{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T19:07:03Z","timestamp":1788894423408,"version":"build-2803163510"},"reference-count":35,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical &amp; Exp Dental Res"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the association between patient behavior and clinician emotional burden, perceived clinical performance, interaction difficulty, and decision\u2010making in implant dentistry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>\n                      A cross\u2010sectional online questionnaire was distributed via individual invitations to 150 dental professionals involved in implant dentistry. A total of 127 clinicians completed the survey (response rate: 84.7%). The questionnaire assessed demographic and professional characteristics, clinicians\u2019 perceptions of patient behavior, emotional responses, and the perceived impact of patient\u2010related factors on clinical performance and decision\u2010making. Composite domains for emotional burden and interaction difficulty were developed, and their internal consistency was assessed using Cronbach's\n                      <jats:italic>\u03b1<\/jats:italic>\n                      . Associations were evaluated using Spearman's correlation and linear regression analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      More challenging patient behavior was significantly associated with increased emotional burden (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u20090.50,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and interaction difficulty (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u20090.46,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Similar findings were observed when patient behavior was compared with usual clinical cases (both\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Procedural difficulty showed only weak or non\u2010significant associations with emotional burden and interaction difficulty. Emotional burden was strongly associated with interaction difficulty (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u20090.84,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), avoidance of scheduling similar patients (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u20090.47,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and lower perceived clinical performance (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u20090.27,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Regression analyses confirmed that patient behavior was significantly associated with emotional burden (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patient behavior appears to be associated with clinician emotional burden and perceived clinical performance more strongly than case difficulty in implant dentistry.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cre2.70450","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T18:15:17Z","timestamp":1788891317000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Patient Behavior and Clinician Emotional Burden, Perceived Performance, and Decision\u2010Making in Implant Dentistry: A Cross\u2010Sectional Study Among Clinicians"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2236-4345","authenticated-orcid":false,"given":"Aspasia","family":"Pachiou","sequence":"first","affiliation":[{"name":"Clinic of Reconstructive Dentistry, Center for Dental Medicine University of Zurich Zurich Switzerland"},{"name":"Department of Prosthodontics, School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9841-1446","authenticated-orcid":false,"given":"Viviane Laura","family":"Humm","sequence":"additional","affiliation":[{"name":"Clinic of Reconstructive Dentistry, Center for Dental Medicine University of Zurich Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6689-2684","authenticated-orcid":false,"given":"Nadja","family":"Naenni","sequence":"additional","affiliation":[{"name":"Clinic of Reconstructive Dentistry, Center for Dental Medicine University of Zurich Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7840-4828","authenticated-orcid":false,"given":"Eleana","family":"Kontonasaki","sequence":"additional","affiliation":[{"name":"Department of Prosthodontics, School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2055-1320","authenticated-orcid":false,"given":"Ronald E.","family":"Jung","sequence":"additional","affiliation":[{"name":"Clinic of Reconstructive Dentistry, Center for Dental Medicine University of Zurich Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1764-7447","authenticated-orcid":false,"given":"Daniel S.","family":"Thoma","sequence":"additional","affiliation":[{"name":"Clinic of Reconstructive Dentistry, Center for Dental Medicine University of Zurich Zurich Switzerland"},{"name":"Department of Periodontology, Research, Institute for Periodontal Regeneration Yonsei University College of Dentistry Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41405-022-00115-7"},{"issue":"1","key":"e_1_2_14_3_1","first-page":"24","article-title":"Does a Higher Frequency of Difficult Patient Encounters Lead to Lower Quality Care?","volume":"62","author":"An P. 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