the face is widely regarded as a symbol of  self  and a smile as a window into one 's personality . in this , the teeth play important roles in the maintenance of a positive self - image , and loss of teeth may result in significant disabilities that can profoundly disrupt social activities . tooth loss may be traumatic and upsetting , and it is regarded as a serious life event that requires significant social and psychological readjustment . the nonacceptance of edentulousness and the individual 's feelings about dentures , which have been the traditional way of replacing missing teeth , are important for the acceptance of new dentures . traditionally , missing teeth are replaced by removable partial dentures , fixed partial dentures ( bridges ) and complete dentures in cases of complete edentulousness . the need to replace lost teeth with a near - natural successor has encouraged rapid research and advancement in the field of dental implants , especially in advanced economies . dental implant is an artificial root that is surgically inserted into the jawbone to support a single tooth replacement ( crown ) , fixed partial or complete denture or maxillofacial prosthesis . it is an ideal option for people with good oral health who have lost a tooth or teeth due to injuries , periodontal diseases , failure of endodontics , etc . it is also used for the treatment of edentulousness and is associated with improved denture retention , stability and functional efficiency and , thus , improving the quality of life of the patient . currently , dental implants are widely accepted as a prosthetic treatment of completely or partially edentulous patients , and studies have shown significant improvement in patients attitudes toward their dental health after treatment with implant prostheses . unfortunately , the same can not be said of developing countries with poorer access to dental care , where different authors have reported wide variability in the acceptance of this newer option of tooth replacement . in our setting , a resource - challenged environment , conservative dentistry is relatively young and there is dearth of information regarding patients knowledge of tooth replacement as a whole and the use of implant - retained prostheses as an option of replacement of missing tooth . with recent improvement in socioeconomic infrastructures in this environment and expansion of the middle class , access to oral health care hence , in order to identify goals in the promotion of oral health and improvement of the overall quality of life of patients with tooth loss , the study was conducted to evaluate the knowledge of patients about tooth replacement as a whole and assess their awareness of implant - retained prosthesis as an option for tooth replacement . a descriptive cross - sectional study of patients attending the dental centre of the university college hospital , ibadan , nigeria was conducted over a period of 6 months . the university college hospital , ibadan , is a major referral tertiary hospital in the south - western part of the country . in the conduct of this survey , the guidelines of ethical consideration were strictly adhered to and participants filled the questionnaire after signing informed consent . information was obtained with the use of structured , self - administered questionnaires given to patients aged 18 years or older , who consented to participate in the study at the dental clinics during the study period between september 2012 and february 2013 . data collected included the sociodemographic characteristics of the study participants , knowledge about implant - retained tooth replacement as an option of replacement , the cost , source of information and knowledge about other options of tooth replacement as a whole . tests of association between variables were conducted using chi square statistics , with the level of statistical significance set at p < 0.05 . a total of 220 participants took part in the study and 199 ( 90.5% ) properly filled questionnaires were analyzed . the ages of the study participants ranged from 18 to 84 years , with a mean of 37.6 ( 16.5 ) years and a male to female ratio of 1:1.1 . one hundred and two participants were married , 86 were single , 10 were widowed and one was divorced . majority of the participants ( 141 , 70.9% ) had tertiary education , while only eight ( 4.0% ) had no formal education [ table 1 ] . demographic characteristics the majority of the participants ( 184 , 92.5% ) were aware of the possibility of replacing lost teeth . a total of 102 ( 51.3% ) participants knew of different ways to replace missing teeth , while 94 ( 47.2% ) had no idea of such methods . the awareness of the different possible options of tooth replacement as perceived by the participants is shown in table 2 . a significantly higher proportion of those who were aware of the possibility of replacing missing teeth knew that removable partial dentures were an option ( p < 0.000 ) . also , a significantly higher proportion of those that were aware of the possibility of replacement did not know about implant as a replacement option for missing teeth compared with removable partial dentures ( p < 0.01 ) [ table 3 ] . knowledge on ways of replacing missing teeth awareness of tooth replacement and knowledge about options of replacement one hundred and forty ( 71.1% ) participants had not heard of dental implant while only 57 ( 28.9% ) of them had heard about it as an option for replacing missing teeth . of those who had heard about this option , 22 ( 38.6% ) believed that they had received reasonable amount of information on the option , 26 ( 45.6% ) perceived that the information received had been inadequate and nine ( 15.8% ) were unsure of the quantity and quality of information they had on it . only 21 of those participants who have heard about implant and claimed it was well explained could explain what they understood by dental implants , of whom 15 ( 71.4% ) gave the correct information about the implant - retained dental prosthesis . the majority ( 68% ) of the participants