Enhancing patient-centered information on implant dentistry through prompt engineering: a comparison of four large language models

Background

Patients frequently seek dental information online, and generative pre-trained transformers (GPTs) may be a valuable resource. However, the quality of responses based on varying prompt designs has not been evaluated. As dental implant treatment is widely performed, this study aimed to investigate the influence of prompt design on GPT performance in answering commonly asked questions related to dental implants.

Materials and methods

Thirty commonly asked questions about implant dentistry - covering patient selection, associated risks, peri-implant disease symptoms, treatment for missing teeth, prevention, and prognosis - were posed to four different GPT models with different prompt designs. Responses were recorded and independently appraised by two periodontists across six quality domains.

Results

All models performed well, with responses classified as good quality. The contextualized model performed worse on treatment-related questions (21.5 ± 3.4, p < 0.05), but outperformed the input-output, zero-shot chain of thought, and instruction-tuned models in citing appropriate sources in its responses (4.1 ± 1.0, p < 0.001). However, responses had less clarity and relevance compared to the other models.

Conclusion

GPTs can provide accurate, complete, and useful information for questions related to dental implants. While prompt designs can enhance response quality, further refinement is necessary to optimize its performance.

Comparing Medium to Long-Term Esthetic, Clinical, and Patient-Reported Outcomes Between Freehand and Computer-Assisted Dental Implant Placement: A Cross-Sectional Study

OBJECTIVE

The aim of the study was to compare medium to long-term clinical and patient-reported outcomes between implants placed with computer-assisted implant surgery (CAIS) and freehand protocols.

MATERIALS AND METHODS

Thirty dental implants in the anterior maxillary region with an average of 4 years after loading were assessed by means of Pink Esthetic Scores (PESs), marginal bone level (MBL), and clinical and patient-reported outcomes.

RESULTS

CAIS significantly outperformed freehand placement with regard to PES scores (p = 0.011). Likewise, implants placed with CAIS showed significantly higher MBLs (p < 0.001). Bleeding on probing, probing depth, and prevalence of mucositis did not differ between the groups, while no peri-implantitis was diagnosed.

CONCLUSIONS

The use of CAIS leads to superior outcomes in terms of esthetics and MBLs for implants placed in the esthetic zone as observed in medium to long-term follow-up. No difference was however observed with regard to peri-implant mucosa inflammation.

CLINICAL SIGNIFICANCE

This article highlights the outcome of computer-assisted implant surgery in achieving higher esthetic, MBL, and esthetic satisfaction compared to freehand implant placement.

THAI CLINICAL TRIAL REGISTRY

TCTR20240422015.

The use of patient-related outcomes (PRO) and experience (PRE) in assessing the periodontal and implant patient

The purpose of this review was to summarize the evidence with regard to behavioral and psychosocial assessment of the periodontitis patient, the candidate for implant therapy, and the peri-implantitis patient. Periodontitis has an adverse effect on quality of life and its treatment can lead to significant improvements experienced by the patient. The latter is true for rehabilitation with dental implants, although patients harbor diverse expectations and perceptions of implant therapy, which can often interfere with satisfaction and/or influence long-term success. A thorough behavioral assessment of the candidate for implant therapy is essential, which should include, perceptions, expectations, as well as risk for behavioral disorders. Remedial action is essential to correct misperceptions and any identified risks. Finally, patients have limited awareness of limited ability to identify signs of peri-implantitis. The diagnosis of peri-implantitis can be a cause of significant distress, resentment, and loss of trust to the treatment and the caregivers. Despite documented value in clinical research, currently available instruments assessing patient-reported outcomes have little application in day-to-day clinical practice. Face-to-face patient to doctor open-ended communication remains the most effective way to comprehensively establish the long-term "therapeutic alliance" essential for the long journey for the periodontitis patient.

Clinical Evaluation of Short (6 mm) and Longer Implants Placed Side by Side in Posterior Partially Edentulous Area: A 3-Year Observational Study

Background

Short implants have been proposed as an alternative solution for the rehabilitation of atrophic posterior region.

Purpose

To compare the clinical outcomes between 6 mm short implants and conventional implants placed under similar conditions of bone quality and occlusal loading.

