Sung-Hee Oh Comparison of fixed implant-supported

Younhee Kim
Joo-Yeon Park
prostheses, removable implant-sup-
Yea Ji Jung ported prostheses, and complete
Seong-Kyun Kim
Sun-Young Park
dentures: patient satisfaction and oral
health-related quality of life

Authors’ affiliations: Key words: complete dentures, fixed implant-supported prostheses, OHIP-14, oral health-
Sung-Hee Oh, Younhee Kim, Joo-Yeon Park, Yea Ji related quality of life, patient satisfaction, removable implant-supported prostheses
Jung, Seong-Kyun Kim, Sun-Young Park, National
Evidence-based Healthcare Collaborating Agency
(NECA), Seoul, Korea Abstract
Sung-Hee Oh, College of Pharmacy, Yonsei
University, Incheon, Korea
Objectives: The purpose of this study was to compare patient satisfaction and oral health-related
Younhee Kim, Institute of Health and quality of life (OHRQoL) among fully edentulous patients treated with either fixed implant-
Environment, School of Public Health, Seoul supported prostheses (FP), removable implant-supported prostheses (RP), or complete dentures
National University, Seoul, Korea
Seong-Kyun Kim, Department of Prosthodontics (CD).
and Dental Research Institute, School of Dentistry, Material and Methods: Eighty-six patients – 29 FP, 27 RP, and 30 CD patients – participated in this
Seoul National University, Seoul, Korea study. The survey was conducted using face-to-face interviews with a questionnaire that included a
Sun-Young Park, School of Pharmacy,
Sungkyunkwan University, Suwon, Korea patient satisfaction scale and Oral Health Impact Profile (OHIP-14). We measured patient
satisfaction after prosthetic treatments and OHRQoL before and after the treatments.
Corresponding author: Results: After prosthetic treatments, OHRQoL increased in all three groups (P < 0.05). The FP and
Sun-Young Park, MPharm
School of Pharmacy RP groups showed no significant difference in patient satisfaction and OHRQoL, and both groups
Sungkyunkwan University showed greater improvement compared with the CD group. Specifically, the OHRQoL dimensions
2066 Seobu-ro, Jangan-gu, Suwon
of functional limitation, physical pain, psychological discomfort, and psychological disability in the
Gyeonggi-do 440-746
Korea FP group, and functional limitation in the RP group, improved greatly in comparison with the CD
Tel.: +82 31 296 4380 group (P < 0.05).
Fax: +82 31 299 4379
Conclusions: Although further research is still needed, prosthetic treatments may provide superior
e-mail: sunyoung.pr@gmail.com
OHRQoL for fully edentulous patients. In particular, both the FP and RP treatments provided
significantly greater improvement of OHRQoL and patient satisfaction than the CD treatment.
Reliable information of OHRQoL and patient satisfaction helps experts and patients choose the
best prosthetic treatment option.

While the prevalence of total tooth loss is
decreasing, transition to edentulousness is
occurring at a later stage in patients’ lives
because of increased life expectancy (Allen
et al. 2001b; Preciado et al. 2012). It is
known that edentulousness can cause func-
tional problems such as diminished chewing
efficiency, nutritional imbalance, disability,
handicap, and reducing quality of life (QoL)
(Allen et al. 2001b; Locker et al. 2002; Rich-
mond et al. 2007). To solve these problems,
Date:
Accepted 28 September 2014
different types of prostheses such as fixed
implant-supported prostheses (FP), removable
To cite this article:
Oh S-H, Kim Y, Park J-Y, Jung YJ, Kim S-K, Park S-Y. implant-supported prostheses (RP), and com-
Comparison of fixed implant-supported prostheses, plete dentures (CD) have been developed for
removable implant-supported prostheses, and complete
dentures: patient satisfaction and oral health-related quality fully edentulous patients (Locker et al. 2002;
of life. Fillion et al. 2013; Preciado et al. 2013;
Clin. Oral Impl. Res. 00, 2014, 1–7.
doi: 10.1111/clr.12514 Emami et al. 2014).
Clinical studies on patient satisfaction or
QoL after prosthetic treatments have shown
successful results (Fillion et al. 2013; Preci-
ado et al. 2013; Emami et al. 2014). Single-
arm studies have showed improvement in
oral health-related quality of life (OHRQoL)
in the FP (Berretin-Felix et al. 2008), RP
(MacEntee et al. 2005), and CD (John et al.
2007) groups. Some studies also compared
either patient satisfaction or OHRQoL
between two of the three groups (Heydecke
et al. 2003b; Kim 2008; Brennan et al. 2010).
When dentists and patients choose a pros-
thetic treatment option for full edentulism,
they should have inferred the comparative
effectiveness on patient satisfaction and
OHRQoL among FP, RP, and CD groups indi-
rectly based on several previous literature

