Gabor Tepper Representative marketing-oriented

Robert Haas
Georg Mailath
study on implants in the Austrian
Christoph Teller population. I. Level of information,
Werner Zechner
Georg Watzak sources of information and need for
Georg Watzek patient information

Authors’ affiliations: Key words: implants, survey, public evaluation, level of information, sources of information,
Gabor Tepper, Robert Haas, Georg Mailath, Werner
need for information, marketing
Zechner, Georg Watzak, Georg Watzek, Department
of Oral Surgery, Dental School of the University of
Vienna, Austria Abstract: The number of dental implants inserted annually worldwide has been estimated to
Christoph Teller, Department of Retailing and
Marketing, Vienna University of Economics, come close to a million. But the level of information available to patients about realistic,
Vienna, Austria evidence-based treatment options by implants is often enough more than fragmentary, and
Gabor Tepper, Robert Haas, Georg Mailath, Werner
what is disseminated by the media and the industry does not always reflect evidence-based
Zechner, Georg Watzak, Georg Watzek, Ludwig
Boltzmann Institute of Oral Implantology and empirical data. This survey of 1000 adults presented with 18 questions was designed to shed
Gerostomatology, Vienna, Austria light on several points. These were (1) level of subjective patient information, (2) sources of
Correspondence to: information and prejudices, (3) future demand for implant treatment and target groups for
Gabor Tepper patient information campaigns, and (4) potential misinformation, information deficits,
Department of Oral Surgery
Dental School of the University of Vienna, Austria
discrepancies of information and how these come about. Of those questioned, 20% said
Waehringerstrasse 25A unprompted that implants were a possibility to replace missing teeth. When prompted, 72%
A-1090 Vienna, said that they knew about dental implants. Most of those questioned felt poorly informed
Austria
Tel: þ 43 1 4277 67011 about the options for replacing missing teeth and many knew less about implants than about
Fax: þ 43 1 4277 67019 other alternatives. The dentist was said to be the desired source of information, but 77% of
e-mail:gabor.tepper@univie.ac.at
those questioned reported that their dentists did not practice implant dentistry. More than
79% of those questioned did not know whether their dentist worked with implants. Forty-four
percent thought that implants should only be placed by specially trained doctors. Sixty-one
percent were of the opinion that dentists who provide implant dentistry were better qualified
than their nonimplanting colleagues. Half of those questioned attributed implant failures to
allergies and incompatibilities, the other half to poor medical care. Only 29% incriminated
poor oral hygiene as a cause of implant failure. Future strategies should be geared to more
professional public relations and patient information. Internationally operating qualified
implant institutions could contribute much to balance discrepant information.

The overwhelming majority of patients younger individuals (Lekholm & Zarb

Date:
Accepted 24 June 2002
To cite this article:
Tepper G, Haas R, Mailath G, Teller C, Zechner W,
Watzak G, Watzek G. Representative marketing-oriented
study on implants in the Austrian population. I. Level of
information, sources of information and need
for patient information.
Clin. Oral Impl. Res, 14, 2003; 621–633.
Copyright r Blackwell Munksgaard 2003
ISSN 0905-7161
with severely compromised local host bone
can nowadays be offered implant-supported
rehabilitation with a very good prognosis
(Adell et al. 1981, 1990; Bergendal &
Engquist 1998; Lindh et al. 1998; Friberg
et al. 2000; van Steenberghe et al. 2001).
Even in patients of advanced age, mastica-
tory comfort can thus be improved at an
implant success rate comparable to that in
1985; Meijer et al. 2001). Of the patients
questioned in a survey, 88% reported that
their self-confidence had increased after
implant treatment, 89% would again un-
dergo implant treatment, and 98% said
their oral health had generally improved
(Grogono et al. 1998).
With about 1 million implants inserted
annually worldwide (Brunski 1999), this

621
Tepper et al . Marketing-oriented study on implants – I
subspecialty of rehabilitative dentistry has
become an integral part in the practice of a
continually increasing number of dentists.
A British survey addressed the implant
activities of British dentists and questioned
them about the products they favor and the
motives for their choice (Young et al. 2001).
Most implant-related publications right-
fully emphasize quality assurance based on
extensive basic research. But the level of
patient information and their need for
information should not be neglected. With-
out access to suitable sources the public is
more often than not confronted with con-
fusing information provided by the media
and the industry, which is at times deliber-
ately misleading and mainly marketing-
oriented (Watzek et al. 2000). A study in
the United States showed that 77% of those
questioned knew about dental implants, but
that their main source of information was
the media, while their dentists did not
contribute much (Zimmer et al. 1992). In
a recent survey, mass media like periodicals,
TV and broadcasts were reported to be the
main sources of mostly negative informa-
tion about dental implants (Berge 2000).
For the professional community, it is
imperative to know whether patients feel
adequately informed and whether what they
know reflects the realities. After all, the
flood of novel trends like immediate im-
plant placement, immediate implant load-
ing, callus distraction, growth factors and
ever-varying implant surfaces is not only
confusing for the uninitiated. Knowing what
the patients know about implants, in the
final analysis, helps to match consumer
expectations with what can realistically be
achieved and to ward off a negative image of
implant dentists caused by a communica-
tions gap and by consumer discontent.
Part I of this representative patient survey
addresses the level of patient information
about implants, the sources of information
and the need for information in the popula-
tion of Austria as a model case for the
European Union (EU). The survey was also
designed to shed light on public opinion about
implanting and nonimplanting dentists.
Material and methods
This representative survey was commis-
sioned by the Oral Surgery Department at
the University of Vienna Dental School and
622 | Clin. Oral Impl. Res. 14, 2003 / 621–633
conducted by the Austrian Gallup Institute
(Dr Karmasin – Marketing Research). Mar-
keting aspects were analyzed in collabora-
tion with the Department of Retailing and
Marketing at the Vienna University of
Economics and Business Administration.
One thousand adults were presented with a
total of 32 questionnaire items. The data
collected are reported in two parts. Part I deals
with 18 items on the level, source and need of
information in the Austrian population with
special emphasis on the identification with
opinion makers and misinformation, if any.
Other items those questioned were presented
with were awareness of implant dentistry
practiced by their dentists, superior qualifica-
tion, if any, of implanting versus nonimplant-
ing dentists, and limitation of implant
dentistry to specialists.
Of the 1000 interviewees, 521 were
females (52.1%) and 479 were males
(47.9%). All of them were above 14 years
of age: 255 were less than 30 years, 367
were between 30 and 50 years, and 378
were more than 50 years old.
The sample was selected by prestratified
multitiered cluster sampling (random sam-
pling). The poll was conducted between 21
March 2001 and 10 April 2001. To obtain
more detailed information, the interview-
ees were allocated to several groups by the
monthly family income (net monthly in-
come below h900, up to h1500, up to h2200
and more than h2200) and by vocational/
professional qualifications. Seven job-re-
lated categories were distinguished: (1)
self-employed, freelancers and executives,
(2) white-collar workers, civil servants, (3)
blue-collar workers, (4) persons working in
agriculture, (5) pupils and students, (6)
housewives, and (7) retirees. The poll was
conducted nationwide. Three categories
were run by the size of the place of
residence: settlements with up to 5000
inhabitants, up to 50,000 inhabitants and
more than 50,000 inhabitants.
The poll was based on face-to-face inter-
views backed by questionnaires in private
households. All interviewers were trained
full-time members of the Austrian Gallup
Institute experienced in face-to-face inter-
viewing techniques. Controls were made in
writing (18%) and by phone (6%) and by
person-to-person in-process and follow-up
questioning. Plausibility was evaluated by
a computerized pre-run of the data (100%)
and by response checks (100%).
In view of the complexity and size of the
survey, this paper is based on the results of
univariate and bivariate analyses (Church-
ill 1999). The confidence interval for the
distribution of the variables evaluated, or
rather the standard error appropriate for a
random sample, was computed as
pffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
S ¼ pð100
pÞ=n;
where p is the distribution in %, n the
sample size or base and s the standard
deviation/error. Data were evaluated to
within 2 SD at a significance level of
95.5%.
Fig. 1 demonstrates the demographic
structure of the interviewed population,
and Fig. 2 details the confidence ranges of
the percentages found.
The 18 items of the 32-item question-
naire presented in this contribution were
subdivided into five sections (see Appen-
dix).
A Level of information about implant-
supported and conventional rehabilita-
tion, degree of awareness, general level
of information, personal opinion
B Sources of information
C Subjectively perceived need for informa-
tion
D Objective need for information
E Level of information about implant-re-
lated activities of the interviewees’ reg-
ular dentist. Would the interviewees want
their regular dentist to provide implant
treatment? Do the interviewees think
dentists providing implant dentistry are
better qualified than those who do not?
The poll was funded in equal shares by
commercial companies/manufacturers:
Nobel Biocare, Friadent-Schütze, Degussa
and Straumann.
Results
Level of information about implant-
supported and conventional rehabilitation
On unprompted questioning about what
alternatives the interviewees knew for
replacing missing teeth, 69% mentioned
crowns and bridges by free association
(Kumar et al. 1999), 50% knew about
dentures, while no more than 20% (19%
of the females and 21% of the males)
spontaneously associated dental implants.
On prompted questioning with a choice of
answers provided, the awareness rate of

