{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T05:23:46Z","timestamp":1779254626484,"version":"3.51.4"},"reference-count":48,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,2,8]],"date-time":"2021-02-08T00:00:00Z","timestamp":1612742400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>This cross-sectional study aimed to investigate the influence of possible factors in the patient history on decision making in the therapy for a severely atrophied edentulous mandible. A vignette-based survey among 250 maxillofacial and oral surgeons was conducted. Determinants that could influence the therapy decision were patient age, smoking, fear of surgery, and radiotherapy in the head and neck area (the implant region is not in the direct radiation area). To achieve a suitable implant site, the options offered to the surgeons were bone split, bone block, augmentation with bone substitute material, and bone resection. There also was the option of rejecting any therapy. The response rate was 47%. Patient age, radiotherapy, and fear of surgery did not influence the approval of a therapy. Smoking was associated with a significantly lower endorsement of a treatment. Resection was preferred by a large majority to all other forms of therapy, regardless of the four determinants. Surgeons tend to refrain from bone block transplants in older patients. In summary, it can be said that, of the four determinants, only smoking influenced treatment refusal. Bone resection is the preferred therapy independent of all determinants.<\/jats:p>","DOI":"10.3390\/ijerph18041596","type":"journal-article","created":{"date-parts":[[2021,2,9]],"date-time":"2021-02-09T23:43:16Z","timestamp":1612914196000},"page":"1596","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Decision-Making in Implantology\u2014A Cross-Sectional Vignette-Based Study to Determine Clinical Treatment Routines for the Edentulous Atrophic Mandible"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8841-2744","authenticated-orcid":false,"given":"Michael","family":"Korsch","sequence":"first","affiliation":[{"name":"Dental Academy for Continuing Professional Development, Karlsruhe, Lorenzstrasse 7, 76135 Karlsruhe, Germany"},{"name":"Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital, Saarland University, Building 73, 66421 Homburg, Germany"},{"name":"Private Practice, Center for Implantology and Oral Surgery, Berliner Str. 41, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Winfried","family":"Walther","sequence":"additional","affiliation":[{"name":"Dental Academy for Continuing Professional Development, Karlsruhe, Lorenzstrasse 7, 76135 Karlsruhe, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4373-339X","authenticated-orcid":false,"given":"Bernt-Peter","family":"Robra","sequence":"additional","affiliation":[{"name":"Institute of Social Medicine and Health Services Research, Otto-von-Guericke-University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aynur","family":"Sahin","sequence":"additional","affiliation":[{"name":"Private Practice, Blumenstrasse 5, 69115 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Hannig","sequence":"additional","affiliation":[{"name":"Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital, Saarland University, Building 73, 66421 Homburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7789-6330","authenticated-orcid":false,"given":"Andreas","family":"Bartols","sequence":"additional","affiliation":[{"name":"Dental Academy for Continuing Professional Development, Karlsruhe, Lorenzstrasse 7, 76135 Karlsruhe, Germany"},{"name":"School for Dental Medicine, Christian-Albrechts-University Kiel, Clinic for Conservative Dentistry and Periodontology, Arnold-Heller-Stra\u00dfe 3, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1038\/sj.bdj.2017.315","article-title":"Evidence summary: The relationship between oral health and pulmonary disease","volume":"222","author":"Manger","year":"2017","journal-title":"Br. Dent. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1177\/2047487318759112","article-title":"Oral health and later coronary heart disease: Cohort study of one million people","volume":"25","author":"Batty","year":"2018","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s00125-011-2342-y","article-title":"Periodontitis and diabetes: A two-way relationship","volume":"55","author":"Preshaw","year":"2011","journal-title":"Diabetology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2918","DOI":"10.1002\/cam4.1221","article-title":"Common oral complications of head and neck cancer radiation therapy: Mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis","volume":"6","author":"Sroussi","year":"2017","journal-title":"Cancer Med."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Marconcini, S., Denaro, M., Cosola, S., Gabriele, M., Toti, P., Mijiritsky, E., Proietti, A., Basolo, F., Giammarinaro, E., and Covani, U. (2019). Myofibroblast Gene Expression Profile after Tooth Extraction in the Rabbit. Materials, 12.","DOI":"10.3390\/ma12223697"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1006\/ijom.2003.0512","article-title":"10-year follow-up of onlay bone grafts and implants in severely resorbed maxillae","volume":"33","author":"Nystrom","year":"2004","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1111\/j.1600-0501.2010.02093.x","article-title":"Effect of bovine bone and collagen membranes on healing of mandibular bone blocks: A prospective randomized controlled study","volume":"22","author":"Cordaro","year":"2011","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1034\/j.1600-051X.2002.291213.x","article-title":"Lateral ridge augmentation by the use of grafts comprised of autologous bone or a biomaterial. An experiment in the dog","volume":"29","author":"Sonohara","year":"2002","journal-title":"J. Clin. Periodontol."