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 1
Oh et al
OHRQoL in fully edentulous patients treated with prostheses
sources. This is because there were few stud-
ies that have compared the results of the
three treatment options in fully edentulous
patients. Therefore, the purpose of this study
was to compare patient satisfaction and
OHRQoL in fully edentulous patients who
received FP, RP, or CD.
Material and methods
Study design and subjects
This study was approved by the Institutional
Review Board (IRB) at the National Evidence-
based healthcare Collaborating Agency (No.
NECAIRB11-014-1). We included patients
who were aged 40–69 years; were fully eden-
tulous and treated with FP, RP, or CD for
edentulous maxilla, mandible, or both; pro-
vided voluntary consent to participate in this
survey; and received prosthetic treatment at
a dental clinic or hospital at least 6 months
prior to the survey date. The sample size was
determined using standard statistical criteria
(alpha = 0.05, power = 0.80) based on the pri-
mary outcome, which was OHRQoL mea-
sured on visual analog scales (VAS) before
and after treatment in the previous studies
(Awad et al. 2003; Heydecke et al. 2003a).
The minimum sample size calculated was 26
patients per group. The quota sampling was
used to select the representative sample, with
quotas related to the main characteristics of
the target population (Moser 1952; Aday &
Cornelius 2006). Samples were extracted in a
quantity proportional to the population dis-
tribution according to the age based on the
forth Korea National Health and Nutrition
Examination Survey (Kim et al. 2011).
This survey was conducted from September
1, 2011 to October 26, 2011. The face-to-face
interview method was used to decrease possi-
ble bias by respondents and increase response
rates (Aday & Cornelius 2006). Interviewers
were extensively trained using the instruc-
tion sheet on each prosthetic treatment
definition with accompanying figures and
questionnaire items.
Questionnaire
A draft of the questionnaire was prepared
based on a literature review and expert opin-
ions. It was pilot-tested on 10 patients, each
of whom received one of the prosthetic treat-
ments. An in-depth interview of five patients
that received prosthetic treatments at hospi-
tals located in Seoul, Korea, was performed
to identify any questions that required revi-
sion. The final version of the questionnaire
was developed reflecting the oral health
2 | Clin. Oral Impl. Res. 0, 2014 / 1–7
context of Korea, and it was divided into
three parts: (1) Characteristics of subjects
including oral health and dental manage-
ment; (2) Patient satisfaction; and (3) OHR-
QoL using the Korean version of the 14-item
Oral Health Impact Profile (OHIP-14) (Bae
et al. 2007). Previous studies have shown
that functional aspects, social aspects, and
overall satisfaction were important factors in
the evaluation of patient satisfaction (Zitz-
mann & Marinello 2000; Heydecke et al.
2003a). Based on these articles, patient satis-
faction after prosthetic treatments was mea-
sured through three domains containing a
total of 14 items – five items in chewing
function, six items in social function, and
three items in overall satisfaction. Responses
were measured by a five-point Likert scale
ranging from 0 (“not at all satisfied”) to 4
(“totally satisfied”). Patient satisfaction was
calculated by totaling each item score – the
scores ranged from 0 to 56. The higher scores
indicated progressively greater satisfaction
with the prosthetic treatment.
OHIP-14 is one of the most commonly
used instruments for measuring OHRQoL. It
was derived from the original extended ver-
sion, OHIP-49, which was developed in 1994
(Slade & Spencer 1994; Montero-Martin et al.
2009). Even though it is the short form, it
has proven to be reliable and valid in several
languages including Korean (Slade 1997;
Allen et al. 2001a; Locker et al. 2004; Lee
et al. 2005; Bae et al. 2007). The self-reported
questionnaire consisted of 14-items divided
into seven dimensions – functional limita-
tion, physical pain, psychological discomfort,
physical disability, psychological disability,
social disability, and handicap. For these
items, subjects were asked to evaluate how
often they felt and experienced an impacts on
oral health during the 12-month period prior
to prosthetic treatment and during the period
after the treatment using a five-point Likert
scale coded 0 (“never”), 1 (“hardly”), 2
(“occasionally”), 3 (“fairly often”), and 4
(“very often”). Total OHIP-14 scores ranged
from 0 to 56 and subtotal scores for each
dimension were calculated by adding together
each item score; higher scores indicated
worse OHRQoL.
Data analyses
Statistical analyses were performed using Sta-
ta/SE 11.1 (StataCorp LP, College Station,
TX, USA) at a significance level of 0.05. Data
were analyzed using descriptive statistics for
representing frequencies of subject character-
istics. The characteristics of the three groups
were compared using the chi-square test or
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Fisher’s exact test for categorical variables.
For patient satisfaction after prosthetic treat-
ments, the median scores were compared
using a nonparametric Kruskal–Wallis test
because data were not normally distributed
according to the Shapiro–Wilk test. In addi-
tion, changes in OHRQoL were calculated as
the difference between OHIP-14 median
scores before and after treatment. After using
the Shapiro–Wilk test of normality, the Wil-
coxon signed-rank test was used to test the
statistical significance between changes in
OHRQoL before and after treatment, within
each group. Among the groups, changes in
OHIP-14 median scores were compared using
the Kruskal–Wallis test; a post hoc pairwise
comparisons that used the Wilcoxon rank-
sum tests with Bonferroni’s correction
(P < 0.017; Bonferroni-corrected P value
threshold) were also performed.
Results
General characteristics
Eighty-six subjects – 29 FP, 27 RP, and 30
CD – took part in this study. The general
characteristics of the three groups are shown
in Table 1. The majority of general character-
istics were similar in each group (P > 0.05).
The survey included 34 (39.5%) male and 52
(60.5%) female subjects. The mean age of the
patients was 55.1 years (SD = 7.1). The vari-
ables “subjective economic status”, “subjec-
tive health status”, and “presence of chronic
disease” showed statistically significant dif-
ferences among the three groups (P < 0.05).
In subjective economic status, all subjects of
the CD group responded as being below the
middle class, while 17.2% of the FP group
and 3.7% of the RP group responded as being
above the upper middle class. The FP group
reported better subjective health status, and
the CD group reported more chronic diseases
than the other groups.
Oral health and dental management-related
characteristics
Oral health and dental management-related
characteristics of the three groups are shown
in Table 2. 69.8% of the subjects were exam-
ined 1–3 years after receiving new prostheses.
Among the subjects, 64.0% reported their
subjective oral health status as either fair or
good, 66.3% did not have oral diseases, and
14.0% received treatment due to side effects
after prosthetic treatment. There were statis-
tically significant differences among the
three groups in the variables “treatment loca-
tion”, “subjective treatment costs”, and
“dental checkups” (all variables, P < 0.05).
 Oh et al
OHRQoL in fully edentulous patients treated with prostheses

