Quality of life in patients rehabilitated with implant-supported prostheses

Aim: To evaluate the impact of rehabilitation with implant- supported prostheses on the quality of life (QoL) of patients. Methods: The OHIP-14 questionnaire was applied to 114 patients and information regarding gender, age, type of prosthesis and time of use were obtained. To analyze whether there were any statistically significant differences between the mean scores of the seven parameters of the OHIP-14, the Mann-Whitney and Kruskal-Wallis test were used. All data were evaluated using a significance level of 5%. Results: Patients were predominanty female (78.9%) and single crowns users (41.2%). Patients reported a good QoL (3.07). Psychological discomfort and physical pain were the worst dimensions evaluated by the subjects. Results differed significantly (p<0.05) only for functional limitations and psychological discomfort in the different genders. Conclusions: Patients presented a high level of quality of life, regardless of age, duration of use and the type of prosthesis used. However, women presented more psychological distress and functional limitations than men.


Introduction
Therapy with implant-supported prostheses implants has been largely studied for the oral rehabilitation of edentulous patients 1 .Due to the limitations of conventional prosthesis treatments, implant-supported prostheses (single crowns; bridges; complete tory function and phonetics in patients.Furthermore, these approaches also improve the physical, psychological and social well-being of the patient 2 and are considered the gold standard for the treatment of edentulism 3 .important for his/her satisfaction with treatment is different to that of the dentist. ute to oral rehabilitation failure and produce typical psychosocial responses, such 4 .During the initial planning of perception of his/her oral health is related to his/her quality of life (QoL) 5 .
According to the World Health Organization (WHO), QoL is the perception, on the part of individuals or groups, regarding the satisfaction of their own needs and what is not denied in propitious for their happiness 6 .Besides that, the WHO emphasizes the importance of oral health-related QoL to use in its campaigns not only images portraying pain-free life but also aesthetic images with beautiful smiles as an image of complete well-being 7 .
parameters rather than individual patient perspective.In contrast, as a result of this difference, recent research is refocused to consider how oral health affects far reaching aspects of life such as psychosocial interaction, self-esteem, intimacy, overall health, and performance at work 8 .
found to negatively interfere in an individual's QoL and this can also be affected by the satisfaction or dissatisfaction with an oral condition 9 .Mcgrath and Bedi 10 have shown psychosocial and were mainly associated with negative feelings.Therefore, rehabilitation with implant-supported prostheses provides a positive effect on the QoL associated with oral health and has a strong social, psychological and emotional impact on the daily life of each patient 11 .
Several instruments have been developed with the aim of evaluating and quantifying form (OHIP-14) was developed by Slade and Spencer 12 , derived from the original version (OHIP-49) also developed by Slade and Spencer 12 .Even in its abbreviated form, this questionnaire is reliable and valid in several languages 13 and is considered a good 5,11 .
As OHIP-14 is easy and quick to apply, it is possible to verify the effectiveness of oral rehabilitation with implant-supported prostheses, evaluating the physical and emo-tional state of the patient, their future limitations, level of performance in their daily life, degree of satisfaction of their needs and the impact on their QoL.Therefore, the aim of this study was to evaluate the impact of oral rehabilitation with prostheses supported or retained by implants on patients' QoL.

Sample
This cross-sectional study was performed in patients with implant-supported prostheses treated at the Department of Dentistry of the Federal University of Rio Grande do Norte (UFRN) during the period from 2000 to 2010.This search was approved by the Ethics Committee of the UFRN (protocol: 349.152/2013) and it has been conducted in full accordance with the World Medical Association Declaration of Helsinki.All patients who agreed to participate of this search assigned a written consent.Patients The calculation of the sample size was based on the mean observed in our study for population of 155 individuals, the sample of patients required for OHIP-14 application was 109 individuals.

Data Collect
After the selection of patients, the OHIP-14 was applied by previously trained researchers and information about gender, age, type of prosthesis and time of use of prosthesis were obtained from the patient's medical records.In cases of patients that used more than one type of prosthesis, the type of prostheses with the highest number of implants was considered.All patients were informed about the OHIP-14 methodology and the interviewer was always available for providing help.
The OHIP-14 consists of 14 items subdivided into seven parameters (functional limitation, physical pain, psychological discomfort, physical incapacity, psychological incapacity, social disability and handicap).For these items, participants were asked - The calculation of the impact of the prosthesis on the patient's QoL was performed question 2 was obtained, and the higher submitted score, the greater the negative impact on QoL for the individual 14 .

