Patients' experiences and clinicians' views of dental implant treatment : a qualitative study

Abstract

Implants have a significant clinical research evidence base which supports positive treatment outcomes for patients; however, the growing provision of implant restoration has been also accompanied by a rising number of complaints relating to dissatisfaction with treatment outcomes (RCS, 2014). This thesis presents the findings of qualitative studies which set out to investigate, and subsequently understand, patients’ experiences and clinicians’ views of dental implant provision. Semi-structured interviews with patients at different stages of dental implant treatment (n=38 interviews) and secondary care implant clinicians (n=8) were undertaken. Data collection and analysis followed the principles of thematic analysis (Braun and Clarke, 2006). While implant restorations are seen as a durable tooth substitute, this research highlighted how patients saw implants as a ‘cure’ for tooth loss. Inherent strength, stability and permanency from the material ‘titanium’; the position ‘rooted within the bone’ and the uniqueness of the technique ‘recent technology’ all contributed to this view. As a result, the direct and long-term potential of implant prosthesis was often misunderstood by inadequately recognising the resources required for regular professional and home care of the implant restoration to ensure longevity. Patients also overestimated the unpleasantness of implant surgery and experienced unanticipated challenges during healing. This was accompanied by uncertainty about maintaining oral hygiene, which continued with both the transitional and final restoration. Clinicians experienced difficulty in communicating information to patients who held high expectations relating to implant provision. Additionally, clinicians’ obligation to negotiate patients’ treatment needs and prioritise between patients places some restrictions on fully shared decision making. Several suggestions were made by clinicians and patients to improve the experience of the implant treatment pathway. These included expanding the role of the clinical support team, using technology and ensuring effective, targeted and timely giving of information according to the patient’s individual circumstances and their stage of treatment.