Original article

A 3-year longitudinal study of quality-of-life outcomes of

elderly patients with implant- and tooth-supported fixed
partial dentures in posterior dental regions
Nikola Petricevic1, Asja Celebic1 and Ksenija Rener-Sitar2
1

Department of Prosthodontics, School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Prosthodontics, Faculty of
Medicine, University of Ljubljana, Ljubljana, Slovenia

doi:10.1111/j.1741-2358.2011.00592.x
A 3-year longitudinal study of quality-of-life outcomes of elderly patients with implant- and
tooth-supported fixed partial dentures in posterior dental regions
Background: Clinical studies have mainly been focused on oral health-related quality-of-life (OHRQoL)
outcomes of removable dentures.
Objective: To evaluate therapy of elderly patients with implant-supported fixed partial dentures (IFPD)
and tooth-supported fixed partial dentures (FPD) in the posterior dental regions.
Patients and methods: The OHIP49 was used to measure OHRQoL in 64 patients with IFPD and 38
patients with FPD, before, 3 weeks and 3 years after rehabilitation. A control group (CG) consisted of 62
individuals.
Results: The Oral Health Impact Profile questionnaire (OHIP) follow-up scores of the patients with FPD
and the patients with IFPD were significantly smaller in comparison with the baseline scores (p < 0.01).
The OHIP scores were further reduced at the 3-year follow-up. The patients with IFPD had significantly
higher scores than the patients with FPD and the CG at the baseline and at the follow-ups. In the patients
with FPD, both age groups (60 and >60) showed equal improvement of the OHRQoL. In the IFPD group,
patients older than 60 years showed better improvement (p < 0.05). There were no significant differences
dependent on gender and antagonistic teeth (p > 0.05).
Conclusion: The FPD and the IFPD treatment showed significant improvement of OHRQoL. The FPD
treatment improved OHRQoL equally in both age groups, while the IFPD treatment improved OHRQoL
better in older patients.
Keywords: oral health impact profile questionnaire, oral health-related quality-of-life, elderly patients,
implant, prosthodontic.
Accepted 4 September 2011

Introduction
Four basic parameters have been described to affect
the outcome of dental therapy: biologic and physiologic parameters (health of oral structures, chewing, nutrition, aesthetics), longevity and survival
rate (of teeth, restorations, implants), psychosocial
parameters (treatment satisfaction, self-esteem,
body image, quality of life) and economic parameters (direct and indirect cost)1,2. The first two
categories have been investigated extensively by
clinicians, while in the last few decades, the
psychosocial outcomes have gained lots of interest3.
e956

Oral health-related quality of life (OHRQoL) is an

important patient-centred endpoint to be considered when assessing the impact of oral diseases and
evaluating professional interventions. In the general population, the number of teeth has the
strongest impact on the OHRQoL4. In the elderly,
tooth loss has an adverse effect on different aspects
of quality of life, particularly in institutionalised
individuals5.
To replace the missing tooth, different treatment
possibilities have been proposed. Until recently,
two main options for restoring the function and
aesthetics of non-restored or inadequately restored

 2011 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2012; 29: e956e963

Quality of life in elderly patients with implant- and tooth-supported fixed partial denture

