Documente Academic
Documente Profesional
Documente Cultură
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
Authors 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: 43 1 4277 67011
Fax: 43 1 4277 67019
e-mail:gabor.tepper@univie.ac.at
presented with 14 questions. Of those familiar with implants as one of the treatment
Date:
Accepted 24 June 2002
634
B
C
Results
Dental status, crowns, bridges and
dentures, if any, and general attitude
towards prosthodontic rehabilitation to
evaluate implant acceptance
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636 |
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
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638 |
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 (Muller 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
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
Resume
Limplantologie buccale est une technique appliquee
dans certaines specialites de medecine dentaire.
Tandis que la proportion devidences saccrot en ce
qui concerne la recherche sur losteontegration et
les facteurs associes, les analyses orientees sur le
marketing et lopinion du public sur lacceptation de
limplant, le prix et la satisfaction se font rares. Cette
etude a ete realisee pour analyser ces differents points
via un echantillon de 1 000 adultes. Les interviewes
ont repondu a` quatorze questions. De ceux qui
etaient familiers a` lidee que les implants pouvaient
etre une alternative au traitement, 61 % ont repondu
quils pourraient si necessaire y recourir. Lacceptation de limplant etait plus importante chez les
hommes et les personnes agees de moins de trente
ans. Linteret a` propos des implants augmentait
paralle`lement aux revenus de la famille. Quatre pour
cent des personnes etaient deja` porteurs dimplants.
Vingt-cinq pour cent connassaient une personne
ayant subi un traitement dimplant buccal. Parmi
toutes les personnes interrogees, la rehabilitation sur
implants semblait trop che`re. Beaucoup dentre-eux
rejetaient la responsabilite des prix trop eleves sur les
dentistes. Un detail etait particulie`rement evident :
la satisfaction parmi les patients posse`dant des
implants etait clairement plus importante que le
taux de satisfaction percu par ceux nen portant pas
mais ayant recu linformation par dautres personnes. Lexperience personnelle etait moins deformee que celle obtenue de manie`re indirecte.
Zusammenfassung
Die orale Implantologie ist eine etablierte Subspezialitat der restaurativen Zahnmedizin und der
Oralchirurgie. Wahrend extensive Evidenz uber die
Grundlagen der Osseointegration und der assoziierten Faktoren publiziert worden ist, sind marketingorientierte Analysen basierend auf reprasentativen
Meinungsumfragen uber die Akzeptanz von Implantaten, uber die von Patienten empfundenen Kosten
und uber die Patientenzufriedenheit rar. In dieser
Studie wird der Versuch unternommen, diese
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Punkte mit Hilfe einer Befragung einer reprasentativen Gruppe von 1000 Erwachsenen anzusprechen.
Den Befragten wurden 14 Fragen gestellt. Von
denen, welche uber Implantate als Behandlungsalternative Bescheid wussten, gaben 61% an, sie
wurden Implantate bei sich akzeptieren, falls die
Notwendigkeit dafur besteht. Die Akzeptanz von
Implantaten war bei Mannern und Befragten unter
30 Jahren am grossten. Das Interesse an Implantaten
nahm mit zunehmendem Familieneinkommen zu.
Vier Prozent der Befragten hatten bereits Implantate.
Funfundzwanzig 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 grosser als die von
anderen Leuten empfundene Zufriedenheit, welche
uber Implantatversorgung von anderen gehort haben.
Erfahrungen mit Implantaten aus erster Hand waren
mit weniger Vorurteilen behaftet als Informationen
aus zweiter Hand, uber die berichtet wurde.
Resumen
La implantologa oral es una subespecialidad establecida de restauracion dental y ciruga oral. Mien-
References
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P.I. & Jemt, T. (1990) A long-term follow-up
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Akagawa, Y., Rachi, Y., Matsumoto, T. & Tsuru, H.
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Berge, T.I. (2000) Public awareness, information
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401408.
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Brunski, J.B. (1999) In vivo bone response to
biomechanical loading at the bone/dental implant
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341.
Colgan, P.J. (1999) Implant identification system.
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Davies, J.E. (1996) In vitro modelling of the bone/
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Appendix
Questionnaire PART II
5.
More than 10
No
All teeth
5ydissatisfied
No
Metal-based dentures
Full-arch dentures
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.
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
Dealer
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.
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