Keywords OHRQoL Orofacial esthetic scale Chewing function questionnaire Prosthodontic therapy Dental implant support Patients outcome.

Transcription

1 DOI /s Influence of different prosthodontic rehabilitation options on oral health-related quality of life, orofacial esthetics and chewing function based on patient-reported outcomes Sanja Peršić Asja Čelebić Accepted: 29 September 2014 Ó Springer International Publishing Switzerland 2014 Abstract Purpose The aim was to assess influence of different prosthodontic rehabilitation options on improvement of orofacial esthetics, chewing function (CF) and oral healthrelated quality of life. Methods Patients treated with 70 conventional complete dentures (CDs), 38 implant-supported mandibular complete dentures opposed to maxillary CDs, 56 conventional removable partial dentures, 15 implant-supported removable partial dentures, 25 conventional fixed partial dentures (FPDs) and 59 implant-supported fixed partial dentures (IFPDs) were included. The survey was conducted using the three questionnaires: the OHIP-CRO14, the Orofacial Esthetic Scale (OES-CRO) and the Chewing Function Questionnaire (CFQ), and administrated twice: at the baseline prior the therapy and 3 months after prosthodontic rehabilitation had been finished. Results The after-treatment scores were significantly better than the baseline scores (p \ 0.001) for the OES, OHIP14 and CF questionnaires in all types of treatments. The two-factor ANOVA showed no significant difference for the OES after-treatment scores between different rehabilitation options and implant presence, but the OHIP14 and CFQ after-treatment scores were significantly better in FPD and IFPDs than in removable implant and conventional denture wearers. The score change was S. Peršić (&) Department of Prosthodontics, School of Dental Medicine, University of Zagreb, Gunduliceva 5, Zagreb, Croatia persic@sfzg.hr A. Čelebić Department of Prosthodontics, School of Dental Medicine and Clinical Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia significantly higher in all implant removable denture patients for the OES, OHIP and CFQ. The lowest score change was registered in the FPD wearers. (p \ 0.01). Conclusions Removable denture implant patients most benefited from implant support, but IFPD and FPD had the best after-treatment scores. The assessed clinical parameters may help dentists in choice of the best rehabilitation option with the highest treatment effect. Keywords OHRQoL Orofacial esthetic scale Chewing function questionnaire Prosthodontic therapy Dental implant support Patients outcome Introduction In order to make a decision about the most appropriate treatment option in prosthodontic rehabilitation, a dentist must understand the benefits of prosthodontic therapy. The improvement of oral health-related quality of life (OHR- QoL) including chewing function and orofacial esthetics as important parts of patient s well-being has become the main goal in dentistry. The chewing function is one of the most important functions of orofacial system. Reduced number of natural teeth, poor quality and/or inadequate choice of prosthodontic therapy may cause impairment of a chewing function [1, 2]. Improvement of orofacial esthetics is also very important for patients acceptance of new dentures and their overall satisfaction [3, 4] and is one of the main reasons why patients seek dental treatment [3]. Better OHRQoL has been observed in individuals who are satisfied with their dental appearance [3, 4]. Since missing teeth are related with a reduced chewing ability, impaired esthetics and reduced OHRQoL, adequate prosthodontic rehabilitation is necessary for patient well-

2 being. However, different types of treatment can be applied for the same clinical status, so it is very important to choose the option which will best fulfill each patient s expectations. Until recently, the principal treatment options were either fixed partial dentures (FPDs) (in those patients who had some of their posterior teeth present), removable partial dentures (RPDs) (in patients when FPDs could no longer be made, mostly due to the loss of posterior teeth) and complete dentures (CDs) in completely edentulous patients. However, there were drawbacks, as many studies revealed that diet was poor and speech unclear in RPD and CD patients [5, 6]. Studies found the success of such treatment often depended mostly on patients adaptive capacity to overcome reduced retention and stability of RPDs and CDs [7, 8]. The implant-prosthodontic therapy has become an important treatment modality in the last three decades as many studies confirm a significant benefit of increasing patients OHRQoL [9 11]. Implant insertion enables treatment with an implant fixed partial denture (IFPD) instead of a RPD. Implants also provide a significant improvement of stability and retention of implant-supported removable partial dentures (IRPDs) and implantsupported complete dentures (ICDs) [12 15]. All previous studies were concerned mostly on OHR- QoL. However, improvement of orofacial esthetics and a chewing function also plays an important role in patient s acceptance of any type of prosthodontic rehabilitation [1 4, 16]. The most world-wide spread questionnaire to measure OHRQoL is the OHIP Questionnaire [17 26], which is supposed to be the seven-dimensional Questionnaire concerned mostly with physical, psychological and social oral health well-being, although recent studies revealed only four OHIP dimensions [20, 22 24]. As the OHIP14 Questionnaire does not contain enough questions related to esthetics [22 24], the OES Questionnaire has been recently developed as the unidimensional instrument. It measures only orofacial esthetics [27, 28]. Moreover, the unidimensional Chewing Function Questionnaire (CFQ) has also been recently developed in response to the lack of similar psychometrically approved questionnaires in the dental literature [29]. One study used the food intake Questionnaire to measure chewing function, but the study was mostly based on different raw Japanese foods [30]. The newly developed CFQ measures impacts of impaired chewing function in prosthodontic patients who eat foods common in the European and USA cultural milieu. The objective of this study was to assess influence of different conventional and implant-supported types of prosthodontic rehabilitation options on orofacial esthetics, chewing function and OHRQoL. Materials and methods Participants The study included 263 patients (101 men and 162 women, mean age ± 12.69) who were treated either with conventional or with implant-supported dentures at the Department of Prosthodontics, School od Dental Medicine, University of Zagreb in a period from the September 2011 till the February The ethic committee of the Dental School approved the study. Each participant signed the informed consent. The participants were categorized according to their degree of oral treatment: complete denture wearers, removable partial denture wearers and FPDs wearers. They were also categorized into two groups according to implant support: without implants (no) and with implant support (yes) (Table 1). At baseline, when seeking prosthodontic rehabilitation, all patients were without any dental implant in their mouths. Only those participants whose removable dentures had satisfactory retention and stability after the treatment were included in the study. A specialist of prosthodontics evaluated the quality of new dentures and rated complete and removable partial denture s retention and stability using the 1 5 scale (1 represented poor and 5 represented excellent quality). Prior to the assessment, three different dentists (specialists in prosthodontics) separately evaluated 30 different RPDs and 30 CDs. Kappa test revealed sufficient consistency between them, both for CDs ( ) and Table 1 Sample overview (number, age, gender) Sample Sample type N Age mean (SD) Age range % Women Complete denture wearers (CDs) Convenience (10.26) Removable partial denture wearers (RPDs) Convenience (12.02) Fixed partial denture wearers (FPDs) Convenience (16.83) Implant-supported complete denture wearers (ICDs) Convenience (8.39) Implant-supported removable partial denture wearers (IRPDs) Convenience (8.16) Implant-supported fixed partial denture wearers (IFPDs) Convenience (10.96)

3 for RPDs ( ), but it was decided that only one of the dentists should evaluate all patients. However, only those patients whose removable dentures were assessed as excellent or very good were allowed to take a part in the study. Other patients were excluded, as the low quality of their dentures could negatively affect the results of a prosthodontic rehabilitation. Some previous studies showed that gender, monthly income and education level affected results of satisfaction with new prosthodontic restorations as patients with low education level and low monthly income had lower expectations than higher educated patients and those with higher income [16 18, 31, 32]. Therefore, all available patients with medium or high education level who reported sufficient income for normal everyday life and who fulfilled the criteria of having goodquality dentures after treatment were included. Sample size and sampling strategy for each sample group, together with gender and age, are presented in Table 1. A total of 70 patients received conventional CDs in both jaws, and 38 edentulous patients received implant-supported mandibular complete dentures (ICDs) together with conventional CDs in the maxilla (ICD group). A total of 56 patients received conventional RPDs Kennedy Class I or II (0, 1 or maximum 2 modification spaces in posterior areas) in both jaws, while 15 patients received implant-supported removable partial dentures (IRPD: 9 patients received IRPDs in the mandible and 6 