Hesitance in acceptance of dental implants as a treatment modality amongst adult

population of Jazan region- A single-center Study

Abstract

Objectives: The present survey was aimed to evaluate and assess the patient’s

knowledge and hesitance regarding implant treatment as an alternative to the fixed

dental prosthesis in the Jazan region, Saudi Arabia.

Materials and methods: This self-explanatory cross-sectional survey was completed

over two months. A questionnaire was designed, and a pilot study was performed with

20 participants to assess the reliability and validity of the questions. Finally, 149

participants took part in the survey. The questions were divided into two sections.

Section I: inquiries related to the demographic status, and section II: evaluate

knowledge and hesitance to opt for implant therapy as a treatment option.

Statistical Analysis: A significant association between the variables was measured by

employing a one-way ANOVA test. A p-value of < 0.05 has been considered a

statistically significant level.

Results: 149 participants, with 104 (69.8%) males and 45 (30.2%) females, answered

the questionnaire. About 79 (53.3%) participants had adequate knowledge about

implant therapy. The majority of participants, 104 (73.8%), thought implant-supported

dentures required meticulous care. The reason for abstaining from implant denture as a

substitute for missing teeth showed that 111 (74.5%) patients felt the treatment was

costly, followed by fear of unknown side effects (56.6%) participants, fear of pain 55.7%

of participants, increased in the duration of therapy (46.3%) patients and requirement

for surgery. No statistical significance was measured between the variables (p<0.05).

1
Conclusion: This survey concluded that the selected dental patients had adequate

knowledge and awareness regarding dental implant treatment. However, cost and

meticulous care seem to be major constrain for implant treatment.

Keywords: Hesitance; knowledge; Dental implants; tooth loss;

INTRODUCTION

Tooth decay, periodontitis, facial trauma, root canal failure, and iatrogenic factors are

prevalent causes of tooth loss (AlQahtani, 2018). The American Association of Oral

Surgeons report mentioned that 70 to 80% of individuals aged 30 to 40 years lost at

least one permanent tooth, and adults aged 70 to 75 lost almost all their permanent

teeth (AlQahtani, 2018). According to the World health organization (WHO), partially or

completely edentulous patients serve as physically impaired since the tooth is

considered one of the essential parts of the body (Gaviria, Salcido, Guda, Ong, &

Surgeons, 2014). Tooth loss causes difficulty in mastication, temporomandibular

ailments, and aesthetics, affecting social and physical well-being (Brennan, Houston,

O'Sullivan, O'Connell, & Implants, 2010).

Fixed and removable dentures, tooth-supported prostheses, and implant-supported

prostheses are some treatment modalities for missing teeth (Hultin et al., 2012).

However, these oral rehabilitation methods have their advantages and drawbacks.

Treatment of choice for replacing lost teeth are fixed and removable partial dentures (Al-

Quran, Al-Ghalayini, & Al-Zu'bi, 2011). Although patients quite well acknowledge

removable partial dentures, limitations associated with this method are mastication,

denture instability, and loss of retention leading to an increase in chances of alveolar

ridge resorption (Dias, Moghadam, Kuyinu, & Jahangiri, 2013). Fixed partial dentures

2
(FPDs) are not considered a treatment option by numerous practitioners as they lead to

the loss of a significant percentage of tooth structure, leading to hypersensitivity, and

also the difficulty patients face in maintaining adequate oral hygiene, and an increased

risk of endodontic therapy (Al-Quran et al., 2011; Dias et al., 2013).

The necessity to replace missing teeth with normal substitutes has prompted significant

growth in the field of dental implants (Geckili, Bilhan, Bilgin, & geriatrics, 2011).

Recently, implant-supported dentures have become the standard treatment modality for

complete or partially edentulous patients. Merits associated with this treatment are

improved denture stability, retention, masticatory efficiency, and a positive effect on the

oral health-related quality of life (Hultin et al., 2012). Current statistics suggest that

around 100,000 to 350,000 implant surgeries are performed yearly around the globe,

which is nearly equal to the number of hip and knee joint replacement surgery (Gupta,

Dhanraj, & Sivagami, 2010). Even though implant therapy is considered a standard

treatment option in most edentulous cases (Al-Johany, Al Zoman, Al Juhaini, & Al

Refeai, 2010), complete information on this treatment option and alternative treatments

should be provided to guide the patient to make the appropriate choice (Müller, Salem,

Barbezat, Herrmann, & Schimmel, 2012). In maximum cases, the patient’s decision is

based on financial status, knowledge, and awareness about alternative treatment

(Kranjcic, Mikus, Mehulic, & Vojvodic, 2015; Sheiham, Maizels, & Cushing, 1982). Pain,

fear of unknown side effects, and several visits also play a substantial role in the

definitive choice of treatment (Kohli, Bhatia, Kaur, & Rathakrishnan, 2015).

