Transcript
Gabor Tepper
Robert Haas
Georg Mailath
Christoph Teller
Thomas Bernhart
Gabriel Monov
Georg Watzek
Representative marketing-oriented
study on implants in the Austrian
population. II. Implant acceptance,
patient-perceived cost and patient
satisfaction
Author’s affiliations:
Gabor Tepper, Robert Haas, Georg Mailath,
Thomas Bernhart, Gabriel Monov, Georg Watzek,
Department of Oral Surgery, Dental School of the
University of Vienna, Austria
Christoph Teller, Department of Retailing and
Marketing Vienna University of Economics,
Vienna, Austria
Gabor Tepper, Robert Haas, Georg Mailath,
Thomas Bernhart, Gabriel Monov, Georg Watzek,
Ludwig Boltzmann Institute of Oral Implantology
and Gerostomatology, Vienna, Austria
Key words: implants, survey, public evaluation, implant acceptance, patient satisfaction,
Correspondence to:
Gabor Tepper
Department of Oral Surgery, Dental School of the
University of Vienna, Austria
Waehringerstrasse 25A
A-1090 Vienna,
Austria
Tel: þ 43 1 4277 67011
Fax: þ 43 1 4277 67019
e-mail:
[email protected]
presented with 14 questions. Of those familiar with implants as one of the treatment
patient-perceived cost, marketing
Abstract: Oral implantology is an established subspecialty of restorative dental and oral
surgery. While an extensive body of evidence on the fundamentals of osseointegration and
associated factors has been published, marketing-oriented analyses based on representative
public opinion polls of implant acceptance, patient-perceived cost and patient satisfaction
are scarce. In this study, an attempt was made to address these points by questioning a
representative sample of 1000 adults in the household setting.The interviewees were
alternatives, 61% reported they would accept implants if the need arose. Implant
acceptance was highest among males and interviewees below the age of 30 years. The
interest in implants increased with increasing family incomes. Four percent of those
questioned already had implants. Twenty-five percent knew someone who had undergone
implant treatment. All those questioned found implant-supported rehabilitation to be very
expensive. Many of them blamed the dentists for the high cost. One detail was particularly
evident: satisfaction among implanted patients was clearly higher than satisfaction rates
perceived by them from what they were told about implants by others. First-hand
experiences with implants proved to be less biased than reported second-hand information.
Date:
Accepted 24 June 2002
To cite this article:
Tepper G, Haas R, Mailath G, Teller C, Bernhart T,
Monov G, Watzek G. Representative marketing-oriented
study on implants in the austrian population. II. implant
acceptance, patient-perceived cost and patient
satisfaction.
Clin. Oral Impl. Res, 14, 2003; 634–642
Copyright r Blackwell Munksgaard 2003
ISSN 0905-7161
634
In 1988 about 300,000 implants were
inserted worldwide (Davies 1996). Shortly
before the turn of the millennium, the
implant insertion rate was estimated to be
more than 1 million (Brunski 1999).
Implant-supported rehabilitation substantially improves the quality of life and selfconfidence of the patients by giving them
more masticatory comfort (Mu¨ller et al.
1994). In a literature search of reports on
dental implants, roughly 6000 citations
were found. These reflect the extensive
basic and clinical research on a wide
spectrum of aspects ranging from novel
implant surfaces, to bioactive growth fac-
tors to such details as the ideal suture
material in dental implantology (Ivanoff &
Widmark 2001). But what the public
thinks about dental implants has largely
been neglected. The result is that those
involved in the industry risk going ahead
without regard to the consumers, i.e. the
patients, because they ignore market requirements and let things go their own
way. However, medical responsibility and
vital economic interests necessitate an
appraisal of the role accorded to implants
by the public by analyzing patient feedback.
In a Swedish study, long-term satisfaction
rates were determined 10 years after
Gabor Tepper, et al . Marketing-Oriented study on implants –II
implant treatment. These showed 97% of
those questioned to be generally satisfied
with masticatory function and phonation
and to be more self-confident (Sandberg et
al. 2000). In a survey evaluating patient
satisfaction after implant treatment, even if
provided by office-based dentists with little
experience in this field, implant-supported
solutions were reported to be clearly superior to conventional removable dentures in
terms of chewing comfort, esthetic appearance and phonation (De Bruyn et al. 1997).
