With increasing public awareness of the benefits of dental implants, an increasing number of patients are considering this treatment option. While current studies often focus only on clinical aspects such as osseo-integration, patient responses to psychological and psychosocial changes are only infrequently addressed. Dental Tribune International Group Editor Daniel Zimmermann spoke with Dr Bo Chen from the Department of Oral Implantology (Beijing University School of Stomatology in China) about her latest study on patients’ attitudes following implant placement and subsequent restoration.

Daniel Zimmermann: Dr Bo, studies on patient satisfaction figures of patients who have had maxillofacial surgery with implants are very rare, even in well-developed dental markets like Europe or the US. What motivated your study in China?
Dr Bo Chen: Severe jawbone defects due to tumour resection present a major problem for functional restoration (mastication, swallowing and speech), which severely influences patients’ quality of life. Reconstruction of lost tissue in order to facilitate implant placement often means relatively complex maxillofacial surgeries accompanied by certain morbidities. Unlike Europe or the US, where patients suffering from head or neck tumours are mostly treated by ENT surgeons and plastic surgeons, oral and maxillofacial surgeons in China treat such tumours in addition to conducting the subsequent bone reconstruction. The sample of such patients at the Peking University School of Stomatology is quite large compared with what is available in the literature. Thus, I decided upon investigating patient satisfaction of this kind of treatment series.

Oral defects and edentulism can have a significant impact on people’s lives. How do they generally affect the social status of people in China?
Oral defects and edentulism may lower body image significantly. People tend to limit their social activities and contact with their surroundings. They tend to be more depressed and frustrated, less tolerant of their family and irritable.

Are dental implants already a standard treatment option for maxillofacial surgery in China, and if not why not?
Maxillofacial surgery is practised at a high standard at the Peking University School of Stomatology and is quite affordable for the patients. But dental implants are not yet a standard treatment option in China. Although the lack of public awareness and availability of competent clinicians may contribute to this, the high cost of this treatment option, which is usually not covered by insurance, may be the most significant factor.

What measures did you use for the study and how did you implement them?
Questionnaires in the form of a visual analogue scale (VAS) of patients’ treatment satisfaction were used in addition to OHIP-14 (Oral Health Impact Profile-14) in this retrospective study. Patients were invited to the clinic for these evaluations, which took 30 minutes on average. For those who could not come to the clinic, the evaluation was conducted by telephone.

In a nutshell, what was the outcome and what psychological and psychosocial changes following surgery did the patients report?
According to a number of studies on patients suffering from head or neck tumours, frequent problems regarding the patients’ OHIP were reported, especially within one year after tumour resection. The retrospective study indicated that patients were satisfied with the outcome of functional reconstruction with osseo-integrated implants despite the morbidity of the surgery. Their OHIP score was not significantly different to that of a healthy population, which means that they did not have more frequently reported psychological or psychosocial problems. For the majority who did not undergo functional reconstruction, the high cost of implant treatment was their most significant concern.

What conclusions did you draw from these results?
The patients’ satisfaction of functional reconstruction is very high. Their quality of life has greatly improved as demonstrated by the OHIP score. For financial reasons, only about 10 per cent of the patients are undergoing functional reconstruction with implants thus far.

It is not easy to find figures on implant procedures in China. What is the estimated number of dentists placing implants and where are they located?
Indeed, it is quite difficult to find reliable figures! The estimated number of dentists placing implants on a regular basis in China may be around 300. Thus far, they are mostly located in university-affiliated dental hospitals in the large cities. Some, but not many, are in private practice.

Should implantology form part of the curriculum in dental schools?
Only a few dental schools have begun offering implantology in their curriculum within the last couple of years. In the long term, implantology should and will form part of the standard curriculum. However, we need qualified and well-trained dental professionals who would like to convey their knowledge to dental students in a responsible way.

Industry experts have forecasted a 30 per cent annual growth rate in the implant market in China. What prospects do you predict for the specialty from a clinical perspective?
The next decade will witness a boom in implant dentistry in China. There will be increasing demand for training and education in this field in order to guarantee standardised development. Owing to the shortage of competent clinicians, we foresee a critical period ahead of us. We certainly need to strengthen cooperation with any possible positive resources, including the industry, for training and educational programmes.

The Chinese Stomatological Association recently announced a new partnership with the International Congress of Oral Implantologists to promote implant technology can improve quality of life. Is there a need for more public awareness in the field?
There is definitely a need for more public awareness in the field. We are lagging far behind in this regard compared to Europe or the US.

Thank you very much for the interview.