Currently, due to the global economic crisis and fierce competition among businesses,

competition is intensifying in dental services. It has also changed patients’ way toward

3
dental treatment, especially with expensive treatments like implant placement.

Moreover, with the advent of social media, patients are now flooded with information

regarding all types of dental treatment. Hence, it is the responsibility of dentists and

dental authorities to guide patients comprehensively on implant treatment and post-

operative care.

Numerous researches have been performed regarding the knowledge, awareness, and

acceptance of dental implants as treatment options around the globe (Almalki &

AlJameel, 2020; Kranjcic et al., 2015; Müller et al., 2012; Özçakır Tomruk, Özkurt-

Kayahan, & Şençift, 2014; Saha, Dutta, Vijaya, & Rajnikant, 2013; Suprakash et al.,

2013). Moreover, different approaches to evaluate the knowledge and understanding of

the patient were performed to get evidence-based results worldwide. Research

assessing patients’ knowledge and awareness regarding dental treatments such as

dental implants should be conducted regularly. This practice will eventually inform

clinicians about patients’ perceptions of implant treatment. To this day, many

researches are published on the knowledge and awareness of patients about dental

implants. However, few articles have emphasized patients’ reluctance toward this

treatment modality. Furthermore, no study has been done on the local adult population

of the Jazan region to evaluate reasons for patients’ hesitance in accepting implant

treatment as a treatment modality. Consequently, the present survey aimed to evaluate

and assess the patient’s knowledge and hesitance regarding implant treatment in the

Jazan region, Saudi Arabia.

MATERIALS AND METHODS

4
This observational questionnaire-based survey was conducted among patients in the

College of Dentistry's outpatient department and dental clinics. Ethical approval was

taken from the Standing Committee of scientific research, College of Dentistry (Ref No.

REC-43/10/210) before the commencement of the survey. The survey was conducted

from February to April 2022 at the Department of Prosthetic Dental Science.

Patient selection

Initial data were collected from R4 software for all the patients who had at least one

missing tooth, wanted a replacement, and were treated with the fixed dental prosthesis

in the dental clinics in the year 2021. Patients were contacted telephonically and were

asked if they wanted to participate in the survey. On acceptance, verbal consent was

taken from all the willing participants, the questionnaire was read out in the native

language, and the responses were marked. Some patients were busy, provided other

suitable times for contacting them, and the responses were recorded.

Questionnaire

A comprehensive questionnaire based on prior research (Almalki & AlJameel, 2020;

Satpathy, Porwal, Bhattacharya, & Sahu, 2011) was used and modified to assess the

participant's understanding, knowledge, belief, and perception of the level of acceptance

of dental implants as a treatment modality. It was mainly focused on knowing the

reasons for their hesitance to opt for implants as a treatment modality. The first draft of

the questionnaire was designed in English and had 23 questions. It was distributed

amongst the clinicians and students to be reviewed, and their suggestions and

5
responses were welcomed. After piloting in an initial twenty participants for validity and

reliability, the questionnaire was modified and finalized. After a complete evaluation, the

culture-specific Arabic version of the questionnaire was designed to acquire precise

information from common people. This questionnaire was checked for its relevance and

accuracy by native speakers.

A structured close-ended self-explanatory questionnaire (Table 1) having 18 questions

was utilized to collect the data and was based on two structured sections, namely,

Section I- Demographic data comprises age, gender, marital status, monthly income,

and educational levels.

Section II- To evaluate the knowledge, understanding, and perception about dental

implants, including alternative treatment options, merits of dental implants, the duration

of dental implant surgery, treatment costs, implant limitations, etc.

All the responses in the second section were recorded systematically in a Microsoft

Excel spreadsheet (Microsoft Corporation, USA) for all the patients on a three-point

Likert scale with options Agree, Disagree, and Neutral/don’t know.