The outcome of another two surveys is of
particular interest: 51% of the fully dentate
individuals said implants would be the
desired treatment of first choice vs. no
more than 7% and 8%, respectively, of the
edentulous patients. This indicated that
the subjectively perceived need for highquality implant-supported rehabilitation
decreased with increasing deterioration
of dental health and dental status
(Uhrbom & Bjerner 1990; Palmqvist
et al. 1991).
In this representative opinion poll, an
attempt was made to pinpoint the role
currently accorded to dental implants by
the public in Austria as a model case for the
European Union (EU). To this end, personal
interviews were conducted by professionally trained interviewers from an institute
for market research in private households
based on targeted focused questions. Part I
addressed the level of information, the
sources of information and the subjectively
perceived as well as the objective need for
patient information (Tepper et al. 2003).
This contribution (Part II) deals with
implant acceptance, subjective patient
views about cost and cost-generating factors as well as patient satisfaction with
implants in situ. A special point was made
to compare satisfaction reported first hand
by those who had already undergone
implant treatment themselves with second-hand experiences communicated to
the interviewees by others. The data
gathered were analyzed from the vantage
point of modern marketing with a dual
purpose in mind: (1) to enable both hospital
and office-based dentists to design suitable
communication strategies for patient information and (2) to enable the industry and
the dental schools to anticipate intermediate-range demand both for production
planning and training of implant dentists
and maxillofacial surgeons.
Material and methods
The present poll was commissioned by the
Department of Oral Surgery, University of
Vienna Dental School, and conducted by
the Austrian Gallup Institute (Dr Karmasin – Market Research). The data accumulated were subjected to a marketingoriented analysis by the Department of
Retailing and Marketing at the Vienna
University of Economics and Business
Administration. The methods used were
reported elsewhere (Tepper et al. 2003) and
are summarized briefly.
Thirty-two questions were presented to a
total of 1000 individuals. Of these, 14 are
dealt with in this contribution. The items
in the first set of questions, about implant
acceptance included dental status, replacements for missing teeth, if any, and the
general attitude towards the need for
prosthodontic rehabilitation. In a second
set of questions, public opinion on the cost
of implant treatment and the patientperceived cost-generating factors was
probed. And finally patient satisfaction
with implants was evaluated, with special
emphasis on comparing personal experiences made by implant-treated patients
with those communicated to the interviewees by friends and acquaintances.
The demographic data of the sample, the
polling period, the polling method and the
follow-up mechanisms are identical to
those reported in Part I (Tepper et al.
2003). Fig. 1 gives a brief outline.
The Appendix lists those 14 of the total
of 32 items, which form the basis of this
report. They were grouped together in three
sets:
A
B
C
Dental status, crowns, bridges and
dentures, if any, and general attitude
towards prosthodontic rehabilitation
for evaluating implant acceptance
Cost of implant treatment
First-hand or second-hand experience
with implants and satisfaction with
implant-supported rehabilitation.
Results
Dental status, crowns, bridges and
dentures, if any, and general attitude
towards prosthodontic rehabilitation to
evaluate implant acceptance
Of those questioned, 97% felt that missing
teeth should be replaced in adults. But only
72% (77% of the women and 66% of the
men) found that this was absolutely necessary. Twenty-five percent (29% of the
women and 22% of the men) would only
have their missing teeth replaced if the gap
were visible. Three percent of the sample
(1% of the women and 5% of the men)
thought that closing a gap in the row of
teeth was unnecessary. Of the interviewees
with higher professional qualifications in
the higher income brackets who lived in
communities with more than 50,000 inhabitants, 99% were affirmative about the
need of prosthodontic rehabilitation vs.
94% of those living in communities with
less than 50,000 inhabitants.
Asked whether they had already lost at
least one tooth or more, 41% answered
Fig. 1. Brief summary of the Material and methods.
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Clin. Oral Impl. Res. 14, 2003 / 634–642
Gabor Tepper, et al . Marketing-Oriented study on implants –II
‘yes’ and 59% answered ‘no’. In this
respect there was no difference between
males and females (males 50%, females
50%). Twenty-six percent had lost three
teeth, 8% four to five teeth, 7% up to 10
teeth, 4% more than 10 teeth and 5%
almost all their teeth. Six percent of those
questioned were edentulous and 5% did
not contribute any answer to this question.