Table 1. General characteristics according to the type of prosthetic treatment (score ≥ 2) in social function and overall sat-
Removable isfaction (Table 4). However, 14.7%, 11.1%,
Fixed implant- implant- and 15.6% of the CD group answered “unsat-
supported supported Complete isfied (score ≤ 1)” for chewing function,
prostheses prostheses dentures Total
Variables (N = 29) (N = 27) (N = 30) (N = 86) P value social function, and overall satisfaction,
respectively. The satisfaction of the CD
Age, Mean (SD) 54.4 (6.9) 54.7 (7.7) 56.1 (6.8) 55.1 (7.1) 1.000
Gender, n (%) group was lower than that of the other
Male 12 (41.4) 10 (37.0) 12 (40.0) 34 (39.5) 0.944 groups.
Female 17 (58.6) 17 (63.0) 18 (60.0) 52 (60.5)
Residential area, n (%)
Metropolitan area 26 (89.7) 27 (100.0) 25 (83.3) 78 (90.7) 0.073*
Change in the oral health-related quality of life
before and after treatment
Urban area 2 (6.9) 0 (0.0) 5 (16.7) 7 (8.1)
Rural area 1 (3.5) 0 (0.0) 0 (0.0) 1 (1.2) As the Shapiro–Wilk test showed that the
Monthly household income (USD)§, n (%) results of the three groups (Total OHIP-14
<$1000 0 (0.0) 1 (3.7) 1 (3.3) 2 (2.3) 0.051* scores) were not normally distributed
$1000–$3000 1 (3.5) 1 (3.7) 7 (23.3) 9 (10.5)
(P = 0.006), the Wilcoxon signed-rank test
$3000–$5000 14 (48.3) 14 (51.9) 16 (53.3) 44 (51.2)
Above $5000 14 (48.3) 11 (40.7) 6 (20.0) 31 (36.1) was performed to check differences in OHR-
Subjective economic status, n (%) QoL before and after prosthetic treatments.
High 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0.026* There were no differences in total OHIP-14
Upper-middle 5 (17.2) 1 (3.7) 0 (0.0) 6 (7.0)
Middle 21 (72.4) 17 (63.0) 19 (63.3) 57 (66.3)
scores before treatments among the three
Lower-middle 3 (10.3) 8 (29.6) 7 (23.3) 18 (20.9) groups (Kruskal–Wallis test, P = 0.622;
Low 0 (0.0) 1 (3.7) 4 (13.3) 5 (5.8) Table 5). After prosthetic treatment, limita-
Subjective health status, n (%)
tion in QoL due to oral issues was signifi-
Very poor 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0.026*
Poor 3 (10.3) 5 (18.5) 3 (10.0) 11 (12.8) cantly reduced in all seven dimensions and
Fair 7 (24.1) 16 (59.3) 16 (53.3) 39 (45.4) in the total OHIP-14 scores for all three
Good 18 (62.1) 6 (22.2) 10 (33.3) 34 (39.5) groups (P < 0.05, Table 5). In other words,
Very good 1 (3.5) 0 (0.0) 1 (3.3) 2 (2.3)
OHRQoL was significantly improved after
Prevalence of chronic disease, n (%)
Had not diseases 22 (75.9) 20 (74.1) 13 (43.3) 55 (64.0) 0.014 treatment in all three groups (FP = 24,
Had diseases† 7 (24.1) 7 (25.9) 17 (56.7) 31 (36.0) RP = 22, and CD = 17, difference of total
Diabetes 1 (3.5) 2 (7.4) 4 (13.3) 7 (8.1) OHIP-14 median scores; Table 6). The level
Hypertension 5 (17.2) 3 (11.1) 14 (46.7) 22 (25.6)
Other diseases‡ 3 (10.3) 3 (11.1) 4 (13.3) 10 (11.6) of OHRQoL improvement was higher in all
Smoking, n (%) dimensions for the FP and RP groups (FP = 4
No smoking 24 (82.8) 24 (88.9) 21 (70.0) 69 (80.2) 0.264* and RP = 3, median difference) than for the
<1 pack a day 3 (10.3) 2 (7.4) 8 (26.7) 13 (15.1)
CD group, while the CD group showed
More than one > 1 pack a day 2 (6.9) 1 (3.7) 1 (3.3) 4 (4.7)
Dental-related private health insurance, n (%) improvement of the OHIP-14 score of 3 as
Enrolled 2 (6.9) 1 (3.7) 1 (3.3) 4 (4.7) 0.840* the median difference only in the two dimen-
Not enrolled 27 (93.1) 26 (96.3) 29 (96.7) 82 (95.4) sions – psychological disability and social dis-
*The P value was calculated by Fisher’s exact test. ability. There were significant differences in
†
Multiple-alternative question. the degree of improvement of OHRQoL
‡
Hemopathy, Mental disorder, Allergy.
§ among the three groups (P < 0.05), and total
Exchange rate: USD 1 = KRW 1,108 (2010).
SD, Standard deviation. OHIP-14 scores improved in the FP
(P = 0.003, Bonferroni) and RP (P = 0.061,
Most of the patients in the FP (51.7%) and that in the FP (6.9%) and RP (11.1%) groups. Bonferroni) groups compared with the CD
RP groups (55.6%) belonged to mandibular e- A total of 66 respondents (90.4%) did not pay group. Specifically, the OHRQoL dimensions
dentulism, and most of the patients in the for regular dental checkups. of functional limitation, physical pain, psy-
CD group (43.3%) were patients with full e- chological discomfort, and psychological dis-
dentulism. With regard to the subjective Patient satisfaction after prosthetic treatments ability in the FP group, and functional
treatment costs, most respondents in the FP Satisfaction scores for chewing function, limitation in the RP group improved signifi-
and RP groups stated that treatment costs social function, and overall satisfaction after cantly compared with the CD group
were either expensive or very expensive, prosthetic treatments were greater in the FP (P = 0.015, Bonferroni). However, there were
while more than half of the CD group and RP groups than in the CD group no significant differences in all dimensions
respondents answered that the treatment (Table 3). The Kruskal–Wallis rank test between the FP and RP groups (P > 0.017,
costs were either reasonable or cheap. More showed that satisfaction scores in each Bonferroni; see Table 6).
specifically, the percentage of subjects in the domain and total scores were statistically sig-
FP group who thought that treatment costs nificantly different among the three groups Discussion
were very expensive was very high compared (P < 0.05).
with the other groups – FP 64.3%, RP 29.6%, Frequency analysis of satisfaction also The results of this study confirm that pros-
and CD 3.3%. The majority (56.7%) of the showed a similar trend – 95.9% of the FP thetic treatments can provide better OHR-
CD group did not receive regular dental group and 97.0% of the RP group were satis- QoL for fully edentulous patients and the FP
checkups for prosthetic management after fied with their chewing function. The degree and RP treatments may improve OHRQoL
treatment; this was significantly higher than of satisfaction was more than neutral and patient satisfaction better than CD

