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ePaper created 2014-11-23, 21:56:20 | version 1.30.01
_Tooth replacement Inthecontextofimplanttreatment,itiswelles- tablished that edentulousness and wearing of a completedenturehaveanumberofnegativephys- iological, functional and psychosocial effects. These influence oral function and aesthetics, as well as satisfaction, self-esteem, body image and quality of life.2 Consequently, improving the reten- tion of a denture by fixation on to two to four im- plants or the fixation of a fixed complete dental prosthesis on to four to six implants has a tremen- dous effect on oral health-related quality of life. However, adaptation to tooth loss varies individu- ally and many patients cope very well with fewer teeth and do not always desire replacements, let alone dental implants. In Europe, the demand for tooth replacement is increasingly based upon normative and theoretical groundsandnotalwaysonpatient-specificassess- ment. Clinicians are often stuck in dogmatic, non- evidence-based thinking. Often, they impose their personalviewconcerningthesuggestedtreatment option.Someexamplestoillustratethisarefavour- ing long implants and bone grafting instead of short implants, believing that the more implants the better, favouring over-dentures on connected implants, believing that ceramics are better than acrylic teeth, and regarding aesthetics as being of sole importance. _The best option Long-term clinical studies demonstrate that a singleimplantisthebestoptionforamissingtooth. Ithasagreaterinitialcost,buthasasurvivalrateof above95%andcanbeconsideredmorecost-effec- tive than a three-unit conventional bridge.3 Stud- ies have also found that implant-retained over- dentures are worth the price given the increase in quality of life and treatment satisfaction. Further- more, when patients’ resources are limited, the two-implant solution is a better option from a cost–benefit perspective than a fixed dental pros- thesis on four to six implants. Unfortunately, patients’ financial situation im- poses a significant barrier to treatment choice. Al- though dental implants have become a mass prod- uct, the price does not reflect normal economic trends in price reduction. On the contrary, prices rise yearly. The high-tech evolution of 3-D radi- ographic analysis, the use of stereolithographic- guided surgery, the need for individualised aes- thetics, and the increased use of additional regen- erative procedures have all further increased the total cost. Although these techniques offer the ability to facilitate surgery and enhance aesthetics, the cost aspect is seldom taken into account. _Affordability of implant treatment One can question whether this does not lead to exclusive treatments for the happy few. In Europe alone, every year close to one million patients be- comecompletelyedentulous.Itisunlikelythatthey can afford dental implants. Research in Austria has economy I I 29implants4_2014 [PICTURE: ©WOAISS]