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The Journal of Advanced Prosthodontics
437
Impact of a “TED-Style” presentation on
potential patients’ willingness to accept dental
implant therapy: a one-group, pre-test post-
test study
Henry Ghanem1†, Kelvin Ian Afrashtehfar2,3,4†, Samer Abi-Nader2,5, Faleh Tamimi2*
1
Private practice limited to Prosthodontics, Riyadh, KSA
2
Division of Prosthodontics and Restorative Dentistry, Faculty of Dentistry, McGill University, Montreal, QC, Canada
3
Division of Fixed Prosthodontics, School of Dental Medicine, University of Bern, Bern, Switzerland
4
Private practice limited to Prosthodontics, Riviera Maya, Mexico
5
Private practice limited to Prosthodontics, Montreal, QC, Canada
PURPOSE. A survey was conducted to assess the impact of a TED-like educational session on participants’
willingness to accept dental implant therapy. MATERIALS AND METHODS. Volunteers interested in having
information about dental implant therapies were recruited and asked to complete a two-part survey before and
after an educational session. The initial survey elicited demographic information, self-perceived knowledge on
dental implants and willingness to this kind of treatment. A “TED-style” presentation that provided information
about dental implant treatments was conducted before asking the participants to complete a second set of
questions assessing the impact of the session. RESULTS. The survey was completed by 104 individuals, 78.8%
were women and the mean age was 66.5±10.8. Before the educational session, 76.0% of the participants refused
dental implants mainly due to lack of knowledge. After the educational session, the rejection of dental implants
decreased by almost four folds to 20.2%. CONCLUSION. This study proved that an educational intervention can
significantly increase willingness to accept treatment with dental implants in a segment of the population who is
interested in having information about dental implant therapy. Furthermore, educational interventions, such as
TED-like talks, might be useful to increase popular awareness on dental implant therapy. [J Adv Prosthodont
2015;7:437-45]
KEY WORDS: Dental implants; Dental education; Treatment; Acceptance; Refusal; Cost; Fear
http://dx.doi.org/10.4047/jap.2015.7.6.437http://jap.or.kr
J Adv Prosthodont 2015;7:437-45
INTRODUCTION
The detrimental impact of partial and complete edentulism
on oral function and social interactions is well document-
ed.
1,2
The prevalence of edentulism has decreased over the
last decades,
1
however, the aging population in need of
dental prosthesis is expected to keep increasing
3
due to
higher life expectancy.
4
Implant-prosthodontics has been accepted as an alter-
native to traditional restorative treatments for partially and
completely edentulous patients.
5,6
Single and multiple tooth
implants-retained prostheses have been shown to achieve
high levels of success and patient satisfaction.
7,8
For instance,
implant supported overdentures have been associated with
an improvement in esthetics, functional efficiency and qual-
ity of life.
9-12
Although, this treatment has limitations, just
as any other dental treatment, and some clinicians still
believe that it should not be considered a gold standard,
11,13
the McGill
10
and York Consensus
11
on overdentures, and
Corresponding author:
Faleh Tamimi
Division of Prosthodontics and Restorative Dentistry, Faculty of Dentistry,
McGill University, Room M64, 3640 University Street, Montréal, QC
H3A 0C7, Canada
Tel. 1 514 398 7203x09654: e-mail, faleh.tamimimarino@mcgill.ca
Received May 5, 2015 / Last Revision November 20, 2015 / Accepted
November 24, 2015
© 2015 The Korean Academy of Prosthodontics
This is an Open Access article distributed under the terms of the Creative
Commons Attribution Non-Commercial License (http://creativecommons.
org/licenses/by-nc/3.0) which permits unrestricted non-commercial use,
distribution, and reproduction in any medium, provided the original
work is properly cited.
pISSN 2005-7806, eISSN 2005-7814
† Both authors contributed equally for this manuscript.
438
most academic prosthodontists of the United States,
12
sup-
port the idea that a two-implant overdenture should be the
first-choice of treatment for an edentulous mandible.
Despite all their benefits and being promoted as the
treatment of choice for many conditions, dental implants
are still scarcely used.
14
It has been reported that patients’
willingness to accept implant therapy is generally affected
by the cost of the treatment, the treatment itself (surgical and
prosthetic steps) and unfavorable patients’ health conditions.
To-date, the patient’s financial circumstances remains a major
obstacle to implant prosthetic treatment.
5,15-17
However, when
finance is not a limitation, patient acceptance may also be
limited by the time-intensive and multi-step process
involved in the implant treatment.
18
Unfavorable health
conditions and/or psychological and emotional factors,
19
such as fear, anxiety and disbelief, can also act as barriers to
dental implants acceptance.
15
Lack of awareness has also
been noted as an influential factor to negate the therapy.
14
It has been reported that more information about dental
implants should be provided to patients seeking dental
prosthesis.
20,21
TED and TED-like talks have been found to
be an excellent tool for releasing scientific information to
the public. Indeed, the TED Talks website is the single
most popular conference and events website in the world.