Statistical analysis

Descriptive statistics were performed using the Statistical Package for Social Sciences

(SPSS version 23 IBM, USA). Data were represented as Frequency, Percentage, Mean

and Standard Deviation. The One-Way ANOVA Test calculated the association

between sociodemographic variables and mean score. A P-value less than 0.05 was

taken as statistically significant, and p < 0.001 were highly significant.

RESULTS

6
The present survey result provides comprehension of the knowledge, awareness,

perception, and reasons for hesitance towards opting for the dental implant as a

treatment substitute over fixed partial dentures among the sample population of

southern Saudi Arabia.

A total of one hundred forty-nine participants, with 104 (69.8%) males and 45 (30.2%)

females, answered the questionnaire. The highest number of participants were from the

age group of 21-30 years (59.7%), followed by less than 20 years (20.1%), 31-40 years

(10.7%), and the least patients were above 40 years (9.4%) of age. Participants with an

educational qualification of bachelor, up to high school, and post-graduation were

approximately equally distributed with a maximum of 35.6%, 32.9%, and 30.9%,

respectively. At the same time, only 0.7% of the participants were uneducated.

Occupation-wise, about 30.2% of participants were employed, followed by unemployed

(24.8%), student (23.5%), professional (18.1%), and retired (3.4%). Based on monthly

income, the maximum number of participants (56.4%) earned less than five thousand

riyals, whereas only 7.4% had more than fifteen thousand riyals. Figure 1 summarizes

the socio-demographic data of the participants.

Knowledge, understanding, and Awareness of Dental Implants

Figure 2 represents the distribution of questions and responses related to participants'

knowledge and perception in opting for the implant as a treatment modality. Among 149

participants, 79 (53 %) had adequate knowledge and understanding of implant therapy

as a treatment option. However, 47 % of the participants had either poor knowledge or

could not recollect about implants.

7
When asked about their perception of being old to receive dental implants, 75.8% of

participants disagreed and did not consider that a factor. 72.5 % of participants had no

medical problems, and 74.5 % were not on any medications that prohibited them from

taking implant treatment. Even 49% disagreed when asked if they were frightened about

the surgical procedure.

However, participants needed clarification about the knowledge related to fixed partial

denture prosthesis and could not connect to the experience of their family and friends

(43%). However, 25.5% of them were convinced and went with their experience. Only

29.5 % of the participants had a previous satisfactory experience with the fixed partial

denture.

Most participants had no knowledge or disagreed when asked about the presence or

lack of good bone quantity, non-acceptance of bone grafting procedures, or any history

of radiation preventing them from opting for implants. Even 86.6 % thought there should

be further detailed awareness programs about implant procedures.

Reasons for hesitance in opting for dental implants

The reasons for abstaining from implant prosthesis as a substitute for missing teeth

revealed that 111 (74.5%) participants felt the implant treatment was costly, followed by

110 (73.8 %) who thought Implants and the supported prosthesis demanded meticulous

care, fear of unknown complications that may arise postoperatively (84, 56.6%), fear of

pain (83, 55.7%), time taken for implant procedure (74, 49.7%), increased number of

visits for implant treatment (69, 46.3%) and afraid from the surgical procedure (61,

41.6%).

8
When asked about the difficulties faced by family and friends who underwent implant

treatment, the majority (48.3%) of the participants did not have any knowledge, and

38.2% disagreed; however, only 17.4 % found this as a reason that prevented them

from accepting implants.

One-way ANOVA statistical test was employed to check the association between age,

gender, education, occupation, and income, and the mean score about knowledge and

awareness of implant procedure resulted in no statistically significant difference

(Figure3, Table 2)

DISCUSSION
The current survey aimed to evaluate the factors associated with the hesitance of

patients to opt for dental implants as a treatment modality for missing teeth. Despite

adequate knowledge about dental implants, various reasons for their reluctance of not

choosing dental implants were extracted. Majorly participants were not sure to opt for

implant treatment due to the high cost and requirement of meticulous care, even though

this survey reported that participants were keen to learn about implant treatment

modalities and desired awareness programs.