got informed about implant - retained prosthesis through the dentist , 23% got it through the media while 6% of the participants got to know through the internet [ figure 1 ] . source of information on dental implant while 45 ( 22.6% ) participants would like to have implant - retained prosthesis as an option for replacement of missing teeth , 24 ( 13.3% ) said they would not want it , while the majority , 112 ( 61.9% ) , were not sure if they would like to have it or not . of the 78 participants who gave reasons why they would not like to have their missing tooth / teeth replaced with dental implant - retained prosthesis , majority ( 46.2% ) claimed that they would not consider it because they do not have any idea about what it is , while seven ( 9.0% ) thought it was expensive [ figure 2 ] . reasons for not considering dental implant one hundred and fifty - four ( 84.6% ) of the participants would like to be educated on dental implant as an option for replacement of missing teeth , while just nine ( 4.9% ) did not want to know about it and 19 ( 10.4% ) cared less about the education on dental implant . one hundred and ten ( 61.8% ) of the participants claimed they would consider implant - retained prosthesis as an option for tooth / teeth replacement if they had good knowledge about it . while 15 ( 8.4% ) would not consider it , 53 ( 29.8% ) of the participants are not sure of considering it even if it is well explained to them . a statistically significant relationship was found when education on implant and if participant would consider implant is well explained ( p = 0.000 ) . among the 57 participants who have heard about implant , only 21 ( 36.8% ) have the knowledge about the cost implication , of which 15 ( 71.4% ) have the right information on cost implication and the remaining six ( 28.6% ) have wrong information on the cost . the study also showed a statistically significant relationship between those who have heard about implant - retained prosthesis and their knowledge of cost implication ( p = 0.000 ) . the ages of the study participants ranged from 18 to 84 years , with a mean of 37.6 ( 16.5 ) years and a male to female ratio of 1:1.1 . one hundred and two participants were married , 86 were single , 10 were widowed and one was divorced . majority of the participants ( 141 , 70.9% ) had tertiary education , while only eight ( 4.0% ) had no formal education [ table 1 ] the majority of the participants ( 184 , 92.5% ) were aware of the possibility of replacing lost teeth . a total of 102 ( 51.3% ) participants knew of different ways to replace missing teeth , while 94 ( 47.2% ) had no idea of such methods . the awareness of the different possible options of tooth replacement as perceived by the participants is shown in table 2 . a significantly higher proportion of those who were aware of the possibility of replacing missing teeth knew that removable partial dentures were an option ( p < 0.000 ) . also , a significantly higher proportion of those that were aware of the possibility of replacement did not know about implant as a replacement option for missing teeth compared with removable partial dentures ( p < 0.01 ) [ table 3 ] . knowledge on ways of replacing missing teeth awareness of tooth replacement and knowledge about options of replacement one hundred and forty ( 71.1% ) participants had not heard of dental implant while only 57 ( 28.9% ) of them had heard about it as an option for replacing missing teeth . of those who had heard about this option , 22 ( 38.6% ) believed that they had received reasonable amount of information on the option , 26 ( 45.6% ) perceived that the information received had been inadequate and nine ( 15.8% ) were unsure of the quantity and quality of information they had on it . only 21 of those participants who have heard about implant and claimed it was well explained could explain what they understood by dental implants , of whom 15 ( 71.4% ) gave the correct information about the implant - retained dental prosthesis . the majority ( 68% ) of the participants got informed about implant - retained prosthesis through the dentist , 23% got it through the media while 6% of the participants got to know through the internet [ figure 1 ] . source of information on dental implant while 45 ( 22.6% ) participants would like to have implant - retained prosthesis as an option for replacement of missing teeth , 24 ( 13.3% ) said they would not want it , while the majority , 112 ( 61.9% ) , were not sure if they would like to have it or not . of the 78 participants who gave reasons why they would not like to have their missing tooth / teeth replaced with dental implant - retained prosthesis , majority ( 46.2% ) claimed that they would not consider it because they do not have any idea about what it is , while seven ( 9.0% ) thought it was expensive [ figure 2 ] . reasons for not considering dental implant one hundred and fifty - four ( 84.6% ) of the participants would like to be educated on dental implant as an option for replacement of missing teeth , while just nine ( 4.9% ) did not want to know about it and 19 ( 10.4% ) cared less about the education on dental implant . one hundred and ten ( 61.8% ) of the participants claimed they would consider implant - retained prosthesis as an option for tooth / teeth replacement if they had good knowledge about it . while 15 ( 8.4% ) would not consider it , 53 ( 29.8% ) of the participants are not sure of considering it even if it is well explained to them . a statistically significant relationship was found when education on implant and if participant would consider implant is well explained ( p = 0.000 ) . among the 57 participants who have heard about implant , only 21 ( 36.8% ) have the knowledge about the cost implication , of which 15 ( 71.4% ) have the right information on cost implication and the remaining six ( 28.6% ) have wrong information on the cost . the study also showed a statistically significant relationship between those who have heard about implant - retained prosthesis and their knowledge of cost implication ( p = 0.000 ) . the present study showed a high rate of awareness of replacement of missing teeth in this environment , with 92.5% of the participants being aware that missing teeth can be replaced . furthermore , the option of removable partial dentures for teeth replacement was the most recognized by the participants . this may be because removable partial dentures have been the most widely available and traditional way of replacement in this country ; it is relatively cheap and affordable for most socioeconomic classes in resource - poor settings and has been found to be satisfactory to patients in terms of appearance , retention and stability . while 28.9% of the participants have heard about dental implant , only 22.6% of them were aware that it is an option of replacement of missing teeth . there was a significant relationship ( p = 0.01 ) when those who have heard of dental implant were compared with those who were aware of possible replacement of missing teeth , with a higher proportion of those who have knowledge of replacement of missing teeth showing low knowledge about dental implant as an option of tooth replacement . the level of awareness of implant as an option for replacement of missing teeth recorded in this study is higher than what was recorded by kumar et al . , who had an awareness of 4.83% . this may be due to the fact that the present study was conducted in a tertiary hospital situated in an urban environment , with the majority of the participants ( 84.8% ) having at least secondary school education as against the population studied by kumar et al . , who were people of lower socioeconomic and education levels of the area ( khammam , andhra pradesh in india ) and were also unskilled workers educated only to the secondary level or lower . however , the level of awareness recorded in this study is lower when compared with that reported by al johanny et al . berge and best , who recorded the level of awareness in their different studies to be from 66.4% to as high as 77% . this may be due to the relatively low level of practice of implant dentistry in this environment and sensitization of patients by dentists toward the use of implant - retained prosthesis as option of tooth replacement . dentists were the major source of information ( 68% ) to those who have heard about dental implants followed by the media , internet and other sources such as friends . this is similar to the study by kumar et al . , which recorded the dentist as being the main source of information ( 38.25% ) . however , this result is contrary to some other studies that have media and internet as the major source of information on dental implant . this could be due to the fact that majority of the people in this environment depend on professionals such as dentists , on their source of information and the fact that accessibility to the internet is relatively expensive and still limited to those of middle and high socioeconomic classes . however , of the 21 participants who had this option of tooth replacement explained to them by dentists , 15 ( 71.4% ) had the right information while six ( 28.6% ) were either wrongly informed or did not understand what was explained about this option of tooth replacement . although this misconception about dental implant has been recorded in a study , it was more through information from the internet and media . of the majority of the participants who claimed that they were not sure if they would like to have dental implants as an option to replace missing teeth , the major reason given by 46.2% of these participants was the fact that they do not have any idea about it , while 39.7% had no particular reason . high cost of implant as perceived by seven ( 9% ) of the participants was another reason given for not considering dental implants . this further buttresses the need for adequate education , as was confirmed in this study by the response of the participants to education on dental implants , with majority of the participants claiming that they would appreciate it if they could be better informed about the advantages and disadvantages that might make them consider it as a better option . , satpathy et al . and al johany , who also recorded a higher percentage of their participants requesting to have more knowledge on dental implants . a statistically significant relationship was also found when education on implant and consideration of dental implant for use by participant was compared ( p = 0.000 ) . thus , if the procedure of implant - retained prosthesis is well explained to patients , they will consider having it as an option of replacing missing teeth . there was misconception and low level of knowledge about the cost implication of dental implants among the 57 participants who have heard about it , with just 21 ( 36.8% ) claiming that they know the cost , of whom 15 ( 71.4% ) were rightly informed . this low awareness and misconception about the cost is similar to that reported by rustemeyer and bremerich and tepper . there was also a significant relationship about the knowledge of cost implication when those who have heard about the implant prosthesis were compared with their knowledge of the cost implication ( p = 0.000 ) . thus , there is need for patients adequate information vis a vis the cost , advantages , disadvantages and possible complications of dental implant prostheses as a better option for teeth replacement . the study has shown that there is a low level of awareness about dental implant in this environment even though people are aware of the possibility of tooth replacement . adequate awareness and rich , right and detailed information are the necessary tools that project dental implant - retained prostheses as the best option for the tooth and lost maxillofacial tissue replacement . the dentist as a professional has the major role to play in this regard , and this can be fulfilled by implementing patient education programmes and counseling centers on dental implant use , advantages and possible complications in order to prepare a patient 's mind .