Materials and Methods

Nine patients received atone 6 mm implant and one standard-length (8 mm length or longer) implants in a total of 10 partially edentulous areas. Implants were left submerged for 3-6 months healing period and the screw-retained splinted prostheses were delivered. When the provisional or final restoration was placed, and at each year after loading, standardized intraoral radiograph was taken for themarginal bone level (MBL) changes around the implants. Subsequently, the patients were recalled for the clinical examination evaluating the implant survival, sulcus bleeding index, suppuration, and the incidence of prosthetic complications at every 6 months after the definitive crown delivery. The observation period was continued to 3 years (mean follow-up was 3.4 ± 0.3 years) after functional loading.

Results

Nine patients (10 short implants and 10 standard length implants) were selected in this study. Cumulative survival rates of the short implants and standard-length implants were 100% in both groups, and no biological and prosthetic complication were found in 3 years observation period. Cortical bone thickness of implant insertion sites was 1.39 ± 0.45 mm at short implants and 1.38 ± 0.69 mm at standard-length implants, and trabecular bone computed tomography values of implant insertion sites was 424.1 ± 290.1 at short implants and 410.9 ± 267.9 at standard-length implants. The MBL changes were -0.30 ± 0.71 mm at short implants and -0.19 ± 0.78 mm at standard-length implants at 3 years follow-up visit. No significant difference was found in the average of MBL changes between implant length.

Conclusions

Within the limits of this study, it can be concluded that 6 mm short implants in a posterior edentulous region showed excellent results compared with conventional implants.

Patient satisfaction following dental implant treatment: A survey

PURPOSES

This aim of this cross-sectional study was to investigate the factors associated with patient satisfaction in patients with a dental implant-supported single crown or fixed prosthesis.

MATERIALS AND METHODS

One hundred and ninety-six patients with dental implants functioning more than 1 year were provided with a 13-question questionnaire to report their satisfaction regarding the functional aspects, aesthetic outcome, cleansing ability, general satisfaction, treatment cost, and overall satisfaction. Patient satisfaction was reported using a visual analogue scale (VAS). The association of these variables and each aspect of satisfaction were investigated by multivariate linear regression analysis.

RESULTS

One hundred forty-four of 196 patients reported high overall satisfaction (VAS > 80%). All aspects of patient satisfaction levels were very high (mean VAS > 80%), except for satisfaction in cleansing ability and treatment cost (mean VAS < 75%). The patients with a history of implant failure had significantly lower satisfaction in the functional aspects, aesthetic outcome, and general satisfaction than patients without implant failure (p ≤ 0.001). The subjects who experienced mechanical complication were less satisfied with treatment cost (p = 0.002). Sinus augmentation negatively affected functional satisfaction compared with individuals without sinus augmentation (p = 0.041). The subjects with a higher income or a posterior implant had significantly higher overall satisfaction (p = 0.003 and p < 0.001, respectively). Moreover, restoration by specialists positively affected general satisfaction compared with being restored by post-graduate students (p = 0.01).

CONCLUSION

Patients restored with a dental implant-supported single crown or fixed prosthesis had very high patient satisfaction. Implant failure, mechanical complication, and sinus augmentation negatively affected patient satisfaction in multiple aspects. In contrast, the factors positively affecting patient satisfaction were a posterior implant, patient's monthly income, and restoration by specialists. These results have to be interpreted with care due to the cross-sectional study design.

The Influence of Health Behavior on Immediate Loading Implant Success and Patient Satisfaction In The Complete Edentulous Treatment

Objective: The cases of edentulous treatment are increasing in Turkey. The patients are less satisfied with the health care facilities of the public sector health institutes. The government of Turkey is facing critical challenges for medical reforms in the public sector to improve the living standards of the public. The objective of current research is to determine the influence of health behavior on immediate loading implant success and patient satisfaction in complete edentulous treatment. Method: A Likert scale questionnaire is employed and the response rate of this research is 71%. The population of this research is the patients visiting different clinics for edentulous treatment and loading implant success. Results: The research findings demonstrate the satisfaction of the patients and implant success is influenced by the health behavior of patients. Conclusion: The model of this research is enrichment in the knowledge of the edentulous treatment of the patients. The practical implications of this research are outstanding to influence the satisfaction of the edentulous treatment patients who are getting the treatment of loading implant success. The research has certain limitations that are straightforwardly presented with future directions to enrich the knowledge of edentulous treatment by the research work of scholars in health care.

