Treatment of Two Combined Therapeutic Indications With One Biomaterial

Behavioral psychology plays a critical role in both medicine and dentistry, particularly in dental implant therapy where patient behavior can significantly influence treatment outcomes. Effective communication between providers and patients is essential,^1-3 yet it is often hindered by the lack of standardized tools for assessing psychological and behavioral factors. Patient-reported outcome measures (PROMs) offer a promising solution. These validated instruments provide insight into patient expectations, concerns, and attitudes, and can serve as valuable screening tools prior to implant therapy.^4-10

Despite their potential, PROMs remain underutilized in routine clinical practice, highlighting a need for greater awareness and integration of them into treatment workflows. While dental education typically stresses tec hnical competence, it does not emphasize psychological and behavioral training. Although providers may develop these skills over time with experience, new clinicians may be unprepared to manage the complex interpersonal dynamics that impact treatment outcomes. Standardizing behavioral assessment—through tools such as Likert scale questionnaires—could improve communication, foster individualized care, and enhance outcomes across specialties, including general dentistry, periodontics, and prosthodontics.¹¹ One particularly relevant strategy is the identification of personality traits. For instance, recognizing traits such as neuroticism may enable clinicians to anticipate heightened anxiety, adjust their communication, and proactively manage patient expectations.¹²

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This article explores the role of behavioral assessment in implant dentistry by synthesizing current literature and presenting case-based applications. By leveraging insights from behavioral psychology, clinicians can improve patient-centered care, strengthen provider–patient relationships, and ultimately enhance treatment success (Table 1).

Methods

A literature review was conducted using PubMed with search terms related to “implant therapy” and “behavioral psychology.” Articles were initially screened by title and abstract, with full-text reviews performed as necessary. Inclusion criteria encompassed studies published between 2000 and 2023, conducted either in the United States or internationally, written in English, and including relevant book excerpts. Bibliographic data—such as journal title, publication year, authorship, article title, ISSN, DOI, abstract, and access date—were extracted using reference management software (Zotero, zotero.org). Key study characteristics and findings were organized in a structured Microsoft Excel spreadsheet. Only articles deemed directly relevant to the study objectives were included in the final synthesis.

In addition to the literature review, a retrospective case series was conducted involving patients receiving implant therapy at a Boston, Massachusetts–based periodontal office (The Perio Studio). Patients were selected based on provider-identified personality traits aligned with the five-factor model: openness, conscientiousness, extraversion, agreeableness, and neuroticism (OCEAN). Inclusion criteria required that patients had undergone implant therapy and were identified with a dominant personality trait by their provider. Investigators met each selected patient and verified eligibility through pre-established screening procedures. A total of five representative cases were selected to illustrate how specific personality traits (Table 2) may influence treatment experiences and outcomes.

Results

The literature review yielded 564 articles, of which 24 were included in the final analysis. These studies highlighted key self-reported factors influencing treatment outcomes, such as patient expectations, perceptions, attitudes, anxiety, and personality traits. These included patient expectations, perceptions of care, treatment-related attitudes, dental anxiety, and underlying personality traits. Likert scale surveys were commonly used as tools for assessing these factors and demonstrated potential for incorporation into pretreatment screening protocols.

Building on the literature findings, a retrospective case series of five patients undergoing implant therapy was analyzed (Figure 1 through Figure 5). Each case was selected based on a dominant provider-identified personality trait from the aforementioned OCEAN five-factor model.¹³ The impact of these traits on clinical presentation, treatment planning, patient communication, and postoperative experiences is summarized in Table 3.

Discussion

Despite the well-documented influence of patient behavior on treatment outcomes, a lack of standardized behavioral assessment tools continues to challenge clinical practice. Integrating PROMs into dental workflows offers a path toward more effective provider–patient communication, improved pretreatment screening, and, ultimately, better clinical outcomes in implant therapy.^7,14-17

Contemporary dental care is increasingly integrating radiographic, clinical, and patient-reported data to support personalized treatment planning. As implant procedures become more widespread—across general practices, specialist practices, and international settings—the need for tools that capture patient expectations, attitudes, and psychological profiles becomes even more critical. PROMs,^4-10 including Likert scale surveys,¹⁸ oral health–related quality of life,^19-24 oral health impact profile,^20,21 and personality screening frameworks,¹² provide a structured means of assessing behavioral factors and tailoring care accordingly.

Building on the findings from the present authors’ literature review, a case-based approach was applied to explore the role of patient personality traits in implant therapy. The following cases highlight how tailoring communication and treatment strategies to individual behavioral profiles may improve patient experiences, compliance, and outcomes.