spaces were removable or fixed partial dentures

(FPD). In recent years, implant therapy has gained
more importance and significance.
To date, clinical studies have mainly been
focused on OHRQoL outcomes of partial and
complete removable dentures6,7. Nevertheless,
some studies also evaluated implant therapy by
changes of the patients OHRQoL811. According to
some studies, quality of life has been significantly
improved after the treatment with implantsupported removable overdentures in comparison
with the previous experience of wearing complete
dentures12,13. With respect to chewing14, bite
force15, comfort, function, speech, aesthetic, selfimage and dental health16, implant-supported
removable dentures provided greater improvement
of oral health. Concerning the rehabilitation with
implant-supported removable dentures in elderly,
improvement of functional aspects and oral health
has been confirmed17,18, as well as after the rehabilitation with implant-supported fixed partial
dentures (IFPD)19. Despite some articles20 and
general opinion that patients who have implantsupported removable overdenture are less satisfied
and have lower OHRQoL than the patients with
IFPDs, some authors21 found out that both patient
groups have been equally satisfied.
Selection of the appropriate psychometric
instrument for evaluating OHRQoL has a powerful
influence on the final result, as instruments specifically designed for problems related to the oral
cavity such as Oral Health Impact Profile questionnaire (OHIP) are apparently more sensitive
than generic ones that assess the health-related
quality of life4,10,18. Most studies on the OHRQoL
investigated different types of dentures and age
groups. Despite a large number of OHRQoL studies,
only few of them assessed patients with FPD and
IFPD prosthodontic treatments in distal edentulous
areas and particular effects on the improvement of
the OHRQoL in elderly population.
The aim of this study was to compare outcomes
of prosthodontic rehabilitation with IFPD and
tooth-supported FPD in the posterior edentulous
alveolar regions by assessing changes of the OHRQoL. The aim was also to assess influence of gender, age and antagonistic teeth on the OHRQoL
outcome after prosthetic therapy.

Patients and methods

The present study was approved by the Facultys
Ethic Committee. Patients were provided with
full written information, and written consent was
obtained.

e957

Sample
A total of 64 patients with IFPD (mean age =
46.50 years, SD = 11.16, 43.8% women) and 38
patients with FPD (mean age = 57.63 years, SD =
14.39, 63.2% women) were selected for this
study. Healthy adults without any need for
prosthetic treatment who came for regular dental
check-ups were selected as a control group (CG)
(age mean = 42.3 years, SD = 6.42, 69.4% women).
All participants were of good general health.
Patients were partially edentulous in the posterior
dental regions, had no previous history of removable denture wearing, were without history of
TMD problems or clenching or a higher degree of
tooth wear and were fully able to cooperate
and respond to the questions. The IFPD group also
had adequate bone volume for placement of
implants and had no need of bone augmentation
prior to implant insertion. Selected patients had
no problems with prosthodontic suprastructure
(ceramic fracturing and chipping) during the
3-year period of wearing.
Surgical and prosthodontic procedure
In the IFPD group, standard implant placement was
performed by a single oral surgeon in all patients,
with the aid of surgical guide when needed. Implant
diameter varied from 3.80 to 4.25 mm (Kohno,
Sweden and Martina, Italy). Implant levelling was
based on the height of the surrounding bone crest,
achieving the primary stability. After the healing
period of 3 months, cover screws were changed by
the healing abutments.
The FPDs in both groups were made of metal
ceramics (Metal-Duceralloy, Ceramic-Duceram Kiss;
DeguDent, Hanau, Germany). The patients with
IFPD received a total of 160 implants, which were
used for the treatment for a single tooth (six cases)
or for rehabilitation with bridges (58 cases), and
in 69% (44 patients) implants were inserted in
the mandible. The patients with FPD received 35
bridges and three crowns, and in 61% (23
patients), FPDs were inserted in the mandible. The
majority of the patients with FPD were edentulous
posterior to the canines, and in 37% (14 patients),
at least one canine tooth had to be included as the
abutment of the FPD, while 42% (27 patients) of
the patients with IFPD had at least one maxillary
canine missing with an implant inserted in the
place of the lost tooth. It is important to mention
that none of the implants had been lost during
follow-ups and none of the prosthodontic

 2011 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2012; 29: e956e963

(14.48)
(3.59)
(3.80)
(2.78)
(1.67)
(2.59)
(1.05)
(1.34)
18.80
4.87
4.15
3.02
1.34
1.94
0.40
0.71
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
FPD, fixed partial dentures; IFPD, implant-supported fixed partial dentures; OHIP, oral health impact profile questionnaire.
*Statistically significant (p < 0.05); statistically significant (p < 0.001); NS, not significant (p > 0.05).