The answers given differed substantially
by age. Below 30 years, 25% of those
interviewed reported to have lost one to
three teeth vs. 56% of those below 50 years
and 85% of those above 50 years. The
socio-economic status and the net family
income also made a difference. In the
income bracket up to h900 73% of the
sample had lost at least one to three teeth
vs. no more than 40% with an income
above h2200. The size of the place of
residence was irrelevant for the dental
status.
Of those who had lost one or more teeth,
70% said they had their missing teeth
replaced. Thirty-four percent had crowns or
bridges, 13% had removable partial dentures, 18% had complete dentures at least
in one jaw and 4% had implant-supported
replacements. The others did not give any
information on this point. Below age 50
only 2% had full-arch dentures vs. 31%
above age 50. Thirty percent of the sample
had at least one gap without any replacements.
Asked about how satisfied they were
with the way in which their missing teeth
were replaced, the mean satisfaction score
on a rating scale equivalent to the school
grades in Austria (1 – 5) was 2.06 for the
men vs. 1.73 for the women (Dillon et al.
1994). The mean score for the entire
sample was 1.87. Of those above 50, who
mostly had removable dentures, 36% said
they were very satisfied. Of those in the
younger age group, who were mostly
rehabilitated with nonremovable bridges,
41% were very satisfied. All in all, 41% of
those rehabilitated with crowns, bridges or
dentures were very satisfied irrespective of
the type of prosthodontic work. Among
those with implant-supported rehabilitations, the satisfaction rate was much higher, i.e. 51% for function and 62% for
esthetic appearance.
Of those who were familiar with implants, 61%, i.e. 65% of the men and 58%
of the women, would have their missing
636 |
Clin. Oral Impl. Res. 14, 2003 / 634–642
teeth replaced by implants. Aside from the
gender, age also made a difference: Implants
would be accepted by 73% of those below
30 years, by 64% of those up to 50 years
and by no more than 51% of those over 50
years. Implant acceptance also varied as a
function of the monthly family income. Up
to a net income of h900, 55% were prepared
to accept implants. The implant acceptance
rate increased to 61% at an income of up to
h1500, to 64% at up to h2200 and to 74%
at incomes above this level. Twenty-three
percent of the sample decidedly rejected
implants. Only 37% thought every one
could be rehabilitated with implants.
Cost of implant treatment
Asked to estimate what a single implant
without suprastructure would cost, 18%
said up to h750, 26% said h1000, 20% said
h1500, 11% h2000, 16% said more than
h2000 and 9% were undecided. Seventyeight percent felt the price they had
estimated was too high, 12% found it fair,
1% thought it was favorable and 9% did
not answer. Even of those who gave an
estimate of h750 at most, 75% felt that this
was too expensive. In the group already
rehabilitated with implants, 79% thought
implant treatment was too expensive.
The interviewees were also asked how
much – in their view – a dentist himself
would have to pay for purchasing an
implant. Nine percent thought up to
h100, 26% up to h200, 34% up to h350,
14% up to h700, 2% up to h1000, 1% more
than h1000 and 15% did not know. A
below-average purchasing price for the
dentist of 100 at most was quoted by 12%
of those in the lowest income bracket vs.
only 2% of those in the highest income
bracket and by 12% of those living in
smaller communities with less than 5000
inhabitants vs. only 5% of those living in
towns with more than 50,000 inhabitants.
Sixty-two percent of the sample attributed the cost of implant treatment to the
dentists, 21% to the lab technicians, 15%
to the manufacturers and to taxes, 9% to
the dealers, while 7% were undecided. Of
those rehabilitated with implants, 54%
thought the dentists were responsible for
the price, 23% held the lab technicians
responsible, 12% the dealers, 10% the
taxes and 6% the manufacturers. Two
percent did not reply.
Asked who should pay for implant
treatment, 72% said the sick funds/social
security agencies, 21% said private insurers, 14% felt the patient should bear
the cost and 4% were undecided. Among
the women, 18% would have the patient
pay vs. only 9% among the men. This view
was shared by 8% of those below 30 years
and 14% of those above 50 years. Of those
already rehabilitated with implants, 80%
felt the sick funds/social security agencies
should bear the cost for implant treatment.