Patient “O”

Having a high level of openness, Patient O was notably curious, inquisitive, and eager to explore all aspects of her treatment. She underwent extraction, socket preservation, and implant placement at site No. 21. Although she appeared engaged during clinical visits, she later concealed postoperative pain and instead pursued at-home herbal remedies and acupuncture in the jaw region without notifying her care team. Despite careful surgical planning, her delayed healing and persistent discomfort ultimately required referral to oral medicine for specialized pain management (Figure 1).

This case highlights the unique challenge of managing highly open patients: while their curiosity can foster strong engagement, it may also lead them to explore alternative therapies independently. To better align care with these patients’ tendencies, clinicians can encourage shared decision-making, utilize visual aids, and provide detailed explanations to strengthen trust, promote transparency, and support adherence to recommended treatment protocols.

Patient “C”

Selected for having high conscientiousness, Patient C exemplified the qualities of a highly compliant, detail-oriented individual who meticulously followed all postoperative instructions. Treatment included extraction, socket preservation, and implant placement at site No. 30. Follow-up imaging demonstrated stable site development and successful implant integration, with minimal need for intervention (Figure 2).

This patient’s attentiveness and precision directly contributed to the predictability and efficiency of the treatment course. For highly conscientious patients, enabling structured, clearly staged treatment protocols reinforces their natural diligence and helps optimize outcomes while minimizing complications.

Patient “E”

With a high degree of extraversion, Patient E was talkative and outgoing and consistently sought reassurance throughout care. Seven years after implant placement at site No. 19, the patient presented with peri-implantitis. Management required both nonsurgical and surgical interventions, including repeated removal of residual nonresorbable membrane material. Patient E’s extraverted tendencies were reflected in high engagement levels and frequent requests for updates during treatment (Figure 3).

This case underscores the importance of providing frequent check-ins, fostering a collaborative care environment, and maintaining provider accessibility to meet the emotional and informational needs of highly extraverted individuals.

Patient “A”

Selected for a high level of agreeableness, Patient A was trusting, pleasant, and tended to minimize personal concerns throughout treatment. Implant therapy at site No. 9 involved extraction, site preservation, and implant placement, with clinical and radiographic follow-up demonstrating uneventful healing and stable esthetic outcomes. While the treatment course was objectively successful, the patient’s underreporting of postoperative symptoms suggested a desire to avoid being burdensome to the provider (Figure 4).

This case emphasizes the importance of proactive communication and monitoring when managing highly agreeable patients, ensuring that even subtle concerns are identified and addressed early. Creating an empathetic environment that invites honest feedback is key to optimizing outcomes for this patient population.

Patient “N”

Having high neuroticism, Patient N exhibited persistent anxiety with a strong focus on potential complications throughout the treatment process. Site development and implant placement were completed at tooth No. 4 following a fracture. Despite clinical success, this patient required extensive reassurance, including frequent communication to address concerns about pain and healing. Shortly after extraction surgery, the patient reported episodes of extensive bleeding, supplemented by self-supplied photographic documentation, underscoring the heightened emotional response (Figure 5).

This case highlights the critical need for increased counseling, clear postoperative instructions, and proactive emotional support when managing highly anxious individuals to mitigate distress and promote treatment satisfaction.

The Influence of Personality Traits

This case series illustrates how personality traits can influence the clinical course of implant therapy. For example, recognizing traits such as neuroticism allowed providers to proactively address anxiety and improve emotional support, while tailoring communication for extraverted and open patients fostered engagement and trust. Similarly, understanding conscientious or agreeable traits enabled enhanced treatment compliance and early identification of underreported issues.

These findings reinforce the importance of integrating behavioral frameworks—such as the five-factor model—into everyday practice. Specifically, conscientious patients benefit from structured plans and positive reinforcement; agreeable patients require proactive check-ins to surface unvoiced concerns; extraverted patients thrive with frequent communication and collaborative decision-making; open patients respond best to shared decision-making and detailed educational efforts; and neurotic patients need early counseling, clear expectations, and emotional reassurance.

Recognizing and addressing these behavioral tendencies allows providers to tailor communication, anticipate challenges, and strengthen the provider–patient relationship. Ultimately, standardizing behavioral assessments through PROMs and personality screening may serve as a critical adjunct to radiographic and clinical evaluations, contributing to more personalized, effective, and satisfying dental implant care.