(8.97)
(2.65)
(2.44)
(2.63)
(2.38)
(2.99)
(1.74)
(2.58)
22.91
4.53
4.36
3.56
3.28
2.55
1.44
3.19
(14.37)
(2.66)
(2.54)
(1.83)
(2.78)
(3.11)
(2.25)
(2.53)
45.19
8.69
8.44
6.94
6.98
4.56
3.31
6.25
(22.26)
(4.35)
(5.47)
(2.66)
(3.93)
(3.92)
(2.96)
(2.98)
78.94
15.69
15.75
11.31
12.06
8.38
5.88
9.88
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
0.198 NS
0.018*
<0.001**
(6.24)
(1.63)
(0.73)
(2.19)
(1.13)
(1.21)
(0.27)
(0.92)
3.92
1.21
0.47
0.97
0.74
0.68
0.08
0.26
(7.50)
(1.66)
(1.01)
(2.91)
(1.21)
(1.41)
(0.27)
(0.93)
5.89
1.34
0.95
1.34
1.05
0.82
0.08
0.32

28.47
8.97
5.53
5.63
4.68
2.21
0.34
0.90

(20.44)
(6.53)
(4.64)
(5.42)
(3.43)
(3.66)
(0.94)
(1.40)

Score (SD)
p
3 Years after
treatment
(SD)
3 Weeks after
treatment
(SD)
Before
treatment
(SD)

OHIP Summary Score

Functional limitation
Physical pain
Psychological discomfort
Physical disability
Psychological discomfort
Social disability
Handicap

The OHIP scores for all three groups of patients

are presented in Table 1, together with significance of the difference between the three measurements in the patient with FPD and patient
with IFPD groups (before treatment, 3 weeks and
3 years after the treatment). The follow-up scores
were significantly smaller in comparison with the
baseline scores for both, the patient with FPD and
the patient with IFPD, respectively. Still, in the
FPD group, baseline and follow-up scores were
smaller in comparison with the IFPD group. The
FPD follow-up scores were even smaller than the
OHIP summary score and the subscale scores of
the CG group.
The comparison of the mean scores between
the IFPD, FPD and CG groups revealed significant
differences in each of the three measurements
(Table 2). The Sheffe post-hoc tests revealed that
the patient with IFPD had significantly higher
scores in comparison with the patient with FPD
and the CG at the baseline. The patient with
FPD had higher OHIP summary scores than the

Variable

Results

3 Years after
treatment
(SD)

The OHIP scores and the OHIP subscale scores were

calculated using statistical software (SPSS 17 for
Windows, Chicago, IL, USA). Descriptive statistics,
Friedman test for related samples, one-way ANOVA
(Sheffe post-hoc) and independent sample t-tests
were used. A significance level of 5% was adopted
in all tests.

3 Weeks after
treatment
(SD)

Statistical analysis

Before
treatment
(SD)

The OHRQoL was measured using the Oral

Health Impact Profile (OHIP49)22,23. The questionnaire was administered with supervision to 64
patients with IFPD and 38 patients with FPD
before treatment, 3 weeks after and 3 years after
prosthodontic rehabilitation. Another group of 62
healthy individuals was collected as a CG. Sociodemographic data were collected, including age
and gender.
Patients were given prior instructions and
explanations of the different aspects and questions
contained in the questionnaire, which had been
filled in at home. If any difficulty in understanding
the text occurred, the dentist helped the patients
filling in the answers at the next visit.

IFPD

OHRQoL evaluation

FPD

appliance and/or soft tissue failures were recorded

during the observation period.

CG

N. Petricevic et al.

Table 1 Mean OHIP scores (SD) in patients with FPD and IFPD (before treatment, 3 weeks and 3 years after prosthodontic treatment) and significance of the
difference between the three scores (Friedman test for related samples). Mean OHIP scores (SD) of the CG (control group) are also presented.

e958

 2011 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2012; 29: e956e963

CG, control group; FPD, fixed partial dentures; IFPD, implant-supported fixed partial dentures; OHIP, oral health impact profile questionnaire.
*Statistically significant (p < 0.05); **statistically significant (p < 0.001); NS, not significant (p > 0.05).