Dental implants have been the treatment of choice for partial or completely edentulous

patients in recent years. The current survey reported that the majority of participants

had adequate knowledge about dental implants, but a detailed description of implant

procedures, such as time, adequate bone quality, etc., remained a challenge for 56.7%

of participants. Similar findings were reported in a study by Al-Johany et al. (Al-Johany

et al., 2010) in the Riyadh region of Saudi Arabia, with 66.4% of participants having

adequate knowledge of implant therapy. In contrast, the study by Almalki and Al

Bandary (Almalki & AlJameel, 2020) amongst the Saudi population reported that 82.5%

9
of responders had heard about dental implants. In another study by Surprakash et al.

(Suprakash et al., 2013) and Chowdhary et al. (Chowdhary, Mankani, Chandraker, &

Implants, 2010) on the Indian population, only 33% and 23.24% of participants residing

in urban areas were knowledgeable about implant surgery. However, in the Turkish

population study, Tobruk et al. (Özçakır Tomruk et al., 2014) reported that most

participants had no knowledge or had never heard about dental implants. These

inconsistencies might result from surveys on different populations and discrepancies in

various initiatives and programs for dental implants in various regions around the globe.

Participants in this survey reported that the reasons for the reluctance to opt for dental

implants were high cost (74.5%), fear of postoperative complications (56.6%), treatment

duration (49.7%), and the number of visits (46.3%). These findings are in accordance

with the survey conducted by Prashanti et al. (Prashanti & Mohan, 2013), Satpathy et

al. (Satpathy et al., 2011), Bhat et al. (Bhat, Prasad, Sharma, & Hegde, 2012), and

Narby et al. (Narby, Kronström, Söderfeldt, & Palmqvist, 2008). However, these

surveys had not reported post-operative pain as one of the factors associated with

ignorance of implant surgery.

Several studies (Kohli et al., 2015; Kranjcic et al., 2015; Müller et al., 2012; Özçakır

Tomruk et al., 2014; Saha et al., 2013), including this survey, have said the expenditure

related to implant treatment is a substantial hurdle in opting for this treatment. In their

survey, Zimmer et al. [23] reported that even though esthetics was one of the motivating

factors in opting for implant treatment, expenses related to implants were the topic of

argument. Similarly, in studies were done by Satpathy et al. (Satpathy et al., 2011) and

Radhika et al. (Arora, Poovani, & Shetty, 2018), around 31% of patients reported cost

10
as one of the major factors in the opting dental implant as a treatment modality for the

replacement of missing teeth. These consistent findings indicate that dental

practitioners need to ease the fear in patients regarding implant therapy by explaining

the complete procedure comprehensively, and the cost of treatment should be the

primary focus. Also, dental practitioners must explain to patients different treatment

options and the importance of the implant-supported prosthesis, which helps improve

oral health-related quality of life with implant treatment. This can eventually help

patients make concrete decisions regarding replacing missing teeth.

In the current survey, 73.8% of patients contemplate that dental implants require more

care, and only 6% of respondents believed that less maintenance is needed for

implants. Similarly, the findings in the survey by Rustmeyer and Bermerich

(Rustemeyer, Bremerich, & surgery, 2007) showed that only 7% of patients believed

implants required low maintenance. Many patients need to be made aware of the

conceptualization, implementation, and aftercare of implant-supported dentures,

although the notion that implants require less care than natural teeth is not ubiquitous.

Hence, it is the primary responsibility of the dental surgeon to explain to patients the

post-operative care and functional performance of dental implants.

Postoperative pain (55.7%) related to implant surgery was mentioned as one of the

factors for reluctance in this survey. Similarly, in the study by Ellis et al. (Ellis et al.,

2011), the fright of pain associated with implant surgery was reported as one of the

significant hindrances. Even though other studies (Reissmann, Poulopoulos, & Durham,

2015) have proven that implant placement surgeries cause lower pain than impaction or

11
apicectomy, persistent pain and edema have been considered as one of the major

reasons for the reluctance of implant surgery.

Of 149 participants, most were young and could imagine receiving implant treatment.

Compared with similar studies on the elderly cohort, the acceptance of implant

treatment was much lower than in the young cohort (Müller et al., 2012). In the study by

Zimmer et al. (Zimmer, Zimmer, Williams, Liesener, & Implants, 1992) on the American

population, a clear correlation between age and implant acceptance was found. They

reported that young participants favored implant treatment more than older individuals.