22
Even though, this type of talks have been criticized of
dumbing down ideas, and being overly enthusiastic and
mainly designed to entertain,
23
TED talks and similar plat-
forms may be able to provide opportunities for the acade-
my to further transmit research that might otherwise would
go unnoticed by the general public.
24
To our knowledge, there is no information about the
impact that “TED-style” educational interventions could
have on the awareness of potential dental implant patients.
Therefore, to assess the impact of TED-like talks on the
educational needs of the society in dental implantology, we
designed a survey to evaluate the public knowledge on den-
tal implant therapies, before and after attending a tailored
TED-like educational session. This approach helped evalu-
ate the impact of this type of educational tool on prospec-
tive candidates interested in knowing more about dental
implant treatments.
MATERIALS AND METHODS
Approval from McGill University Health Centre Research
Ethics Board was obtained to proceed with this study.
Newspaper advertisements were used to invite general pub-
lic to attend an informative session about dental implants
for replacement of missing teeth as part of the Mini-Med
School presentations program designed for general audi-
ence at the Sir Mortimer B. Davis Jewish General Hospital
(Montreal, Canada) auditorium. Volunteer participants (over
18 years old, missing at least a tooth other than a third
molar, able to understand English and living in, or nearby
the city) were recruited to complete the survey; no incen-
tives were provided to participate in the study. Participants
were excluded if they had been previously treated with den-
tal implant. An informed consent assuring anonymity and
confidentiality was signed by each respondent. The first
survey elicited demographic information such as age, gen-
der, education, income, marital status, mother tongue lan-
guage, type of denture used if any, self-perceived knowl-
edge about implants and information on whether the
respondents had ever considered treatment with dental
implants. In the case of treatment refusal, the reasons were
also registered choosing one choice of three categories:
lack of knowledge, high cost or fear/anxiety. After com-
pleting the first part of the survey, the participants received
a “TED-style” comprehensive educational lecture about
dental implant therapy by a Prosthodontist (S.A.).
25
The
educational session addressed patient selection, surgical and
prosthetic phase, postoperative indications, treatment
options, benefits, risks of complications, maintenance and
approximate costs. After the lecture, the participants com-
pleted the second part of the survey which included their
willingness to accept dental implants, and their reason for
refusing this treatment option, if any. In order to be includ-
ed in the study, participants should have reported their level
of self-perceived knowledge on dental implants prior to the
educational session (‘not at all’ being the lowest and ‘very
well’ the highest), and their willingness to accept dental
implant therapy before and after the session.
The timing of the posttest measure is important and
should be as short as possible in order to prevent the effect
of the intervention from being diluted or influenced by
confounding factors such as participation in other programs,
as well as social, or environmental circumstances. Therefore,
volunteer assessment was done immediately after the edu-
cational intervention in order to minimize impact on the
recall rate.
Statistical analyses included descriptive statistics of the
demographic characteristics of participants. Differences
among subgroups in regarding “level of implant knowl-
edge” and willingness to accept implant treatment were
assessed using chi square tests and logistic regression. The
results were expressed as odds ratio, both crude (OR) and
adjusted (AOR) for the confounding variables age, gender,
marital status, income, level of education, denture wearing,
and level of implant knowledge. The latter variable was
only considered as confounder for AOR calculations on the
analysis of “willingness to accept implant treatment”. OR
and AOR were used to determine how strongly each level
of implant knowledge was associated with the willingness
to accept implant treatment in our population sample.
The “before” and “after” educational session data were
compared using two-tailed Fisher’s exact test to determine
statistical significance of the change in willingness to accept
implant therapy and the reasons for refusal of implants.
The data analysis was conducted using the Statistical
Package Service Solutions software (SPSS, version 20.0,
Chicago, IL, USA). The level of significance was set at P <
.05 for all analyses.
J Adv Prosthodont 2015;7:437-45
The Journal of Advanced Prosthodontics
439
RESULTS
Out of 129 participants, 104 (response rate = 80.6%) report-
ed the self-perceived level of dental implant knowledge,
and the willingness to accept dental implants treatment
before and after the educational session. The “Total” col-
umn of table 1 presents the demographic characteristics of
respondents. More than three-fourths of the respondents
were women and a majority was above 65 years of age
(mean age 66.5 ± 10.8).
Prior to the educational session, nearly half of the par-
ticipants (47.1%) reported to have poor or no previous
knowledge on dental implants, while the other half (52.9%)
reported moderate to extensive knowledge on dental
implant treatments (Table 1). Associations between ‘level
of implant knowledge’ and age, gender, annual house
income, level of education, denture wearer and marital sta-
tus were analyzed (Table 1). Chi square analysis and crude
OR indicated that individuals with higher annual household
income (>$50,000) had significantly increased odds of hav-
ing higher implant knowledge than individuals with lower
income(≤$50,000).Similarlyindividualswithlessthancol-
lege education had lesser odds of having implant knowl-
edge than individuals with college or higher education.