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 3 | Clin. Oral Impl. Res. 0, 2014 / 1–7
Oh et al
OHRQoL in fully edentulous patients treated with prostheses

Table 2. Oral health and dental management-related characteristics according to the type of pros- edentulous patients; most CD group respon-
thetic treatment
dents had full edentulism of the maxilla and
Removable mandible (P < 0.05). According to Leles et al.
Fixed implant- implant-
(2011), FP and RP are the preferred treatment
supported supported Complete
prostheses prostheses dentures Total option for the mandible rather than the max-
Variables (N = 29) (N = 27) (N = 30) (N = 86) P value illa while CD is the preferred treatment
Treatment period, n (%) option for both the maxilla (52.7%) and man-
<1 year 7 (24.1) 4 (14.8) 6 (20.0) 17 (19.8) 0.946* dible (41.1%). The CD group, which received
1–3 year 19 (65.5) 20 (74.1) 21 (70.0) 60 (69.8)
the cheapest treatment of the three options
Above 3 year 3 (10.3) 3 (11.1) 3 (10.0) 9 (10.5)
Subjective oral health status, n (%) in Korea (Kim et al. 2011), responded that
Very poor 1 (3.5) 0 (0.0) 3 (10.0) 4 (4.7) 0.693* they were of lower economic status and their
Poor 8 (27.6) 11 (40.7) 8 (26.7) 27 (31.4) treatment costs were lower compared with
Fair 15 (51.7) 13 (48.2) 15 (50.0) 43 (50.0)
Good 5 (17.2) 3 (11.1) 4 (13.3) 12 (14.0)
those in the other groups (P < 0.05). Cost of
Very good 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) treatment was also one of the factors that
Oral disease, n (%) influenced edentulous patients’ preferences
Had not oral diseases 20 (69.0) 16 (59.3) 21 (70.0) 57 (66.3) 0.646
for prosthetic treatment (Leles et al. 2011).
Had oral diseases† 9 (31.0) 11 (40.7) 9 (30.0) 29 (33.7)
Cavity 0 (0.0) 2 (7.4) 3 (10.0) 5 (5.8) The factors considered when deciding on
Periodontal disease 7 (24.1) 9 (33.3) 6 (20.0) 22 (25.6) types of prostheses, such as treatment loca-
Halitosis 4 (13.8) 4 (14.8) 3 (10.0) 11 (12.8) tion and costs, may influence OHRQoL as
Past prosthetic treatment experience, n (%)
well as clinical outcomes; and an understand-
No 21 (72.4) 18 (66.7) 18 (60.0) 57 (66.3) 0.601
Yes‡ 8 (27.6) 9 (33.3) 12 (40.0) 29 (33.7) ing of these factors helps clinicians provide
Treatment location, n (%) the best treatment that matches patients’
Fully edentulous 6 (20.7) 1 (3.7) 13 (43.3) 20 (23.3) 0.011 desires (Awad et al. 2000b; Leles et al. 2011).
Fully edentulous maxilla 8 (27.6) 11 (40.7) 7 (23.3) 26 (30.2)
Fully edentulous mandible 15 (51.7) 15 (55.6) 10 (33.3) 40 (46.5) Comparison of patient satisfaction after
§
Subjective treatment costs , n (%) treatment in the three groups showed a simi-
Very cheap 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) <0.001* larly high level of satisfaction in the FP and
Cheap 0 (0.0) 0 (0.0) 3 (10.0) 3 (3.5)
RP groups in all domains (i.e., chewing func-
Reasonable 1 (3.6) 0 (0.0) 14 (46.7) 15 (17.4)
Expensive 9 (32.1) 19 (70.4) 12 (40.0) 40 (46.5) tion, social function, and overall satisfaction),
Very expensive 18 (64.3) 8 (29.6) 1 (3.3) 27 (31.4) whereas the satisfaction level in the CD
