Impacto da reabilitação com próteses totais fixas implantossuportadas na qualidade de vida e sua relação com gratidão e autoestima

Abstract

The clinical success of treatment in oral rehabilitation should incorporate patientcentered outcome measures besides technical aspects. This thesis consists of two manuscripts. Manuscript I is a narrative literature review on the use of patient-centered outcome measures in oral rehabilitation studies. The literature shows that clinical studies should include outcomes obtained by self-reported perception of the benefits of treatment in terms of functional, psychological and social aspects. Most studies use instruments with different dimensions of oral health-related quality of life (OHRQoL), such as GOHAI (Geriatric Oral Health Assessment Index), DIDL (Dental Impact on Daily Living), OHIP (Oral Health Impact Profile), OHQoL-UK (W), OIDP (Oral impacts in daily presentations). In general, the questionnaires’ items were formulated in a negative way, with a focus on oral health problems. OHIP-14 has been the most used instrument because it is simple and validated in several languages and for different clinical situations. Other positive psychology tools, such as the Rosenberg and McCullough questionnaires, have been suggested to assess the perception of selfesteem and gratitude, with a focus on long-term patient’s well-being and satisfaction. These instruments have still been little used in dentistry and can be useful for a more comprehensive understanding of the patient's psychosocial aspects. Manuscript II refers to a clinical study that analyzed the impact of oral rehabilitation with implantsupported fixed complete dentures (IFCDs) on OHRQoL up to 5 years and its relationship with self-esteem and gratitude. A cross-sectional study was conducted with a subsample of 66 patients of a prospective cohort. Three instruments were used to collect data through self-report of OHRQoL (OHIP-14), gratitude (GQ-6 by McCullough), and self-esteem (Rosenberg scale). The questionnaires were applied individually by a single trained examiner, after at least one year of rehabilitation with screw-retained metal-acrylic IFCDs. The OHIP-14 questionnaire was used before rehabilitation (baseline) and at 1, 3 and 5 years after the prosthesis’s installation. The OHIP-14 data were analyzed using the total average score and in its seven domains. The occurrence of prosthetic complications over the period was computed to assess their influence on OHRQoL over time. The difference between the initial and final OHIP-14, defined as the impact of rehabilitation on OHRQoL, was tested for association with gratitude and self-esteem through the Spearman correlation test, at the 0.05 significance level. Gratitude, self-esteem and OHIP before and after rehabilitation showed mean scores of 38.65 ± 2.97, 36.87 ± 3.8, 22.13 ± 13.76, 1.72 ± 2.26, respectively. There was a statistically significant difference (p <0.05) between initial OHIP-14 (22.13 ± 13.76) and 1, 3 and 5 years after rehabilitation (2.34 ± 3.69; 1.91 ± 3.13 and 1.80 ± 2.33 respectively). However, no statistically significant difference was found between the different post-rehabilitation follow-up times, as well as for the seven dimensions of OHIP-14. Thirteen out of 66 patients (19.7%) had repairable prosthetic complications, but there was no difference between the average OHIP-14 scores between patients with and without prosthetic complications. The gratitude and self-esteem values showed a moderate association (rs = 0.36; p = 0.003), however both had no association with the difference between the initial and final OHIP-14 scores (rs = 0.19; p = 0.11; rs = -0.06; p = 0.61, respectively). Based on both the literature and the clinical study, it can be concluded that the study of patientcentered outcomes can be enriched with the use of various methods to capture the patient's perception of the benefits of implant-supported rehabilitation. The treatment with IFCD has a long -term positive impact on patients' OHRQoL, for a period of up to 5 years, even when prosthetic complications occur. However, the improvement in OHRQoL is not associated with gratitude and self-esteem, although both are related to each other.