Desconforto percebido no tratamento com overdenture mandibular sobre implante: estudo prospectivo com participantes de um ensaio clinico

• Autor(a) principal: Sousa, Camila Garcia e
• Data de Publicação: 2019
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UFG
• dARK ID: ark:/38995/00130000046gf
• Texto Completo: http://repositorio.bc.ufg.br/tede/handle/tede/10029
• topic: Overdenture mandibular; Burdens; Implante dentário; Prótese dentária; Percepção do paciente; Qualidade do cuidado; Burdens; Dental implant; Dental prosthesis; Mandibular overdenture; Quality of care; Patient perception; ODONTOLOGIA::CLINICA ODONTOLOGICA

Introduction: Multiple factors may influence the intention and behavior of edentulous patients when it comes to oral rehabilitation, including their perception of costs and access to dental care. However, another relevant aspect of adherence to treatments is the way patients perceive the burdens associated with treatment itself. Perceived burdens by patients, due to the treatment process, can be defined as the burden during treatment and the impact of treatments on daily activities and on the patient's well-being. Objective: To evaluate the patient's perceived burdens during the rehabilitation treatment stages with mandibular overdenture retained by one or two implants. Material and Methods: A sample of 47 total edentulous individuals was rehabilitated with conventional maxillary total prosthesis and mandibular overdenture retained by 1 (n=24) or 2 implants (n=23). Each of the relevant clinical procedures adopted during all stages of treatment were listed in order to record patients' perceptions of their burdens four stages of treatment - pre-surgical, surgical, post- surgical and prosthetic - defined and divided according to clinical specific and sequential procedures at each stage. The questionnaire was applied in two periods: (1) before the treatment in the planning consultation of the preoperative treatment and (2) immediately after each of the treatment stages. Patients were asked to rank how burdensome are each of these items, measured on a four-point ordinal scale: (1) not at all; (2) somewhat burdensome; (3) very burdensome; and (4) extremely burdensome. The first application was considered as the patient’s "expected" burden, and the second application was defined as the "experienced" burden of the patient. After each dental visit, the clinician also evaluated the perceived burdens on a four-point ordinal response scale, according to the quality of the procedure: (1) very favorable; (2) favorable; (3) unfavorable; and (4) very unfavorable. Data were first analyzed by means of descriptive statistics and bivariate comparison tests. Beside that, the reliability of the composite item score of the scale of overloads and subscales was calculated using Cronbach's Alpha to measure the internal consistency of the instruments.Results: The perceived burdens were low both before and after the treatment. Regarding the measured global scores, from a range of 1-4, we found 0.46± and 0.33± for expected and perceived burdens, respectively. In all clinical stages the perceived burdens were lower than expected except for anesthesia and suture removal. Although the duration of surgery was higher for the group of two implants (92.2±21.4 vs 71.3±13.0; p<0.001), the operator perceived burden did not differ between groups (p=0.259).There was a significant moderate correlation between patient’s experience burdens and the burdens perceived by the operator (r s =0.33; p=0.026). The analysis showed that the patient's overall burden was significantly affected by the patient's expected burdens (f= 44.9, p<0.001) and by the operator's perceived burdens (f=4.26, p=0.045) (Adjusted R 2 =0,57). Conclusion: Both perceived and expected burdens were considered low. Perceived burdens had lower scores than expected burdens at all clinical stages, except for anesthesia and suture removal. Although the duration of surgery was higher for the group of two implants the operator perceived burden did not differ between groups. In addition, the analysis showed that the patient's overall burden was significantly affected by the expected burdens of the patient and by the operator perceived burdens.