Statistical Analysis
For the statistical analysis of parameters in relation to gender, the Mann-Whitney test was used.The Kruskal-Wallis test was utilized for the variables; age, type of prostheses and time of use of prosthesis.For statistical purposes, all variables were cate-negative effect of the rehabilitation The individual's age was categorized according to the age, as adult (<60 years) or elderly (≥60 years).The type of prosthesis was categorized as single crowns, overdentures and multiple partial prostheses or total pros-

Results
The OHIP-14 was applied in 114 patients during the period of May/2013 to had a mean age of 55.46 years (±12.91)with a variation from 18 to 84 years.Furyears of mean time of use.
Results demonstrate that the patients evaluated have a high QoL, as the value of the general OHIP-14 was close to zero (3.07), with a variation from 0 to 56.However, it can be seen that the dimensions of psychological discomfort and physical pain presented the highest means, even though these parameters demonstrated low values (Fig. 1).
The distribution of the analysis of the OHIP-14 or the parameters of gender, age, type ferences (p<0.05)just for gender, with regard to functional limitations and psychological discomfort, which presented the worst QoL scores (Tables 1 and 2).

Discussion
The application of the OHIP-14 questionaire in this study showed that patients using prostheses present a satisfactory QoL.According to Slade 14 , this instrument presents less time for application, favoring its use during the evaluation of oral health and QoL.
Additional and recent studies also used the OHIP-14 version to evaluate QoL in individuals who used implant-supported prostheses [1][2]5,11 , as this test is proven to be a valid instrument that is reproducible, reliable and simple for use. Othe studies have also reported the OHIP-14 to represent a good instrument for evaluation of QoL 1,5,[15][16] .
Despite these considerations, the cross-sectional evaluation used herein presents the whole population with regard to improvements in QoL or evaluate cause-effect relationships between QoL and implant-supported prostheses use 17 .However, paring before and after treatment with implant-supported prostheses [1][2]5,11,15 . This fct corroborates the low values found in this study.Other studies have reported and psychological discomfort, in addition to providing aesthetic, retention and satisfactory stability [18][19] .
In this study, gender had an impact on the two parameters where women complained more about functional limitations and psychological discomfort.It is commonly considered that women are more interested in their appearance than men.This the higher dissatisfaction level for females could be related to the idea that the self-esteems of females could be affected from physical injuries more than males [20][21]   The perception of most negative may show women are more worried with their oral health when they evaluate their QoL 13 .According to Cohen-Carneiro et al. 13 , these differences in gender could vary according to sociodemographic characteristics.Due to to justify or discuss these discrepancies in relation to gender.
ferences in relation to the time of use of prostheses, according to OHIP-14 [5][6]22 . Koupala et al. 2 also compared groups of patients for 3 to 12 years and 13 to 22 years of follow-up regard to the type of prosthesis.However, Cakir et al. 1 demonstrated that QoL values were mainly due to functional limitations, physical incapacity and psychological discomfort lous patient. Tese types of prostheses present advantages and disadvantages, although 22   .23 and less mobility in the mouth than to conventional prostheses, and the cost over multiple prostheses or total 24-26   .The advantages and the important factors for the choice of treatment with multiple prostheses or total prostheses 23,26,27   .Therefore, more research relating QoL and costs, considering the number of implants and the type of prosthesis, are necessary.The results of this cross-sectional study indicate prosthetic rehabilitation with implants -mation and patients' perception, beyond those commonly and routinely observed in rate success (biological and mechanical factors of rehabilitations), should be performed.
It can be concluded patients with implant-supported prostheses present a satisfactory QoL.However, increased attention should be given by professionals in relation limitations.Therefore, the OHIP-14 used to evaluate the impact of rehabilitation with implants on oral health and the QoL of patients could be considered as an important

Caption:
Circles and stars are respectively outliers and extreme outliers.

Table 2 .
Distribution of the impact of oral health on QoL, as evaluated by OHIP-14, with regard to the type of prosthesis used and time of use of prosthesis.

Table 1 .
Distribution of oral health impact on QoL, as evaluated by the OHIP-14, and parameters according to gender and age. .
Could not perform the test due to presenting cells with lower than the expected counts of 5. a