Only 8% would have the patient pay for it.
Views about who should pay also varied by
professional qualifications: self-financing
was advocated by 25% of the self-employed, freelancers and executives vs. only
9% of the blue-collar workers, 10% of the
civil servants and white-collar workers and
12 of the retirees. Of those in the highest
income bracket, 19% were ready to pay
themselves for implant treatment vs. only
13% of those in the lowest income bracket.
First-hand or second-hand experience with
implants and satisfaction with implantsupported rehabilitation
Twenty-five percent of the sample reported
to know someone fitted with implants.
Four percent had themselves undergone
implant treatment. This applied to 2% of
those below 30 years of age and to 6% of
those above 50 years as well as to 10% of
the self-employed, freelancers and executives vs. no more than 2% of the blue-collar
workers with an obvious gradient between
urban and rural communities: only 3% of
those living in communities with less than
5000 inhabitants had undergone implant
treatment vs. 12% in an urban environment with more than 50,000 inhabitants.
Of the implanted patients, only 10% had
had removables before, i.e. 12% of the men
and only 5% of the women.
In the group of implanted patients, 18%
of those above 50 years had had removables
before vs. 0% of those younger than 50
years. Of those earning less than h900 and
h1500, 11% and 15%, respectively, had
had removables before vs. no one among
those in the higher income brackets. Sixtytwo percent of the implanted patients were
very satisfied with their esthetic appearance. But only 51% were very satisfied
functionally. On average, the esthetic
appearance scored 1.4 on a school grade
Gabor Tepper, et al . Marketing-Oriented study on implants –II
scale of 1 – 5 vs. 1.61 for function. Of those
under 30 years, 75% were very satisfied
both esthetically and functionally vs. no
more than 34% of those above 50 years.
Interviewees
with
implant-treated
friends or acquaintances reported that only
29% of these were very satisfied, while 6%
were dissatisfied.
The bar charts in Fig. 2 illustrate the
most important data.
Discussion
The major differences between this representative patient poll about the level of
information and the attitude of the Austrian public towards dental implants and
most of the earlier studies were highlighted
at length in Part I (Tepper et al. 2003). They
mainly relate to the type of questioning, the
number of items covered, the size and
representativeness of the sample and a
marketing-oriented approach to data analysis and interpretation. In keeping with the
marketing-oriented approach, face-to-face
interviews in private households, while
cost-intensive, appeared to be best suited
for obtaining valid data in view of the
complex nature of the subject and the
intended minimization of the nonresponse
rate (Zikmund 1999).
The analysis of the complex questionnaire brought forth a number of conclusions. Situated in Central Europe, the
polling area, i.e. Austria, is well compar-
able with the standards generally prevailing
in the EU in terms of socio-economic
variables, health care, average monthly
income, life expectancy, education and
dental care provision. Consequently, the
data collected can be expected to reflect
conditions in most of the country members
of the EU (Statistik Austria 2001).
A. Dental status, crowns, bridges and
dentures, if any, and general attitude
towards prosthodontic rehabilitation to
evaluate implant acceptance
Interestingly, 25% of those questioned felt
that replacing missing teeth was only
necessary if the gap was visible. This agrees
well with a published report indicating that
79% of the Swedish population did not
Fig. 2. (a – e) Bar charts illustrating the most important data.
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Clin. Oral Impl. Res. 14, 2003 / 634–642
Gabor Tepper, et al . Marketing-Oriented study on implants –II
think missing teeth needed to be replaced
(Palmqvist et al. 1991). Dental care providers should make a greater effort to
sensitize their patients to the complex
consequences of intermediate or terminal
gaps left unattended for the entire masticatory system, lest they neglect their obligation to provide information on late sequels.
Early instruction in oral hygiene and
information about the need for regular
preventive dental care should particularly
target the socio-economically less privileged, because 73% of those in the lowest
income bracket had lost up to three teeth
vs. no more than 40% of those in the
highest income bracket. As 30% of the
sample reported to have at least one
unattended gap, the potential for restorative
dentistry, both implant-supported and conventional, is still largely untapped.
