This was a structured questionnaire based study. 3 questionnaires were formulated in printed and online formats. The questionnaire A evaluated the awareness, knowledge and attitude of subjects towards dental implants as a treatment modality. The questionnaire B assessed the influence of personality traits on decision making ability. The questionnaire C assessed patient’s expectations regarding pain, anxiety, function and esthetics before and after placing dental implants. In the pilot study, we found 6 questions from questionnaire A to be non-reliable. We deleted 2 questions and rephrased 4 questions. The final questionnaire A consisted of 12 questions. 27 questions from questionnaire B which assessed the psychoticism trait were excluded as they were found to be beyond the scope of this study and the respondents opined that questionnaire B was time consuming. We selected a Revised Eysenck Questionnaire with 57 questions for the study.

The study was conducted in 4 stages.

In the first stage, objective assessment of awareness, knowledge and attitude was done. We set 50% knowledge level as the benchmark based on previous studies. We found a significant severe knowledge deficit in all the 3 parameters .The knowledge deficits were widely distributed across age, gender, education and occupation groups with no significant correlation.

In the second stage, we conducted an interactive educational sessions using audio-visual aids. A limited number of subjects participated in the educational sessions to improve the knowledge deficit. There was a significant improvement in the knowledge post educational sessions. We made an attempt to assess the influence of personality traits on decision making ability of subjects who agreed and did not agree to participate in the educational sessions. We used Eysenck personality test for this assessment. We found that subjects in both the groups showed a tendency towards extrovertism and neuroticism. A single personality trait did not influence the participation of subjects in educational sessions. However detailed analysis should be done in future studies.

In the third stage, we followed up the patients who agreed to undergo implant treatment in our institution. We tried to assess if personality traits significantly differed among the subjects who opted for implant treatment and who did not using Eysenck Personality Inventory Questionnaire. Subjects in both the groups showed a tendency towards extrovertism and neuroticism. There was no significant influence of personality traits on decision making. However, the sample size was relatively small in both the groups.  Hence there is a need to conduct structured longitudinal studies using a larger sample size to validate the results.

We tried to assess if patients’ attitude towards dental implants changed post treatment. This was measured in terms of pain, anxiety, functional and esthetic benefits using VAS scale. There was a significant improvement in patient’s perception of dental implant as a treatment modality. This suggests that professionally imparted knowledge can bring about a change in the attitude towards a treatment modality. However sample size was limited and results should be interpreted with caution.

In the 4^th stage, we re-assessed awareness, knowledge and attitude of patients towards dental implants in the treated group after 1 year. We found a significant improvement in the level of information, subjective and objective need for information. This suggests that there was retention of imparted knowledge even at the end of 1 year. Hence we can assume that knowledge reinforcement had a positive impact on this sub-population.

A single session of educational intervention using interactive audio-visual aid had a significant improvement in knowledge. However it has been shown that frequent reinforcement of knowledge can bring about tangible benefits for longer term. Hence we may opine that frequent innovative upgradation of educational material and establishing a good rapport with the patients can bring about a significant change in awareness, knowledge and attitude of patients towards dental implants.

Limitation of questionnaire based studies is that evaluation of results is based on self-reported data. The misinterpretation of questions and memory errors can cause measurement errors. In our study educational intervention was limited to a small population. Studies have shown that educational efforts should not limited to smaller populations and target the general public. However a study with a larger sample size and respondents with varied cultural and ethnic backgrounds is needed to validate the conclusion.