Conclusion

This study underscored the clinical value of incorporating behavioral assessment into implant planning. By identifying traits such as anxiety, neuroticism, or conscientiousness through standardized tools, providers can proactively adapt communication strategies, anticipate patient needs, and minimize complications associated with misaligned expectations or poor compliance. Ultimately, the use of patient-reported outcome measures enhances patient-centered care by fostering mutual understanding, increasing treatment predictability, and empowering patients to actively engage in their dental care journey. As treatment becomes increasingly individualized, communication must evolve to meet each patient’s psychological and behavioral profile. Standardizing these assessments could represent a meaningful step forward in achieving this goal.

Moving forward, a prospective approach involving the administration of Likert scale surveys at multiple timepoints—preoperatively, on the day of treatment, and postoperatively—may further validate the role of PROMs in enhancing patient-centered care. By systematically capturing behavioral insights, clinicians can better understand individual patient needs and refine their communication strategies and treatment planning accordingly.

ACKNOWLEDGMENT

The authors thank Tufts University School of Dental Medicine Research Department, Tufts University Hirsh Library services, The Perio Studio, and Brookline Periodontal Associates teams, as well as referring doctors Katerina Antonellou, DDS, DMD, MSD; Khaled El Rafie, DMD; Peter Juriansz, DMD; Ryota Kikuchi, DMD; and Larry Phan, DMD.

ABOUT THE AUTHORS

Kyle E. Wright, DMD Candidate
Tufts University School of Dental Medicine, Boston, Massachusetts

Diandra S. Luz, DDS
Harvard School of Dental Medicine, Boston, Massachusetts

Irina F. Dragan, DDS, DMD, MS, eMBA
Adjunct Associate Professor, Periodontology, Tufts University School of Dental Medicine, Boston, Massachusetts; Faculty Member, Harvard School of Dental Medicine, Boston, Massachusetts; Private Practice limited to Periodontology and Implant Dentistry, Boston, Massachusetts

Figures and Images

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Figure 1

Fig 1. Pretreatment intraoral frontal view.

Figure 2

Fig 2. Pretreatment intraoral lateral buccal view.

Figure 3

Fig 3. Pretreatment CBCT coronal view of maxillary left first premolar.

Figure 4

Fig 4. Pretreatment CBCT sagittal view of maxillary left first premolar presenting radiolucency area involving more than two thirds of the root, including the cervical area and alveolar bone crest.

Figure 5

Fig 5. PA radiograph at baseline for extraction of maxillary left first premolar.

Figure 6

Fig 6. The xenograft–alloplastic biomaterial plug was trimmed for optimal socket adaptability.

Figure 7

Fig 7. Maxillary left first premolar extraction. Fresh socket showing preserved soft-tissue contour.

Figure 8

Fig 8. Buccal flap slightly elevated to show good level of vascularity and immediate blood clot formation within the socket.

Figure 9

Fig 9. The xenograft–alloplastic biomaterial plug placed within the socket, and PTFE mattress suture in place.

Figure 10

Fig 10. PA radiograph immediately post-ARP.

Figure 11

Fig 11. Implant 3D positioning in digital planning.

Figure 12

Fig 12. Buccal view of healthy soft tissues 5 months post-extraction of the maxillary left first premolar.

Figure 13

Fig 13. Occlusal view of the alveolar ridge’s preserved volume after extraction.

Figure 14

Fig 14. Occlusal view of the osteotomy for implant placement.

Figure 15

Fig 15. Occlusal view of the ridge immediately after implant placement.

Figure 16

Fig 16. Occlusal view of the suture demonstrating primary closure.

Figure 17

Fig 17. Occlusal view of healthy soft tissues and ridge width 6 months after implant placement.

Figure 18

Fig 18. Buccal view immediately after implant uncovery, abutment placement, and buccal soft-tissue management.

Figure 19

Fig 19. PA radiograph confirming abutment well-fitted to the implant.

Figure 20

Fig 20. Two weeks after implant uncovery, note healthy soft tissues in buccal view.

Figure 21

Fig 21. Occlusal view of ridge width 2 weeks after implant uncovery highlighting improvements on buccal aspect of soft tissue.

Figure 22

Fig 22 and Fig 23. At 16-month follow-up, intraoral occlusal view (Fig 22) and lateral buccal view (Fig 23) showing the screw-retained implant-supported restoration.

Figure 23

Fig 22 and Fig 23. At 16-month follow-up, intraoral occlusal view (Fig 22) and lateral buccal view (Fig 23) showing the screw-retained implant-supported restoration.

Figure 24

Fig 24. At 16-month follow-up, PA radiograph revealing stable crestal bone levels and no pathology detected.