Fig. 1. Structure of the interviewed population.
dental implants was 72%. Thirty-two
percent of the high-income earners men-
tioned dental implants spontaneously vs. no
more than 11% of the blue-collar workers.
Only 4% of the interviewees felt very
well informed about dental implants and
only 5% about nonimplant-supported alter-
natives. By contrast, 42% said they were
not at all informed about dental implants.
This compared with only 22% who felt
uninformed about alternative denture treat-
Tepper et al . Marketing-oriented study on implants – I
ments. On a rating scale from 1 to 5
(1 ¼ very well informed, 5 ¼ poorly or not
at all informed; the scale was adapted from
the grading scale used in Austrian schools)
(Dillon et al. 1994), the level of implant-
related information scored 4.0 and that of
alternatives 3.45. The size of the interview-
ees’ place of residence was found to be the
major discriminating variable for this item.
Only 18% of the residents in settlements
with more than 50,000 inhabitants felt not
at all informed about dental implants vs.
54% of those living in rural settlements
with less than 5000 inhabitants. Of the self-
employed, freelance and executive group,
20% said they had no information about
implants vs. 60% of the pupils and students
and 47% of the retirees. Of those below 30
years of age, 52% felt not at all informed
about implants vs. 41% of those older than
50 years. When questioned about nonim-
plant-supported dentures, both conventional
removable and nonremovable, 40% of those
below 30 years and 12% of those above 50
years reported not to be informed at all. This
answer was given by 28% of the interview-
ees from settlements with less than 5000
inhabitants vs. no more than 5% of those in
towns with 50,000 inhabitants.
Of the entire sample, with respect to the
advantages of nonremovables, 44% said
they did not feel like foreign bodies, 40%
felt they were less annoying in the mouth,
39% equated nonremovables with natural
teeth in terms of function, and 36% were
convinced they were esthetically more
attractive than removable dentures.
When comparing the advantages of non-
removable bridges with those of removable
dentures, 75% of the interviewees opted for
the first alternative, 16% for the second and
8% were undecided. Of the interviewees
wearing implant-supported reconstruc-
tions, 91% voted in favor of nonremovables
while only 9% favored removables.
When asked whether they would be
content with removables to replace several
missing teeth, 54% said yes, 41% said no
and 5% gave no answer. A breakdown by
age groups showed 70% of those above 50
to accept removable dentures vs. 47% of
those below 50, 41% of those below 30
and 76% of the retirees. In the lowest
income category, 63% were positive
about removables vs. 47% of those in the
highest income category. Of the intervie-
wees from settlements with less than 5000
inhabitants, 58% were prepared to accept
removables vs. 53% of those from towns
with more than 50,000 inhabitants.
Sources of information
For 68% of those questioned, the main
source of information was the dentist,
followed by printed media (23%) and by
friends and acquaintances (22%). In the self-
employed, freelance and executive group,
623 | Clin. Oral Impl. Res. 14, 2003 / 621–633
Tepper et al . Marketing-oriented study on implants – I

Confidence Ranges with implant-related information vs. 42%

in the more densely populated areas.
Percentage 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Objective need for information
or 95% 90% 85% 80% 75% 70% 65% 60% 55% 50%

