How do specialist surgeons treat the atrophic tooth gap? A vignette-based study among maxillofacial and oral surgeons

Background There is little information available regarding the decision-making process of clinicians, especially in the choice of therapy for a severely atrophic tooth gap. The aim of this research was to use case vignettes to determine the influence of possible factors on the decision making of maxillofacial and oral surgeons. Methods A total of 250 maxillofacial (MFS) and oral (OS) surgeons in southern Germany were surveyed for atrophic single- or multiple-tooth gap with the help of case vignettes. The influence of different determinants on the therapy decision was investigated. Two case vignettes were designed for this purpose: vignette 1 with determinants patient age and endocarditis prophylaxis and vignette 2 with determinants anxiety and bisphosphonate therapy. Furthermore, the specialist designation was assessed for both. The options available to achieve a sufficient implant site were bone split, bone block, augmentation with bone substitute material and bone resection. Therapy was either recommended or rejected based on principle. Results A total of 117 participants returned the questionnaire: 68 (58%) were OS and 49 (42%) MFS. Patient age and patient anxiety were not significantly associated with any therapy decision. However, required endocarditis prophylaxis led to significantly higher refusal rates for bone split, bone block and bone replacement material and to higher rates of general refusal of a therapy. Bisphosphonate therapy was significantly associated with general refusal of therapy, but with no significant correlation with different therapy options. In vignette 1, OS refused therapy significantly more often than MFS, though there was no association with the specialist designation for other therapy modalities. In vignette 2, specialty was not significantly associated with the therapy decision. Conclusion Patient age as well as patient anxiety appear to have no or little influence on the treatment decision for severely atrophic single- or multiple-tooth gap by specialist surgeons. Surgeons more often refuse treatment for patients with endocarditis prophylaxis and bisphosphonate therapy.

Automated summary

The study found that patient age and anxiety appear to have little influence on the treatment decisions made by maxillofacial and oral surgeons, but patients requiring endocarditis prophylaxis and bisphosphonate therapy are more likely to be refused treatment.