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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 9  |  Issue : 1  |  Page : 3-8

Patient satisfaction after rehabilitation with tooth-supported fixed partial dentures: A cross-sectional study


Department of Prosthodontics, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India

Date of Web Publication11-Oct-2019

Correspondence Address:
Dr. Rajlakshmi Banerjee
Vrindavan Ground Floor, Sagar Palace Building I/9, Lakshmi Nagar, Nagpur - 440 022, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmd.ijmd_36_18

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  Abstract 


Introduction: Patients' perceptions of their oral health status are important outcomes in prosthodontics. There is an increasing realization that patient evaluation of the satisfaction with the worth of such treatment must be a consideration in any measure of overall prosthodontic success.
Aims and Objectives: This study aimed to evaluate the patients' satisfaction after rehabilitation with fixed partial dentures (FPDs) considering esthetic and functional outcome as well as comfort and overall quality of life after treatment.
Materials and Methods: Two hundred patients undergoing FPD treatment at the Department of Prosthodontics, VSPM Dental College and Research Centre, Nagpur, were selected to participate in the cross-sectional study using a patient satisfaction questionnaire after a week of insertion of the FPD prosthesis.
Results: About 86.3% of the examined patients were satisfied with the fixed prosthesis, whereas 13.7% were not satisfied with their fixed prosthesis. Ninety-four percent of the patients were satisfied with the appearance of the prosthesis immediately after placement which increased to 98% after a week of cementing the prostheses. Regarding the functioning masticatory ability, 91% of the examined patients were satisfied with the fixed prosthesis. On evaluation of the patient satisfaction for cleansability and awareness of oral hygiene practices, 58% of patients were happy with the cleansability of the prosthesis, whereas 42% were unsatisfied with the cleaning of their prosthesis. Three percent of patients complained of bad taste and foul odor from the base of the prosthesis.
Conclusion: Factors such as cleansability and comfort of the fixed prosthesis also play an important role along with appearance and masticatory ability while considering the patient satisfaction and success of prosthesis. Counseling the patients regarding unrealistic expectations should be taken care of right from the diagnosis and treatment planning stage to ensure high satisfaction level and overall success of the fixed prosthodontic treatment.

Keywords: Fixed partial denture; self perceived satisfaction; VAS


How to cite this article:
Banerjee R, Gajbhiye V, Radke U, Bangare T. Patient satisfaction after rehabilitation with tooth-supported fixed partial dentures: A cross-sectional study. Indian J Multidiscip Dent 2019;9:3-8

How to cite this URL:
Banerjee R, Gajbhiye V, Radke U, Bangare T. Patient satisfaction after rehabilitation with tooth-supported fixed partial dentures: A cross-sectional study. Indian J Multidiscip Dent [serial online] 2019 [cited 2019 Dec 12];9:3-8. Available from: http://www.ijmdent.com/text.asp?2019/9/1/3/268991




  Introduction Top


Edentulism and dental disease have a profound effect on the quality of life of patients.[1] Dentofacial problems have known effects on patients' satisfaction with their dentition as they affect esthetics, performance, and function. Fixed partial dentures (FPDs) have become the treatment of choice for the replacement of missing teeth due to their advantage of being fixed in the mouth and being economical as compared to implants.[1] There is an increasing realization that patient evaluation of the satisfaction with the worth of such treatment must be a consideration in any measure of overall prosthodontic success.[1] It is important to know whether patients perceive that the treatment imparts value relative to the overall oral comfort, quality of life, esthetics, and oral functions and that they have gained economic value from the treatment.[2] This is particularly relevant in fixed prosthodontic treatment, which is often perceived as expensive with limited application to the overall population. Although the dental literature has numerous articles on the topic of FPDs, only a few number of them deal with patients' perceptions of clinical outcomes and level of satisfaction with FPD treatment.[3],[4],[5] Although there are studies about patient perception with complete dentures and implants,[6],[7],[8] studies of satisfaction among patients treated with FPDs are scanty.[9],[10],[11] In these studies, even though patient satisfaction with treatment received was reported as high, it was lower than that had been expected before the start of treatment. The general conclusion is that patient satisfaction is a complex and multidimensional phenomenon,[12] much of which remains unclear. Studies to investigate patients' satisfaction were carried out in different countries, including Sweden, Finland, The Netherlands, Croatia, and Singapore,[10],[13],[14],[15],[16],[17] and all concluded that patients' satisfaction with FPD was very high; however, not many such studies have been carried out in India.