<0.001**
<0.001**
<0.001**
<0.001**
0.305 NS
0.058 NS
0.468 NS
0.510 NS
0.111 NS
0.802 NS
0.913 NS
0.499 NS
<0.001**
0.399 NS
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
0.002*
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
0.804 NS
0.116 NS
0.599 NS
0.584 NS
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**

0.053 NS
<0.001**
0.365 NS
0.002*
0.926 NS
<0.001**
0.989 NS
0.916 NS

<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
OHIP summary
Functional limitation
Physical pain
Psychological discomfort
Physical disability
Psychological disability
Social disability
Handicap

<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**
<0.001**

FPD-CG
(p)
IFPD-CG
(p)
IFPD-FPD
(p)
IFPD-FPD
(p)
IFPD-CG
(p)

FPD-CG
(p)
IFPD-FPD
(p)
Variable

IFPD-CG
(p)

FPD-CG
(p)

3 Years after treatment

3 Weeks after treatment
Before treatment

Table 2 Significance of the difference between the OHIP scores at the baseline and follow-ups (before, 3 weeks and 3 years after prosthodontic treatment) of the
patients with FPD and IFPD and the CG (one-way ANOVA, Scheffe post-hoc test).

Quality of life in elderly patients with implant- and tooth-supported fixed partial denture

e959

CG at the baseline, and the difference almost

approached statistical significance (p = 0.053).
However, at the baseline, the patient with FPD
and the CG showed no significant difference
considering the OHIP subscores in the OHIP domain of physical pain, physical disability, social
disability and handicap. Although significant
improvement in the OHRQoL existed 3 weeks
after treatment, the patients with IFPD retained
the highest OHIP scores (p < 0.05). It is very
interesting that the OHIP scores in the patients
with FPD were lower in respect to the CG at this
stage for the OHIP summary score, as well as for
the functional limitation, physical pain and
psychological discomfort subscales (Table 1). The
OHRQoL was further improved in the both
patient groups 3 years after the treatment, and at
this stage, the lowest OHIP scores were recorded
again in the FPD group. The FPD group had
significantly better OHRQoL outcomes than the
patients with IFPD, but at this stage of the
observation (3-year follow-up), there were no
significant differences observed between the
patients with IFPD and the CG, except for the
physical disability, social disability and handicap
subscores, which still remained significantly
higher than in the CG.
Furthermore, there was no significant difference
between the OHIP scores dependent on age in the
patients with FPD, neither before (p = 0.811) or
after 3 weeks (p = 0.391) and 3 years (p = 0.910)
after the treatment. Both age groups showed equal
improvement across all aspects of the OHIP
instrument.
Contrary to this, in the patients with IFPD, there
was a significant difference in the physical pain and
the handicap OHIP subscores dependent on age
(p = 0.007, p = 0.046) before the treatment, as
younger patients had significantly higher subscale
scores (Table 3). Three weeks after the treatment,
all of the OHIP scores were significantly lower, but
the OHIP summary score and the most of the
subscale scores were significantly lower in patients
older than 60 years in comparison with the younger group. Three years after the treatment, the
OHIP scores continued to reduce in the patients
with IFPD. At this stage, only the OHIP summary
score remained significantly lower in the older
patients compared to the younger group, while the
OHIP subscale scores showed no significant difference any more between the older and younger
patients. Also, there were no significant differences
recorded dependent on gender or antagonistic
teeth in the opposing jaw (natural teeth vs. FPD)
(p > 0.05).

 2011 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2012; 29: e956e963

0.185 NS
0.310 NS
0.83 (1.03) 1.339
2.50 (2.50) 1.024
IFPD, implant-supported fixed partial dentures; OHIP, oral health impact profile questionnaire.
*Statistically significant (p < 0.05); NS, not significant (p > 0.05).