patients received IRPDs in the maxilla). A total of 25 patients received conventional FPD distally from a canine, or including a canine tooth (10 FPDs in the maxilla and 5 FPDs in the mandible, 10 patients received FPD in both jaws); 59 patients received implant-supported fixed partial dentures (IFPDs; 38 IFPDs were made in the maxilla, and 21 IFPDs were made in the mandible; only 6 IFPDs included frontal teeth, while all other IFPDs were bridges distally from a canine, or including a canine, as implant had been inserted in the canine region) (Table 1). Two types of dental implants were inserted to a total of 112 implant patients: MIS C1 (Israel) (60 patients) or Straumann (Swiss) (52 patients). All implants had standard platform widths (3.75 or 4.2 mm). All dentures were attached to implants by ball attachments. Questionnaires All patients completed three questionnaires: the Croatian version of the short form of the Oral Health Impact Profile (OHIP14) [33, 34], the Croatian version of the Orofacial Esthetic Scale (OES-CRO) [27] and the Chewing Function Questionnaire (CFQ) [29]. Using the OHIP14 questionnaire, patients rated their oral health on a scale ranging from 0 to 4: Zero indicated the absence of problems; higher scores indicated more impaired oral health. Summary scores ranged from 0 to 56. Using the OES-CRO, patients rated their orofacial esthetic on a scale ranging from 1 to 5 (1 = completely unsatisfied; 5 = completely satisfied; summary score ranged from 1 to 40; the higher summary score indicated greater satisfaction with esthetics). The assessment scale for the CFQ ranged from 0 to 4 (zero = absence of problems, 4 = the most impaired chewing function). Summary scores obtained from the ten questions in the CFQ ranged from 0 to 40; higher summary score indicated more impaired chewing function. The questionnaires were administrated twice: first time (baseline scores) when patients came to a dental office seeking prosthodontic rehabilitation, and the second time 3 months after the new dentures were provided and all adjustments were made. All questionnaires were psychometrically tested in previous studies and were proved to have excellent psychometric properties [27, 29, 33, 34]. Summary scores of these three questionnaires (OHIP14, OES and CFQ) enable monitoring changes of patients orofacial esthetics, chewing function and OHRQoL (score change), as well as comparison of after-treatment scores between different types of prosthodontic treatments. Statistical analysis The data analysis was made using the SPSS software (version 17.0, SPSS Inc., Chicago, IL, USA). Paired samples t test was used to test the significance of the differences between the baseline summary scores and the aftertreatment summary scores for all provided treatment options. The two-factor ANOVA was performed for the dependent variable: the after-treatment summary score and two factors: different types of prosthodontic therapy (CD, RPD, FPD) and implant support (yes, no), with the baseline summary score as a covariate. The Pearson coefficients of correlation were calculated between the variables: the baseline summary scores and the after-treatment summary scores. The two-factor ANOVA was also performed for the dependent variable: the score change (difference between the baseline and the after-treatment summary scores) to test the effects of factors: different types of prosthodontic treatment (CD, RPD, FPD) and implant support (yes, no), also including the baseline scores as covariates. The Pearson coefficients of correlation were calculated between the score change and the baseline score. P value of \0.05 was considered statistically significant. Results The baseline and the 3-month after-treatment scores for each questionnaire in the CD, RPD and FPD patients with

4 Table 2 Significance of the differences of the baseline scores and after-treatment scores for the OES Questionnaire, OHIP14 Questionnaire and Chewing Function Questionnaire (CFQ) in complete, partial removable and fixed denture patients with and without dental implants CD complete denture, ICD implant-supported complete denture, RPD removable partial denture, IRPD implantsupported removable partial denture, FPD fixed partial denture, IFPD implantsupported fixed partial denture Types of prosthodontic treatment Before treatment: after-treatment Questionnaire score Baseline mean values (SD) After-treatment mean values (SD) t df p CDs OES (7.47) (4.03) \0.001 OHIP (11.0) 8.44 (5.68) \0.001 CFQ (8.63) (6.26) \0.001 ICDs OES (7.05) (3.27) \0.001 OHIP (8.89) 4.40 (3.51) \0.001 CFQ (8.30) 7.23 (2.84) \0.001 RPDs OES (6.45) (4.17) \0.001 OHIP (11.18) 5.71 (5.02) \0.001 CFQ (9.47) 8.55 (4.98) \0.001 IRPDs OES (8.03) (4.14) \0.001 OHIP (9.38) 3.93 (2.52) \0.001 CFQ (8.62) 4.94 (3.61) \0.001 FPDs OES (4.97) (3.72) \0.001 OHIP 16.8 (12.50) 3.44 (3.68) \0.001 CFQ (8.39) 5.00 (4.09) \0.001 IFPDs OES (6.91) 36.8 (2.96) \0.001 