The main goal of oral rehabilitation is not only to replace missing teeth with a prosthesis that will last for life but also to improve patients’ quality of life and satisfaction. The latter relies on many factors, such as function (mastication, speech), comfort, aesthetics, and self-esteem.4
According to the existing literature,8,11,23−31patient satisfaction is evaluated using both general and specific questions that focus on a particular aspect in order to avoid the false positive responses associated with general questions. The questionnaire used in this study contained both general parameters (overall satisfaction) and specific parameters most commonly used in previous studies to investigate patients’ oral health satisfaction, i.e. comfort, appearance, mastication, and speech.8,11,23−31
The rehabilitation of patients with severe ridge resorption using implant-supported prosthesis presents a huge challenge. The treatment plan involves a bone grafting procedure to improve the bone-implant foundation area, but this procedure may be limited by the age and medical condition of the patient, the extension of the edentulous space, cost efficiency, surgeon expertise, donor site morbidity, and patient preference. Basal implants have been prescribed as an alternative treatment for these patients with a high success rate, less severe complications, and lower cost and number of surgeries.12−14,20,21 There is an increased need for clinical research to evaluate patient satisfaction and quality of life in relation to this treatment modality as a major parameter indicating implant success.
Most patients enrolled in this study were female, in line with previous studies41 − 43 reporting that females are more prone to dental caries, which is one of the main causative factors of tooth loss. Additionally, females tend to visit dental clinics more often than males, increasing the possibility of tooth extraction and edentulism.41,42
Khalifa et al.43 reported a low percentage of complete edentulism among the Sudanese population, as individuals seemed to have extracted only teeth that hurt. Moreover, the high cost of implant prostheses for completely edentulous patients combined with low economic status may limit those seeking implant treatment to partially edentulous patients.43
In accordance with other studies conducted by Saha et al.,44 Annibali et al.,31 Pommer et al.,45,46 and Kohli et al.,47,48 most of our patients were referred by other dentists. This could be due to the limited information available about implants in developing countries; therefore, dentists are still the main source of information about implants, followed by friends, and online media. Thus, it is necessary to increase patients’ awareness about implant treatment including basal implants.
Patients’ expectations are an important parameter that has a great impact on their satisfaction.8,31,49 Similar to other studies,11,49−51 our results showed that patients’ main expectations of basal implant treatment included having a fixed treatment modality and improving their mastication, aesthetics, and retention relative to their previous prostheses. Many authors8,11,12,20,49 reported that in cases of severe ridge resorption, conventional removable prostheses may have some drawbacks that might adversely affect patient satisfaction, such as denture instability (especially the mandibular denture), inefficient mastication, poor retention, and discomfort. These drawbacks increase in the case of severe ridge resorption. On the other hand, several techniques have been advanced in order to optimise the aesthetic and functional outcomes of the prosthetic rehabilitation of patients with severe alveolar ridge resorption including the bone graft procedure,12,13,18,20 use of short implants,16 use of ‘All-on-4 concept’,13 and utilisation of remote basal bone areas for anchorage such as the cortical bone of the nasal floor and maxillary sinus, pterygoid plate of the sphenoid bone, zygomatic bone, inferior cortex of the mandible, and buccal and lingual cortex of the mandible for basal implants.12,13,18,20
The main reasons given by our patients for changing from a fixed conventional prosthesis were caries and fracture of the abutment, which is similar to numerous previous studies.24,52−54 Goodacre et al.52 noted that the most common complications associated with conventional fixed partial dentures were caries, need for endodontic treatment, loss of retention, aesthetics, periodontal disease, tooth fracture, and prosthesis/porcelain fracture. Pjetursson et al.23 reported in a meta-analysis that the most frequent complications with fixed prostheses were of biological nature, such as caries and loss of pulp vitality. De Backer et al.53 reported that the most common fixed prosthesis complications were irreversible ones such as caries, loss of retention, fracture of the framework, abutment fracture, and periodontal and apical problems. Younes et al.54 found that the most frequent complications encountered with resin bonded dental prostheses were de-bonding, caries, and periodontal breakdown.
Basal implants are a special type of implant integrated mainly in the strongest basal bone, providing a high degree of support, stability, and retention to patients with severe ridge resorption, something that cannot be achieved with a removable prosthesis. Basal implants also allow for immediate restoration, which decreases patients’ discomfort and omits the need for transitional or temporary restoration. This treatment also minimises the cost and time required, offering a more conservative approach compared with bone grafting procedures.12−22 All of these factors may have contributed to the high overall satisfaction rates obtained in this study. Despite the lack of knowledge regarding patient satisfaction and quality of life in relation to basal implants specifically, the results of this study are in line with other conventional endo-osseous implant results,23,28,31,36−39 indicating that patients’ quality of life significantly improved after treatment with implant-supported prostheses.
The strongest anchorage obtained with basal implants offers stable occlusal units leading to good chewing function.12,13,16,18,21 Most of the patients in our study reported a significant improvement in their satisfaction with mastication from average to excellent after basal implant treatment, a finding that matches the findings of S. Ihde and A. Ihde12,18 and Scortecci15 and is in accordance with other studies on endo-osseous implant treatment showing improved mastication with implant-supported prostheses.55−59
Since speech is usually affected by edentulism, improving patients’ speech is one of the main purposes of replacing missing teeth.11 According to the literature on conventional implants,23,30,40 implant-supported prostheses improve patients’ speech because of their limited tissue coverage, minimal or no interference with the tongue and lips, and the fact that they do not require palatal or rugae area coverage. Our study showed that patients’ satisfaction with speech significantly improved with basal implants. However, two of the patients in the study complained about their phonation when pronouncing the letter S. The same complaint was reported in the studies of Goodacre et al.52 and Heydecke et al.,30 who observed that a greater number of speech problems occurred when restoring the maxillary arch with conventional fixed implant-supported prosthesis compared to removable implant-supported prosthesis. This was attributed to air escaping through the space required for oral hygiene maintenance between the edentulous ridge and the fixed implant prosthesis.
There was a significant improvement in patients’ satisfaction with aesthetics after basal implant treatment, which is in accordance with the findings of Emami et al.,40 Zitzmann and Marinello,26 Gurgel et al.,25 and Annali et al.,31 concluding that implant treatment produced a significant improvement in patients’ satisfaction with aesthetics, eating, degree of comfort, and phonetics, as well as general satisfaction.
Two patients in our study complained about the small size of the artificial teeth. In general, in implant prosthesis construction, the artificial teeth are smaller than natural teeth in order to decrease the occlusal table, minimise or avoid the cantilever effect, prevent offset forces, and increase the axial loading. Out findings matched the occlusal considerations discussed in the studies of Misch and Wang,60 Kim et al.,61 Yi et al.,62 and Abichandani et al.63
Easy cleaning and oral hygiene maintenance are essential for maintaining good peri-implant health. All patients in this study were able to maintain their oral hygiene habits except for one who experienced some difficulty. This matches the results of Annali31 and Pjetursson et al.,23 but is in contrast with Yi et al.,62 who reported that it was more difficult to maintain oral hygiene after implant prosthesis.
Despite the limitation of the relatively small sample size in the present study, the high level of patient satisfaction obtained suggests that basal implant-supported prostheses (BCS→) in edentulous and partially edentulous patients have a positive impact on patient satisfaction and hence enhance their quality of life. There were marked improvements in patients’ overall satisfaction and specific satisfaction with comfort, aesthetics, mastication, and speech. Further research needs to evaluate patient satisfaction and the oral health impact of basal implants using a larger sample size and a longer follow-up period.