},{"key":"ref_9","first-page":"183","article-title":"Vertical ridge augmentation of the atrophic posterior mandible with interpositional block grafts: Bone from the iliac crest versus bovine anorganic bone","volume":"1","author":"Felice","year":"2008","journal-title":"Eur. J. Oral Implant."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1111\/j.1600-0501.2010.02127.x","article-title":"The effects of bone grafting material and a collagen membrane in the ridge splitting technique: An experimental study in dogs","volume":"22","author":"Han","year":"2011","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1111\/clr.13410","article-title":"Clinical and patient-reported outcomes of implants placed in autogenous bone grafts and implants placed in native bone: A case\u2013control study with a follow-up of 5\u201316 years","volume":"30","author":"Thoma","year":"2019","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e86","DOI":"10.1590\/1807-3107bor-2018.vol32.0086","article-title":"Short implants versus longer implants with maxillary sinus lift. A systematic review and meta-analysis","volume":"32","author":"Cruz","year":"2018","journal-title":"Braz. Oral Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1007\/s12663-015-0762-9","article-title":"Osteoradionecrosis of the Jaws: Clinico-Therapeutic Management: A Literature Review and Update","volume":"14","author":"Nadella","year":"2015","journal-title":"J. Maxillofac. Oral Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1002\/JPER.16-0350","article-title":"Peri-implantitis","volume":"89","author":"Schwarz","year":"2018","journal-title":"J. Periodontol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/idj.12489","article-title":"General genetic and acquired risk factors, and prevalence of peri-implant diseases\u2014Consensus report of working group 1","volume":"69","author":"Meyle","year":"2019","journal-title":"Int. Dent. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1563\/1548-1336(2002)028<0074:RFADIS>2.3.CO;2","article-title":"Risk factors affecting dental implant survival","volume":"28","author":"Vehemente","year":"2002","journal-title":"J. Oral Implant."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1007\/s00104-011-2230-5","article-title":"Wound healing complications in smokers, non-smokers and after abstinence from smoking","volume":"83","author":"Goertz","year":"2012","journal-title":"Chirurg"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1097\/01.id.0000148564.88384.de","article-title":"Private Practice Results of Dental Implants. Part I: Survival and Evaluation of Risk Factors\u2014Part II: Surgical and Prosthetic Complications","volume":"13","author":"Kourtis","year":"2004","journal-title":"Implant. Dent."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Cosola, S., Marconcini, S., Boccuzzi, M., Fabris, G.B.M., Covani, U., Pe\u00f1arrocha-Diago, M., and Pe\u00f1arrocha-Oltra, D. (2020). Radiological Outcomes of Bone-Level and Tissue-Level Dental Implants: Systematic Review. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17186920"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1515\/folmed-2015-0029","article-title":"Impact of Dental Anxiety on the Decision to Have Implant Treatment","volume":"57","author":"Lalabonova","year":"2015","journal-title":"Folia Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1055\/s-2005-858903","article-title":"Determinants of hospital admission\u2014investigation by case vignettes","volume":"68","author":"Robra","year":"2006","journal-title":"Gesundheitswesen"},{"key":"ref_22","first-page":"117","article-title":"Gleiche Erwartungen, unterschiedliche Dispositionen-niedergelassene \u00c4rzte und Krankenhaus\u00e4rzte im Spiegel systematischer Fallvignetten","volume":"1","author":"Robra","year":"2005","journal-title":"Krankenh. Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1001\/jama.283.13.1715","article-title":"Comparison of vignettes, standardized patients, and chart abstraction: A prospective validation study of 3 methods for measuring quality","volume":"283","author":"Peabody","year":"2000","journal-title":"JAMA"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1055\/s-2004-813125","article-title":"Versorgungsforschung-auf dem Weg zu einer Theorie der \u201cletzten Meile\u201d","volume":"9","author":"Schmacke","year":"2004","journal-title":"Gesundh\u00f6kon. Qual. Manag."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1007\/s11606-004-0003-2","article-title":"An evaluation of vignettes for predicting variation in the quality of preventive care","volume":"19","author":"Dresselhaus","year":"2004","journal-title":"J. Gen. Intern. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"771","DOI":"10.7326\/0003-4819-141-10-200411160-00008","article-title":"Measuring the Quality of Physician Practice by Using Clinical Vignettes: A Prospective Validation Study","volume":"141","author":"Peabody","year":"2004","journal-title":"Ann. Intern. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1007\/s11606-015-3365-8","article-title":"Methods of Observing Variations in Physicians\u2019 Decisions: The Opportunities of Clinical Vignettes","volume":"30","author":"Converse","year":"2015","journal-title":"J. Gen. Intern. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.coms.2019.01.005","article-title":"Bone Augmentation Techniques for Horizontal and Vertical Alveolar Ridge Deficiency in Oral Implantology","volume":"31","author":"Tolstunov","year":"2019","journal-title":"Oral Maxillofac. Surg. Clin. N. Am."