OHIP (11.67) 2.98 (3.30) \0.001 CFQ (9.66) 3.86 (3.49) \0.001 and without dental implant support are presented in Table 2, together with the significance of the differences (paired Student s t test). All of the observed scores were significantly better after treatment in comparison with the baseline scores for all types of rehabilitation options (p \ 0.001). All patients rated their esthetics significantly better after the treatment (higher scores), and all patients had significantly lower OHIP14 and CFQ scores (better OHRQoL and better chewing function). For the dependent variable, the after-treatment esthetic score (OES after-treatment scores), the two-factor analysis of variance revealed no significant effects of the factor: different types of prosthodontic therapy (CD, RPD, FPD) (F = 1.602; p = 0.204), while a significant effect was obtained for the factor: implant support (yes, no) (F = 6.29; p = 0.03) and for the covariate: the baseline OES score (F = 16.74; p \ 0.001). Three month after prosthodontic rehabilitation, all patients with conventional dentures were equally satisfied with their esthetic outcomes, but patients with implant dentures were more satisfied. However, the RPD patients had the lowest OES scores in both, implant and non-implant groups. The baseline OES scores were weakly and positively correlated with the OES after-treatment scores (r = 0.231; p \ 0.01). The after-treatment OHIP scores were significantly different in different types of prosthodontic therapy (CD, RPD, FPD) (F = 8.225; p \ 0.001) and implant support (yes, no) (F = ; p \ 0.001). The covariate of the baseline OHIP score also elicited significant effects (F = 52.64; p \ 0.001). All patients with dental implants had significantly lower OHIP after-treatment scores (significantly better OHRQoL) than patients without dental implants in all three types of prosthodontic rehabilitation (CD, RPD, FPD). Patients with CDs had the highest OHIP after-treatment scores (the worst OHRQoL). In both, implant and non-implant groups, FPD patients rated better their OHRQoL than RPD and CD patients. The lowest OHIP score was registered in the IFPD patients. The baseline OHIP14 scores were positively and significantly correlated with the OHIP14 after-treatment scores (r = 0.376; p \ 0.01). For the dependent variable, the after-treatment CFQ scores, the two-factor analysis of variance revealed significant effects of both factors: the type of prosthodontic treatment (CD, RPD, FPD) (F = 9.82; p \ 0.001) and implant support (yes, no) (F = 37.68; p \ 0.001), with a significant effect of the covariate the baseline CFQ summary score (F = 35.28; p \ 0.001). The CFQ aftertreatment scores was significantly higher (more impaired chewing function) in all types of conventional denture wearing (non-implant patients) than in implant patients. In both, implant and non-implant patients, CD wearers had higher CFQ after-treatment scores (more chewing difficulties) than both, RPD patients and FPD patients; the RPD

5 Fig. 1 Mean values and standard deviations of the summary score change [difference between baseline summary scores (before treatment) and after-treatment summary scores (3 month after prosthodontic rehabilitation)] of three Questionnaires in different types of prosthodontic treatment (CD = complete denture, n = 70; RPD = removable partial denture, n = 56; FPD = fixed partial denture, n = 25; ICD = implant-supported complete denture, n = 38; IRPD = implant-supported removable partial denture, n = 15; IFPD = implant-supported fixed partial denture, n = 59. a Orofacial Esthetic Scale score difference (OES D-Score); b Oral Health Impact Profile score difference (OHIP14 D-Score); c Chewing Function Questionnaire score difference (CFQ D-Score) wearers had higher CFQ after-treatment scores than patients with FPDs (p \ 0.001). The lowest CFQ aftertreatment score (best chewing ability) was registered in the IFPD patients. The after-treatment CFQ scores were positively and significantly correlated with the CFQ baseline scores (r = 0.352; p \ 0.01). The variable, the score change (difference between the baseline and the after-treatment scores), for all three questionnaires is presented in Fig. 1. For the dependent variable: the OES score change, the two-factor ANOVA showed a significant effect of the factor: dental implant support (yes, no) (F = 6.29; p = 0.013) and the covariate: the baseline OES score (F = ; p \ 0.001), but not of the factor: type of prosthodontic treatment (CD, RPD, FPD) (F = 1.542; p = 0.216) (Fig. 1a). All patients with dental implant support had significantly higher OES score change in all types of denture wearing, compared with non-implant patients. The FPD patients without dental implant support had the lowest OES score change. The OES score change showed strong, negative and significant correlation with the OES baseline score (r =-0.860; p \ 0.01). Considering the