After adjusting for all other confounding factors, AOR sug-
gested that participants who were denture wearers had high-
er implant knowledge than non-denture wearers (Table 1).
Gender differences were not significant, however women
showed a tendency of being more knowledgeable about
implants than men (Table 1).
The influence of demographic and clinical characteristics
on the willingness to accept treatment with dental implants
prior to the informative session was analyzed. Before the
information session, only 24% of respondents were willing
to consider implant treatment. Chi square analysis revealed
that higher level of knowledge on dental implants was signif-
icantly associated with higher odds for accepting treatment
with dental implants (P < .05). Individuals having a moder-
ate-to-very good knowledge on dental implants were 3.8
times (Crude OR) more likely to accept the treatment than
those with none-to-very little knowledge. Moreover, den-
tures wearers were significantly more likely to accept treat-
ment with implants than non-wearers. Logistic regression
analysis adjusting for potential confounders indicated that
Table 1. Factors influencing “level of implant knowledge”
Characteristics
Total
n (%)
104 (100)
Very well/
Moderately well
n (%)
55 (52.9)
Poorly/
Not at all
n (%)
49 (47.1)
OR
(95% CI) PAOR
(95% CI)†P
Age* ≤ 65 28 (35.9) 13 (33.33) 15 (38.5) 1
> 65 50 (64.1) 26 (66.67) 24 (61.5) 1.25
(0.49-3.16) .64 1.28
(0.33-9.34) .72
Gender Men 22 (21.2) 10 (18.2) 12 (24.5) 1
Women 82 (78.8) 45 (81.8) 37 (75.5) 1.46
(0.57-3.76) .43 4.03
(0.79-19.75) .09
Marital status Single 24 (23.1) 15 (27.3) 9 (18.4) 1
Married 71 (68.3) 37 (67.3) 34 (69.4) 0.65
(0.25-1.69) .38 6.42
(0.52-78.86) .15
Other 9 (8.6) 3 (5.4) 6 (12.2) 0.30
(0.06-1.51) .14 7.31
(0.47-114.50) .16
Level of education College or
higher 65 (62.5) 39 (70.9) 26 (53.1) 1
Less than
College 39 (37.5) 16 (29.1) 23 (46.9) 0.46
(0.21-1.04) .06 1.12
(0.31-4.10) .86
Annual household
income** ≤ $50,000 14 (20.9) 4 (11.11) 10 (32.3) 1
> $50,000 53 (79.1) 32 (88.89) 21 (67.7) 3.81
(1.06-13.75) .04 2.15
(0.23-10.86) .35
Denture wearer Yes 21 (20.2) 12 (21.8) 9 (18.4) 1
No 83 (79.8) 43 (78.2) 40 (81.6) 0.81
(0.31-2.12) .66 0.15
(0.03-0.83) .03
OR: Crude Odds Ratio; AOR: Adjusted Odds Ratio
† The AOR was adjusted for age, gender, annual house income, level of education, denture wearer and marital status.
n=104, unless specified
* For ‘age’ the n=78 because 26 responses were missing.
** For ‘annual household income’ the n=67 because 37 responses were missing.
Impact of a “TED-Style” presentation on potential patients’ willingness to accept dental implant therapy: a one-group, pre-test post-test study
440
only age was a significant factor associated with willingness
to accept dental implant treatment. AOR showed that par-
ticipants over the age of 65 were more likely to accept den-
tal implant treatment than younger ones (P = .02); although
this may be a result of inflation of the estimate due to the
associated small cell count for acceptance in the group of
participants younger than 65 years of age.
Willingness to accept implant therapy was analyzed
again after the TED-like educational session, and it was
found the proportion of respondents who were willing to
accept implant treatment increased significantly from 24%
to 80% (P < .05). Interestingly, after the session no signifi-
cant association was found between any of the participants’
characteristics and their willingness to accept implant treatment.
The change in willingness to accept dental implants
before and after the educational session and its association
with potential confounders was assessed (Table 2). This test
was based on a cross tabulation of responses among people
who accepted/refused implant treatment prior to the infor-
mation session and either kept or changed category after
the information session. In our study, none of the respon-
dents who had initially expressed their willingness to accept
implant treatment refused it implants after the information
session. Moreover, a large portion of respondents that
rejected implant treatment prior to the information session
change their opinion after the session. The change in will-
ingness after the educational session was apparent in all of
the sub-groups analyzed, however, due to the limited num-
ber of participants in some sub-groups, it was only signifi-
cant among the following categories: older than 65 years,
women, married, both low and higher education, income
above $50,000, non-denture wearers and those who initially
had a higher level of implant knowledge (P < .05) (Table 2).
Before the session, respondents that answer negatively
to the question ‘Have you ever considered implants?’ had to
give a reason by answering ‘If your answer to the previous
question is “no” kindly state why’. All answers fell within
one of the four categories identified in tables. ‘Lack of
knowledge’ was the main reason for not considering
implant treatment Followed by ‘cost’, ‘fear’ and ‘unknown’
(Table 3). The reason was classified as ‘unknown’ when the
participants did not specify an answer.
