DENTAL IMPLANTS AS AN OPTION FOR MISSING TOOTH/TEETH REPLACEMENT: A STUDY ON PATIENT AWARENESS AND SOURCES OF INFORMATION

Objectives: This study was designed with an aim to assess the level of awareness of patients who reported to dental outpatient department, regarding dental implants as a treatment modality for replacement of missing teeth, and to determine their sources of information regarding implants. Methods: This was a questionnaire-based study to assess the awareness about dental implants and the related sources of information in 350 patients who reported to Department of Dentistry, Shyam Shah Medical College Rewa, Madhya Pradesh from 1 st October 2022 to 31 st December 2022. Results: Only 36.86% (n=129) of participants had heard of dental implants. Among these patients (N=129), only 30.23 % (n=39) received information about dental implants from dentists. Only 4 (3.10%) patients had themselves undergone treatment with dental implants. Awareness regarding implant composition was poor with only 6.98% (n=9) participants being aware that implants are made of titanium. Fear of surgery (33.33%) and high treatment cost (30.23%) were the most common limiting factors that governed the decision of patients regarding undergoing treatment with dental implants. Conclusion: The findings of the study indicate a low level of awareness about dental implants as a treatment option for replacing missing teeth. A very less number of participants received information from reliable sources. It is important to create awareness in general population regarding feasibility of implants for prosthetic rehabilitation and to


INTRODUCTION
Dental implant resembles the radicular part of the root and is surgically inserted into the jawbone to support a single tooth replacement, fixed partial, complete denture or maxillofacial prosthesis [1].It has become preferred treatment modality for as a prosthetic rehabilitation and is known for excellent long-term results [2,3].An implant-retained prosthesis provides greater stability, improved biting and chewing forces, and higher patient satisfaction [4].However, the general public is often unaware or lesser informed regarding the treatment procedure, benefits, the costs involved, and the post-treatment care [5].The study aimed at assessing the level of knowledge and source of information regarding the use of dental implants as a treatment option for missing tooth/teeth replacement.

METHODS
A cross-sectional questionnaire-based study was conducted with the aim to evaluate the awareness in population of Rewa district (M.P) about dental implants.The study was approved by the institutional scientific review board and informed consent was obtained from the participants.A total of 350 patients attending the outpatient department of Shyam Shah Medical College, Rewa, India, during 1 st October 2022 to 31 st December 2022, were included in the study.Random sampling method was used to select the participants for this study.The inclusion criteria were patients with at least a single missing tooth or those with multiple missing teeth who consented to be a part of the study.Exclusion criterion were patients with missing teeth in the form of extracted third molars, physically challenged or intellectually disabled patients, patients involved in Dental/Medical professions, and those who were not willing to participate or failed to participate in the study.A pre-validated structured questionnaire was administered to the participants by face-to-face interview.The questionnaire was prepared in English language and translated to Hindi language to facilitate a better understanding of the questions among participants.Section 1 procured sociodemographic information of the participant including age, gender, and education.Section 2 gathered information on 10 questions aimed at assessing the level of awareness regarding options of replacement of missing tooth/teeth and about dental implants as a treatment modality.

RESULTS
Out of a total of 350 participants, majority (62.86%) were males and the most common age group was 54-65 years (39.43%)followed by 35-54-year age group (26.29%) (Table 1).The awareness about removable partial dentures and fixed partial dentures in the study population was found to be good with 82% and 71.14% participants, respectively, being aware (Table 2).The awareness about dental implants was low and only 36.86% participants had heard of implants.However, majority of the patients (64.86%) had keen interest in learning about the same (Table 3).Out of a total of 129 participants who had heard of dental implants only 30.23% (n=39) participants obtained information about dental implants from Dentists.Only 4 (3.10%)participants had themselves got dental implant treatment done and 20 (15.50%) participants reported that their immediate contacts (family/friends) have undergone treatment with dental implants.The awareness about composition of dental implants was very low with only 6.98% participants (n=9) being aware that dental implants are made of titanium.The fact that dental implants were to jaw bones was known to only 40.31% participants.Majority of participants (60.46%) believed that dental implants require special maintenance in comparison to natural teeth.Fear of surgery was cited as the limiting factor while deciding upon getting missing teeth replaced by dental implants by majority (33.33%) of the participants.Cost of the treatment and long treatment time were also reasons for dilemma as stated by 30.23% and 24.03% of participants, respectively (Table 4).

