapy. Significantly greater percentage of group 1 participants were not willing to receive dental implant treatment.

Discussion

The current observational research was conducted to determine and compare whether there is a disparity in the level of awareness and knowledge of dental implants as a replacement option for missing teeth in a sample of partially /completely edentulous and dentulous subjects in Chennai, South India. Many studies on knowledge and awareness of DI among the general population of various countries have previously been documented and it has been widely observed that western people reported higher levels of awareness.

Literature evidence on the same in Indian studies is unclear with contradicting reports, where in few authors observe higher levels of awareness and knowledge whilst many indicate lower or severe deficit in dental implant information. As health care professionals, it is essential for patients to be sufficiently educated about the risks and benefits of any interventions or treatment provided, thereby allowing them to be an active part in the treatment process. Misconceptions and myths about dental procedures often create a mental barrier that prevents patients from seeking dental care, and DI is no exception. Thus, cross sectional studies like these allow dental professionals to identify and bridge the knowledge gaps that create negative attitudes towards replacement of missing teeth using DI enabled through both individual education in a clinical set up and on a larger scale through mass media. 

In this study it was observed that edentulous subjects (133, 53.2%) were more aware about dental implants as a replacement option for missing teeth than dentulous subjects (119, 47.6%) this perhaps can be attributed to the fact that they have missing teeth and probably be looking for option to replace them. This is supported by their response that missing teeth should be replaced (90.4%). The current study population had moderate level of awareness on DI and this was in contrast to the studies reporting higher awareness for instance Zimmer et al in the USA¹⁰ 77%, Berge et al. in Norway¹³ 70.1%, Esfahani and Moosaali in Iran¹⁴ 76.7%, Tepper et al. in Austria¹² 72%, Al-Musawi and colleagues in Kuwait¹⁵ 96.4%. Studies from the cities of Mangalore¹⁶ and Bhubaneswar¹⁷ have reported very poor awareness on DI i.e. 17.8% and 15.91% respectively. Likewise, cross sectional studies from Rajasthan¹⁸ and Madhya Pradesh¹⁹ have also reported inadequate awareness on DI i.e. 38% and 25.8% respectively. On the contrary, Ahmed Siddique et al.²⁰ reported higher awareness (93.4%) among residents in Dharwad, Karnataka. 

The main source of information on DI in the present group of edentulous subjects were family/friends followed by dentist, however in the dentulous subject’s dentist was the main source of information followed by family/friends, apparently in both the groups the role of media in dissipating knowledge on DI was very insignificant (3.75% and 14.28% respectively). On scrutiny, it was evident from the studies in Indian cities^18,20,21,22 that media has a very minimal role in creating awareness on DI among the public in the Indian scenario, on the other hand in the US¹⁰ and Norway,¹³ the primary source of information was through the media. Rajesh Hosadurga et al.²¹ emphasised on the misinformation that could be created by the electronic and mass media and therefore recommended the dissemination of quality information from the dental practitioner. Hence, dentist should play a more dynamic role in dissemination of information to the public. In Hong Kong, media created fallacy that DI can restore the dentition to absolute normality in terms of function, appearance and quality of life was noted among adults, further they had unrealistic expectations, underestimated the expertise for placement and daily care needed and overestimated the longevity of DI.²³ These observations highlight the need for creating better awareness. 

On questioning, regarding the site of implant placement it was noticed that more dentulous subjects (110, 92.4%) were aware that DI were placed surgically in the jaw bone, whereas only 66% of edentulous subjects were aware about the placement site. This showed a greater deficit in the knowledge on the site of implant placement in the edentulous group in this population. Amit Gharpure and Prasad Bhange²² in their observational study among Mumbai city residents identified that only 65% knew that DI were placed in bone. Kuwaiti respondents felt that placement of metal within the jaw was dangerous and majority of them considered implant surgical procedure as difficult and complicated.¹⁵ 

Knowledge on the failures associated with DI was evaluated in this study group and it was noticed that the majority of the edentulous subjects had a misconception that dental implants were always successful whilst contrary dentulous subjects predominantly felt that dental implants can fail. The above finding further underscores the inadequate knowledge on DI longevity among the edentulous group in this population. Literature search showed comparable lack of knowledge in the Indian population. It was noticed that 46% of subjects expected DI to last lifelong in Dharwad²⁰ and in Indore,¹⁹ 48.1 % were not aware about the DI longevity and 49% felt that it lasted for their lifetime. On the contrary in their multicentre trial in China, Yao et al observed that the majority of them were well informed, knew about the complications associated with DI and almost 90% felt that implants were safe, well tested and should be placed only by a specialist dentist. They had better knowledge, knew that DI failed and did not last longer like natural teeth.²⁴ 

Majority of the edentulous subjects were not willing to undergo DI placement, contrary to the dentulous group and this could possibly be attributed to the better knowledge on DI among the dentulous group. The former group believed that DI looked aesthetically far superior to other replacement prosthesis but higher cost and the associated long treatment time were the limitations. Likewise, the latter group also felt that high cost followed by the surgical procedure was the biggest disadvantage of DI. Pragathi Kaurani¹⁸ in their study reported that 56% were not willing for DI even after educating them about DI. Possibly less knowledge or lack of information, no clarity on the procedure, high cost, fear of surgery / complications and multiple other factors could possibly be the reasons for not choosing DI. In their systematic review, Michael edelmayer²⁵ observed that 52.6%±25.4% subjects did not opt for DI due to high cost. In agreement with our observation, Indian studies have similarly reported that high cost was a barrier for not choosing DI and a wide perception that it can be afforded only by rich people.

Limitations of this study could be the small sample size, convenience sampling and being a self-reporting survey there is a likelihood that the respondents may not answer honestly. 

Conclusions

Moderate levels of awareness on DI was observed in both the edentulous and dentulous subjects in this study. More than half of the edentulous subjects knew about DI as a replacement option for missing teeth compared to the dentulous subjects. Nevertheless, the latter group had better knowledge and information on DI than the former group. Dentists and family or relatives were the primary source of information and high cost, surgical procedure and long treatment duration were the limiting features for DI as a treatment option in both the groups. Finally, the majority of the dentulous subjects were willing for DI procedure than the other group. The study therefore highlights the need to disseminate better knowledge, to raise awareness on DI and to eliminate the associated misconceptions, thereby facilitating the general population to take maximum advantage of these novel biomaterials to serve the dual purpose of aesthetics and function.  

Acknowledgement: Nil

Source of funding: Nil

Conflict of interest: None

Authors Contribution:

Dr.Tadepalli Anupama conceptualized and gathered the data with regard to this work. Dr. Tadepalli Anupama and Dr. Appukuttan Devapriya analysed these data and necessary inputs were given towards the designing of the manuscript. Dr.Tadepalli Anupama,Dr. Appukuttan Devapriya, Dr. Subramanian Sangeetha, Dr.Jenefa Judithdiscussed the results and commented on the manuscript and contributed to the final manuscript.

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