dependent variable, the OHIP14 score change (Fig. 1b), the significant effects were obtained for both factors: type of prosthodontic treatment (CD, RPD, FPD) (F = 8.29; p \ 0.001) and implant support (yes, no) (F = ; p \ 0.001), as well as for the covariate: baseline OHIP scores (F = 1,292.35; p \ 0.001). Removable denture wearers showed higher score changes elicited by a therapy than fixed denture wearers in both groups, with and without implant support. Implant patients showed higher score change than non-implant patients in all groups. The OHIP14 score changes were negatively, strongly and significantly correlated with the OHIP14 baseline scores (r =-0.899; p \ 0.01) revealing higher score changes in patients with worse OHRQoL at baseline. For the dependent variable, the CFQ score change, the ANOVA showed a significant effect of both factors: the type of prosthodontic treatment (F = 10.96; p \ 0.001) and the implant support (F = 35.24; p \ 0.001), as well as of the covariate, baseline CFQ score (F = ; p \ 0.001). All patients had significantly higher CFQ score changes when their dentures were supported by dental implants. Removable denture patients had higher score changes than patients with FPDs in conventional and implant-supported denture wearing (Fig. 1c). The lowest CFQ score change was registered in the IFPD and the FPD patients. Discussion A therapist s understanding of a patient s expectations and satisfaction has become a crucial requirement for treatment planning and decision making. Satisfaction with a prosthodontic therapy depends on many different factors such as denture function or appearance, absence of pain, physical adaptability of an individual [1 4, 6 8, 35, 36]. Patient psychological factors, personality factors and social factors may affect acceptance and satisfaction of any prosthodontic appliance [37, 38]. Many studies confirmed that

6 patient-based outcome measures were necessary in clinical decision making, and therefore, specific instruments were developed to help clinicians and researchers to assess patient-based outcomes [32, 39, 40]. In order not to jeopardize results by possible low-quality dentures, in the present study, we excluded patients whose removable dentures had not met excellent criteria. However, it is very difficult to standardize all parameters that may contribute to the after-treatment summary scores or to score changes. Some studies showed that gender and education level affected satisfaction with prosthodontic restorations [16 18, 31, 32]. Therefore, we excluded low educated patients as they might have had lower expectations. All studied participants were living in a city and had a satisfactory income, so lack of money was not the reason why patients received a certain type of prosthodontic rehabilitation. Only anatomical restriction of residual alveolar ridges or an attitude toward receiving dental implants was a reason why some patients received conventional prosthodontic therapy instead of implant-supported dentures. Better after-treatment rating of orofacial esthetics in patients with implant-supported dentures in comparison with conventional denture patients may be attributed to their increased and high overall satisfaction. Some of the patients had previous experience with conventional removable denture wearing and in their enthusiasm with the benefits provided by a dental implant support they probably rated even the esthetics better than conventional removable denture patients. Moreover, some patients who received IFPDs had a missing canine at baseline, which was visible (implant was inserted into the canine region), while the FPD patients had their own canines (which were later prepared for a FPD). Some patients replaced conventional clasp retained RPDs with IRPDs and thus overcame the clasp visibility. The lowest after-treatment OES scores registered in this study in conventional RPD patients may be attributed to the visibility of denture clasps. The lowest OES score change registered in the FPD patients may be attributed to the fact that FPDs were constructed in the posterior parts of the jaws, so patients were probably not much concerned about their orofacial esthetics even before treatment. Relatively weak but significant correlation between the baseline and the aftertreatment OES scores may be attributed to patients psychological factors and personality, i.e., the patients who rated orofacial esthetics better (or worse) at baseline did the same after treatment. However, effects of the covariate, baseline summary scores, as well as negative and strong significant correlation between the baseline OES scores and the OES score change revealed that patients with the worst baseline ratings most benefited considering orofacial esthetics. Although all implant removable denture patients had higher after-treatment OHIP scores (worse OHRQoL) than the IFPDs and the FPDs, they improved their