Risks and complications

Managing patient expectations from implant therapy: new strategies for an old risk!

Treatment success can be thoroughly evaluated, and there are a number of different parameters for measuring tissue integration, tissue health, function and aesthetics. The patient’s perception may differ from our clinical perspective.

“The patient’s perception may differ from our clinical perspective”

Patients may be looking to get back something they had lost or to get something which they never had before; or they may be looking for an improvement to their quality of life, which is a multifaceted concept and should be highly individualised. Whatever their original motivation is, their satisfaction with the final result and treatment outcomes will be greatly influenced by their expectations (Allen & McMillan. 2003).

“The patient’s satisfaction is highly dependent on their previous expectations”

Expectations are continuously forming in our mind and are part of the decision-making process (Bowling et al. 2012). In 2014, Yao et al. carried out a systematic review to identify the factors influencing the process of forming expectations about dental treatment outcomes. In addition to personal characteristics, social environment and previous experiences with dental treatment (which are innate to the patient), there are some factors which the dentist can alter or modify, such as: knowledge, attitudes, values and beliefs (Yao et al. 2014).

For a thorough diagnosis, the chief complaint together with medical and dental histories should be taken into consideration, and an assessment of the patient’s perceptions and expectations should be carried out.

A considerable number of patients have misconceptions. Apart from their dentist, their main source of information about treatment comes from their social environment or the internet (Yao et al. 2017). In 2017, the educational value of YouTube and its potential for misleading statements was investigated. Its contents were analysed and compared to the EAO’s patient information booklet (Ho et al. 2017).

“A considerable number of patients have misconceptions.”

Of the 270 videos which were analysed, less than 0.5% had genuine patient testimonials. References to complications or negative results were lacking, references to patient selection were minimal and there were a number of statements made which were potentially (and even dangerously) misleading.

Dentists are still reluctant to discuss the life expectancy of implants with the patient or predict their longevity (Kashbour et al. 2018). This issue still remains controversial due to the many factors which may influence the clinical evolution of implant reconstructions over the years.

Altered expectations of patients were also studied in cases involving peri-implantitis, and the authors found unrealistically high expectations around implant therapy (Abrahamsson et al. 2017). In these cases, it was shown that patients with unrealistic expectations are not capable of coping with the problem and as a consequence they do not understand why they have to pay more for the treatment, so they lose trust in their dentists and show ambivalence towards implants in the future.

“Patients with unrealistic expectations … lose trust in their dentists and show ambivalence towards implants”

As a conclusion, we shouldn’t keep on relying on a simple equation of: patient’s complaint — implant treatment — objective: successful outcome’ (Figure 1).

During the diagnostic phase, the patients’ expectations should be assessed, based on a number of psychosocial and biographic factors. We should try to guide these expectations along the treatment process to finally reach not only an objective for success, but a satisfactory outcome as well.