In a survey by Berge (Berge, 2000) in Nigeria, 57% of adults around the age group of

40-50 years accepted the implant treatment, while 23% were unwilling due to age

constraints. In the current survey, the maximum of the population was under the age of

40 years, and they were ready to accept implants as a treatment. However, according to

the statistics of other studies, it could be inferred that with increasing age, the

perception of oral health-related quality of life is overshadowed by other systemic

problems. A breakup analysis of this finding showed no statistical difference among the

groups (age, gender, educational status, and occupation). Hence, this finding outlines

the yearning amongst dental patients to learn about implant treatment modalities.

In this survey, around 86.6% of participants were interested in having detailed

awareness programs about dental implants. They wanted to know more about implants

as a treatment modality for replacing missing teeth. The results were consistent with the

study by Satpathy et al. (Satpathy et al., 2011), where 89% of participants were keen to

learn about implant treatment. Overall this survey infers that dental surgeons and health

care regulating bodies should focus more on general information about implants and

12
implant-related procedures. More programs should be planned at the center and

community levels to impart knowledge and create awareness amongst the general

population. As per the survey, high cost and maintenance procedures were the

significant drawbacks of implant treatment. Although many people believed dental

implants were expensive, they were keen to learn more about implant and implant-

related procedures. Overall, participants in this study lacked knowledge about the ideal

requirements to undergo implant surgery. Hence, they demanded to learn more about

the different treatment options available in the form of detailed awareness programs to

replace missing teeth in partially edentulous arches.

Oral health care knowledge and awareness are prerequisites for improved oral health-

related quality of life. Several studies have established an association between

improved quality of life and oral health. Complete information about implant treatment

and alternative therapies must be provided to assist patients in deciding on a treatment

to replace missing teeth. Moreover, the information available to patients on many

aspects of implant surgery from friends or relatives is generally fragmented.

The major limitation of this survey was that it was a single-center study with a limited

number of participants. Hence, the finding of this survey cannot be generalized. Another

constraint was the self-administered questionnaire. Although the questionnaire was

verified beforehand on a small group, validity should be checked on a larger sample

size. To reproduce more evidence-based results, multicenter research should be

planned to cover a region or national level to have in-depth knowledge about the

associated factors with the hesitance to opt for the dental implant as a treatment option.

This will help the governmental organizations plan awareness programs and policies,

13
which will help health insurance companies and practitioners provide cost-effective

treatment modalities to the general population.

CONCLUSION

In the survey population, knowledge and awareness of dental implant treatment are

adequate, and the rate of objection to treatment is low. High cost, meticulous care, fear

of complications, and treatment time were the most substantial reason for reluctance.

The statistical analysis reported no significant association between the socio-

demographic variables and the mean score. However, the acceptance rate of implant

treatment can be increased by conducting awareness programs and emphasizing oral

health-related quality of life. In conclusion, with the proper information and promotion of

oral health-related quality of life, it is possible to increase the acceptance of implant

treatment in the general population. Reduction in cost and minimally invasive therapy

should be developed. So that patients can positively opt for implant treatment on priority

basis as an alternative to missing teeth.

Acknowledgments: We appreciate the help provided by the Research Unit in the

collection of Data

Funding: Self-Funded

Conflict of Interest: None declared

REFERENCES

Al-Johany, S., Al Zoman, H. A., Al Juhaini, M., & Al Refeai, M. J. T. Saudi Dental Journal. (2010).
Dental patients’ awareness and knowledge in using dental implants to replace missing

14
 teeth: A survey in Riyadh, Saudi Arabia. 22(4), 183-188. Doi:
10.1016/j.sdentj.2010.07.006

Al-Quran, F. A., Al-Ghalayini, R. F., & Al-Zu'bi, B. BMC Oral Health (2011). Single-tooth
replacement: factors affecting different prosthetic treatment modalities. 11(1), 1-7.
http://doi.org/10.1186/1472-6831-11-34

Almalki, S. A., & AlJameel, A. World J Dent (2020). Knowledge, Attitude, and Awareness of
General Population in Saudi Arabia toward the Use of Dental Implants for Replacement
of Missing Teeth. 11(2), 117. DOI: 10.5005/jp-jounals-10015-1706

AlQahtani, S. M. J. Int. J. Oral. Care. Res. (2018). Awareness and acceptance of dental implants
as a treatment modality for replacement of missing teeth among patients in Aseer
Region, Kingdom of Saudi Arabia. 6(1), 58-64. DOI: 10.5005/jp-journals-10051-1050

Arora, N., Poovani, S., & Shetty, G. Int. J of Scientific Res. (2018). Patient awareness and
acceptance of dental implants as a treatment modality for the replacement of missing
teeth. 7(5), 74-78.