After the session, ‘cost’ became the most popular rea-
son for refusal of treatment followed by ‘fear’ (Fig. 1).
Table 2. Comparison of participants’ willingness to accept implant therapy
Characteristics
Before informative session After informative session
P†
Accept n (%)
25 (24.0)
Reject n (%)
79 (76.0)
Accept n (%)
83 (79.8)
Reject n (%)
21 (20.2)
Age* ≤ 65 3 (18.8) 25 (24.0) 24 (38.8) 4 (25.0) .62
> 65 13 (81.2) 37 (46.8) 38 (61.2) 12 (75.0) .02
Gender Men 6 (24.0) 16 (20.3) 18 (21.7) 4 (19.0) .25
Women 19 (76.0) 63 (79.7) 65 (78.3) 17 (81.0) .01
Marital status Single 6 (24.0) 18 (23.7) 20 (24.1) 4 (19.0) .29
Married 17 (68.0) 54 (68.4) 55 (66.3) 16 (76.2) .01
Other 2 (8.0) 7 (8.9) 8 (9.6) 1 (4.8) .78
Level of education College or higher 14 (56.0) 51 (64.6) 54 (65.06) 11 (52.38) .04
Less than College 11 (84.0) 28 (33.4) 29 (34.94) 10 (47.62) .02
Annual household
income** ≤ $50,000 4 (21.0) 10 (20.8) 12 (20.1) 2 (22.2) .66
> $50,000 15 (79.0) 38 (79.2) 46 (79.3) 7 (77.8) .04
Denture wearer Yes 10 (40.0) 11 (13.92) 17 (20.48) 4 (19.05) .06
No 15 (60.0) 68 (86.08) 66 (79.52) 17 (80.95) .02
Level of implant
knowledge Poorly/Not at all 6 (24.0) 43 (54.4) 38 (45.8) 11 (52.4) .20
Very well/
Moderately well 19 (76.0) 36 (45.6) 45 (54.2) 10 (47.6) .01
Total 25 (24.0) 79 (76.0) 83 (79.8) 21 (20.2) 0.003
* For ‘age’ the n=78 because 26 responses were missing.
** For ‘annual household income’ the n=67 because 37 responses were missing.
† P value derived using Fisher's exact test for the difference in values recorded before and after the information session.
J Adv Prosthodont 2015;7:437-45
The Journal of Advanced Prosthodontics
441
Respondents who indicated ‘lack of knowledge’ as the rea-
son for not considering implants were significantly (P =
.001) reduced down to zero after the information session.
There was no significant difference in the proportion of
respondents before and after the session who indicated
‘cost’ or ‘fear’ as the reason for refusing implants (Table 3).
DISCUSSION
This study establishes the usefulness of TED-like presenta-
tions in facilitating knowledge on dental implants to the
public. Patients’ knowledge shapes their preferences about a
treatment and is crucial for their decision-making.
17,26,27
Given the rapid changes in technologies and venues for
public release scientific information old methods to inform
the public should be reassessed.
22
TED-style talks have been successful tools for teaching
students as well as the public in many healthcare sectors.
28
However, the application of this educational approach in
dentistry has barely been explored. Underneath we discuss
our findings regarding the use of this educational approach
on knowledge translation on dental implants to the public.
Even though there is a considerable lack of sufficient
knowledge amongst the general public regarding dental
implant treatments,
14
the participants of this study reported
to be even less knowledgeable on dental implants than
those of previous studies.
16,20,21,29-32
Differences among stud-
ies could be attributed to the fact that each study was per-
formed on populations of different countries and cities,
and there might be important variations among these popu-
lations in terms of health awareness.
In our study, the willingness to accept dental implants
from participants interested in knowing more about the
treatment option, prior to the educational session, was rela-
tively low (24%) compared to previous population-based
(56.7%),
29
patient-based (75%),
30
and edentulous patient-
based studies (79%).
32
This seems to confirm that there
might be substantial differences among populations in
terms of their willingness to accept the treatment. It seems
that those who need the treatment more, such as dental
patients, especially edentulous ones, are more likely to
accept it. This possibility was confirmed in our study as we
observed that edentulous participants showed higher levels
of self-reported knowledge on dental implants, and higher
odds for accepting the treatment (prior to the educational
session) than the rest of the study group. The fact that in
Fig. 1. Pie charts describing the proportion of participants rejecting treatment and their reasons before and after the
TED-talk presentation.
Table 3. Major reasons for not considering implants before and after the TED talk session
Reason Before information session (n = 79)
n (%†/%‡)
After information session (n = 21)
n (%†/%‡)P value (two-tailed)
Fear 11 (13.9/10.6) 7 (33.3/6.7) .105
Cost 17 (21.5/16.3) 9 (42.9/8.7) .140
Lack of Knowledge 24 (30.4/23.1) 0 (0/0) .001
Unknown 27 (34.2/26.0) 5 (23.8/4.8)
† Percentages are reported in relation to the sample who refused implants (n = 79, before; n = 21, after).