Oral health-related quality of life characterizes patients' perception of oral health, and instruments or questionnaires used to measure the oral health-related quality of life should be able to measure patients' perceived benefits of prosthodontic treatments. The Geriatric Oral Health Assesment Index[18] and Oral Health Impact Profile[19] have been used in earlier studies to evaluate patient-based outcome, but these indices are actually a measure of the degree of impairment, discomfort, limitation, disability, and the handicap experienced, which may not be directly equivalent to patients' perceived satisfaction about the prostheses. Therefore, a need was felt to evaluate the patient satisfaction after rehabilitation with FPDs considering esthetic and functional outcome as well as comfort and overall quality of life after treatment. The objective is to assess parameters that affect patient perception the most and as to which areas need to be critically paid attention to during the diagnosis, treatment planning, or communication with a patient to improve overall patient satisfaction.


  Materials and Methods Top


The cross-sectional study was conducted on 200 patients undergoing FPD treatment in the department of prosthodontics at a dental institution in Nagpur. The sociodemographic data of the study population are shown in [Figure 1]. Inclusion criteria were the participants receiving single to multiple unit restorations not exceeding five FPD units in the mouth. Exclusion criteria included patients with full-mouth restorations and implant-supported prostheses. A pilot study was conducted among 30 individuals, and the sample size was derived at probability of 90% and error of 5%. The final sample size was calculated to 200. Variables assessed were patient satisfaction regarding appearance, mastication, phonetics, and cleansability of their prostheses. Ethical approval (Ref No. IEC/VSPMDCRC/33/2017 dated June 15, 2017) was obtained from the Institutional Ethics Committee (Ethics Comm. Reg. No. ECR/885/Inst/MH/2017) prior to the start of the study.
Figure 1: Types of prostheses evaluated

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A validated patient satisfaction questionnaire developed by Layton and Walton in 2011[20] was used to interview the patients after a week of insertion of the FPD prosthesis. The interviewer was a single person, other than the operator, to prevent bias in the reporting. Questions in the questionnaire sought patients' satisfaction with appearance, mastication, phonetics, and cleansability of their prostheses. Two retrospective questions sought patients' remembered satisfaction with appearance and cost when their prostheses were inserted initially. With the benefit of hindsight, the complications experienced, or the lack of intervention required, the current satisfaction with the initial cost of the prostheses at the time of the questionnaire was reported. Patients' responses were marked using a visual analogue scale by marking a cross on the 10-cm line at the point representing the appropriate response between the worst possible satisfaction/discontent (left anchor) and the best possible satisfaction (right anchor). Answer to the question whether the patient would undergo the same treatment again was asked as a yes/no response. Overall, current satisfaction was calculated as the mean of current appearance, mastication, phonetics, cleansability, and cost satisfaction.


  Results Top


A total of 200 institutionalized elderly were included in the study, of which 57% were males and 43% were females. Majority of the patients belonged to the age group of 25–40 years (46%), and 28 patients were between the age groups of 40 and 60 years, respectively. Only four patients belonged to the age group of 70–78 years. None of the patients were >80 years of age. Approximately 39% of the patients were educated up to university level, whereas only 4.67% of the patients had education up to primary level, respectively. Thirty-six percent of the patients were educated up to higher secondary level of education. The majority of the participants, i.e., 154 (77%) were in skilled occupation, and 46 (23%) of participants were in unskilled occupation. The sociodemographic data of the study population are shown in [Table 1]. From the total of 200 patients receiving FPDs, 36% received single-unit crowns and 64% received three to four-unit FPDs, of which 48% were unilateral FPDs, 27% were bilateral, and 25% were anterior FPDs crossing the midline [Figure 1].
Table 1: Sociodemographic data of the study population

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The results of the study showing patient satisfaction responses in percentage have been tabulated in [Table 2]. In general, 86.5% of the examined patients were satisfied with the fixed prosthesis whereas 11.5% were not satisfied with their fixed prosthesis, whereas 2% were not sure about their perception regarding the prosthesis [Figure 2]. Ninety-four percent of the patients were satisfied with the appearance of the prosthesis immediately after placement, and 98% patients were satisfied with the appearance after a week of cementing the prostheses which when compared did not show any significant difference [Figure 3]. Regarding the functioning masticatory ability, 91% of the examined patients were satisfied with the fixed prosthesis; on the other hand, only 8.5% were unsatisfied with the functional masticatory ability of their fixed prosthesis. On evaluation of the patient satisfaction for cleansability and awareness of oral hygiene practices, 58% of patients were happy with the cleansability of the prosthesis whereas 42% were unsatisfied with the cleaning of their prosthesis. Three percent of patients complained of bad taste and foul odor from the base of the prosthesis. On inquiring, 74% were not using interdental aids to clean their fixed prosthesis whereas only 16% were using interdental aids intermittently and only 10% were using interdental aids to clean the prosthesis routinely. Reasons for not using dental aids showed that 91.1% were not informed by the dentist, 2.1% found it difficult to use, 4.8% thought dental aids were not of importance, while 2% for other unmentioned reasons. When patients' expectation was assessed, 74% of patients agreed that the treatment turned out as they expected while 26% showed that the treatment did not rise up to their expectation. For the patients with unfulfilled expectations, the reasons were mainly esthetic, especially in women, followed by cleansability, mastication, and then speech. Sixty-five percent of patients felt that the FPDs were costly, and only 35% of patients felt that the prosthesis was fairly priced before placement of the prosthesis, whereas after a week of placement, the percentage of patients satisfied with the cost of the treatment rose to 60%, and about 70% of the patients seemed to be satisfied regarding cost of the treatment [Figure 4].
Table 2: Patient satisfaction responses in percentage

