Implantology: your patients do not have the same expectations as you

Implantology: the critical gap between patient expectations and practitioner perceptions

The clinical success of an implant, supported by survival rates exceeding 90% over 10 years, does not systematically guarantee patient satisfaction. This paradox is explained by the decisive influence of pre-therapeutic expectations: a technically perfect result can be perceived as a failure if it does not meet initial requirements, which are often modeled on natural dentition. However, practitioners frequently struggle to identify the true priorities, beliefs, and fears of their patients, creating a gap that compromises the quality of patient-centered care.

This study aimed to develop and psychometrically validate a 16-item "mirror" measurement instrument designed to compare two perspectives: patients' actual expectations before treatment and dentists' perceptions of them. The objective was to quantify the magnitude and direction of these discrepancies at the item level, while analyzing the influence of practitioners' demographic characteristics and clinical experience.

The authors tested the hypothesis that patients and dentists systematically diverge across several areas of care. They postulated that the intensity of this disagreement would vary depending on the topic addressed and the dentist's level of expertise, thus highlighting the need for more structured communication during initial consultations.

Methodology: the challenge of the mirror effect

How to scientifically measure a perception gap? This cross-sectional study, conducted at the Faculty of Dental Surgery of Gazi University, uses a "mirror" design to confront the actual expectations of patients with the beliefs of practitioners.

Recruitment has enabled the formation of two independent cohorts:

• 250 patients (response rate: 77.64%): adults in initial pre-implant consultation, with no history of implantation.
• 200 dentists (response rate: 72.2%): a representative panel including oral surgeons, periodontologists, prosthodontists and general practitioners.

The protocol is based on a 16-item instrument scored on a 5-point Likert scale. The principle is rigorous: each question has two semantically identical versions where only the grammatical person changes (1st person for the patient, 3rd person for the dental surgeon). This symmetry ensures that the measured gaps reflect a pure divergence of perspective, without formulation bias.

In terms of statistics, robustness is ensured by a ratio of 10 subjects per item. The authors used Cronbach's alpha for internal consistency and the Cliff’s δ index to quantify the magnitude of differences in perception between the two groups. The study was calibrated to detect a medium effect size (Cohen’s d = 0.50) with a power of 0.95.

Cohort constitution and representativeness

The study involved two independent samples recruited from the Gazi University Faculty of Dentistry to evaluate pre-treatment expectations via a 16-item mirror instrument. Out of 322 patients solicited, 250 were included (response rate of 77.64%). The practitioner group consists of 200 dentists (response rate of 72.2%), including specialists in oral surgery, periodontology, prosthodontics, and general practice.

Decoding a clinical perception divergence

The study conducted at Gazi University highlights a major issue: although implant success clinically exceeds 90%, final satisfaction depends intrinsically on pre-operative expectations. By comparing 250 patients and 200 dentists via a 16-item mirror instrument, the research highlights that the clinician often evaluates success through a biological and technical prism, whereas the patient prioritizes psychosocial and functional feelings. This asymmetry suggests that an osseointegrated implant can be perceived as a failure by the patient if their initial expectations, often modeled on natural dentition, have not been correctly identified or moderated.

The methodological originality lies in the use of semantically identical items and effect size (Cliff’s δ), ensuring that the observed discrepancies reflect a real divergence in perspective rather than a formulation bias. The authors' hypothesis is confirmed: there is a systematic difference in vision depending on the fields concerned. However, the study has limitations, notably its cross-sectional design and the recruitment of independent samples rather than patient-practitioner dyads, which limits the analysis to a group comparison without being able to evaluate the agreement within a specific pair.

For the practitioner, these results serve as a reminder that pre-therapeutic communication must not be limited to technical informed consent. An explicit alignment between patient expectations and realistic clinical outcomes is essential to transform a biological success into a perceived therapeutic success.

Summary of results

This cross-sectional study, conducted among 250 patients and 200 dentists, uses a 16-item "mirror" instrument to quantify the perceptual discrepancies between patient expectations and what practitioners imagine them to be. While the implant survival rate exceeds 90%, the analysis demonstrates that objective clinical success does not guarantee patient satisfaction if their initial expectations, often unknown to the clinician, are not aligned.

In concrete terms, for the practitioner:

• Identify real expectations: Do not assume your patients' priorities; use the initial consultation to specifically explore their aesthetic and functional projections, which are often higher than the clinical reality.
• Integrate PROMs: Adopt Patient-Reported Outcome Measures (PROMs) from the pre-operative phase to reduce the gap between biological success and subjective satisfaction.
• Refine your advice: Adjust your communication based on your clinical experience to transform a "high-stakes" procedure into a mutually perceived success.

Technical lexicon of the study

Patient-centered care: A healthcare framework prioritizing responsiveness to individual patient preferences and values, considered here as a central dimension of therapeutic quality.

PROMs (Patient-reported outcome measures): Measurement tools capturing subjective perspectives (function, aesthetics, psychosocial well-being) to evaluate treatment success from the patient's point of view.

Mirror-design methodology: A research approach using semantically identical parallel questionnaires to quantify perception gaps between two groups (practitioners vs. patients) on the same subject.

Marginal bone stability: Classic objective clinical indicator measuring the durability of peri-implant bone, often dissociated from subjective patient satisfaction.

Edentulous patients: Patients presenting partial or total tooth loss, constituting the target population for dental implant rehabilitations.

Expectation-sensitive intervention: Therapeutic procedure (such as implant placement) where the clinical outcome, even if perfect, may be perceived as a failure if preoperative expectations have not been aligned.

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