‡ Percentages are reported in relation to the total population (n = 104).
Impact of a “TED-Style” presentation on potential patients’ willingness to accept dental implant therapy: a one-group, pre-test post-test study
442
our study the information session increased treatment
acceptance to levels reported in patient-based studies
(79%)
33
seems to suggest that differences in treatment
acceptance among populations are probably related to their
knowledge level. In the following sections we address in
detail the different factors that influenced willingness to
accept implant treatment.
Similarly to a previous report,
14
in this study, prior to
the educational intervention, older participants (over 65
years) were more likely to accept dental implants than young-
er ones. This observation could be explained by the fact
that even though younger people might have a positive atti-
tude towards dental implants,
16,29-31,34
in our study, older par-
ticipants showed relatively higher levels of knowledge on
dental implants than younger ones. These findings seem to
confirm that age differences in willingness to accept
implants are probably knowledge-based.
Although it has been reported that men might be more
likely to accept dental implant treatments than women,
14
in
our study we could not observe gender differences in will-
ingness to accept these treatments.
Also, we observed that participants with higher level of
education showed a tendency to have a higher level of
knowledge on dental implants (Table 1), confirming previ-
ous reports.
20
However, we were not able to observe the
association between participants’ level of education and
their willingness to accept the treatment that has been
reported elsewhere,
34
probably due to the overall high level
of education of our study group.
Economic and social factors have been described to
affect patient decision.
35
In the present study, our higher
income group was significantly more knowledgeable about
dental implants than the lower income one (Table 1), which
is in agreement with previous studies.
20
However, we could
not observe the relation between ‘income’ and ‘willingness
to accept treatment reported in other studies.
29,34
Before the information session, denture wearers had
significantly more knowledge on dental implants (Table 1)
and higher willingness to accept dental implant treatments
than non-denture wearers. This suggests that people who
have the need are usually more interested in seeking knowl-
edge, and those who have more knowledge on dental implants
might be more likely to accept the therapy. However, previ-
ous evidence is controversial; some studies
14,32
have report-
ed higher implant acceptance amongst denture wearers,
whereas, others have reported the opposite.
34,36
These dif-
ferences among studies are probably associated to other
factors such as previous knowledge on dental implants.
14
As a result of the educational session, significant chang-
es in acceptance of implants were noted. Recent studies in
the medical field demonstrated the positive impact of edu-
cational sessions such as TED-like talks, on participants’
willingness to accept treatment or preventive behavior.
33,37
Within the dental field, a similar pre- and post-testing
approach has been carried out for participants’ willingness
to accept esthetic treatments resulting in positive results.
38
However, the present is the first study of this nature related
to dental implants. Here we confirm that our “TED-style”
educational session had a very strong impact on partici-
pants’ willingness to accept treatment with dental implants,
particularly among people older than 65 years, women,
married individuals and those with high income (Table 2).
There are various barriers for acceptance of implant
treatment. Our study demonstrates that the level of implant
knowledge plays a major role when potential patients have
to make a decision regarding the therapy. Before the infor-
mation session, a high portion of respondents refused
implant treatments due to their limited knowledge on the
topic. Previous studies have reported that lack of knowl-
edge could be the reason behind 11.8% of implant treat-
ment refusals among patients.
14
However, the significant
fourfold increase in participant willingness to accept dental
implant treatments after the educational session seems to
indicate that the importance of patient knowledge of the
treatment might have been underestimated. The magnitude
of change in treatment acceptance after the educational
session indicates that lack of knowledge could be the rea-
son behind almost 50% of treatment refusals. This further
demonstrates the importance of creating awareness and the
need of providing information to the general public to help
them make informed decisions. Notably, after the session
none of the participants indicated lack of knowledge as a
refusal reason anymore, which implies the appropriateness
of the content of the educational session. Another barrier
for accepting dental implant therapy is cost. In this study,
‘cost’ became the most frequent answer for refusing implants
after the session (Table 3). This financial constraint has also
been reported as the main reason for refusal in previous
studies,
14,16,21,31,34,39
which is consistent among both high and
low income groups.
20
It is well known that patients’ deci-
sion-making towards dental treatments is highly dependent
on their willingness-to-pay for the treatment. Therefore, it
is important that clinicians carefully convey the benefits of
dental implants with the increased costs, and present feasi-
ble financing options to their patients.
40
Our results con-
firmed that fear of surgical risks and complications can lead
patients to abstain from choosing implant treatments.
32,41
There is an inverse relation between knowledge and anxiety
that can be managed by reducing unfamiliarity.
26,27
However,
the fact that the educational session was unable to reduce
the number participants afraid of dental implant treatments
reveals limitations in our approach that would have to be
addressed in future educational interventions focused on
fear management.
In summary, after the session ‘lack of knowledge’ was
no more a reason for refusal of implant therapy whereas
‘cost’ and ‘fear’ remained influencing factors (Table 3).