Frequency of dental checkups, n (%) group was relatively low (P < 0.05). These
Not at all or Feeling discomfort 2 (6.9) 3 (11.1) 17 (56.7) 22 (25.6) <0.001
Regular visits 27 (93.1) 24 (88.9) 13 (43.3) 64 (74.4)
results corroborated as well as integrated the
Treatment for complication, n (%) findings of previous studies. Using VAS, com-
No 25 (86.2) 23 (85.2) 26 (86.7) 74 (86.0) 0.987 parison of patient satisfaction in eight
Yes 4 (13.8) 4 (14.8) 4 (13.3) 12 (14.0)
patients after FP and in five maxillary edentu-
*The P value was calculated by Fisher’s exact test. lous patients after RP found that general satis-
†
Multiple-alternative question. faction after RP treatment was significantly
‡
Single-tooth implant 13.8%, Bridge 44.8%, Complete denture 31.0%, Partial denture 17.2%.
§
One subject nonresponsive in FP group.
higher (Heydecke et al. 2003a). In contrast, in
another study that also used VAS, 20 maxil-
lary edentulous patients treated with either
FP or RP reported similar levels of satisfaction
Table 3. Satisfaction scores† after prosthetic treatments
with their prosthetic treatments with regard
Median (IQR)
to comfort and retention, function, esthetics
Fixed implant- Removable implant- Complete and appearance, taste, speech, and self-esteem
supported prostheses supported prostheses dentures (Zitzmann & Marinello 2000). In two other
(N = 29) (N = 27) (N = 30) P value
studies, patient satisfaction of the mandibular
Chewing ability 14 (3) 14 (3) 12 (3) <0.001* edentulous patients treated with the RP was
Social function 19 (2) 18 (2) 17 (5) <0.001*
Overall satisfaction 9 (1) 9 (0) 8 (3) 0.007* higher than that of the patients treated with
Total scores 42 (4) 40 (6) 37 (11) <0.001* the CD (Geertman et al. 1996; Raghoebar
et al. 2003). Taken together, these earlier
*Degree of satisfaction between three prosthetic treatment groups showed statistically significant
difference in all dimensions (Kruskal–Wallis rank test, P < 0.05). studies indicated that patient satisfaction
†
Increasing points mean higher satisfaction for prosthetic treatments (chewing ability 0-20, social after either FP or RP treatment was higher
function 0-24, overall satisfaction 0-12, total scores 0-56). than that after CD treatment (P < 0.05),
IQR, interquartile range.
although there was no significant difference
between the FP and RP groups; or it was diffi-
treatment. Patient satisfaction assessments showed that the RP and FP groups had better cult to draw any conclusions.
in the three groups revealed greater satisfac- results compared with the CD group for func- Comparison of OHRQoL using OHIP-14
tion in the FP and RP groups than the CD tional limitation, physical pain, psychological scores before and after prosthetic treatments
group, in all domains of chewing function, discomfort, and psychological disability. revealed that all three groups showed higher
social function, and overall satisfaction. Meanwhile, most of the respondents in the QoL after treatment than before treatment. In
Analysis of the seven dimensions of OHIP-14 FP and RP groups were fully mandibular addition, comparing degree of improvement