3.70 (2.32)
6.46 (2.59)
5.33 (0.98)
8.33 (1.78)
6.00 (3.24)
10.23 (3.10)

0.701 0.486 NS
2.038 0.046*

7.29 (2.95)
4.85 (3.36)
10.67 (2.99)
6.67 (1.78)
12.38 (4.07)
4.77 (4.18)

1.375 0.174 NS
1.701 0.094 NS

Discussion

1.58 (1.85)
3.35 (2.60)
1.67 (0.49) 2.988 0.004*
5.33 (2.15) 1.402 0.166 NS

0.096 NS
0.219 NS
2.25 (1.14) 1.689
1.58 (1.00) 1.243
3.52 (2.53)
2.77 (2.25)
5.67 (1.30) 1.856 0.068 NS
3.33 (0.98) 1.537 0.129 NS

4.58 (1.51) )0.350 0.727 NS

2.58 (1.56) 1.443 0.154 NS
4.31 (2.62)
3.79 (2.78)
16.62 (5.34)
11.46 (2.90)

12.00 (4.51)
10.67 (0.98)

2.772 0.007*
0.932 0.355 NS

8.77 (2.63)
7.23 (1.73)

7.00 (1.48) 2.240 0.029*

5.67 (1.78) 2.605 0.007*

81.15 (23.30) 69.33 (14.07) 1.682 0.098 NS 47.38 (14.73) 35.67 (7.45) 2.667 0.010*
15.69 (4.56) 15.67 (3.45) 0.018 0.985 NS 9.08 (2.73)
7.00 (1.48) 2.542 0.014*

OHIP summary
Functional
limitation
Physical pain
Psychological
discomfort
Physical disability
Psychological
disability
Social disability
Handicap

24.12 (9.32) 17.67 (4.62) 2.323

4.81 (2.73) 3.33 (2.02) 1.767

t
>60
60
>60

>60

p
60
60
Variable

3 Years after treatment

3 Weeks after treatment
Before treatment

Table 3 The OHIP scores (SD) in the patients with IFPD and the t-test for independent samples dependent on age group at each observation stage.

0.023*
0.082 NS

N. Petricevic et al.

e960

Dental implant therapy outcomes are primarily

described in terms of implant survival rates and the
durability of implant superstructures. Recent studies assessed the success of implant therapy through
the assessment of patients satisfaction and their
quality of life811.
To date, clinical research in the field of patientbased outcomes has mostly been concentrated on
implant-supported removable denture treatment
for the edentulous patients8,10. Patient-based outcomes with other prosthodontic treatments such as
single crowns and bridges supported by the
implants in the posterior regions are not well
represented in the literature.
The OHIP questionnaire was used in this study to
monitor changes of the OHRQoL owing to its sensitivity to detect the impact of dental treatment and
its extensive international usage10,19. The OHIP
questionnaire was administered at different observation periods in patient groups: before treatment,
3 weeks after and 3 years after the treatment. The
reason for observing the patients for a longer period
was owing to the fact that longitudinal measurements evaluate better the overall success of dental
treatment in comparison with the short observation period24.
The group of 64 patients was selected with a
criterion of missing posterior teeth only in one jaw
and the presence of natural teeth or FPDs in the
antagonistic jaw. The patients in the IFPD group
with previous experience with implant treatment
were excluded from the study, because the level of
their satisfaction after the treatment might be different in the follow-ups owing to the previous
experience24.
The pre- and post-treatment OHIP summary and
subscale scores of the FPD and the patients with
IFPD demonstrated a significant decrease in OHIP
scores, which described the significant increase in
the OHRQoL after the therapy, revealing high
patients satisfaction (Table 1). This result had been
expected as previous studies have demonstrated
that placement of IFPDs improved patients quality
of life10,17,19. Similar findings were also presented
for implant-supported removable dentures, which
provided better functioning and OHRQoL than
conventional removable dentures13,18. Szentpetery
et al.11 concluded that the number of problems
decreased substantially after prosthodontic treatment, especially after FPD treatment.
Our results revealed simultaneous long-term
increase in the OHRQoL after the therapy in both
the patients with FPD and patients with IFPD, with