Berge, T. I. Clin Oral Implant Res. (2000). Public awareness, information sources and evaluation
of oral implant treatment in Norway. 11(5), 401-408. http://doi.org/10.1034/j.1600-
0501.2000.011005401

Bhat, A. M., Prasad, K. D., Sharma, D., & Hegde, R. (2012). Attitude toward desire for implant
treatment in South Coastal Karnataka population: A short-term epidemiological survey.
19(30), 31-45. DOI: 10.5005/jp-journal-10012-1068.

Brennan, M., Houston, F., O'Sullivan, M., O'Connell, B. J. I. J. o. O., & Implants, M. (2010).
Patient satisfaction and oral health-related quality of life outcomes of implant
overdentures and fixed complete dentures. 25(4).

Chowdhary, R., Mankani, N., Chandraker, N. K. The Int. J of Oral & maxillofac Implants (2010).
Awareness of dental implants as a treatment choice in urban Indian populations. 25(2).

Dias, R., Moghadam, M., Kuyinu, E., & Jahangiri, L. J. T. J. o. p. d. (2013). Patient satisfaction
survey of mandibular two-implant–retained overdentures in a predoctoral program.
110(2), 76-81. DOI: 10.1016/S0022-3913(13)60343-1.

Ellis, J. S., Levine, A., Bedos, C., Mojon, P., Rosberger, Z., Feine, J., & Thomason, J.
Gerodontology (2011). Refusal of implant-supported mandibular overdentures by
elderly patients. 28(1), 62-68. DOI: 10.1111/j.1741-2358.2009.00348.x.

Gaviria, L., Salcido, J. P., Guda, T., Ong, J. J. of the Korean Asso. of oral & maxillofac Surgeons
(2014). Current trends in dental implants. 40(2), 50. DOI: 10.5125/jkaoms.2014.40.2.50

15
Geckili, O., Bilhan, H., Bilgin, T. J. A. o. g., & geriatrics. (2011). Impact of mandibular two-implant
retained overdentures on life quality in a group of elderly Turkish edentulous patients.
53(2), 233-236.

Gupta, A., Dhanraj, M., & Sivagami, G. Indian J Dent Res. (2010). Status of surface treatment in
endosseous implant: a literary overview. 21(3), 433.

Hultin, M., Davidson, T., Gynther, G., Helgesson, G., Jemt, T., Lekholm, U., . . . Rohlin, Int. J
Prosthodont (2012). Oral rehabilitation of tooth loss: a systematic review of quantitative
studies of OHRQoL. 25(6).

Kohli, S., Bhatia, S., Kaur, A., & Rathakrishnan, T. J. Indian J of Dent (2015). Patients awareness
and attitude towards dental implants. 6(4), 167. DOI: 10.4103/0975-962X.168518

Kranjcic, J., Mikus, A., Mehulic, K., & Vojvodic, D. J. Journal Of Prosthodontics (2015).
Knowledge and awareness of dental implants among elderly people in Croatia. 24(1),
37-42. DOI: 10.1111/jopr.12172

Müller, F., Salem, K., Barbezat, C., Herrmann, F. R., & Schimmel, M. J. Gerodontology (2012).
Knowledge and attitude of elderly persons towards dental implants. 29(2), e914-e923.

Narby, B., Kronström, M., Söderfeldt, B., & Palmqvist, S. Int. J of Prosthodont (2008). Changes in
attitudes toward desire for implant treatment: a longitudinal study of a middle-aged and
older Swedish population. 21(6).

Özçakır Tomruk, C., Özkurt-Kayahan, Z., & Şençift, K. J Adv Prosthodont (2014). Patients'
knowledge and awareness of dental implants in a Turkish subpopulation. 6(2), 133-137.
DOI: 10.4047/jap.2014.6.2.133

Prashanti, E., & Mohan, M. Int J Appl Res (2013). Awareness of dental implants among
undergraduate dental students at Mangalore, India. 3(10), 1-2. DOI:
10.1111/j.ijom.2007.05.003

Reissmann, D. R., Poulopoulos, G., & Durham, J. J. J. o. D. (2015). Patient perceived burden of
implant placement compared to surgical tooth removal and apicectomy. 43(12), 1456-
1461.