Total 1000 ±1.4 ±1.9 ±2.3 ±2.5 ±2.7 ±2.9 ±3.0 ±3.1 ±3.1 ±3.2 To assess the level of general knowledge,
SEX the interviewees were asked where im-
male 479 2.0 2.7 3.3 3.7 4.0 4.2 4.4 4.5 4.5 4.6 plants were anchored. Sixty-one percent
female 521 1.9 2.6 3.1 3.5 3.8 4.0 4.2 4.3 4.4 4.4 said in the jawbone, 7% thought in the
AGE gums, 6% opted for the neighboring teeth
under 30 a 255 2.7 3.8 4.5 5.0 5.4 5.8 6.0 6.1 6.2 6.3
under 50 a 367 2.3 3.1 3.7 4.2 4.5 4.8 5.0 5.1 5.2 5.2 and 29% did not know.
over 50 a 378 2.2 3.1 3.7 4.1 4.5 4.7 4.9 5.0 5.1 5.1 Twenty-six percent of those above 30
PROFESSION years and 28% of those above 50 years did
self –empl. / fr.lancer 82 4.8 6.6 7.9 8.8 9.6 10.1 10.5 10.8 11.0 11.0 not know where implants were anchored.
white-coll. / civ.serv. 255 2.7 3.8 4.5 5.0 5.4 5.7 6.0 6.1 6.2 6.3
This contrasts with an above-average rate
blue-collar workers 222 2.9 4.0 4.8 5.4 5.8 6.2 6.4 6.6 6.7 6.7
working in agricult. 30 8.0 11.0 13.0 14.6 15.8 16.7 17.4 17.9 18.2 18.3 of 37% among those below 30 years. The
pupils / students 71 5.2 7.1 8.5 9.5 10.3 10.9 11.3 11.6 11.8 11.9 jawbone as the correct implant host site
housewives 98 4.4 6.1 7.2 8.1 8.7 9.3 9.6 9.9 10.1 10.1 was mentioned by an above-average 75% of
retirees 242 2.8 3.9 4.6 5.1 5.6 5.9 6.1 6.3 6.4 6.4 the self-employed, freelancers and execu-
MONTHLY
tives vs. just 48% of the pupils and
INCOME
up to 9 00 342 2.4 3.2 3.9 4.3 4.7 5.0 5.2 5.3 5.4 5.4 students and 56% of the blue-collar work-
up to 15 00 265 2.7 3.7 4.4 4.9 5.3 5.6 5.9 6.0 6.1 6.1 ers. In settlements with less than 5000
up to 22 00 188 3.2 4.4 5.2 5.8 6.3 6.7 7.0 7.1 7.3 7.3 inhabitants, 32% of those questioned did
over 22 00 123 3.9 5.4 6.4 7.2 7.8 8.3 8.6 8.8 9.0 9.0 not know where implants were anchored
DISTRICT
vs. 21% in towns with more than 50,000
Vienna 203 3.1 4.2 5.0 5.6 6.1 6.4 6.7 6.9 7.0 7.0
Low.Austr./Burgld. 225 2.9 4.0 4.8 5.3 5.8 6.1 6.4 6.5 6.6 6.7 inhabitants. Of the implant patients, who
Styria/Carinthia 229 2.9 4.0 4.7 5.3 5.7 6.1 6.3 6.5 6.6 6.6 should theoretically be better informed,
Upp.Austr./Salzburg 229 2.9 4.0 4.7 5.3 5.7 6.1 6.3 6.5 6.6 6.6 67% said the jawbone was the right site
Tyrol/Salzburg 113 4.1 5.6 6.7 7.5 8.1 8.6 9.0 9.2 9.4 9.4 for anchoring implants. No less than 8%
SIZE OF CITY
opted for the gums, 11% for the neighbor-
max. 5.000 447 2.1 2.8 3.4 3.8 4.1 4.3 4.5 4.6 4.7 4.7
max. 50.000 239 2.8 3.9 4.6 5.2 5.6 5.9 6.2 6.3 6.4 6.5 ing teeth and 16% did not know.
over 50.000 111 4.1 5.7 6.8 7.6 8.2 8.7 9.1 9.3 9.4 9.5 Among the major disadvantages of im-
plant dentistry, high cost was cited by 76%,
HAD IMPLANT the need for surgery by 34% and the long
THERAPY
treatment time by 15%. Of the intervie-
Yes. 263 2.7 3.7 4.4 4.9 5.3 5.7 5.9 6.0 6.1 6.2
- themselves 44 6.6 9.0 10.8 12.1 13.1 13.8 14.4 14.8 15.0 15.1 wees rehabilitated with implants, 80% felt
- acquaintance 245 2.8 3.8 4.6 5.1 5.5 5.9 6.1 6.3 6.4 6.4 implants were too expensive, 26% com-
No 737 1.6 2.2 2.6 2.9 3.2 3.4 3.5 3.6 3.7 3.7 plained about the surgical procedure
CARRYING needed, and 11% thought that the time
DENTAL WORK
for healing and prosthodontic management
Yes 417 2.1 2.9 3.5 3.9 4.2 4.5 4.7 4.8 4.9 4.9
No 175 3.3 4.5 5.4 6.0 6.5 6.9 7.2 7.4 7.5 7.6 was too long. Both in the lowest and in the
highest income groups, implant treatment
Fig. 2. Confidence ranges of the percentages found. was reported to be too expensive (81% and
75%, respectively).
34% obtained implant-related information about dental implants. Most of them (48%) When asked how long they thought
from the media versus no more than 14% in were executives and civil servants. Of those implants would survive, 3% said up to 5
the retiree group. In towns with more than interested in more information about im- years, 21% up to 10 years, and 33% up to
50,000 inhabitants, 91% of the interviewees plants, 76% wanted it to come from the 20 years. Thirty-four percent assumed that
looked to the dentist for information about dentist, but only 34% from the media. implants would last for a lifetime and 9%
implants vs. 63% of the residents in settle- Modern media were the preferred source of did not reply. Of the implant patients, 46%
ments with less than 5000 inhabitants. information for 40% of those below 50 thought implants lasted for a lifetime,
years and for no more than 23% of those while 33% believed they lasted for up to
Subjectively perceived need for above 50 years. Major differences were seen 10 years.
information in this respect between settlements with Thirteen percent of those interviewed
less than 5000 inhabitants and those with blamed the patients themselves for implant
Thirty-one percent of those interviewed more than 50,000. In the rural areas only losses, 47% attributed implant failures to
would be interested in more information 30% wanted the media to provide them poor dentist work, 29% incriminated poor