The satisfaction rates with what restorative solutions patients currently have provide a major challenge for the future: as
only 41% of the nonimplanted patients
were very satisfied with them vs. 62%
(esthetics) and 51% (function) of the implanted patients, nonremovables should be
offered to as many patients as possible. This
would require that dentists, implantologically oriented organizations and the industry provide adequate information about this
option before the need for treatment arises
(Tepper 2003). Interestingly, a study conducted in Germany showed that elderly
patients are more willing to put up with
functionally poor dentures (Mu¨ller et al.
1994), because they more or less unconsciously accept age-related losses of masticatory function and tend to develop
compensatory adaptive processes (Korunder & Marken 1967).
The acceptance rates of implant treatment varied considerably by gender (65%
of the males vs. 58% of the females) and by
age (75% of those under 30 years vs. 51%
of those above 50 years). This contrasts
with a German study, which did not find
resentments about oral implants to be agedependent (Mu¨ller et al. 1994). In the
present study only 55% of those in the
lowest income bracket were open-minded
about implants vs. 74% of those in the
highest income bracket. This agrees well
with a recent Norwegian study showing
that low age, high educational level, high
income and urban residence correlated
most strongly with the readiness to undergo
638 |
Clin. Oral Impl. Res. 14, 2003 / 634–642
implant treatment (Berge 2000). Reports
from Norway and Sweden also indicated
that low socio-economic status with poor
oral health was associated with a lack of
interest in implants (Rise & Holst
1982;Palmqvist et al. 1991, 1993). Looking
into implant denial rates, a study from
Finland showed that, despite very poor
function, only 15% of the denture patients
were interested in implant-supported rehabilitation (Salonen 1994). At first glance,
this study is not fully comparable with the
results of others. But as it involved a
preselected sample of edentulous Finns
aged 55 years, it once more confirmed that
a poor dental status was associated with a
lack of interest in implant treatment (Rise
& Holst 1982;Palmqvist et al. 1991, 1993).
In a German study the most common
reasons for rejecting implants were that
those above 67 years felt they were too old
and those below this age were satisfied with
what rehabilitation they had (Mu¨ller et al.
1994).
B. Cost of implant treatment
In the present study 61% of those questioned were convinced that implants were
only ‘for the rich’ without, however,
knowing how much they actually cost.
Expectedly, cost was not just a local
problem. In fact, 31% of the subjects
questioned in Japan (Akagawa et al.
1988), 30% in a Swedish study (Palmqvist
et al. 1991) and 29% in the USA (Zimmer
et al. 1992) reported that they rejected
implants because of the excessive financial
burden. Cost was not a major factor for the
patients in only one study conducted in
Germany (Mu¨ller et al. 1994). While most
of those interviewed correctly quoted the
price the patient has to pay for dental
implants and the dentist has to invest for
purchasing them, both implanted patients
and all other subjects questioned felt that
current prices billed to end users were too
high. Three-quarters of those interviewed
thought that social security agencies should
pay for implants, while only 14% would
want the patients themselves to pay for
them. More information about the investments needed for research, training and
implant production could help to make the
patients accept the expenses incurred by
implant treatment more readily. When
patients realize that implantology in many
respects touches upon the most complex
areas of state-of-the-art dentistry, they may
well be prepared to reconsider their views
about implant cost.
C. First-hand or second-hand experience
with implants and satisfaction with
implant-supported rehabilitation
Asked about how common implants were,
one-quarter (25%) of the sample admitted
to know at least one implanted patient.
This compares with 17% in the USA
(Zimmer et al. 1992). Four percent of the
subjects had undergone implant treatment
with at least one implant themselves. The
rate substantially differed in urban and rural
areas, with 3% implanted patients in the
rural communities and 12% in urban
environments. Thus, urban residence and
easier access to implant dentists or clinics
are major factors underlying implantation
rates.
In regard to patient satisfaction with
endosseous implants, negative impressions
apparently tend to be more readily communicated than positive experiences. This
was reflected by the satisfaction rates with
in situ implants. Of the implanted patients,
62% reported to be very satisfied with their
implants esthetically and 51% functionally. But when asked about the satisfaction
of implanted patients they knew, they said
only 29% of them were very satisfied. In
several studies very high satisfaction rates
were noted among implanted patients with
access to first-hand information, e.g. 97%
satisfied patients in the study by Grogono
et al. (1989). In another two studies 90–
93% of the implanted patients said they
would again undergo implant treatment
(Gu¨nay et al. 1991; De Bruyn et al. 1997).