4 | Clin. Oral Impl. Res. 0, 2014 / 1–7 © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Oh et al
OHRQoL in fully edentulous patients treated with prostheses

Table 4. Distributions of satisfaction after prosthetic treatments

Removable implant-
Fixed implant-supported supported prostheses Complete dentures
prostheses (N = 29) (N = 27) (N = 30)

Dissatisfied† Satisfied‡ Dissatisfied† Satisfied‡ Dissatisfied† Satisfied‡

Chewing function, %
Total 4.1 95.9 3.0 97.0 14.7 85.3
No problems in chewing hard food 0.0 100.0 7.4 92.6 20.0 80.0
No discomfort in chewing 0.0 100.0 0.0 100.0 6.7 93.3
No problems in gum 0.0 100.0 0.0 100.0 10.0 90.0
Foreign substances do not get stuck easily 13.8 86.2 3.7 96.3 26.7 73.3
Cheek and tongue are not chewed 6.9 93.1 3.7 96.3 10.0 90.0
Social function, %
Total 0.0 100.0 0.0 100.0 11.1 88.9
Appearance improved 0.0 100.0 0.0 100.0 6.7 93.3
No discomfort during conversation 0.0 100.0 0.0 100.0 13.3 86.7
No discomfort during pronunciation 0.0 100.0 0.0 100.0 20.0 80.0
No difficulty in personal relationship 0.0 100.0 0.0 100.0 6.7 93.3
Able to smile naturally 0.0 100.0 0.0 100.0 6.7 93.3
Confident in teeth 0.0 100.0 0.0 100.0 13.3 86.7
Overall satisfaction, %
Total 0.0 100.0 0.0 100.0 15.6 84.4
Overall satisfied with the treatments 0.0 100.0 0.0 100.0 0.0 100.0
Will receive the same treatment if another prosthetic 0.0 100.0 0.0 100.0 26.7 73.3
treatment is needed due to tooth loss
Will recommend the same treatment to other people 0.0 100.0 0.0 100.0 20.0 80.0
who are in need of prosthetic treatment due to tooth loss
†
Dissatisfied: highly unlikely (score 0), unlikely (score 1).
‡
Satisfied: neutral (score 2), likely (score 3), highly likely (score 4).