624 | Clin. Oral Impl. Res. 14, 2003 / 621–633


oral hygiene, 51% allergies and incompat-
ibilities, 2% opted for ‘other reasons’ and
9% did not answer. Multiple entries were
admitted under this item. Of the implant
patients, 23% blamed the patients them-
selves for implant failures, 55% the dentist,
38% poor oral hygiene, and 28% allergies
and incompatibilities.
Questioned about the need for special
care and hygiene of implant patients, 44%
thought these were not necessary. They
would clean the implants just like natural
teeth. Forty-six percent would take more
time for oral hygiene than for their natural
teeth and 46% would take less time. Six
percent did not reply.
Level of information about implant-related
activities of the regular dentist – should
implant treatment be done by the regular
dentist?
Seventy percent of those interviewed were
unable to say whether their regular dentist
practised implant dentistry. Twenty-three
percent thought their regular dentists were
involved in implant dentistry, while 7%
said they were not. Of those below 30
years, 7% knew that their regular dentist
offered implant treatment vs. 30% of those
above 50 years. In settlements with less
than 5000 inhabitants, 74% did not know,
and in towns with more than 50,000
inhabitants, 68% had no idea whether their
regular dentist practised implant dentistry.
Of those who believed their regular dentist
practised implant dentistry (23%), 69%
thought their dentist used state-of-the-art
techniques. Only 1% said their dentist was
not up to date with the techniques used.
Thirty percent could not tell. With increas-
ing age, the interviewees tended to be less
skeptical about their dentist’s state-of-the-
art techniques. No more than 56% of those
below 30 years granted that their dentist
was up to date in implant techniques vs.
73% of those in the higher age groups. Of
the retirees, pupils and students, 80%
trusted their dentist in this respect. This
contrasts with only 62% of the freelancers,
executives and self-employed. This opinion
was shared by 67% of those living in
settlements with less than 5000 inhabi-
tants vs. 75% of those living in towns with
more han 50,000 inhabitants. Of the
patients fitted with implants, 75% were
convinced that their dentist used state-of-
Tepper et al . Marketing-oriented study on implants – I
the-art techniques. When asked to rate the
dentist of friends and acquaintances fitted
with implants, this view was shared by no
more than 61% of those interviewed.
Of the interviewees who, as far as they
could tell, thought their dentist did not
practise implant dentistry (7%) or who did
not know about it (70%), 46% would want
their regular dentist to provide implant
treatment. Forty-four percent felt that
implants should only be inserted by specia-
lists, while 10% were undecided. Fifty
percent of the males vs. only 42% of the
females were of the opinion that their
dentist should provide implants. Of the
self-employed, freelancers and executives,
50% would welcome the provision of
implant dentistry by their dentist vs. only
27% of the retirees. In the age group below
30 years, 60% would want their dentist to
provide implant treatment vs. no more than
32% of those above 50 years. Seventy
percent of the patients fitted with implants
elsewhere, because their regular dentist
does not provide implants, would want
their own dentist to turn towards implant
dentistry. Only 32% of the patients reha-
bilitated with nonimplant-supported den-
tures or bridges thought that their regular
dentist should add implant dentistry to his/
her repertory vs. 61% of those who neither
had bridges nor dentures.
Sixty-one percent of those questioned
believed that dentists who practise implant
work were better qualified than those who
do not. This view was not shared by 30% of
the interviewees, while 9% abstained from
answering. Sixty percent of the males and
64% of the females were affirmative about
this item as were 58% of those below 30
years, 71% of those up to 50 years and 56%
of those above 50 years. This view was
expressed by 72% of the self-employed,
freelancers and executives vs. only 51% of
the retirees and 87% of those who had
already been rehabilitated with implants.
The bar charts in Fig. 3 illustrate the
most important data.
Discussion
This representative patient poll of the level
of information in the Austrian public about
dental implants differs from most other
earlier studies in terms of the method used,
the number of items asked, the size and
representative nature of the sample, and the
analysis of the data by an independent
academic institution.
As in a recent study (Berge 2000), face-
to-face interviews in private households
were chosen for this survey. This is more
time-consuming and cost-intensive com-
pared to other published studies based on
interviews in public, e.g. in the streets
where time is a factor, or on mailed or
hand-out questionnaires (Akagawa et al.
1988; Grogono et al. 1989; Zimmer et al.
1992) which tend to produce unsatisfactory
feedback. The low response rates and high
nonresponse rates of 64% (Grogono et al.
1989), 79.4% (Palmqvist et al. 1991) or
70.8% (Berge 2000), which were reported
to be major drawbacks of surveys in writing
(Zikmund 1999), are typical of earlier
studies and were the reason to opt for the
method described. In a nonpatient-related
survey based on questionnaires exclusively
sent to implant dentists, a British group
recorded no more than 66.9% completed
returns (Young et al. 2001, parts I and II).
Another group (Butterworth et al. 2001)
scored a response rate of 75%. With the
protocol chosen for this poll, the response
rate was 100%.
The number of items covered also
exceeded that in most other surveys. In
this poll 32 items (18 in Part I and 14 in
Part II) were presented. This contrasts with
only six in a survey from Japan (Akagawa et
al. 1988), four from Sweden (Palmqvist et
al. 1991), 23from America (Zimmer et al.
1992), seven from finland (Salonen 1994),
10 from Germany (Müller et al. 1994) or
four from Norway (Berge 2000). As a result,
more details were elicited and the body of
information collected about the subject of
interest was substantially extended.
The sample size of 1000 individuals was
another distinguishing factor. Admittedly,
3000 persons were questioned in a Swedish
study (Palmqvist et al. 1991) and 5000 in a
study conducted in Norway (Berge 2000).
But most other studies were based on
smaller sample sizes, e.g. 358 (Akagawa
et al. 1998), 73 (Günay et al. 1991), 120
(Zimmer et al. 1992), 64 (Müller et al.
1994), 150 (Salonen 1994), 61 (De Bruyn et
al. 1997), 135 (Sandberg et al. 2000) or 83
(Allen et al. 2001). As the sample size
chosen for this poll was representative for
Austria, the data collected can be taken as
conclusive.
625 | Clin. Oral Impl. Res. 14, 2003 / 621–633
Tepper et al . Marketing-oriented study on implants – I

Fig. 3. (a–i). Bar charts showing the most important data.