},{"key":"ref_29","first-page":"419","article-title":"Resektion statt Augmentation","volume":"21","author":"Korsch","year":"2013","journal-title":"Implantologie"},{"key":"ref_30","first-page":"5","article-title":"The effects of monetary incentives on the response","volume":"1","author":"Mehlkop","year":"2007","journal-title":"Methoden Daten Anal."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e830","DOI":"10.1097\/MAO.0000000000002338","article-title":"An Educational Intervention for Acute Dizziness Care: A Randomized, Vignette-based Study","volume":"40","author":"Meurer","year":"2019","journal-title":"Otol Neurotol."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Rousseau, A., Rozenberg, P., Perrodeau, E., and Ravaud, P. (2018). Variation in severe postpartum hemorrhage management: A national vignette-based study. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0209074"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1038\/s41415-019-0203-0","article-title":"The impact of dental phobia on care planning: A vignette study","volume":"226","author":"Heidari","year":"2019","journal-title":"Br. Dent. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"397","DOI":"10.5051\/jpis.2019.49.6.397","article-title":"Prevalence and risk factors of peri-implant mucositis and peri-implantitis after at least 7 years of loading","volume":"49","author":"Ahn","year":"2019","journal-title":"J. Periodontal Implant. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"506","DOI":"10.11607\/jomi.7025","article-title":"Patient-Centered Risk Assessment in Implant Treatment Planning","volume":"34","author":"Curtis","year":"2019","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1111\/cid.12322","article-title":"An Up to 12-Year Retrospective Follow-Up on Immediately Loaded, Surface-Modified Implants in the Edentulous Mandible","volume":"18","author":"VanDeWeghe","year":"2015","journal-title":"Clin. Implant. Dent. Relat. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"169","DOI":"10.11607\/jomi.6931","article-title":"Immediate Loading of Two Unsplinted Implants in Edentulous Patients with Mandibular Overdentures: A 10-year Retrospective Review of Patients from a Previously Conducted 1-year Cohort Study","volume":"34","author":"Wulfman","year":"2019","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_38","first-page":"89","article-title":"Oral complications of head and neck irradiation","volume":"45","author":"Rogulj","year":"2017","journal-title":"Libri Oncol."},{"key":"ref_39","first-page":"14","article-title":"Hyperbaric oxygen therapy in the management of osteoradionecrosis of the mandible","volume":"54","author":"Brown","year":"1998","journal-title":"Adv. Otorhinolaryngol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.ijom.2016.10.014","article-title":"Survival of Br\u00e5nemark System Mk III implants and analysis of risk factors associated with implant failure","volume":"46","author":"Hasegawa","year":"2017","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1177\/154411130401500406","article-title":"Implantology and the Severely Resorbed Edentulous Mandible","volume":"15","author":"Stellingsma","year":"2004","journal-title":"Crit. Rev. Oral Biol. Med."},{"key":"ref_42","first-page":"177","article-title":"Lights and shadows of bone augmentation in severe resorbed mandible in combination with implant dentistry","volume":"30","author":"Baj","year":"2016","journal-title":"J. Boil. Regul. Homeost. Agents"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/j.cden.2011.07.006","article-title":"Bone Grafting the Mandible","volume":"55","author":"Louis","year":"2011","journal-title":"Dent. Clin. N. Am."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"114","DOI":"10.11607\/jomi.4203","article-title":"Radiographic Evaluation of Crestal Bone Level in Split-Crest and Immediate Implant Placement: Minimum 5-Year Follow-up","volume":"32","author":"Bruschi","year":"2016","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_45","first-page":"299","article-title":"Lateral alveolar ridge augmentation with autogenous block grafts fixed at a distance vs resorbable poly-D-L-lactide foil fixed at a distance: 5-year results of a single-blind, randomised controlled trial","volume":"12","author":"Korsch","year":"2019","journal-title":"Int. J. Oral Implantol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1034\/j.1600-0501.2002.130511.x","article-title":"Morbidity of harvesting of retromolar bone grafts: A prospective study","volume":"13","author":"Nkenke","year":"2002","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1111\/joor.12605","article-title":"Bone augmentation followed by implant surgery in the edentulous mandible: A systematic review","volume":"45","author":"Oomens","year":"2018","journal-title":"J. Oral Rehabil."},{"key":"ref_48","first-page":"353","article-title":"Anterior mandibular bone augmentation techniques. Literature review","volume":"116","author":"Guiol","year":"2015","journal-title":"Rev. Stomatol. Chir. Maxillofac. Chir. Orale"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/4\/1596\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:21:19Z","timestamp":1760160079000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/4\/1596"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,8]]},"references-count":48,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["ijerph18041596"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18041596","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,8]]}}}