Patients ’ expectation and satisfaction with complete denture before and after the therapy

Background/Aim. Difficulties in the acceptance of dentures are multifactorial including psychosocial ones. It is questionable whether the patients’ satisfaction depends only on the complete denture therapy characteristics. The aim of the study was to evaluated patients’ expectation and satisfaction with complete dentures before and after the treatment concerning phonetics, chewing, comfort of use and aesthetics. Methods. Forty complete edentulous patients rated their expectation before and satisfaction after the treatment based on a questionnaire scores. Patient-related variables regarding age, gender and previous experience (whether worn complete denture or not) were also recorded. Results. Patients’ rating for expectations were higher than the satisfaction after treatment regarding phonetics, chewing, comfort of use and aesthetics. A negative significant correlation was shown between the items before and after the treatment rating for phonetics, chewing, comfort of use and aesthetics. No statistical correlation was found between all the evaluated aspects’ (i.e. phonetics, chewing, comfort of use and aesthetics) of expectation and satisfaction, and age, gender, and previous experience except a weak negative correlation noticed between age and comfort of denture use. Conclusion. Patients’ expectations ratings significantly exceeded their satisfactions. Expectations and satisfaction ratings were irrespective of gender and patients previous experience.


Introduction
Despite the decline in edentulism rates documented by Marcus et al. 1 , due to ageing of the society, it is estimated that the number of edentulous patients will not decrease.Complete dentures are a favoured treatment option for edentulous patients.It deserves to be noted that the complete dentures are commonly accepted as they provide a pleasing appearance and maintain normal speech, as well as supply occlusal support and adequate means for mastication of food.Additionally, these dentures should be comfortable and should generally make a patient satisfied.Previous studies indicate that the great majority of completely edentulous patients are satisfied with their complete dentures 2,3 , while great emphasis is placed on the pa-Correspondence to: Desong Zhan, Department of Cadres Clinic, School of Stomatology, China Medical University, 117 South Nanjing Street, Heping District, Shenyang 110002, China.E-mail: zhandesong11@126.comtients who remain dissatisfied despite the clinical perfection of their oral rehabilitation, as patients' satisfaction with their dentures seems to be associated with their quality of life [3][4][5][6] .
Difficulties in the acceptance of dentures are multifactorial, therefore, the risk of the dissatisfaction should be considered.Satisfaction with complete dentures has been associated with several factors as confirmed by several studies 7 .Among these factors, general health, age, gender, personality traits, experiences with previous dentures and patient expectation regarding treatment were evaluated in previous studies [8][9][10][11][12][13][14] .Although some studies found associations between those factors and complete denture satisfaction 10,11 , some did not 8,9,12 .Furthermore, some studies [14][15][16] , albeit not all [17][18][19] , have revealed that patient satisfaction is unrelated to denture quality and to sophisticated techniques for the treatment 4 .
There remains a widespread acknowledgement that psychological factors may influence the outcome of denture treatments.For instance, some authors 15,19 have found that psychological factors may play an important role in those patients who experience difficulty in adapting to new dentures.Furthermore, the majority of studies have evaluated the expectation as strongly associated with patients' satisfaction after treatment, yet not all the samples are observed 20 .
The aim of the study was to evaluated patients' expectation and satisfaction with complete dentures before and after the treatment concerning phonetics, chewing, comfort of use and aesthetics.

Methods
The sample consisted of 40 individuals (22 women and 18 men), generally healthy, who attended the China Medical University and went through the completely new dentures therapy from February 2012 to December 2013.The selected patients were all completely toothless, in good health (to avoid the influence of their medical problems on their satisfaction with dentures), enjoying adequate cognitive ability for understanding and capacity to answer questions and to complete a form.The patients who met the eligibility criteria mentioned above received a written informed consent to participate.The study was approved by the China Medical University Ethical Review Board.
The dentures were made by graduate students under the supervision of professors, using a standardized tech-nique compromising the following procedure: complete initial clinical examination; making of preliminary impression using a stock tray and irreversible hydrocolloid (alginate); and final impression using custom trays and light-bodied silicone impression material, after border moulding.The denture bases were polymerised with heat-cured acrylic resin (Vipi Cril Plus) at 72°C for 12 h.Occlusal wax rims were made over the denture bases and adjusted as necessary.The bases were mounted in centric relation at a predetermined occlusal vertical dimension in semi-adjustable articulators.The artificial acrylic resin teeth were arranged in balanced occlusion and tried in, and the dentures were flasked and polymerized (72°C/12 h) and then inserted and adjusted.