626 | Clin. Oral Impl. Res. 14, 2003 / 621–633


A marketing-oriented analysis of the data
was chosen to alert dentists to the need for
client management and how information
gathered from patients could be used for the
benefit of dentist – patient relations. In a
study published in the United States
(Zimmer et al. 1992), the need to analyze
polling data with up-to-date marketing
techniques was also stressed. One major
concern in the present study was to
establish the ideal sources of product-
related information for the patients with a
view to relieving implant dentists of pro-
viding economic information as entrepre-
neurs so that they can concentrate on their
medical ethical and moral responsibilities.
All this is designed to enhance patient
satisfaction and to generate more demand
for implant dentistry by polishing the
image of the dentists.
Situated in Central Europe, Austria’s
socio-economic parameters, i.e. health
care, average monthly income, life expec-
tancy, educational level or density of dental
care provision, match those in other coun-
try members of the EU. Consequently, the
data collected should be well comparable
with those in most of the other EU
members (Statistik Austria 2001).
In order to provide further insight into
the perception of the implantologist in the
Austrian population, details about national
dental training with special emphasis on
implantology are added. Dental students
are acquainted with the state-of-the-art in
implantology in three federal dental uni-
versities associated with medical schools.
Although dental students have an opportu-
nity to watch trained implantologists at
work, they are practically involved in
interdisciplinary treatment planning and
prosthetic work. During post-graduate
training, a variety of theoretical and prac-
tical courses, such as hands-on workshops
on human cadavers and prosthetic work-
shops, offer abundant opportunities to
acquire practical skills. These courses are
provided throughout the country and are
accessible for every dentist. Currently,
there is no mandatory training to become
an implantologist, but the national medical
association and some university clinics are
discussing guidelines for oral surgeons and
implantologists requiring continuous col-
lection of postgraduate training credits.
Comparable systems are to be found in
Germany and Switzerland. The number of
Tepper et al . Marketing-oriented study on implants – I
Austrian dentists performing implant in-
stallments is roughly 10–20% of 4200
registered dentists in a population of 8
million people. Additionally, another 30–
40% provide prosthetic work for patients
previously referred to colleagues for im-
plant placement. Implant treatment is
mainly paid for by the patients themselves
and usually not covered by social or private
insurances. However, in certain cases,
where extreme degrees of residual ridge
atrophy, poor general health or poverty
present a condition of medical or social
need, implant treatment is being paid for by
social insurance.
Level of information about implant-
supported and conventional rehabilitation
Questioned about various alternatives to
replace missing teeth, only 20% of those
interviewed spontaneously mentioned im-
plants. When prompted, 72% said they
were aware of dental implants. In an
American and a Norwegian sample, the
level of awareness was 77% and 70.1%,
respectively (Zimmer et al. 1992; Berge
2000). The exceptionally high awareness
level recorded in the American survey may
reflect differences between the American
and European populations. But as the
sample was composed of middle-aged and
elderly individuals, it was hardly represen-
tative. Major differences were seen between
the high-income earners (32%) and those in
the lowest income group (11%). This
would suggest that the latter should speci-
fically be targeted in future information
campaigns to make them aware of the
existence of implant dentistry, its indica-
tions and its affordability. The subjective
level of information about oral implants
was all but satisfactory considering that
42% of those questioned said they were not
informed at all, while only 4% said they
were well supplied with information about
implants. Residence in urban areas, high
professional qualifications, high income
and age above 50 years were the main
factors underlying a higher level of informa-
tion. This confirms the Norwegian data,
which suggested that an age above 45 years
and a high educational level were most
strongly associated with a high level of
information about implants (Berge 2000).
Persons at the lower and upper end of the
age range, i.e. pupils/students and retirees,
were found to be the most ignorant about
implants. The subjective level of patient
information about conventional dentistry
was only marginally higher than that about
implant dentistry (mean score 3.45 vs. 4.0).
Rather than making the implant-related
data appear in a less negative light, this
throws doubt about the quality of the
public relations work carried out by the
dentists generally and their communica-
tion strategies. Improved public relations
providing the target group with compre-
hensible, easily accessible information
about oral implants would not only help
to avoid misunderstandings but would also
benefit the economic interests of dentists
and implant manufacturers. This agrees
well with a recent study from Norway,
which postulated that the public should be
supplied with competent and targeted
information (Berge 2000).
Most of those questioned (75%) were
convinced of the advantages of nonremov-
able bridges vs. removable alternatives. In
fact, patients already fitted with implants
scored highest in this respect (91%). Over-
all, 44% of those interviewed said non-
removables did not feel like foreign bodies,
39% thought they were equal in function
with natural teeth and 36% were con-
vinced that they were esthetically more
attractive. American patients also reported
that implant-supported rehabilitations
were esthetically more attractive than
removables and rated this as a major
advantage of implant dentistry (Zimmer et
al. 1992). The weighting given by the
public to the advantages of implant-sup-
ported solutions does not reflect evidence-
based data, which clearly showed improved
denture stability and masticatory function
to be the main benefits for implant patients
(Carr & Laney 1987; Akagawa et al. 1989).
Still, 54% of the sample said they could
live with removables if need be. This
average rate was based on the readiness of
70% of those above 50, 76% of the retirees,
63% of those in the lowest income category
and 58% of those living in smaller places to
make do without nonremovables, although
they were aware of their benefits and
amenity. This option was only accepted
by 41% of those below 30, 34% of the self-
employed, freelancers and executives, and
53% of those living in larger towns.
Consequently, the subjectively perceived
need for high-quality nonremovables was
627 | Clin. Oral Impl. Res. 14, 2003 / 621–633
Tepper et al . Marketing-oriented study on implants – I
correlated with low age, high socio-eco-
nomic status and urban residence.
Sources of information
For 68% of those interviewed, the dentist
was the most important source of informa-
tion about oral implants. Less than one-
quarter accorded first place to the printed
media or to friends and acquaintances. This
was radically different from what four
published studies reported. In a survey in
the United States, the media were found to
be the most important source of informa-
tion, while the dentists were mentioned in
no more than 17% of cases (Zimmer et al.
1992). A study in Japan showed that
dentists provided not more than 20% of
the information (Akagawa et al. 1988).
Studies in Australia and in Norway also
found the media to be the main source of
information, while dentists played a sec-
ondary role at best (Best 1993; Berge 2000).
In the present study, the large number of
implant dentists and the easy access to
them in larger towns explains why they
were mentioned as the main source of
information about implants (91% of cases).
For residents in smaller settlements, they
played a less prominent role (63% of
entries). The fewer the implant dentists
available locally to provide information
first hand, the more important the role of
the media. Also, individuals with higher
professional qualifications turned to the
media for information three times as often
as retirees. In this context, a Norwegian
study is of particular interest, where tele-
vision and broadcasts were found to provide
mostly negative information by concentrat-
ing on complications and treatment fail-
ures, while magazines were shown to
research the subject more carefully and
publish unbiased reports (Berge 2000).
Subjectively perceived need for
information
Thirty-one percent of all those interviewed
said they would be interested in more
information about dental implants, among
them almost half of those with higher
professional qualifications (48%). Three-
quarters of those questioned would want to
obtain this information from their dentists.
But those below 50 years and those living in
urban areas clearly tended to turn to the
628 | Clin. Oral Impl. Res. 14, 2003 / 621–633
media for information. The shift in empha-
sis towards the media should prompt these
to pay more attention to objective, evi-
dence-based reporting about implants and
to make sure that marketing-oriented
industry-sponsored reporting is labeled as
such with all due liability for the content.
Objective need for information
Despite the comparatively high level of
awareness of endosseous dental implants,
only a surprising 61% of those interviewed
correctly cited the jawbone as the host site
for implants. In this item urban residence
(79%), higher professional qualifications
(75%) and age above 50 years (72%) were
positively correlated factors.
Asked about the most serious disadvan-
tages of implant dentistry, 76% of those
interviewed mentioned high cost and 34%
the need for stressful surgery. Only 15%
complained about what may often be
protracted healing and prosthodontic man-
agement times. This agrees well with an
American and a Japanese study in which
the cost factor and resentments about
surgery were also reported to be the major
disadvantages of implant dentistry (Akaga-
wa et al. 1988; Zimmer et al. 1992). This
goes to show that dentists should take
greater pains to explain the surgical proce-
dure carefully and comprehensibly to their
potential patients and to dispel their wor-
ries by detailing what treatment is planned
for them to match the conditions of their
jaws. Depending on the type of treatment
planned, reservations about the long time
needed for healing and prosthodontic man-
agement can also be dispelled in many
cases nowadays. Most importantly, ex-
pected implant survival, which is more
often than not unrealistic, should be put in
its proper perspective. In this representative
survey, 34% of the general population and
no less than 46% of patients fitted with
implants thought that implants lasted for a
lifetime. This misconception no doubt
points to misinformation or incomplete
information of the public in terms of a
major information gap. In a Japanese study,
only 28% of those questioned believed
their implants would last forever (Akagawa
et al. 1988). Interestingly, highly unrealis-
tic patient expectations were also found in a
study of nonimplant-supported full-arch
dentures (Davis et al. 1986).
Implant losses were blamed on the
dentist by 47% of those questioned, while
51% incriminated allergies and incompat-
ibilities. Of the implant patients, up to
55% blamed the dentist for implant fail-
ures. By comparison, only 13% of the
sample in a Japanese study had any idea
of the potential causes of implant failure
(Akagawa et al. 1988).
Only 44% of the sample thought that
special oral hygiene or dental care was
necessary for implants. But in a German
study only a few patients said they would
forego implant dentistry because of the need
for more rigorous oral hygiene (Müller et al.
1994). The mechanisms underlying im-
plant-related complications, their manage-
ment and the causes of implant failure were
addressed in several detailed reports (Espo-
sito et al. 1999; El Askary et al. 1999; Lang
et al. 2000). Dentists still have a long way to
go to correct misconceptions by providing
legally tenable information, if they want to
ward off legal action and warranty suits.
Level of information about implant-related
activities of the regular dentist
No reference data from earlier studies were
available for comparison with the data
gathered on this economically important
item. Seventy percent of those interviewed
in this study did not know whether their
dentist practiced implant dentistry. This
testifies to severe shortcomings in dental
care marketing on the part of the dentists.
Ignorance of this item was particularly
rampant in the group of interviewees below
30 years (78%) and those living in settle-
ments with less than 5000 inhabitants
(74%). Comparable data from other coun-
tries were not available. But regional and
multinational comparisons of what the
patients know about implant-related activ-
ities of their dentists could provide valuable
insights into the effectiveness of the pro-
motional and marketing methods used.
Only 69% of those who thought their
dentist practised implant dentistry believed
that he/she used state-of-the-art techniques.
Confidence in their own dentist in this
matter was most widespread among urban
residents and in the highest age group. As
already mentioned above, the tendency of
reporting more negative than positive in-
formation about implants was also brought
to light under this item. Of the patients