Hence, besides educational interventions, cost control strate-
gies and psychological interventions design to decrease fear
should also be put into place to remove these obstacles.
42
It has been estimated that the majority of patients do
not have the information they need for health care deci-
sion-making.
43
Accordingly, in our study we provided par-
ticipants with detailed information on topics that usually
J Adv Prosthodont 2015;7:437-45
The Journal of Advanced Prosthodontics
443
affect patients’ attitudes regarding treatments with dental
implants. This included details on treatment benefits, suc-
cess rate, duration, and costs, as well as surgical procedures,
post-surgical maintenance and alternative therapies.
40,41,44
The positive results of our educational intervention indicat-
ed that participants’ lack of knowledge on dental implants
and the associated refusal of the treatment could be suc-
cessfully addressed (Fig. 1).
Evidence suggests that health behavior is influenced by
confidence, incentives, expectations, goals, beliefs and moti-
vation.
45
Beliefs and preferences are in turn based on
knowledge and previous experiences.
20,40
Our study demon-
strates that there is certain public ignorance on the treat-
ment options available to manage edentulism, and TED-
style talks could be useful and effective tools for satisfying
the demand for healthcare information on this topic. TED
talks could also be an interesting way to increase awareness
of the excellent research our academic colleagues are con-
ducting amongst the practicing community, which may, as a
secondary benefit, serve as a means of promoting and
attract dentists to their continuing education programs.
Although the results of this survey provide a fair indica-
tion of what is taking place in our study sample, certain
limitations are inevitable. The pre-test/post-test design is a
widely accepted approach which evaluates quantitative
changes in outcomes, especially behavioral items. However,
its biggest weakness is the ‘response shift bias’ due to a
change in the participants’ metric due to a new understand-
ing of a concept being taught.
46
Self-perceived surveys are
not the most accurate method for measuring knowledge,
47
and hypothetical situations may produce an over-estimation
of affirmative responses for a therapy when compared to
real life decision-making scenarios.
48
Previous exposure to
information on dental implants was not assessed. However,
the participants’ self-perceived level of knowledge was reg-
istered.
Our study sample was relatively limited and had a skewed
representation in many categories such as gender with very
high proportion of females (78.8%), marital status and
annual household income with under-representation of sin-
gles and low income individuals, respectively. Furthermore,
age was heavily concentrated in the older age range.
However, we do not find this a substantial predisposition
since young patients need implants less often than older
patients.
30,49
For these reason, future studies with a larger
sample size would allow to investigate additional relation-
ships that could not be confirmed in our study. Our partici-
pants recruited were driven by the newspaper invitation and
therefore this study may not be generalized to the entire
population. Despite these limitations, this study could set
the base for conducting further studies in order to be trans-
ferred to a population seeking implant knowledge.
This survey showed missing data for age and income
with 26 and 37 non-respondents in their categories, respec-
tively. In this study, no population characteristic factors
were significantly associated with missing age data (P >
.05). Nevertheless, missing data for annual household
income was more predominant for females (P = .002) and
individuals aged 65 and above (P = .009). Therefore, an
inference of randomly missing data could not be estab-
lished. Hence, multiple imputation (MI) or weighting tech-
niques for missing data was not carried out due to the valid-
ity issues associated with MI for non-random missing data.
50
The reason for refusal was not reported by some of the
respondents who refused the treatment (34.2% before and
23.8% after the educational session). More detailed studies
are required to better understand the behavioral and patient
management requirements for increasing implant accep-
tance. Also, future studies with a larger sample size would
be able to overcome the problems raised by the missing
data.
CONCLUSION
A TED-like educational session can increase potential
patients’ awareness on dental implants and significantly
increase the willingness to accept the treatment. Therefore,
proper education is a major promoter in individuals’ deci-
sion-making heuristics towards an evidence-based decision.
Future research should focus on evaluating such education-
al programs in clinical environments.
ORCID
Kelvin Ian Afrashtehfar http://orcid.org/0000-0002-6053-8967
Faleh Tamimi http://orcid.org/0000-0002-4618-8374
REFERENCES
1. Geissler CA, Bates JF. The nutritional effects of tooth loss.
Am J Clin Nutr 1984;39:478-89.
2. Afrashtehfar KI, Kurtzman GM, Mahesh L. Improving oral
rehabilitation through the preservation of the tissues through
alveolar preservation. J Adv Prosthodont 2012;4:174-8.
3. Turkyilmaz I, Company AM, McGlumphy EA. Should eden-
tulous patients be constrained to removable complete den-
tures? The use of dental implants to improve the quality of
life for edentulous patients. Gerodontology 2010;27:3-10.
4. Naert I, Koutsikakis G, Duyck J, Quirynen M, Jacobs R, van
Steenberghe D. Biologic outcome of implant-supported res-
torations in the treatment of partial edentulism. part I: a lon-
gitudinal clinical evaluation. Clin Oral Implants Res 2002;13:
381-9.