OHRQoL by provided prosthodontic rehabilitation to the highest extent (the highest OHIP score change, Fig. 1b). Significantly lower OHIP after-treatment scores in all groups with dental implant support indicates that implant patients more benefited from the received therapy than non-implant patients. In both, implant and non-implant groups, better OHRQoL in the FPD than in the RPD and CD patients was attributed to the adverse effects of removable dentures such as palatal coverage, resiliency of oral mucosa and denture movements when chewing foods. The lowest OHIP after-treatment score, registered in the IFPD patients, may be attributed to the fact that they were the most enthusiastic patients as related to the benefit of a therapy, as some of them replaced their previous RPDs with IFPDs, and/or they were aware that they would, without dental implants, receive removable dentures. The results of improved OHRQoL elicited by a provided therapy in this study are in line with previous papers, especially those reporting benefits from a dental implant therapy [13, 16, 41 46]. The results for the after-treatment OHIP scores in the IFPD and the FPD groups are in line with another study which registered better 3-year after-treatment OHIP scores in the old IFPD patients [41]. The CFQ after-treatment scores were significantly affected by a type of prosthodontic therapy, implant support and the covariate, namely baseline score. Significantly lower CFQ after-treatment scores in removable implant denture patients can be attributed to better stability and retention of removable dentures provided by implant support. Although dental implants improved retention and support of removable dentures, the outcome never reached the achievements of FPDs or IFPDs, as removable denture patients had significantly more impaired chewing function than fixed denture patients in both, implant and nonimplant groups. The worst CFQ after-treatment score in the implant-supported denture group registered in the ICD patients may be attributed to the fact that only mandibular CD was supported by dental implants opposed by a conventional CD. The highest CFQ score change registered in implant removable denture patients indicates that they improved their chewing function to a highest extent. Obviously, implant removable denture patients most benefited from the implant support by enhancing retention and stability of removable dentures; however, their after-treatment scores still remained higher than in both implant and non-implant fixed denture groups. The lowest CFQ score change elicited by a therapy in the FPD group was attributed to the fact that those patients were able to chew different foods with their remaining teeth even before they received FPDs.

7 Overall, all baseline scores were weakly and positively related to the after-treatment scores, which was attributed to patients personality traits (those patients who rated better at baseline did same after treatment). The effect of the covariate: baseline summary score and negative and strong correlation between the baseline summary score and the score change can be attributed to the fact that patients with the worst baseline ratings most benefited from the provided therapy. Overall, implant therapy enhanced chewing function and OHRQoL more than conventional treatment options. Moreover, esthetic outcomes were better in the implant groups, probably due to their increased overall satisfaction. In their enthusiasm, they rated esthetics better than patients with conventional dentures. The limitations of the present study are the sample size variability among the six studied groups, possible differences of antagonistic jaw status in some of the studied groups and/or absence of patient personality judgment. The major strength of this study is the assessment of patient-reported measures related to esthetics, chewing function and OHRQoL for six different prosthodontic treatment modalities. Moreover, results of this study, obtained from the CFQ and the OES questionnaires for the different prosthodontic rehabilitation options with and without dental implants, have not been reported yet. Conclusions All patients regardless of the type of prosthodontic treatment significantly improved their orofacial esthetics, chewing function and OHRQoL. All implant patients better improved OHRQoL, chewing function and orofacial esthetics than conventional treatment groups (CD, RPD, FPD). The implant removable denture patients improved chewing function and OHRQoL to the highest extent by the provided therapy (highest CFQ and OHIP14 score differences), but still had higher after-treatment scores (more impairment) than the FPD and the IFPD group. The IFPD followed by the ICD and the CD patients best rated orofacial esthetics. Baseline scores were weakly positively related with the after-treatment scores and strongly, negatively with the score changes. The results