fitted with implants, 75% were convinced
their own dentist was excellently qualified.
But other dentists, who had provided im-
plant treatment to friends or acquaintances,
were only accorded these qualifications by
61% of those questioned on the basis of
what they had been told. Apparently the
majority of implanted patients thought they
had a better dentist than their equally
implanted friends and acquaintances.
Maybe these had not been told to expect
transitory postoperative discomfort and
communicated this traumatic experience
to others close to them in the initial stages
of treatment. A recent British survey among
members of ADI (Association of Dental
Implantology) evaluated implantological ac-
tivities and clinical experiences made by
British dentists (Young et al. 2001). It
showed that 29.8% of the registered im-
plantologists had inserted less than 50
implants. Only 4.3% qualified as very
experienced with more than 2000 implants
and only 2.6% were certified for implantol-
ogy. In a similar study, 49.5% of the dentists
questioned claimed to practise implant
dentistry, although more than one-third of
them had treated less than 10 patients a year
(Butterworth et al. 2001).
In the present survey, 44% of those
questioned thought that implant dentistry
should only be practised by specially
trained experts and 61% felt that implant
dentists were better qualified than their
nonimplanting colleagues. These views
were most widespread in the group with
the highest professional qualifications
(72%) and among those already fitted with
implants (87%). This suggests that, in the
course of their surgical and prosthodontic
management, implant patients had gath-
ered the impression they were treated with
a complex sophisticated high-tech method,
which required special qualifications and
special training on the part of the dentist.
Marketing-related discussion of the results
The content of most of the representative
opinion polls about implants conducted
worldwide in more than 15 years has been
extensively quoted in the previous sections
(Davis et al. 1986; Akagawa et al. 1988,
1989; Grogono et al. 1989; Günay et al.
1991; Palmqvist et al. 1991; Zimmer et al.
1992; Best 1993; Müller et al. 1994; Salonen
1994; De Bruyn et al. 1997; Berge 2000;
Tepper et al . Marketing-oriented study on implants – I
Sandberg et al. 2000; Allen et al. 2001;
Butterworth et al. 2001;Young et al. 2001).
In these surveys, the multifaceted attitudes
of the public, the patients and doctors
towards dental implants were evaluated at
length by different approaches. Profession-
ally conducted marketing analyses in this
field based on large-scale surveys have so far
not been available. In medicine, more than
in any other field, ethical and moral
responsibilities no doubt play an overriding
role. But endosseous implants absorb exten-
sive research, development, manufacturing
and dental care funds so that neglecting vital
economic aspects would be irresponsible. In
fact, the whole enterprise would ultimately
lose its financial basis. This is why a
compact factorial evaluation conducted by
the Department of Retailing and Marketing,
Vienna University of Economics and Busi-
ness Administration, will be presented in
full awareness of the legitimate ethical
arguments that may be raised against it.
The low level of information of those
questioned in this poll amply demonstrates
a marketing need, i.e. to use instruments of
sales promoting communication system-
atically in order to close the information
gap in the targeted markets and to channel
demand (Scheuch 1996; Becker 1998;
Kotler 2000; Meffert 2000; Pepels 2000).
In this effort the complex nature of the
product ‘implant’ and the component
aspects of medical care like specialized
training, high-cost equipment and person-
nel should be made transparent by opti-
mally using communication tools (Becker
1998). Face-to-face communication be-
tween the dentist and the patient appears
to be the most appropriate tool for this
purpose, because their pre-established re-
lationship based on confidence and trust
provides the best insight into the supply
and demand situation. The fact that 70% of
those questioned in the poll did not know
whether their own dentist practised im-
plant dentistry testifies to grave shortcom-
ings in the service marketing efforts by the
dentists. This could be remedied by direct
marketing campaigns of implant dentists,
e.g. by informative mailings to the patient
pool on record offering customized treat-
ment to generate demand. PR efforts by
national and international organizations
like the European Association for Osseoin-
tegration (EAO) or the Academy of Os-
seointegration (AO) would be another
qualified tool to disseminate knowledge
about implant dentistry as an alternative to
conventional rehabilitation and to improve
the image of implantologists. The indus-
tries are also called upon to support the
dentists with their marketing know-how.
After all, the medical community is the
indispensable link between their product,
i.e. the implant, and the consumer, i.e. the
patient. But in view of the special ethical
sensitivities in medicine, the industries
should keep a low profile and make a
serious effort to stick to the truth (Watzek
et al. 2000). The practical use of sales
promoting communication strategies in
terms of advertising should be considered
in the light of the stringent ethical criteria
applicable to medicine (Kotler 2000). An
intensified and coordinated communica-
tion of evidence-based information about
the potentialities and limitations of oral
implants would enhance product informa-
tion and establish product preferences, thus
creating a demand for implant-supported
solutions instead of conventional rehabili-
tation (Scheuch 1996;Kotler & Bliemel
2000). This could transform what today is
still a supplier market in implant dentistry
into a user market (Scheuch 1996; Brickau
2001). At the same time the prevailing
‘push effect’ could be converted into a ‘pull
effect’: the service providers, i.e. the im-
plant dentists, would no longer have to
acquaint their patients with the service to
be marketed and make them want it.
Rather the users, i.e. the patients, would
request it. This is likely to generate
optimum benefits for both the dentist and
the patient. As an ideal by-product of all-
out patient information and care before,
during and after treatment, the resultant
patient satisfaction is designed to provide
positive reinforcement and thus generate
more demand in the patients’ immediate
environment. Efficient partnership can
thus help to build strong patient relations
for the benefit of both parties (Scheuch
1996; Brickau 2001).
Acknowledgments: This survey was
funded in equal shares by Nobel
Biocare Austria, Friadent – Schütze,
Degussa Dental Austria GmbH and
Straumann GmbH Austria. The report is
based on a commissioned survey
conducted by Dr Karmasin Institute for
629 | Clin. Oral Impl. Res. 14, 2003 / 621–633
Tepper et al . Marketing-oriented study on implants – I
Market Research – Austrian Gallup
Institute/Interview Division. The
authors are indebted to the
Department of Retailing and