Matters were, however, quite different for
second-hand experiences. In a study conducted in the USA, only 10% of the
nonimplanted interviewees thought their
implanted friends and acquaintances were
satisfied (Zimmer et al. 1992). Apparently
negative experiences communicated by
implanted patients made a greater impact
and prompted their friends and acquaintances to rate their satisfaction as suboptimal. This may, at least in part, be
attributable to the tendency of primarily
communicating first impressions gathered
during the immediate postsurgical or
prosthodontic management stage rather
Gabor Tepper, et al . Marketing-Oriented study on implants –II
than experiences made later with fully
functional and uneventfully incorporated
bridges or dentures that the patients have
become used to. Dramatized negative
experiences with in-use problems communicated to others may also be a factor. This
is supported by the clearly higher satisfaction rates of the implanted patients themselves, who need not go by second-hand
information and have often experienced
dramatic improvements in chewing comfort and quality of life during variable in-use
times. In a Swedish study, patient satisfaction with the esthetic outcome scored
much higher than comparable ratings by
the prosthodontists (Chang et al. 1999).
Esthetic criteria important for the prosthodontists like red–white esthetics apparently
were of secondary importance for the
patients. The high satisfaction rates of
implanted patients should, however, be
seen in the light of a key factor elicited in
a Swedish study: 83% of those questioned
said they did not want to have implants
because they were quite happy with their
removable dentures (Palmqvist et al. 1991).
To balance matters it is important to quote
a recent study, which showed that implant
treatment personally experienced was the
key factor underlying a positive attitude
towards dental implants (Berge 2000).
Marketing-oriented
interpretation of the data
For ethical reasons, marketing-oriented
analyses are a highly sensitive matter in
medicine generally. What objections and
concerns have been raised against them was
dealt with at some length in Part I of this
study (Tepper et al. 2003). In full awareness
of treading on virgin ground, a brief marketing analysis of the data shall nevertheless be
added. This appears to be justified for
several reasons, among them the inherent
need to provide a sound financial basis for
state-of-the-art medical and dental care of
the masses in the future.
Considering that 30% of the sample had
at least one missing tooth that was not
replaced, the market potential available to
oral implantology is all but fully exhausted.
Competent communication between the
doctor and the patient by professional
relational management supported by implant organizations would appear to be the
most important source for generating and
channeling demand for implants. Consumer-oriented, i.e. patient-oriented, information campaigns designed to dispel
misconceptions could eventually boost the
patients’ demand for implants and, given an
adequate purchasing power, generate a pull
effect (Scheuch 1996; Kotler & Bliemel
2001).
In regard to subjectively perceived prices,
it should be noted that consumers of
implants can at best give limited estimates
of what implants are worth. Both the
complex nature of the product and the
service input needed make it extremely
difficult for them to put a figure to the
expected benefits (Meffert 2000). Emphasizing the special advantages of the product
and the service input associated with it in
comparison to alternative treatment options by effective information should have a
positive impact on what patients subjectively think about the cost of implant
treatment. Giving consumers an idea of
what implant dentists have to spend on
investments and maintenance would also
be helpful (Kotler & Bliemel 2001).
In a difficult field like oral implantology
with its many options all dental implant
systems should be subjected to regular
long-term evaluations for purposes of
quality assurance (Morgan & Chapman
1999). A Swedish report on patient satisfaction 10 years after implant treatment
recommended condensing patient experiences into an information leaflet and
making this available to prospective implant patients (Sandberg et al. 1999). As
such a leaflet would be based on first-hand
information, it would be an effective confidence-building tool. Another tool proposed was an international identification
system. It would help to retrace the history
of implants and provide reliable information on complications and re-interventions
(Colgan 1999). Planning for future demand
and anticipating the market potential for
oral implantology is a challenging task for
dental schools, specialized departments and
the industry. A recent study from Sweden
indicated that the percentage of edentulous
individuals below the age 74 years dropped
from 19% in 1975 to a current 3%
(Osterberg et al. 2000). Based on these data,
95% of those below 74 years and 90% of
those below 84 years can be expected to be
more or less dentate by 2015. All this
makes it exceedingly difficult to predict
future demands in restorative dentistry in
general and oral implantology in particular.