obtained in this study from the three questionnaires, which assessed important clinical parameters, may help dentists in decision making to choose the most appropriate rehabilitation option with the highest treatment effect. Acknowledgments To the Ministry of Science of Croatia for funding the University Research Project: Contemporary prosthodontic procedures, materials and OHRQoL dependent on a degree of oral rehabilitation. References 1. Brennan, D. S., Spencer, A. J., & Roberts-Thomson, K. F. (2008). Tooth loss, chewing ability and quality of life. Quality of Life Research, 17, Inukai, M., John, M. T., Igarashi, Y., & Baba, K. (2010). Association between perceived chewing ability and oral health-related quality of life in partially dentate patients. Health and Quality of Life Outcomes, 8, Montero, J., López, J. F., Galindo, M. P., Vicente, P., & Bravo, M. (2009). Impact of prosthodontic status on oral wellbeing: A cross-sectional cohort study. Journal of Oral Rehabilitation 36, Spalj, S., Lajnert, V., & Ivankovic, L. (2014). The psychosocial impact of dental aesthetics questionnaire translation and crosscultural validation in Croatia. Quality of Life Research, 23(4), Yoshizumi, D. T. (1964). An evaluation of factors pertinent to the success of complete denture service. Journal of Prosthetic Dentistry, 14, Zlatarić, D. K., & Celebić, A. (2008). Factors related to patients general satisfaction with removable partial dentures: A stepwise multiple regression analysis. The International Journal of Prosthodontics, 21, Carlsson, G. E. (1998). Clinical morbidity and sequelae of treatment with complete dentures. Journal of Prosthetic Dentistry, 79, Čelebić, A., Knezović-Zlatarić, D., Papić, M., Carek, V., Baucić, I., & Stipetić, J. (2003). Factors related to patient satisfaction with complete denture therapy. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 58(10), M948 M Allen, P. F., & McMillan, A. S. (2003). A longitudinal study of quality of life outcomes in older adults requesting implant prostheses and complete removable dentures. Clinical Oral Implants Research, 14, Assunção, W. G., Barão, V. A., Delben, J. A., Gomes, E. A., & Tabata, L. F. (2009). A comparison of patient satisfaction between treatment with conventional complete dentures and overdentures in the elderly: A literature review. Gerodontology, 27, Strassburger, C., Kerchbaum, T., & Heydecke, G. (2006). Influence of implant and conventional prostheses on satisfaction and quality of life: A literature review. Part 2: Qualitative analysis and evaluation of the studies. The International Journal of Prosthodontics, 19, Cordaro, L., di Torresanto, V. M., Petricevic, N., Jornet, P. R., & Torsello, F. (2013). Single unit attachments improve peri-implant soft tissue conditions in mandibular overdentures supported by four implants. Clinical Oral Implants Research, 24, Persic, S., Palac, A., Vojvodic, D., & Celebic, A. (2014). Initial effects of a treatment by fixed partial dentures supported by mini dental implants from a patient s point of view. Collegium Antropologicum, 38(1), Naert, I., Alsaadi, G., & Quirynen, M. (2004). Prosthetic aspects and patient satisfaction with two implant-retained mandibular overdentures: A 10-year randomized clinical study. The International Journal of Prosthodontics, 17, Fueki, K., Kimoto, K., Ogawa, T., & Garrett, N. R. (2007). Effect of implant-supported or retained dentures on masticatory performance: A systematic review. Journal of Prosthetic Dentistry, 98, Yu, S. J., Chen, P., & Zhu, G. X. (2013). Relationship between implantation of missing anterior teeth and oral health-related quality of life. Quality of Life Research, 22,

8 17. Singh, B. P., Pradhan, K. N., Tripathi, A., Tua, R., & Tripathi, S. (2012). Effect of sociodemographic variables on complete denture satisfaction. The Journal of Advanced Prosthodontics, 4, Lee, I. C., Yang, Y. H., Ho, P. S., & Lee, I. C. (2012). Exploring the quality of life after denture-wearing within elders in Kaohsiung. Gerodontology, 29, e1067 e Slade, G. D., & Spencer, A. J. (1994). Development and the evaluation of the Oral Health Impact Profile. Community Dental Health, 11, John, M. T. (2007). Exploring dimensions of oral health-related quality of life using experts-opinions. Quality of Life Research, 16, Zlataric, D. K., & Celebic, A. (2001). Treatment outcomes with removable partial dentures: A comparison between patient and prosthodontist assessments. The International Journal of Prosthodontics, 14, John, M. T., Reißmann, D. R., Feuerstahler, L., Waller, N., Baba, K., Larsson, P., et al. (2014). Factor analyses of the Oral Health Impact Profile overview and studied population. Journal of Prosthodontic Research, 58(1), John, M. T., Reissmann, D. R., Feuerstahler, L., Waller, N., Baba, K., Larsson, P., et al. (2014). Exploratory factor analysis of the Oral Health Impact Profile. Journal of Oral Rehabilitation. doi: /joor John, M. T., Feuerstahler, L., Waller, N., Baba, K., Larsson, P., Celebić, A., et al. (2014). Confirmatory factor analysis of the Oral Health Impact Profile. Journal of Oral Rehabilitation. doi: /joor Bimbashi, V., Celebić, A., Islami, A., Asllani-Hoxha, F., & Petricević, N. (2012). Psychometric properties of the Albanian language version of the OHIP-ALB49 Questionnaire in the Republic of Kosovo. Collegium Antropologicum, 36, Rener-Sitar, K., Celebić, A., Petricević, N., Papić, M., Sapundzhiev, D., Kansky, A., et al. (2009). The Slovenian version of the Oral Health Impact Profile Questionnaire (OHIP-SVN): Translation and psychometric properties. Collegium Antropologicum, 33, Peršić, S., Milardović, S., Mehulić, K., & Čelebić, A. (2011). Psychometric properties of the Croatian version of the Orofacial Esthetic Scale and suggestions for modification. The International Journal of Prosthodontics, 24(6), Larsson, P., John, M. T., Nilner, K., Bondemark, L., & List, T. (2010). Development of an Orofacial Esthetic Scale in prosthodontic patients. The International Journal of Prosthodontics, 23, Peršić, S., Palac, A., Bunjevac, T., & Čelebić, A. (2013). Development of a new chewing function questionnaire for assessment of a self-perceived chewing function. Community Dentistry and Oral Epidemiology, 41(6), Hsu, K. J., Lee, H. E., Wu, Y. M., La, S. J., Huang, S. T., & Yen, Y. Y. (2014). Masticatory factors as predictors of oral healthrelated quality of life among elderly people in Kaohsiung City, Taiwan. Quality of Life Research, 23, Chen, P., & Yu, S. (2012). Zhu. The psychosocial impacts of implantation on the dental aesthetics of missing anterior teeth patients. British Dental Journal, 213(11), E Knezović Zlatarić, D., Celebić, A., Valentić-Peruzović, M., Jerolimov, V., & Pandurić, J. (2003). A survey of treatment outcomes with removable partial dentures. Journal of Oral Rehabilitation, 30(8), Petričević, N., Čelebić, A., Papić, M., & Rener-Sitar, K. (2009). The Croatian version of the Oral Health Impact Profile Questionnaire. Collegium Antropologicum, 33, Rener-Sitar, K., Petricević, N., Celebić, A., & Marion, L. (2008). Psychometric properties of Croatian and Slovenian short form of oral health impact profile questionnaires. Croatian Medical Journal, 49, Reissmann, D. R., Sierwald, I., Heydecke, G., & John, M. T. (2013). Interpreting one oral health impact profile point. Health and Quality of Life Outcomes, 11, Celebic, A., & Knezović-Zlataric, D. (2003). A comparison of patient s satisfaction between complete and partial removable denture wearers. Journal of Dentistry, 31, Kovac, Z., Troskot, Z., Uhac, I., Cabov, T., Lajnert, V., Pavicić, D. K., et al. (2012). Multivariate analysis of different factors affecting the patient general satisfaction with complete dentures. Collegium Antropologicum, 36, Bellini, D., Dos Santos, M. B., De Paula Prisco Da Cunha, V., & Marchini, L. J. (2009). Patients expectations and satisfaction of complete denture therapy and correlation with locus of control. Journal of Oral Rehabilitation, 36, Locker, D., Clarke, M., & Payne, B. (2000). Self-perceived oral health status, psychological well-being and life satisfaction in an older adult population. Journal of Dental Research, 79, Kovacic, I., Badrov, J., Vidovic, N., & Celebic, A. (2011). Preliminary clinical report of satisfaction with prosthodontic rehabilitation of intellectually disabled young adults provided by parents or caregivers. The International Journal of Prosthodontics, 24(4), Petricevic, N., Celebic, A., & Rener-Sitar, K. (2012). A 3-year longitudinal study of quality-of-life outcomes of elderly patients with implant- and tooth-supported fixed partial dentures in posterior dental regions. Gerodontology, 29(2), e956 e Swelem, A. A., Gurevich, K. G., Fabrikant, E. G., Hassan, M. H., & Aqou, S. (2014). Oral health-related quality of life in partially edentulous patients treated with removable, fixed, fixed-removable, and implant-supported prostheses. The International Journal of Prosthodontics, 27, Fillion, M., Aubazac, D., Bessadet, M., Allègre, M., & Nicolas, E. (2013). The impact of implant treatment on oral health related quality of life in a private dental practice: A prospective cohort study. Health and Quality of Life Outcomes, 14, Wolfart, S., Moll, D., Hilgers, R. D., Wolfart, M., & Kern, M. (2013). Implant placement under existing removable dental prostheses and its effect on oral health-related quality of life. Clinical Oral Implants Research, 24, Duvernay, E., Srinivasan, M., Legrand, L. D., Herrmann, F. R., von Steinbüchel, N., & Müller, F. (2014). Dental appearance and personality trait judgment of elderly persons. The International Journal of Prosthodontics, 27, Kranjcic, J., Mikus, A., Mehulic, K., & Vojvodic, D. (2014). Knowledge and awareness of dental implants among elderly people in Croatia. Journal of Prosthodontics. doi: /jopr