Marketing, Vienna University of
Economics and Business Administration
(Head: Prof. Stieglitz) for their analysis.
Résumé
Le nombre d’implants dentaires insérés annuelle-
ment dans le monde se chiffrerait à environ un
million. Mais le niveau d’information disponible du
patient en ce qui concerne les options de traitement
basées sur l’évidence est souvent fragmentaire, et
l’information dispensée par les média et l’industrie
ne reflète pas toujours ces options. Cette enquête
réalisée sur mille adultes ayant reçu un question-
naire de 18 questions a été effectuée afin de mettre
en évidence certains points. Ces derniers étaient 1) le
niveau de l’information subjective du patient, 2) les
sources d’information et préjudices, 3) la demande
future pour le traitement implantaire et les groupes
cibles pour les campagnes d’information des pa-
tients, 4) les mauvaises informations potentielles, les
déficits d’information, les désaccords de l’informa-
tion et les causes de ces derniers. De ces personnes
questionnées, 20% ont répondu spontanément que
les implants étaient un moyen de remplacer les dents
manquantes. Lorsqu’ils étaient interrogés, 72% ont
répondu connatre les implants dentaires. La plupart
de ces personnes se sentaient cependant peu in-
formées sur les options de remplacement des dents
manquantes et beaucoup d’entre-elles possédaient
très peu d’information sur les implants par rapport
aux autres possibilités existantes. Le dentiste sem-
blait être la source préférentielle d’information mais
77 % des personnes questionnées ont rapporté que
leur dentiste ne plaçait pas d’implant. Plus de 79%
ne savaient pas si leur dentiste pratiquait l’implan-
tologie. Quarante-quatre pour cent étaient persuadés
que les implants ne pouvaient être placés que par des
spécialistes. Soixante et un pour cent pensaient que
les dentistes pratiquant de la dentisterie implantaire
étaient plus qualifiés que les autres collègues. La
moitié attribuait les échecs implantaires aux allergies
et aux incompatiblités, l’autre moitié aux mauvais
soins médicaux. Seul 29% incriminaient la mau-
vaise hygiène buccale comme une cause d’échec
implantaire. Des stratégies futures devraient être
orientées vers davantage de relations publiques
professionnelles et d’informations du patient. Des
institutions d’implants internationales pourraient
grandement contribuer à changer cette mauvaise
information.
Zusammenfassung
Eine repräsentative marketing-orientierte Studie
über Implantate in der Bevölkerung von Oesterreich.
Teil I: Stand der Information, Informationsquellen
und Bedürfnis bezüglich Patienteninformation
Die Anzahl weltweit gesetzter Implantate pro Jahr
wird auf fast eine Million geschätzt. Aber die den
630 | Clin. Oral Impl. Res. 14, 2003 / 621–633
Patienten zur Verfügung stehende Information über bilidad para reemplazar dientes ausentes. Cuando se
realistische, auf Evidenz basierende Behandlungs- les preguntó, 72% dijeron que sabı́an acerca de los
möglichkeiten mit Implantaten ist mehr als lück- implantes dentales. La mayorı́a de los encuestados se
enhaft. Was durch die Medien und durch die sentı́an pobremente informados acerca de las op-
Industrie verbreitet wird, wiederspiegelt nicht im-
ciones para reemplazar dientes ausentes y muchos
mer auf Evidenz basierende empirische Daten. Diese
sabı́an menos acerca de los implantes que sobre otras
Untersuchung an 1000 Erwachsenen, welchen 18
alternativas. Se dijo que el dentista era la fuente de
Fragen gestellt wurden, wurde entwickelt, um Licht
información mas deseada, pero 77% de los encues-
auf verschiedene Punkte zu werfen. Die Punkte
betrafen (1) Stand der subjektiven Patienteninforma- tados manifestó que sus dentistas no practicaban
tion ; (2) Informationsquellen und Vorurteile ; (3) implantologı́a. Mas del 79% de los encuestados no
zukünftiger Bedarf an Implantatbehandlungen und sabı́an si su dentista trabajaba con implantes. El 44%
Zielgruppen für Propaganda zur Patienteninforma- pensaba que los implantes debı́an ponerse solamente
tion ; (4) potentielle Fehlinformation, Informations- por doctores especialmente entrenados. El 61% eran
defizite, Diskrepanzen in der Information und wie de la opinión de que los dentistas que realizaban
diese zustande kommen. Von den gefragten Indivi-
odontologı́a de implantes estaban mejor cualificados
duen sagten ohne Vorinformation 20%, dass Im-
que sus colegas que no lo hacı́an. La mitad de los
plantate eine Varainte für den Ersatz von fehlenden
encuestados atribuı́an los fracasos de los implantes a
Zähnen darstellen. Mit Vorinformation sagten 72%,
alergias e incompatibilidades, la otra mitad a pobres
dass sie von dentalen Implantaten Kenntnis haben.
cuidados médicos. Solo el 29% incriminó a la pobre
Die meisten der Befragten fühlten sich über die
Möglichkeiten bezüglich Ersatz fehlender Zähne higiene oral como causa de fracaso de los implantes.
schlecht informiert und viele wussten weniger über La futura estrategia debe ser encaminada a unas
Implantate als über andere Behandlungsvarianten. relaciones públicas más profesionales y a más
Es wurde gesagt, der Zahnarzt sei die gewünschte información del paciente. Las instituciones de
Informationsquelle, aber 77% der Befragten berich- implantes cualificadas que operan internacional-
teten, dass ihr Zahnarzt keine Behandlungen mit mente podrı́an contribuir a equilibrar la información
Implantaten anbietet. Mehr als 79% der Befragten discrepante.
wussten nicht, ob ihr Zahnarzt mit Implantaten
arbeitet. Vierundvierzig Prozent dachten, dass Im-
plantate nur durch speziell ausgebildete Aerzte
gesetzt werden sollten. Einundsechzig Prozent
waren der Meinung, dass Zahnärzte, welche Im-
plantatbehandlungen anbieten, besser qualifiziert
sind als ihre nicht-implantierenden Kollegen. Die
Hälfte der Befragten führten Implantatmisserfolge
auf Allergien und Unverträglichkeiten zurück, die
andere Hälfte auf schlechte medizinische Nach-
sorge. Nur 29% bezeichneten eine schlechte Mund-
hygiene als Ursache für Implantatmisserfolge.
Zukünftige Studien sollten Richtung professioneller
Publikums- und Patienteninformation gesteuert
werden. International tätige qualifizierte Implanta-
tinstitutionen könnten beträchtlich zum Ausgleich
von widersprüchlichen Informationen beitragen.
Resumen
El número de implantes dentales insertados anual-
mente en todo el mundo se ha estimado cercano al
millón. Pero el nivel de información disponible para
los pacientes acerca de opciones de tratamiento
reales con implantes basados en la evidencia es
frecuentemente mas bien fragmentaria y lo que se
disemina por los medios y la industria no siempre
refleja los datos empı́ricos basados en la evidencia.
Esta encuesta de 1000 adultos que presentaba 18
preguntas fue diseñada para dar luz en determinados
puntos. Estos fueron (1) nivel subjetivo de informa-
ción de los pacientes; (2) fuentes de información y
prejuicios; (3) demanda futura para tratamiento de
implantes y grupos diana para campañas de informa-
ción; (4) desinformación potencial, déficit de infor-
mación, discrepancias de información y como se
generan.
De aquellos a los que se preguntó, 20% dijeron
espontáneamente que los implantes eran una posi-

