1. Quality of life and implant- based treatment Björn Söderfeldt Dept of Oral Public Health Malmö University, Sweden P-I Brånemark Scientific Symposium, 29-31 October 2009, Gothenburg

2. Two questions: What is Quality of Life? How does it relate to implant treatment?

3. Starting point: The clinical encounter DentistPatient EncounterEncounter Gender Age Training Personality Care organization Work load Control over work Financing system Clinical judgment Health Fear Selfesteem Social class Education Resources Ethnicity Gender Age Training Personality

4. The encounter is not any human relation, but with a specific objective: Health and quality of life! What is that?

5. The health concept International declarations WHO charter 1948 Lalonde report 1974 New Public Health 1985

6. WHO 1948 Health is ”a complete state of physical, mental, and social well-being, and not just the absence of infirmity”

7. The Health Field (Lalonde 1974)

8. The New Public Health Health is not a condition but a dynamic process where new needs emerge. Health is an essential resource for a good life. Health for all will be achieved by the people themselves. A well informed, well motivated and actively participating community is a key element for the attainment of the common goal WHO, Health for All 1985

9. Oral health Inglehart, Bagramian 2002 Oral health related quality of life Functioning -Mastication -Speech Psychological aspects -Appearance -Self-esteem Pain/discomfort -Acute -Chronic Social aspects -Communication -Social interactions

10. Some measures of oral health and quality of life (review by Johansson, Söderfeldt 2004) Cushing et al 1986SIDD, The Social Impact of Dental disease Atchison & Dolan, 1990GOHAI, The General Oral Health Assessment Index Dolan et al 1991DHQ, Dental Health Questions Strauss & Hunt 1993DIP, The Dental Impact Profile Locker & Miller 1994SOSHI, Subjective Oral Health Status Indicators Slade & Spencer 1994OHIP, Oral Health Impact Profile Allen & Locker 2002OHIP 20for edentulous patients Burke & Wilson 1995OHX, Oral Health Index Kressin et al 1996OHRQOL, Oral Health-Related Quality of Life Leao & Sheiham 1996DIDL, The Dental Impact on Daily Living Adulyanon & Sheiham 1996OIDP, Oral Impacts on Daily Performances Cornell et al 1997OH-QoL, The Oral Health Quality of Life Inventory Östberg et al 1999POH, Self-perceived Oral Health McGrath & Bedi, 2000OHQoL-UK, Oral Health-Related Quality of life measure Kressin et al 2002Delta

11. What is then the impact of implants on quality of life? Literature search starting at the year 2000 yielded only 6 empirical studies assessing the effect of implants on OHRQoL

12. Authors, yearDesignSubjectsOHRQoL measure ResultsJournal Packer et al 2009 Before-after9 Parkinson pat.DIDLImprovedGerodont. Nickenig et al 2008 Before-after with control group 219 part edent, 124 dentate OHIP G21From 17.1 to 5.4Craniomaxillofac Surg Berretin-Feliz et al 2008 Follow-up15 patients >60 years old OIDP, OHIP-14, WHOQoL Improved, WHO measure less sensitive Clin Oral Implants Res Jokstad 2006RCT, pre-post12 implant pat vs 15 conventional OHIP, dent satisf Change greater for implant pat Evid Based Dent Heidecke et al 2003 Before-after with control group 60 edentulous, 30 implants, 30 conventional dentures OHIP-20, SF 36 Improvement on both measures Community Dent Oral Epdemiol Melas et al 2001Follow-up83 patOIDPImprovement for those with implant overdentures Int J Oralmaxillofac Implants

13. In addition, there were 6 measurement/methodological studies and 4 reviews Design and quality greatly varying One attempt to develop a specific measure (OHIP-Edent)

14. In a qualitative study in Gothenburg by Ulrika Trulsson(Hallberg) 2005, new ideas were brought forward

15. Grounded theory interviews (a metod for discovery rather than for justification) For patients with implants, new categories emerged in addition to those addressed in OHRQoL measures: Becoming the person one once was Relief from a sense being maimed

16. Conclusions All evidence, although weak, points to dramatic effects on quality of life from implant therapy Further research is urgent, improving evidence and developing SPECIFIC measures, able to capture the uniqueness of implant therapy Thank you for your attention!