Acknowledgements: This study was
funded equally by Nobel Biocare
Austria, Friadent – Schu¨tze, Degussa
Dental Austria GmbH and Straumann
GmbH Austria. The present report is
based on a commissioned opinion poll
conducted by Dr Karmasin Institute for
Market Research – Austrian Gallup
Institute Interview Division. The
authors gratefully acknowledge the
assistance of the Department of
Retailing and Marketing (Head: Prof.
Stieglitz), Vienna University of
Economics and Business
Administration.
Re´sume´
L’implantologie buccale est une technique applique´e
dans certaines spe´cialite´s de me´decine dentaire.
Tandis que la proportion d’e´vidences s’accrot en ce
qui concerne la recherche sur l’oste´oı¨nte´gration et
les facteurs associe´s, les analyses oriente´es sur le
marketing et l’opinion du public sur l’acceptation de
l’implant, le prix et la satisfaction se font rares. Cette
e´tude a e´te´ re´alise´e pour analyser ces diffe´rents points
via un e´chantillon de 1 000 adultes. Les interviewe´s
ont re´pondu a` quatorze questions. De ceux qui
e´taient familiers a` l’ide´e que les implants pouvaient
eˆtre une alternative au traitement, 61 % ont re´pondu
qu’ils pourraient si ne´cessaire y recourir. L’acceptation de l’implant e´tait plus importante chez les
hommes et les personnes aˆge´es de moins de trente
ans. L’inte´reˆt a` propos des implants augmentait
paralle`lement aux revenus de la famille. Quatre pour
cent des personnes e´taient de´ja` porteurs d’implants.
Vingt-cinq pour cent connassaient une personne
ayant subi un traitement d’implant buccal. Parmi
toutes les personnes interroge´es, la re´habilitation sur
implants semblait trop che`re. Beaucoup d’entre-eux
rejetaient la responsabilite´ des prix trop e´leve´s sur les
dentistes. Un de´tail e´tait particulie`rement e´vident :
la satisfaction parmi les patients posse`dant des
implants e´tait clairement plus importante que le
taux de satisfaction perc¸u par ceux n’en portant pas
mais ayant rec¸u l’information par d’autres personnes. L’expe´rience personnelle e´tait moins de´forme´e que celle obtenue de manie`re indirecte.
Zusammenfassung
Die orale Implantologie ist eine etablierte Subspezialita¨t der restaurativen Zahnmedizin und der
Oralchirurgie. Wa¨hrend extensive Evidenz u¨ber die
Grundlagen der Osseointegration und der assoziierten Faktoren publiziert worden ist, sind marketingorientierte Analysen basierend auf repra¨sentativen
Meinungsumfragen u¨ber die Akzeptanz von Implantaten, u¨ber die von Patienten empfundenen Kosten
und u¨ber die Patientenzufriedenheit rar. In dieser
Studie wird der Versuch unternommen, diese
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Gabor Tepper, et al . Marketing-Oriented study on implants –II
Punkte mit Hilfe einer Befragung einer repra¨sentativen Gruppe von 1000 Erwachsenen anzusprechen.
Den Befragten wurden 14 Fragen gestellt. Von
denen, welche u¨ber Implantate als Behandlungsalternative Bescheid wussten, gaben 61% an, sie
wu¨rden Implantate bei sich akzeptieren, falls die
Notwendigkeit dafu¨r besteht. Die Akzeptanz von
Implantaten war bei Ma¨nnern und Befragten unter
30 Jahren am gro¨ssten. Das Interesse an Implantaten
nahm mit zunehmendem Familieneinkommen zu.
Vier Prozent der Befragten hatten bereits Implantate.
Fu¨nfundzwanzig Prozent kannten jemanden, der
sich einer Implantation unterzogen hat. Alle Befragten empfanden Implantatversorgungen zu kostspielig. Viele davon fanden, der Zahnarzt sei schuld an
den hohen Kosten. Ein Detail war von besonderem
Interesse: Die Zufriedenheit bei mit Implantaten
versorgten Patienten war deutlich gro¨sser als die von
anderen Leuten empfundene Zufriedenheit, welche
u¨ber Implantatversorgung von anderen geho¨rt haben.