Table 5. The OHIP-14 scores before and after treatment

Median (IQR)

Fixed implant-supported prostheses* Removable implant-supported

(N = 29) prostheses* (N = 27) Complete dentures* (N = 30)

Dimension Before treatment† After treatment Before treatment† After treatment Before treatment† After treatment
Functional limitation 5 (1) 2 (1) 5 (2) 2 (0) 5 (2) 3 (2)
Physical pain 6 (1) 2 (2) 5 (3) 2 (1) 5 (2) 3 (2)
Psychological discomfort 5 (2) 1 (2) 5 (2) 2 (1) 4 (2) 2 (1)
Physical disability 6 (2) 2 (2) 5 (3) 2 (1) 5 (2) 2.5 (2)
Psychological disability 5 (2) 2 (1) 5 (1) 2 (1) 5 (2) 2 (1)
Social disability 4 (3) 2 (2) 5 (1) 2 (1) 5 (2) 2 (2)
Handicap 4 (2) 2 (2) 4 (2) 2 (2) 4 (2) 2 (0)
Total OHIP-14‡ 35 (7) 12 (12) 35 (10) 14 (8) 33.5 (13) 17 (9)

*The changes of quality of life before and after treatment in all domains of three groups were statistically significant (Wilcoxon signed-rank test, P < 0.05).
†
There were no differences in total OHIP-14 scores before treatments among the three groups (Kruskal–Wallis test, P = 0.622).
‡
Total OHIP-14 scores of range 0–56 are calculated as sum of the seven dimensions, include two items each measured in five-point Likert scale (coded never
[score 0], hardly ever [score 1], occasionally [score 2], fairly often [score 3], and very often [score 4]). Increasing OHIP-14 scores mean higher limitation in
quality of life due to oral issues.
IQR, interquartile range.

on OHRQoL in all dimensions among the
groups, the FP and RP groups showed a greater
improvement than the CD group. The results
were consistent with the findings of earlier
studies (Awad et al. 2000a; Heydecke et al.
2003b; Kim 2008; Brennan et al. 2010) and
showed similar trends for our patient satisfac-
tion study. The FP group’s QoL that was mea-
sured with OHIP-14 and the RP group’s QoL
measured with OHIP-49 or OHIP-20 increased
more significantly compared with the CD
group’s QoL (Awad et al. 2000a; Heydecke
et al. 2003b; Kim 2008). Meanwhile, the RP
group was superior to the CD group in
functional limitation, physical pain, physi-
cal disability, and psychological disability
(Heydecke et al. 2003b). However, this study
showed statistically significant improvements
on OHRQoL in only the functional limitation
of the seven dimensions for the RP group com-
pared with the CD group. For the FP group,
there were statistically significant improve-
ments on OHRQoL in functional limitation,
physical pain, psychological discomfort, and
psychological disability (P < 0.05). Moreover,
there were no significant differences between
the FP and RP groups in all dimensions of
OHIP-14 (P > 0.05). In a previous study on
OHRQoL after treatment for edentulous
patients treated with FP (n = 37) and RP
(n = 25) using OHIP-14, RP patients had lower
OHRQoL than FP patients. In particular, there
was a significant difference in psychological
discomfort (Brennan et al. 2010).
RP provide a great ability to speak and chew
(Heydecke et al. 2003a) and are less likely to
move in the mouth than CD because of being
supported by implants. Meanwhile, the capac-
ity, complications, and cost of RP depend on
the number of the implants (Sadowsky 1997;
Kim et al. 2011; Emami et al. 2014). If a very
small number of implants were placed, the

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 5 | Clin. Oral Impl. Res. 0, 2014 / 1–7
Oh et al
OHRQoL in fully edentulous patients treated with prostheses

Table 6. Changes in OHIP-14 scores before and after treatment in FP, RP and CD groups
Median difference† (IQR) P-value

Fixed implant-supported Removable implant-supported Complete dentures FP vs. RP

Dimension prostheses (N = 29) prostheses (N = 27) (N = 30) vs. CD FP vs. RP FP vs. CD RP vs. CD
Functional limitation 4 (1) 3 (2) 2 (3) 0.002* 0.348 0.001** 0.015**
Physical pain 4 (2) 3 (3) 2.5 (2) 0.008* 0.184 0.002** 0.078
Psychological discomfort 4 (1) 3 (3) 2.5 (2) 0.004* 0.295 0.001** 0.030
Physical disability 4 (3) 3 (3) 2 (2) 0.058 0.512 0.023 0.094
Psychological disability 4 (1) 3 (1) 3 (2) 0.026* 0.219 0.008** 0.127
Social disability 3 (2) 3 (2) 3 (2) 0.418 0.219 0.290 0.987
Handicap 4 (2) 3 (2) 2 (2) 0.219 0.423 0.089 0.319
Total OHIP-14‡ 24 (10) 22 (9) 17 (19) 0.007* 0.126 0.003** 0.061

*Statistically significant (P < 0.05), Kruskal–Wallis test.