Assessment of patient expectation before and satisfaction after the therapy
To rate expectations before and satisfactions after the therapy, a Patient Denture Rating Questionnaire, covering four items relating to denture esthetics, speech, mastication and comfort, was used.The answers for each item could range from 0 (the worst result) to 10 (the best result).All the questions were explained to the patients, as to enable them to understand meanings of each question.All the patients were asked to choose the numbers according to their expectation.After completing the treatment (a week after the insertion), the patients were again asked to choose the numbers according to their satisfaction.
A copy of the self-completed denture rating questionnaire is presented in Table 1.

Assessment of patient-related variables
Patient-related variables including gender, age and previous experience (whether worn complete dentures or not) were noted.

Statistical analysis
The statistical Package for the Social Sciences (SPSS version16.0,SPSS Inc., IBM) was used for statistical analysis.The Wilcoxon Signed Rank test was used to compare the patients' expectation before and satisfaction after the treat-

Table 1
The questionnaire sent to all the patients.The questionnaire was proposed at the same patients before and a week after the treatment.Answers to each question range from 0 (worst possible outcome) to 10 (best possible outcome)

Questions
On this scale of 0-10, how would you score the following aspects?
How do you rate the appearance of your denture?ment, while the Spearman's correlation test was used to determine whether correlations existed between the patients' expectation before and satisfaction after the treatment and to check for possible correlations between age and the abovementioned scores.The Mann-Whitney test was used to test associations between the scores and gender, as well as to check possible associations between the scores and the previous experience.A p-value less than 0.05 were accepted as a statistically significant.

Results
Of the 40 participants who completed all stages and filled in the questionnaires, 56% were female.
The results on correlations between the investigated parameters before and after the treatment a given in Table 2.A negative correlation was found between age and comfort of use expectation (p = 0.0041, -44.41%).No correlation was found between phonetics, chewing and aesthetics, respectively to age (p = 0.608, 8.63%; p = 0.651, 7.39%; p = 0.517, 10.55%).

Discussion
The subjects in this study had higher expectations regarding complete denture treatment compared to satisfaction for phonetics, chewing, comfort of use and aesthetics.Our results corroborate the findings of de Siqueira et al. 12 , while other studies 9, 12 contradict our findings.A possible explanation for the divergence is that the satisfaction with complete denture is a complex phenomenon 7,18 which could be fulfilled by previous comprehensive awareness of anatomical features and, particularly, by an insight into patients' physiological and psychological capacities [21][22][23] .
Furthermore a negative significant correlation was determined between expectation and satisfaction for all the evaluated criteria (i.e.phonetics, chewing, comfort of use and aesthetics).As edentulous patients generally expect that new complete dentures fit and function equal to or even better than their natural teeth, despite the presence of resorbed ridges, collapsed muscles and other physical changes that occurred.Considering patients' baseline physical condition regarding harmony, smile appearance, denture comfort and masticatory and phonic ability, the new dentures provide an adequate solution from dentist's point of view.However, patients do not take into account their own baseline considerations.Sensation of foreign object, nausea, phonetic problems and difficulty in chewing, are among common complaints of edentulous patients during the first few days after insertion of their complete dentures.Since complete dentures do not generally match the patients' expectations, patients are no longer willing to wear their dentures, developing a feeling of mistrust toward their dentist and his/her treatment plan and demand that dentists make numerous and sometimes technically unnecessary adjustments.However, patients should understand that compromises may be necessary.

Table2
The results on correlations between the investigated parameters before (expectation) and after the treatment (satisfaction)  Dentists ought to be fully aware of patients' expectations before treatment and provide a patient with detailed introduction into the problem, which not aims to explain the limitations and possibilities of complete denture treatment per se, but rather to help a patient to learn how to cope with the complete dentures.Therefore, the rate of satisfaction may be raised.
Other variables (previous experience, age and gender) were also tested to assess patients' expectations before and satisfaction after the therapy.However, the majority of these possible associations proved not to be statistically significant in this sample, with the exception of a weak negative correlation between age and comfort of use.These results are incongruent with previous studies 24,25 , but suggested by other studies 20,23 .
The limitations of the present study involve a relatively small number of patients, which limits possible evaluation of causal relationship among the evaluated variables and some other factors, such as denture quality, personality traits and patient/professional relationship 12,13,23 .

Conclusion
Patients' expectations ratings significantly exceeded their satisfactions.Expectations and satisfaction ratings were irrespective of gender and previous experience.
Hence, pondering the necessity of gaining a deeper comprehensive of patients' psychosomatic phenomena, it seems that more extensive, clinically and patient-based research should be carried out to gain more knowledge about patients' expectations and final evaluation after complete denture treatment.

R E F E R E N C E S
do you rate the quality of your mastication?do you rate the removal and insertion of your denture?Zou Y and Zhan D. Vojnosanit Pregl 2015; 72(6): 495-498.

statistically significant difference (Spearman's correlation test and Mann-Whitney test).
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