DISCUSSION
Various treatment options are available for the replacement of missing teeth and the most common choice being fixed partial denture as it is considered to be cost effective and affordable and imparts increased masticatory capacity along with ease in communication and speech [6,7].A non-removable replacement for missing teeth (i.e., FPD or implant supported) provides patients with an enhanced sense of confidence, security, and social well-being [6].
In this study, the awareness regarding removable and fixed prosthesis for missing tooth/teeth replacement was 82% and 71.14%, respectively, which was better in comparison to a study by Jayasinghe RM et al., who reported 77.9% and 25.2%, respectively [8].
The awareness in general population about dental implants was 36.86% in this study which was better than the study by Chowdhary R et al. [9], Jha et al. [7], and Jayasinghe RM et al. [8], who reported that only 23.24%, 25%, and 32.9% of the population, respectively, had heard of dental implants as a treatment option for replacing missing teeth.However, the awareness was low in comparison to study by Alajlan A et al. [10], Thillaigovindan R et al. [6], and Arora K Jr et al. [11], where In our study, 64.86% participants were definitely interested in obtaining more information on dental implants and 14.86% were likely to obtain the same.This was better in comparison to study by Meer Rownaq Ali et al., where 54.60% of participants were definitely interested and 12.90% were likely interested in obtaining information [12].
Dentists were the main source of obtaining information in this study and 30.23% (n=39) participants obtained information from them.This was in accordance with the studies by Esfahani and Moosaali [13], Kohli S et al. [14], and Arora K Jr et al [11] who reported 40.7%, 53.6%, and 34.5% of participants in their studies obtained information from dentists, respectively.The second major source of information in this study was internet as 23.26% of participants obtained information from internet sources.This was in accordance with the study by Meer Rownaq Ali AB et al., where dental professionals (41.90%) followed by the internet (15%) were the major sources of obtaining information [12].However, in studies by Alajlan A et al. [10], and Suwal P et al. [15], friends were the main sources of obtaining information in 45.5% and 30.2% of participants respectively.Similarly, in a study by Mayya A et al., 69.8% of the respondents received information regarding prosthetic options from relatives and friends [1].
Even in those participants who had heard of dental implants, the awareness regarding the basics of implants was found to be low.The implant composition was correctly known to only 6.98% participants.Deeb G et al. in their study divided participants into groups; the first consisted of randomly selected new patients with no plans to receive dental implants and the second consisted of patients presenting for implant screening.Implant composition was correctly known to 16% and 70% of participants, respectively, in these groups [5].Less than half of the participants (40.31%) were aware that dental implants are anchored in jaw bone which was less than those by Gharpure AS et al. [16], and Meer Rownaq Ali AB et al. [12], who reported 65.02% and 55.30%, respectively, in their study.Fear of surgery (33.33%) followed by high treatment cost (30.23%)was cited as the major limiting factors for patients while deciding on choosing dental implants.Other studies in literature have also reported high treatment cost to be a major limiting factor that desists the patients regarding treatment with dental implants [1,4,11,14].However, the results in terms of cost could have been biased because center for this study was a government tertiary care hospital where a significant section of population seeks treatment because of affordability and government health schemes.Another limitation of the study was its cross-sectional nature and the fact that the participants of the study were the people reporting to dental OPD for seeking treatment which could have influenced their knowledge and answers.Long-duration studies with larger sample size comprising general population need to be conducted for generalizing results.
It was observed that awareness regarding dental implants was inadequate in this study; hence, it is important to educate the general population regarding implants.It is imperative that dissemination of information should come from a trusted source, which should be the dental professionals who play a pivotal role in educating as well as reinforcing information [5,17].

CONCLUSION
The awareness regarding dental implants was found to be low in this study.It is vital to raise the awareness about dental implants in general population.Most of the patients found dental implants treatment to be expensive and unaffordable.Efforts should be aimed to make such treatment accessible and economic for general population through its inclusion in government health-care schemes.