Rustemeyer, J., Bremerich, A. Int. J. oral & maxillofac Implant (2007). Patients’ knowledge and
expectations regarding dental implants: assessment by questionnaire. 36(9), 814-817.
DOI: 10.1016/j.ijom.2007.05.003

16
Saha, A., Dutta, S., Vijaya, V., & Rajnikant, N. J Int. Oral Health (2013). Awareness among
patients regarding Implants as a treatment option for replacement of missing teeth in
Chattisgarh. 5(5), 48.

Satpathy, A., Porwal, A., Bhattacharya, A., & Sahu, P. Int. J. of Public Health Dentistry (2011).
Patient awareness, acceptance and perceived cost of dental Implants as a treatment
modality for replacement of missing teeth: A survey in Bhubaneswar and Cuttack. 2(1),
1-7.

Sheiham, A., Maizels, J. E., & Cushing, A. Int Dent Journal (1982). The concept of need in dental
care. 32(3), 265-270.

Suprakash, B., Ahammed, A. Y., Thareja, A., Kandaswamy, R., Kumar, N., & Bhondwe, S. The
Journal of Contemporary Dental Practice (2013). Knowledge and attitude of patients
toward dental implants as an option for replacement of missing teeth. 14(1), 115. DOI:
10.50005/jp-journals-10024-1282.

Zimmer, C. M., Zimmer, W. M., Williams, J., Liesener, J. The Int. J. of oral & maxillofac Implants
(1992). Public awareness and acceptance of dental implants. 7(2).

17
Tables

Table 1 - Close-ended self-explanatory questionnaire to evaluate knowledge,

understanding, and reasons for the hesitance of dental implants as a treatment
modality.
Questionnaire

Section I Sociodemographic data

 Age
 Gender
 Marital status
 Monthly income (SR)
 Education

Section II Q1. I have modest knowledge and understanding of implants as a treatment option
Q2. I am very old for receiving an implant as a treatment option
Q3. I have health issues (medical problems) that prohibit me from undertaking implant surgical
procedure
Q4. I am afraid of surgical procedure
Q5. I am afraid of pain related to the implant procedure
Q6. I am afraid of complications that may arise postoperatively
Q7. I think the number of visits required for implant placement is more
Q8. I think time required for implant treatment is more
Q9. Lack of good bone quality prevents me from accepting implant treatment
Q10. Lack of good bone quantity and non-acceptance of bone grafting procedures
Q11. There were difficulties faced by family and friends who underwent implant treatment that
prevented me from accepting implant treatment.
Q12. I think implants and the supported prosthesis demand meticulous care
Q13. History of radiation therapy received preventing from implant treatment.
Q14. I am presently on medications that prevent implant treatment
Q15. I think there should be further detailed awareness programs about implant procedures
Q16. I think cost of implant treatment is too high
Q17. I feel my previous Fixed Dental prosthesis worked well.
Q18. I am convinced about conventional fixed prostheses from the experience of family and
friends.

18
Table 2: Association between sociodemographic variables and mean score using
One-way ANOVA Test

Variable Category Score

Mean ± SD P value
Age (years) <=20 8.10 2.784 0.463; NS
21-30 7.87 3.184
31-40 9.19 3.229
>40 7.86 2.685
Gender Male 7.85 3.219 0.210; NS
Female 8.53 2.651
Education High school or less 7.61 3.668 0.537; NS
Bachelor /diploma 8.40 2.699
Post graduate / university 8.17 2.775
Uneducated 6.00 -
Occupation Student 8.34 3.334 0.924; NS
Not working/ unemployed 8.08 2.228
Employed 8.07 3.695
Retired 7.20 1.789
Professional 7.78 2.860
Income <5000 7.88 2.996 0.710; NS
5000-10000 8.21 3.538
10000-15000 8.92 2.843
>15000 7.82 1.779
NS; p > 0.05; Not significant

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Figure Legends:
Figure 1: Socio-demographic data of the Participants (n=149)

Figure 2: Question-wise response of Participants (n%)

Figure 3: Mean Score according to various socio-demographic variables.

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