Decision-Making in Implantology – A Vignette-Based Study to Determine Clinical Treatment Routines for the Edentulous Atrophic Mandible

Abstract

BackgroundThe aim of the study was to investigate the influence of possible factors on decision making in the therapy for the severely atrophied edentulous mandible.MethodsA vignette-based survey among 250 maxillofacial surgeons and oral surgeons on the edentulous narrow atrophic mandible was conducted. Determinants that could influence the therapy decision were patient age, smoking, fear of surgery and radiotherapy in the head and neck area. To achieve a suitable implant site, the options offered to the surgeons were bone split, bone block, augmentation with bone substitute material and bone resection. In addition, there was the option of rejecting any therapy.ResultsThe response rate was 46.8%. Resection was preferred by a large majority to all other forms of therapy, regardless of the four determinants. Surgeons tend to refrain from bone block transplants in older patients. Smoking led significantly more often to the rejection of an intervention. Fear of surgery had no influence on the treatment methods, previous radiotherapy treatment only for bone split.ConclusionsIn the narrow atrophic mandible, bone resection is the preferred therapy independent of all determinants. Surgeons tend to refrain from complex and invasive procedures in older patients and generally tend to refrain from interventions in smokers.