Patient-reported outcomes in patients with severe maxillary bone atrophy restored with zygomatic implant-supported complete dental prostheses: a systematic review

Introduction and Objective: Zygomatic implants (ZI) offer a good and predictable alternative to reconstructive procedures of atrophic maxillae. The main objetive of this systematic review was to assess the effect of rehabilitation with zygomatic implants on patient's quality of life (QLP) using Patient Reported Outcomes Measures (PROMs).Materials and Methods: This review followed PRISMA guidelines. An automated electronic search was conducted in four databases supplemented by a manual search for relevant articles published until the end of January 2021. The Cochrane Collaboration Risk of Bias tool and the Newcastle-Ottawa Quality Assessment Scale were used to assess the quality of evidence in the studies reviewed.Results: General findings of this systematic review showed substantial increases in Oral health-related quality of life (OHRQoL) among patients restored with ZI and high scores in terms of general satisfaction, especially in chewing ability and esthetics. An overall survival rate of ZI was 98.3% after a mean follow-up time of 46.5 months was observed. Occurrence of 13.1% biological complications and 1.8% technical complications were reported.Conclusions: Patients rehabilitated with zygomatic implant-supported complete dental prostheses showed substantial improvements in OHRQoL and general satisfaction with the treatment received.

Lateral Alveolar Ridge Augmentation with an Autogenous Bone Block Graft Alone with or without Barrier Membrane Coverage: a Systematic Review and Meta-Analysis

Objectives

To test the hypothesis of no difference in implant treatment outcome following lateral alveolar ridge augmentation with autogenous bone block graft with or without barrier membrane coverage.

Material and Methods

PubMed (MEDLINE), Embase and Cochrane library search in combination with a hand-search of relevant journals was conducted. Human studies published in English until the 8^th of February 2021 were included. Randomised controlled trials with an observation period longer than three months were included. Survival of implants and suprastructures were considered as primary outcomes measures, whereas peri-implant marginal bone loss, dimensional changes of the alveolar ridge, bone regeneration, patient-reported outcome measures, biological and mechanical complications were secondary outcome measures, as evaluated by descriptive statistics and meta-analysis including 95% confidence interval (CI).

Results

Electronic search and hand-searching resulted in 411 entries. Five randomised controlled trials characterised by low or high risk of bias fulfilled inclusion criteria. No statistically significant difference between the two treatment modalities was observed in any of the outcome measures. However, barrier membrane coverage was associated with a non-significant gain in alveolar ridge width of 0.5 mm (95% CI = -0.1 to 1.1) and diminished resorption of -0.9 mm (95% CI = -2.4 to 0.7) compared with no barrier membrane coverage.

Conclusions

Comparable implant treatment outcomes were revealed following lateral alveolar ridge augmentation with autogenous bone block graft alone with or without barrier membrane coverage. However, postoperative dimensional changes of the augmented seems to be diminished with the use of barrier membrane coverage as evaluated by two-dimensional linear measurements.

Dentists' Attitudes Toward Dental Implant Maintenance in Thailand

INTRODUCTION

As implant therapy is a widely applied treatment modality, general dentists are in the frontline of maintaining health in patients with implants. It is however unknown to what extent general dentists are competent and feel prepared to deliver maintenance of implants to patients.

OBJECTIVES

The aim of this study was to investigate the attitudes and self-reported and objectively assessed competences of general dentists with maintenance of dental implants in patients.

METHODS

A questionnaire designed and validated for the purpose of the study, including attitudes and self-reported and objectively assessed competences, was distributed by means of an online platform.

RESULTS

Data from 429 questionnaires were included in the study. Half of the participants were 28 to 33 y old and 78% had been working <10 y. Seventy-eight percent believed that dental implant maintenance should be performed by general dentists, but only 51% were prepared to do this, citing obstacles such as insufficient knowledge and limitations of their working environment. The mean ± SD objectively assessed competence score was 8.97 ± 2.74 of 17. There were significant differences (P < 0.001, 1-way analysis of variance) in the scores among dentists who offered the full range of maintenance and management of complications (10.83 ± 2.45) with those willing to provide comprehensive oral examination and implant maintenance only (9.31 ± 2.73), those offering comprehensive examination but unwilling to conduct maintenance (8.22 ± 2.28), and those who refer all dental implant patients elsewhere (7.2 ± 2.66). Around half of the dentists believed that implants last for life.