**Statistically significant (P < 0.017), Post hoc pairwise comparisons using the Wilcoxon rank-sum tests with Bonferroni correction.
†
Median difference between before and after treatment: Higher values indicate more improvement of quality of life.
‡
Total OHIP-14 scores of range 0–56 are calculated as sum of the seven domains, include two items each measured in five-point Likert scale (coded never
[score 0], hardly ever [score 1], occasionally [score 2], fairly often [score 3], and very often [score 4]). Increasing OHIP-14 scores mean higher limitation in
quality of life due to oral issues.
IQR, interquartile range, FP, fixed implant-supported prostheses, RP, removable implant-supported prostheses, CD, complete dentures.

costs of RP treatment can be reduced; how-
ever, patients may suffer from the bite force
exerted on the gums and the weakening of
chewing ability. The previous studies show
different results in the effect of implant num-
ber and attachment type on patient satisfac-
tion and OHRQoL (Mumcu et al. 2012;
Kuoppala et al. 2013). In our study, only
29.6% of patients in the RP group responded
to the number of implants – the response rate
was low. Because this study also targeted
patients, not just clinicians, many patients
were unfamiliar with the detailed prosthesis
type. Therefore, we could not include infor-
mation about the number of implants and the
detailed prostheses type. The advantages and
important factors for the choice of FP treat-
ment are comfort and stability caused by a
sufficient number of implants being fixed,
such as that experienced with natural teeth.
However, this may increase financial burden
and increase the potential risk of surgery
(Heydecke et al. 2003a; Preciado et al. 2013;
Emami et al. 2014). Meanwhile, although
improvements of OHRQoL in the CD group
were relatively low, CD is currently the
cheapest among the three prosthetic treat-
ments available in Korea. Therefore, further
research on the OHRQoL and costs consider-
ing the number of implants and the detailed
prostheses type would be needed.
Our study has some limitations. First, this
study was performed with 29 FP, 27 RP, and
30 CD patients and there may have been a
potential issue with its representativeness.
However, the minimum sample size calcu-
lated was 26 for each group and previous
studies involved fewer than 30 subjects in
one prosthetic group. Thus, our sample size
was quite reasonable. Second, as respondents
were requested to recollect their experiences
to examine their QoL for 1 year before the
treatment, there may have been recall bias.
Third, patients’ preference may influence the
outcome, especially when the treatments
cannot be blinded and the outcome is based
on patients’ evaluations for treatment (Awad
et al. 2000b). Therefore, it is necessary to
consider the patient preferences for treat-
ments. However, because this study was per-
formed retrospectively, we could not evaluate
the effect of patients’ preference on patient
satisfaction and QoL.
Conclusions
Although our study had some limitations, we
compared all three prostheses treatment
options for fully edentulous patients using a
questionnaire that included patient satisfac-
tion and OHIP-14. We believe that FP, RP,
and CD treatments can provide better OHR-
QoL for fully edentulous patients. In particu-
lar, the FP and RP treatments may grant
greater OHRQoL improvement and patient
satisfaction compared with CD treatment.
This study is expected to provide reliable and
useful information for experts and patients
when they are choosing a prosthetic treat-
ment option. Further research that considers
both OHRQoL and cost-effectiveness of all
three treatments for fully edentulous patients
should be undertaken to validate the best
treatment option.
Acknowledgements: This study was
completed as part of the health technology
assessment project (no. NA-2011-004) funded
by the National Evidence-based Healthcare
Collaborating Agency (NECA) in Korea. Each
author has contributed to this study. SHO
carried out study design, development of
questionnaire, data analyses, interpretation of
data, and writing the manuscript; YHK
carried out study design, development of
questionnaire, and interpretation of data; JYP
participated in development of questionnaire
and interpretation of data; YJJ participated in
development of questionnaire and
interpretation of data; SKK participated in
study design, development of questionnaire,
and clinical interpretation of data; SYP
carried out study concept and design, critical
revision of the manuscript for important
intellectual content, and study supervision.
No other sources of funding were used to
assist in the preparation of this article. The
authors have no conflict of interests that are
directly relevant to the content of this
article.

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