5. Christensen GJ. Recommending the best treatment for pa-
tients. J Am Dent Assoc 2013;144:426-8.
6. Moraschini V, Poubel LA, Ferreira VF, Barboza Edos S.
Evaluation of survival and success rates of dental implants
reported in longitudinal studies with a follow-up period of at
least 10 years: a systematic review. Int J Oral Maxillofac Surg
2015;44:377-88.
7. Awad MA, Lund JP, Dufresne E, Feine JS. Comparing the ef-
ficacy of mandibular implant-retained overdentures and con-
ventional dentures among middle-aged edentulous patients:
satisfaction and functional assessment. Int J Prosthodont
Impact of a “TED-Style” presentation on potential patients’ willingness to accept dental implant therapy: a one-group, pre-test post-test study
444
2003;16:117-22.
8. Boven GC, Raghoebar GM, Vissink A, Meijer HJ. Improving
masticatory performance, bite force, nutritional state and pa-
tient’s satisfaction with implant overdentures: a systematic re-
view of the literature. J Oral Rehabil 2015;42:220-33.
9. Vilhjálmsson VH, Klock KS, Størksen K, Bårdsen A. Aesthetics
of implant-supported single anterior maxillary crowns evalu-
ated by objective indices and participants’ perceptions. Clin
Oral Implants Res 2011;22:1399-403.
10. Feine JS, Carlsson GE, Awad MA, Chehade A, Duncan WJ,
Gizani S, Head T, Heydecke G, Lund JP, MacEntee M,
Mericske-Stern R, Mojon P, Morais JA, Naert I, Payne AG,
Penrod J, Stoker GT, Tawse-Smith A, Taylor TD, Thomason
JM, Thomson WM, Wismeijer D. The McGill consensus
statement on overdentures. Mandibular two-implant overden-
tures as first choice standard of care for edentulous patients.
Gerodontology 2002;19:3-4.
11. Thomason JM, Kelly SA, Bendkowski A, Ellis JS. Two im-
plant retained overdentures-a review of the literature sup-
porting the McGill and York consensus statements. J Dent
2012;40:22-34.
12. Das KP, Jahangiri L, Katz RV. The first-choice standard of
care for an edentulous mandible: a Delphi method survey of
academic prosthodontists in the United States. J Am Dent
Assoc 2012;143:881-9.
13. Vahidi F, Pinto-Sinai G. Complications associated with im-
plant-retained removable prostheses. Dent Clin North Am
2015;59:215-26.
14. Müller F, Salem K, Barbezat C, Herrmann FR, Schimmel M.
Knowledge and attitude of elderly persons towards dental
implants. Gerodontology 2012;29:e914-23.
15. Warpeha WS Jr. Expanding prosthodontic services to the
older patient in dental practices. Northwest Dent 2011;90:21-
4.
16. Zimmer CM, Zimmer WM, Williams J, Liesener J. Public aware-
ness and acceptance of dental implants. Int J Oral Maxillofac
Implants 1992;7:228-32.
17. Afrashtehfar KI. Why would someone refuse the best choice
of treatment? J N J Dent Assoc 2013;84:11-2.
18. Cooper L, Felton DA, Kugelberg CF, Ellner S, Chaffee N,
Molina AL, Moriarty JD, Paquette D, Palmqvist U. A multi-
center 12-month evaluation of single-tooth implants restored
3 weeks after 1-stage surgery. Int J Oral Maxillofac Implants
2001;16:182-92.
19. Heaton LJ, Carlson CR, Smith TA, Baer RA, de Leeuw R.
Predicting anxiety during dental treatment using patients’self-
reports: less is more. J Am Dent Assoc 2007;138:188-95.
20. Pommer B, Zechner W, Watzak G, Ulm C, Watzek G, Tepper
G. Progress and trends in patients’ mindset on dental im-
plants. I: level of information, sources of information and
need for patient information. Clin Oral Implants Res 2011;
22:223-9.
21. Tepper G, Haas R, Mailath G, Teller C, Zechner W, Watzak
G, Watzek G. Representative marketing-oriented study on
implants in the Austrian population. I. Level of information,
sources of information and need for patient information.
Clin Oral Implants Res 2003;14:621-33.
22. Sugimoto CR, Thelwall M, Larivière V, Tsou A, Mongeon P,
Macaluso B. Scientists popularizing science: characteristics
and impact of TED talk presenters. PLoS One 2013;8:
e62403.
23. Tsou A, Thelwall M, Mongeon P, Sugimoto CR. A communi-
ty of curious souls: an analysis of commenting behavior on
TED talks videos. PLoS One 2014;9:e93609.
24. Blouin RA, Riffee WH, Robinson ET, Beck DE, Green C,
Joyner PU, Persky AM, Pollack GM. Roles of innovation in
education delivery. Am J Pharm Educ 2009;73:154.
25. Abi-Nader S. To implant or not to implant: that is the ques-
tion. Montreal, Canada.: 2011. Available from: http://www.
youtube.com/watch?feature=player_embedded&v=_EN9b-
QchfI. 2013.