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Appendix
Questionnaire–Part I

Level of information, sources of information, need for information, subjective views of the public about implanting and nonimplanting
dentists
A. Implant-supported and conventional rehabilitation: level of awareness, general information, personal opinion
1. What alternatives for replacing teeth do you know? (spontaneous unprompted answers)
2. Which of the following alternatives for replacing missing teeth are you aware of? (prompted follow-up)
Crowns–bridgework–adhesive bridges
Metal-based dentures
Implants/implant-supported reconstructions
Full dentures

3. How well informed do you feel subjectively about the different ways of replacing missing teeth?
About implants About other ways of replacing missing teeth
Very well Well Moderately well Poorly Not at all

4. In your view, what are the advantages of nonremovable vs. removable dentures?
Less annoying in the mouth Look nicer
Do not feel like a denture Are as good as one’s own teeth in function
Others

5. All told, which tooth replacement has more advantages in your view?
Nonremovable Removable

6. Assume you would lose some teeth. Would you be content with a removable replacement/denture?
Yes No

B. Sources of information
7. Where from do you get information about alternatives for replacing missing teeth?
About implants About other alternatives
Dentist GP
Friends and acquaintances
Periodicals, magazines, health and wellness magazines
Others

C. Subjectively perceived need for information

8. Would you like to know more Yes no

about implants?

9. If so, where from would you like to get the information?

Dentist GP
Friends and acquaintances Periodicals, magazines, health and wellness magazines
Others

D. Objective need for information

10. Where in the jaw do you think implants are anchored?
In the gums In the jawbone
In/on neighboring teeth Do not know

11. What do you think are the disadvantages of implant-supported dentures/bridges?

High cost Surgery Takes long until fully functional Others

12. How long do you think an implant lasts?

Up to 5 years Up to 10 years Up to 20 years For a lifetime

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 Tepper et al . Marketing-oriented study on implants – I

13. Some patients lose their implants. What would you blame for implant loss?
The patient The dentist Poor hygiene, cleaning
Allergies, incompatibilities Others

14. Do you think implants need special care and hygiene?

No, are cleaned like natural teeth No, need less care than natural teeth
Yes, need more care than natural teeth

E. Awareness of implant activities of regular dentist – desire to have implants provided by regular dentist – professional qualifications of
implanting versus nonimplanting dentists
15. Do you know whether your dentist provides implants as a treatment alternative?
Yes, provides implants No, does not provide implants
Do not know

16. Do you think your dentist used the most up-to-date implant techniques?
Yes No Do not know

17. Would you like your dentist to provide implant treatment?

Yes No, only specialists should insert implants

18. Do you, quite generally, think a dentist who provides implant treatment is better qualified than his/her colleagues who do not?
Yes No

633 | Clin. Oral Impl. Res. 14, 2003 / 621–633