Page 130 - Impact of implant retained overdenture treatment and speech, oromyofunction, social participation and quality of life.

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Chapter 5
group. Observers did not report significant differences in any of the study groups. This impact remained unnoticed by observers during the first 4 to 8 weeks after treatment, although we cannot exclude that knowledgeable others would report such beneficial effects in the longer run. In summary, these results show that only the patients in the most severe group reported improvement, both in experienced quality of life and indices of social participation. These findings are plausible because reconstructions with full dentures imply a bigger physical change than single-unit dentures. According to the WHO ICF model (2001), quality of life is an interaction between physical functions, activity, participation, personality factors and environmental factors. The present work suggests that psycho-social improvements of dental treatments are mainly to be expected in complete jaw restoration cases.
Besides strengths and innovations, there are also a number of limitations that have to be taken into account when interpreting the results of the present work. First, although the size of the present sample is comparable or even larger than other studies 10,24–26, it is still small, so we have to be careful when generalizing from this study. Replications with larger samples have to be conducted before we can substantiate and generalize the present interpretations. A second limitation is the timing of the assessment points, both pre- but also post- treatment. In the ideal case, one should have more assessment points spread across time before treatment, so one can better evaluate whether patients catch-up to pre-existing (even before serious dental problems) levels of quality of life or social participation. In the present study, the post-treatment evaluation was scheduled 4 to 8 weeks after treatment (when patients came back in the hospital for a check-up). The fact that we did not pick up beneficial effects in the single unit group or in the reports provided by the observers may be due to the too short time-frame after the intervention. Patients (and their observers) probably need more time to get used to their implants and to observe effects on patients’ psycho-social status and participation. Likewise, we cannot exclude that the personality variables would have explained part of the change in quality of life or social participation variance between pre- and post-treatment when the evaluation period would have been longer. A third constraint are the different observers, including partners, but also other types of relatives or knowledgeable others. The insignificant correlations between self- and observer reports suggest heterogeneity in familiarity with the target