26. Spalding NJ. Reducing anxiety by pre-operative education:
make the future familiar. Occup Ther Int 2003;10:278-93.
27. Heikkinen K, Helena LK, Taina N, Anne K, Sanna S. A com-
parison of two educational interventions for the cognitive
empowerment of ambulatory orthopaedic surgery patients.
Patient Educ Couns 2008;73:272-9.
28. Nicolle E, Britton E, Janakiram P, Robichaud PM. Using
TED Talks to teach social determinants of health: maximize
the message with a modern medium. Can Fam Physician
2014;60:777-8, 788-9.
29. Berge TI. Public awareness, information sources and evalua-
tion of oral implant treatment in Norway. Clin Oral Implants
Res 2000;11:401-8.
30. Pommer B, Zechner W, Watzak G, Ulm C, Watzek G, Tepper
G. Progress and trends in patients’ mindset on dental im-
plants. II: implant acceptance, patient-perceived costs and pa-
tient satisfaction. Clin Oral Implants Res 2011;22:106-12.
31. 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
Implants Res 2003;14:634-42.
32. Walton JN, MacEntee MI. Choosing or refusing oral im-
plants: a prospective study of edentulous volunteers for a
clinical trial. Int J Prosthodont 2005;18:483-8.
33. Spleen AM, Kluhsman BC, Clark AD, Dignan MB, Lengerich
EJ; ACTION Health Cancer Task Force. An increase in
HPV-related knowledge and vaccination intent among paren-
tal and non-parental caregivers of adolescent girls, age 9-17
years, in Appalachian Pennsylvania. J Cancer Educ 2012;27:
312-9.
34. Narby B. Factors shaping demand for prostethic dentistry
treatment with special focus on implant dentistry. Swed Dent
J Suppl 2011;3-65.
35. Tedesco LA, Garlapo DA. Social and economic factors in
prosthodontic practice and education. J Prosthet Dent 1994;
71:310-5.
36. Salonen MA. Assessment of states of dentures and interest
in implant-retained prosthetic treatment in 55-year-old eden-
tulous Finns. Community Dent Oral Epidemiol 1994;22:130-
5.
37. Brus MJ, Jennit A. HIV knowledge, attitudes and practices
among 12th-grade students in southern India, before and af-
J Adv Prosthodont 2015;7:437-45
The Journal of Advanced Prosthodontics
445
ter an HIV-education session. J Commun Dis 2010;42:123-
33.
38. Bonetti GA, Alberti A, Sartini C, Parenti SI. Patients’ self-
perception of dentofacial attractiveness before and after ex-
posure to facial photographs. Angle Orthod 2011;81:517-24.
39. Palmqvist S, Soderfeldt B, Arnbjerg D. Subjective need for
implant dentistry in a Swedish population aged 45-69 years.
Clin Oral Implants Res 1991;2:99-102.
40. Rustemeyer J, Bremerich A. Patients’ knowledge and expecta-
tions regarding dental implants: assessment by questionnaire.
Int J Oral Maxillofac Surg 2007;36:814-7.
41. Ellis JS, Levine A, Bedos C, Mojon P, Rosberger Z, Feine J,
Thomason JM. Refusal of implant supported mandibular
overdentures by elderly patients. Gerodontology 2011;28:62-
8.
42. Reichart R, Vogel I, Weiss T, Hennig S, Walter J, Kalff R.
Short Psychological Intervention as a Perioperative Pain
Reduction Treatment in Spinal Neurosurgery. J Neurol Surg
A Cent Eur Neurosurg 2011 Nov 16.
43. Straus SE, Tetroe JM, Graham ID. Knowledge translation is
the use of knowledge in health care decision making. J Clin
Epidemiol 2011;64:6-10.
44. Christensen GJ. Helping patients understand and accept the
best treatment plans. J Am Dent Assoc 2011;142:197-200.
45. Bandura A. Health promotion by social cognitive means.
Health Educ Behav 2004;31:143-64.
46. Egger MJ, Miller JR. Testing for experimental effects in the
pretest-posttest design. Nurs Res 1984;33:306-12.
47. Brener ND, Billy JO, Grady WR. Assessment of factors af-
fecting the validity of self-reported health-risk behavior
among adolescents: evidence from the scientific literature. J
Adolesc Health 2003;33:436-57.
48. Halvorsen PA, Selmer R, Kristiansen IS. Different ways to
describe the benefits of risk-reducing treatments: a random-
ized trial. Ann Intern Med 2007;146:848-56.
49. Ostberg AL, Nyholm M, Gullberg B, Råstam L, Lindblad U.
Tooth loss and obesity in a defined Swedish population.
Scand J Public Health 2009;37:427-33.
50. Chen JT, Kaddour A, Krieger N. Implications of missing in-
come data. Public Health Rep 2008;123:260.
Impact of a “TED-Style” presentation on potential patients’ willingness to accept dental implant therapy: a one-group, pre-test post-test study