 2011 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2012; 29: e956e963

Quality of life in elderly patients with implant- and tooth-supported fixed partial denture

the OHIP scores decreasing even more at the 3-year

follow-up than at the 3-week follow-up. A period
of 3 weeks after the prosthetic treatment was
probably too short to completely demonstrate the
benefit of the prosthodontic therapy. We could
speculate that in the FPD group, some abutment
teeth might had still been sensitive and patients
could had not been fully adjusted to the phonetics
and speech. The patients with IFPD had probably
the same problems and could not completely forget
painful experiences during the therapy.
However, after 3 years in function, the patients
with IFPD felt no functional limitation, pain or
psychological problems any more, but had still
somehow higher scores for the physical and
social disability and handicap subscores. The
likely reason for that might be the fact that more
complicated treatment including surgical pretreatment and higher cost raised the patients
expectations and concerns about durability of the
restoration.
In the FPD group before the treatment, missing
teeth caused only functional limitation and psychological problems, without disability, pain and
handicap. This could be partially attributed to the
fact that at the baseline, 61% of the missing teeth
were in the mandible, edentulous spaces were
probably not visible and therefore caused only
minor problems. After the conventional FPD
rehabilitation, the OHRQoL in patients with FPD
was however increased and was even higher than
in the CG, demonstrating the individuals high
perception of oral improvement. Because the CG
consisted of younger individuals without prosthodontic appliance, it was expected that the OHRQoL would be superior in CG than in the FPD
prosthodontic patients even after the treatment. On
contrary, the study demonstrated that simple conventional FPD procedure gave the patients sense of
reliable rehabilitation increasing their OHRQoL
even to a higher level than in the CG. However, the
CG might have been a highly demanding group of
individuals, not being completely satisfied with
their natural teeth alignment, colour or shape
(although individuals with major skeletal discrepancies had been excluded from the CG group) or
might have had some other teeth or soft tissue
problems and therefore slightly higher OHIP scores
were probably registered.
In the IFPD group, higher baseline OHIP scores in
comparison with the FPD group should probably be
attributed to the fact that in 42% of the patients, at
least one canine was missing, which surely influenced the OHIP summary and subscale scores.
Posterior missing teeth in the FPD group prior to

e961

the treatment had less impact to psychological,

social and functional limitations than the loss of
some anterior teeth. We should also keep in mind
that the patients with IFPD were under the psychological pressure and fear of the surgical phase of
the implant placement, about which the patients
with FPD did not have to think about. However,
the patients with IFPD had also on average more
posterior teeth missing than the FPD group, as
usually one posteriorly inserted implant served as
abutment.
Our findings do not imply that every missing
posterior tooth requires prosthodontic treatment25,
but it is observable that in the both groups of patients, the quality of life was significantly improved, which is in accordance with Allen et al.10
and Szentpetery et al.11.
Three weeks after the therapy, the OHIP scores
were still higher in the IFPD group in comparison
with the FPD or the CG group, which could be
attributed to the experienced pain, a fear of
breaking the implant suprastructure, high cost and
an insufficient period to get used to the restoration.
Three years after the therapy, the patients with
IFPD had more self-confidence, having got used to
the appliance and differed no more from the CG in
almost all of the OHIP subscales and the OHIP
summary score.
We should also keep in mind that the patients
might justify the high cost of the implants only
during the longer period of time of the restoration
durability, and this could be detected by the lower
OHIP scores only in the second follow-up. This
could also be explained by improved function,
increased sense of security during function and
finally upgraded social interaction, normal daily
activities and therefore increased overall OHRQoL14,15.
Because the examined groups included an age
range between 28 and 74 years, the examined
population was tested to reveal the possible difference in results between the younger and older age
groups (60, >60). In the FPD group, the results
showed no statistically significant difference
between age groups, either before the treatment or
after the treatment, indicating that tooth-supported
FPD restoration equally improved OHRQoL no
matter how old the patient.
In the IFPD group, the results were different than
in the FPD group. Before treatment, the OHRQoL
did not differ between young and old patients, except for the physical pain and handicap. The older
patients assessed physical pain and handicap better
than the younger patients with IFPD. Three weeks
after the treatment, both age groups assessed their