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Figure 2: Response to satisfaction level of study sample

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Figure 3: Response to esthetic satisfaction immediately and 8 days after prosthesis cementation

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Figure 4: Satisfaction regarding cost of treatment

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  Discussion Top


Patients' perceptions of their oral health status are important outcomes in prosthodontics.[1] The performance of any fixed prosthesis is evaluated by measuring outcomes of chewing function, esthetics, longevity, as well as technical complications.[21] Anderson et al. in 1998 showed that it is important to consider both the clinicians' and the patients' appraisals.[22] Patient satisfaction is an important component of health care and one that has the potential to impact general dentistry treatment outcomes.[23],[24],[25] Satisfaction can be considered a combination of the discrepancy between patients' expectations and their experiences.[26],[27] However, important parameters such as patient satisfaction are clearly underexposed in the current literature.[21] The present cross-sectional descriptive study investigated patients' satisfaction and perception before and after receiving a FPD. The questionnaire included different aspects to measure the satisfaction with FPD. The high percentage of males among the investigated sample suggests that males were more concerned about getting a replacement to their missing teeth may be due to financial independence in making a decision to get the treatments done as most females were financially dependent on their male relatives or spouses to bear the cost of the treatments which is not in accordance with several other studies done abroad where females were more concerned about replacement of missing teeth.[28],[29],[30] In the present investigation, it was concluded that patients with unilateral and bilateral FPD with natural tooth abutment were more than patients with crowns; this can indicate that patients become concerned about replacing missing teeth than restoring them which is similar to data reported in a previous study.[21] Evaluations of treatment outcomes by clinicians do not necessarily correspond to the patients' own judgment which included both function and psychosocial adaption.[21] Patient concerns are mainly related to function, comfort, and esthetics.[23],[24] In the present study, 86.3% of the patients were satisfied with the overall functioning of the fixed prosthesis. The satisfaction related to esthetics increased after 1 week of cementation as patients' adaptation plays an important role in satisfaction.[24] Regarding the functioning masticatory ability, 91% of the examined patients were satisfied with the improved chewing ability after rehabilitation with the fixed prosthesis. The satisfaction regarding masticatory efficiency is in accordance with various studies that prove better chewing ability after restoration of missing teeth with FPDs.[6],[7],[9] On evaluation of the patient satisfaction for cleansability and awareness of oral hygiene practices, 58% of patients were happy with the cleansability of the prosthesis whereas 42% were unsatisfied with the cleaning of their prosthesis. On inquiring, 74% were not using interdental aids to clean their fixed prosthesis whereas only 10% were using interdental aids to clean the prosthesis routinely. Reasons for not using dental aids showed that 91.1% were not informed by the dentist. The patient–dentist communication is an important parameter in determining the patient maintenance and thereby the overall health of the fixed prosthesis.[12] Proper maintenance instructions need to be critically explained to the patients which were found to be a lacking area in this study. When patients' expectation was assessed, 26% of patients said that the treatment did not rise up to their expectation. For the patients with unfulfilled expectations, the reasons were mainly esthetic, especially in women followed by maintainability, comfort, masticatory efficiency, and finally speech. It is the responsibility of the dentists to inform their patients that further care is necessary to maintain the restoration and the remaining teeth. The manner in which dentists communicate with patients proved to influence patients' expectation as well as satisfaction and the overall quality of life of patients receiving the fixed prosthesis.[31] Treatment outcomes in prosthetic dentistry are composed of several complicated parts and one is the concept of patient satisfaction wherein it can be concluded that prosthodontic rehabilitation is facilitated by a calm well-informed and cooperative patient.[32] The three major areas that determine the acceptability of treatment are comfort, function, and esthetics. Mechanical and biological factors determine comfort and function. However, a variety of social and cultural influences, attitudes, and beliefs may determine patients' acceptance of the esthetic aspects of prosthodontic treatment.[33]


  Summary and Conclusion Top


The results of this survey showed that fixed denture prosthesis is still the most commonly used restoration for replacing missing teeth. Majority of patients were satisfied with the overall performance of their fixed prosthesis in terms of mastication and appearance. An important finding of this survey was the majority of patients showed a lack of knowledge regarding oral hygiene measures and the significance of maintenance of fixed prosthesis using dental aids. It can be concluded that greater care needs to be taken in giving proper postinsertion instructions to maintain the restoration and the remaining teeth for overall success of the prosthesis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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