CONCLUSIONS

While general dentists appeared to largely acknowledge the importance of providing implant maintenance care and present with positive attitudes, a large portion was unwilling to engage with maintenance of implants in patients and appeared to lack essential competences to this end. The main obstacles for providing implant maintenance care included insufficient knowledge and lack of a properly equipped clinical environment.

KNOWLEDGE TRANSFER STATEMENT

The results of this study can identify deficiencies in the currently available maintenance competences and schemes for patients with implants. These results can also help dental professionals, scientific bodies, and associations to design appropriate education and professional development strategies that can strengthen the confidence and competences of general dentists, thus offering better service to the public.

Comparing pre- and post-treatment patients' perceptions on dental implant therapy

BACKGROUND

Appropriate patients' perceptions as one of Patient Reported Outcome Measures (PROMs), are shown to be critical for the sustainable success of implant therapy, little is known however of how they prospectively evolve throughout the treatment process.

OBJECTIVE

This study aimed to prospectively assess patients' perceptions before and after treatment with dental implants and to identify the impact of patients' characteristics on their perceptions.

MATERIALS AND METHODS

Patients' perceptions on implant therapy were prospectively assessed by means of purpose-made questionnaire, rating the extent of agreement/disagreement with a set of statements on a visual analog scale. The questionnaire was collected before initial consultation with the implant dentist and post-treatment at least 1 month after prosthetic loading of the implant. Changes in patients' perceptions were analyzed with the Wilcoxon signed-rank test.

RESULTS

Pretreatment questionnaire was collected from 359 patients. While 245 of them proceeded with implant therapy, 145 received final restoration within the timeframe of the study and completed the post-treatment questionnaires between 1 and 6 months after prosthesis delivery. The most common source of information was dental professions (72.4%). Although patients' perceptions were more realistic at post-treatment, few improper perceptions persisted as only 51% of patients agreed with the statement "There is a chance of dental implant failure," 28% agreed with the statement "Dental implants last longer than natural teeth," and higher percentage of patients agreed with "Dental implant therapy is appropriate for all patients."

CONCLUSIONS

Although patients appear to harbor more realistic perceptions of implant therapy, certain improper perceptions still persist at post-treatment. The design of appropriate patient educational program might be essential to correct misperceptions that might affect long term success of implant therapy. This study had been registered on Thai Clinical Trials Registry (TCTR) with the TCTR identification number: TCTR20181101001.

Patient-reported outcome measures of edentulous patients restored with single-implant mandibular overdentures: A systematic review

AIM

To review the literatures concerning the effect of the single-implant mandibular overdenture (SIMO) on patient-reported outcome measures (PROMs) and masticatory function in the fully edentulous patients.

MATERIALS AND METHODS

Electronic databases (PubMed, Cochrane Library, EMBASE and Web of Science) were searched, complemented with manual resources. Prospective studies published in English up to February 2020 reporting the effect of SIMO on PROMs and masticatory function in the edentulous patients were included. This review focused on oral health-related quality of life (OHRQoL), satisfaction and masticatory function outcomes.

RESULTS

Of 1157 initially screened articles, 9 randomised controlled trials (RCTs) and 8 prospective studies involving 551 subjects fulfilled the inclusion criteria. Two RCTs were graded as high risk of bias or some concern, while others were low risk. All prospective studies had adequate representativeness and assessment, but only one study had a controlled cohort. In general, the edentulous patients restored with SIMOs had improved OHRQoL and general satisfaction compared to those with conventional complete dentures (CCDs), but the outcome of masticatory function was controversial. Compared with two-implant mandibular overdenture (TIMO), SIMO showed no significant differences regarding general satisfaction and satisfaction with speech, comfort, chewing ability, aesthetics and social life. Conflicting results were observed in OHRQoL and satisfaction with retention and stability. Better masticatory performance was observed in TIMO group than SIMO group.

CONCLUSION

Within the limitation of this review, SIMO is featured with better OHRQoL and satisfaction than CCD. SIMO and TIMO rendered similar patient satisfaction, but TIMO had better masticatory performance.