Erfahrungen mit Implantaten aus erster Hand waren
mit weniger Vorurteilen behaftet als Informationen
aus zweiter Hand, u¨ber die berichtet wurde.
Resumen
La implantologı´a oral es una subespecialidad establecida de restauracio´n dental y cirugı´a oral. Mien-
tras que se ha publicado una gran cantidad de
evidencias sobre los fundamentos de la osteointegracio´n y factores asociados, los ana´lisis orientados al
marketing basados en encuestas representativas de la
opinio´n pu´blica sobre aceptacio´n de los implantes,
costo percibido por el paciente y satisfaccio´n del
paciente son escasos. En este estudio se hizo un
intento de dirigir estos puntos encuestando una
muestra representativa de 1000 adultos en su hogar.
A los entrevistados se les presentaron 14 preguntas. De aquellos familiarizados con los implantes
como una de las alternativas de tratamiento, el 61%
respondio´ que aceptarı´an los implantes llegada la
necesidad. La aceptacio´n de los implantes fue mayor
en varones y entrevistados menores de 30 an˜os. El
intere´s en los implantes crecio´ con ingresos familiares crecientes. El 4% de los encuestados ya tenı´an
implantes. El 25% conocı´a a alguien que se habı´a
sometido a tratamiento de implantes. Todos los
encuestados encontraron la rehabilitacio´n con implantes demasiado cara. Muchos de ellos culparon a
los dentistas del alto costo. Un detalle fue particularmente evidente: La satisfaccio´n entre los pacientes implantados fue claramente mas alta que
los ı´ndices de satisfaccio´n percibidos por ellos de lo
que se les dijo sobre los implantes por otros. Las
experiencias de primera mano con implantes demostraron ser menos viciadas que las informaciones
reportadas de segunda mano.
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Appendix
Questionnaire – PART II
Implant acceptance, patient-perceived cost, patient satisfaction
A. Dental status, crowns, bridges and dentures, if any, and general attitude towards prosthodontic management to evaluate implant
acceptance
1. Do you think missing teeth should be replaced in adults ?
Yes, definitely
Yes, if the gap is visible
No
2. Have you lost one or more teeth in the past?
Yes
1–3
4–5
6–10
3. Did you have your missing teeth replaced?
Yes
If you did, what with?
Crowns, bridges, adhesive bridges
Implants/implant-supported bridges/dentures
4.
5.
More than 10
Almost all teeth
No
All teeth
4
5ydissatisfied
No
Metal-based dentures
Full-arch dentures
How satisfied are you with your current replacements?
1.
very satisfied
2
3
What do you personally think of implants?
Would have them made, if needed
Implants are good for everyone
Implants are expensive, only for the rich
Would not have any
Implants are not good for everyone
Everyone can afford implants
B. Cost of implant treatment
6.
How much do you think a patient has to pay for an implant in Austria without a crown, i.e. just for the post?
Up to h750
Up to h1,000
Up to h1500
Up to h2000
More than h2000
7.
Do you think this is
Favorable?
8.
9.
10.
C.
Fair?
Too much?
How much do you think a dentist has to pay for purchasing an implant from the manufacturer/dealer ?
Up to h100
Up to h200
Up to h350
Up to h700
Up to h1000
Who/what is mainly responsible for the final price?
Dentist
Lab technician
Manufacturer
Who should pay for the implant?
Patient
Sick fund/social security
Dealer
More than h1000
Taxes
Private insurer
First-hand or second-hand experience with implants and patient satisfaction with implants in situ
11. Have you yourself or any one you know ever had implants?
Yes, I have
Yes, someone I know
No
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12.
Before you had your implants put in, did you have removable dentures? (for implanted patients only)
Yes
No
13.
How satisfied are you with your implant(s)?
Esthetically
Very satisfied
Satisfied
Fair to middling
Not so satisfied
Unsatisfied
14.
If you know someone with implants, how satisfied is he/she with the implant(s)?
Very satisfied
1
Satisfied
2
Fair to middling
3
Not so satisfied
4
Unsatisfied
5
Do not know
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Functionally
1
2
3
4
5