 2011 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2012; 29: e956e963

e962

N. Petricevic et al.

OHRQoL as being better, but the older patients assessed their oral health as significantly better than
the younger patients considering subscales: Psychological discomfort, physical pain and functional
limitation, as well as the overall OHIP score. The
prosthodontic therapy improvement was higher in
older patients. Perhaps, the expectation of older
patients was lower and/or they could be less worried
about the long-term survival of the IFPDs. They
could also be less worried about the possible complications that could be expected in future owing to
their higher age. After 3 years in function, older
patients with IFPD still assessed their OHRQoL better than younger patients, although the significant
difference (compared with younger patients) existed only for the OHIP summary score. At this stage,
younger patients were probably less concerned
about long-term survival of the appliance as previous 3-year-long experience convinced them that
the restorations remained successfully in function in
the oral cavity. However, younger patients with
IFPD could still be more worried and could have
more concerns about the aesthetic outcomes than
the older group. The results of the present study are
in accordance with those authors who stated that
functional and psychosocial influence of oral diseases and conditions have stronger impact on young
individuals as a consequence of different sociodemographic and economic conditions26.
No significant difference in the OHIP scores
dependent on the presence of natural teeth or FPDs
in the antagonistic jaw was observed (p > 0.05).
These findings are in accordance with the study of
Baba et al.27, where they assessed the correlation
between the number of occlusal units and the
OHRQoL. The results of the present study show that
patients adjusted completely to the FPDs and experienced them in the same way as their natural teeth.
On contrary, in the IFPD group patients were more
concerned, probably owing to the high cost and/or
more difficult and more time consuming oral
hygiene maintenance. No difference (p > 0.05) between gender and no difference between the upper
or the lower jaw insertion indicated that the posterior missing teeth and their related influence on
the OHRQoL have the same importance for men and
women, regardless of which jaw was rehabilitated,
which is in accordance with some other studies8,9.
In this study, all patients received the treatment
for their choice, and therefore, the results demonstrated the most accurate change of the OHRQoL10.
The implementation of implants in dentistry has
some burdens, such as a high price and the need for
surgical treatment. The advantages of implant
treatment cannot be foreseen; so, the patients often

refuse it owing to fear of the surgical procedures

and high price.
Although IFPD treatment demonstrated significant increase in OHRQoL, which almost reached
the same scores as of the CG, the patients with
FPD still demonstrated better OHRQoL. However,
further research is necessary, especially concerning the cost-effectiveness of the IFPD treatment
in comparison with other prosthodontic treatment options. The results of the present study
may be relevant for clinicians who wish to have
evidence on how IFPD and FPD treatments in the
posterior part of dental arch improve OHRQoL.
The results can also be helpful to decide which
reconstructive treatment to recommend to the
patient in the posterior region and which outcomes in terms of the OHRQoL might be expected in each individual treatment option
dependent on a patients age.

Limitations of the study

The limitation of this study was unequal age distribution between the prosthodontic groups and
the CG. To be able to compare the results to a
healthy population without any prosthodontic
intervention, the mean age should be similar (age
matching). Also, the loss of canines only present in
the IFPD group before the treatment (42%) may
have lead to a strong impact on the OHRQoL and
unequally higher baseline scores, in comparison
with the patients with FPD.

Conclusion
Within the limitation of the study, both prosthodontic treatment options (FPD and IFPD) showed
significant improvement of the patients OHRQoL
during the first 3-week period and the further
improvement in the next 3-year period. The FPD
treatment improved OHRQoL equally in both age
groups (60, >60), while the IFPD treatment
improved oral health more in older patients.

Acknowledgement
The study was financially supported by Croatian
national grant Nr. 065-0650446-0420 and Slovenian national grant Nr. J3-6286-0381-04.

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Correspondence to:
Dr Nikola Petricevic, School of Dental Medicine,
University of Zagreb, Gunduliceva 5, 10000 Zagreb,
Croatia.
Tel.: +38514802165
Fax: +38514802159
E-mail: petricevic@sfzg.hr

 2011 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2012; 29: e956e963