Clinical Factors Guiding Prosthodontic Treatment Decisions Among Dentists in Maharashtra, India: A Cross-Sectional Survey
DOI:
https://doi.org/10.48165/ajm.2026.9.02.19Keywords:
clinical decision-making, dental implants, dental luting cements, dentists, prosthodontics, treatment planningAbstract
Purpose: To rank factors guiding three prosthodontic decisions among dentists in Maharashtra and examine variation by professional background and practice setting. Materials and Methods: This cross-sectional survey included 400 dentists from 11 districts. A 30-item questionnaire assessed glass ionomer versus resin cement, fixed partial denture versus implant, and implant-supported overdenture versus fixed implant-supported prosthesis decisions on a six-point scale. Internal consistency was evaluated using Cronbach's alpha with bootstrap confidence intervals. Friedman tests with Kendall's W and Holm-adjusted post hoc tests evaluated rankings. Nonparametric tests compared domain scores across groups. Results: Overall internal consistency was good (alpha = 0.881; 95% CI: 0.861-0.897). Marginal seal ranked highest for cement selection (mean 4.43), prognosis and risk of failure for fixed partial denture versus implant decisions (mean 4.51), and retention and stability for complete-arch decisions (mean 4.42). Rankings differed within every domain (all P < 0.001), although Kendall's W indicated modest separation among generally high ratings. Prosthodontic and other specialty respondents scored all domains higher than general dentists, and dentists in hospital-based educational settings scored them higher than private practitioners (all Holm-adjusted P < 0.001). Scores did not differ by gender or correlate with age. Conclusion: Dentists prioritized biological durability, mechanical predictability, and long-term prognosis. Professional training and institutional context were associated with the breadth of factors considered.
Downloads
References
Söderfeldt, B., Palmqvist, S., Eriksson, T., Kronström, M., & Carlsson, G. E. (1996). A questionnaire instrument to assess clinical decision-making in prosthodontics among general practitioners. Acta Odontologica Scandinavica, 54(5), 314–319. https://doi.org/10.3109/00016359609003544
Kronström, M., Palmqvist, S., & Söderfeldt, B. (2000). Prosthodontic decision making among general dentists in Sweden. III: The choice between fixed partial dentures and single implants. International Journal of Prosthodontics, 13(1), 34–40.
Ellakany, P., Fouda, S. M., Alghamdi, M., & Aly, N. M. (2022). Factors affecting clinical decision-making among dentists and dental students: A cross-sectional study. International Journal of Prosthodontics, 35(5), 581–587. https://doi.org/10.11607/ijp.7359
Asa'ad, F. (2019). Shared decision-making (SDM) in dentistry: A concise narrative review. Journal of Evaluation in Clinical Practice, 25(6), 1088–1093. https://doi.org/10.1111/jep.13129
Leung, G. K. H., Wong, A. W. Y., Chu, C. H., & Yu, O. Y. (2022). Update on dental luting materials. Dentistry Journal, 10(11), 208. https://doi.org/10.3390/dj10110208
Ghodsi, S., Arzani, S., Shekarian, M., & Aghamohseni, M. M. (2021). Cement selection criteria for full coverage restorations: A comprehensive review of literature. Journal of Clinical and Experimental Dentistry, 13(11), e1154–e1161. https://doi.org/10.4317/jced.58671
Scheuber, S., Hicklin, S. P., & Brägger, U. (2012). Implants versus short-span fixed bridges: Survival, complications, patients' benefits. A systematic review on economic aspects. Clinical Oral Implants Research, 23(Suppl. 6), 50–62. https://doi.org/10.1111/j.1600-0501.2012.02543.x
Goodacre, C. J., & Goodacre, B. J. (2017). Fixed vs removable complete arch implant prostheses: A literature review of prosthodontic outcomes. European Journal of Oral Implantology, 10(Suppl. 1), 13–34.
Joda, T., Zarone, F., & Ferrari, M. (2017). The complete digital workflow in fixed prosthodontics: A systematic review. BMC Oral Health, 17(1), 124. https://doi.org/10.1186/s12903-017-0415-0
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., Vandenbroucke, J. P., & STROBE Initiative. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology statement: Guidelines for reporting observational studies. The Lancet, 370(9596), 1453–1457. https://doi.org/10.1016/S0140-6736(07)61602-X
Eysenbach, G. (2004). Improving the quality of Web surveys: The Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Journal of Medical Internet Research, 6(3), e34. https://doi.org/10.2196/jmir.6.3.e34
Torres, C. R. G., Ávila, D. M. S., Gonçalves, L. L., Meirelles, L. C. F., Mailart, M. C., Di Nicoló, R., & Borges, A. B. (2021). Glass ionomer versus self-adhesive cement and the clinical performance of zirconia coping/press-on porcelain crowns. Operative Dentistry, 46(4), 362–373. https://doi.org/10.2341/20-229-C
Pyo, S. W., Park, K., Daher, R., Kwon, H. B., Han, J. S., & Lee, J. H. (2023). Comparison of the clinical outcomes of resin-modified glass ionomer and self-adhesive resin cementations for full-coverage zirconia restorations. Journal of Dentistry, 135, 104558. https://doi.org/10.1016/j.jdent.2023.104558
Ellakany, P., Abualsaud, R., Gad, M. M., Atteya, S., El Meligy, O. A., Qutub, O. A., & Mahrous, A. A. (2023). Knowledge of Saudi dental students and interns towards luting cements and their applications in fixed prosthodontics. BMC Oral Health, 23, 337. https://doi.org/10.1186/s12903-023-03054-3
Pjetursson, B. E., Thoma, D., Jung, R., Zwahlen, M., & Zembic, A. (2012). A systematic review of the survival and complication rates of implant-supported fixed dental prostheses after a mean observation period of at least 5 years. Clinical Oral Implants Research, 23(Suppl. 6), 22–38. https://doi.org/10.1111/j.1600-0501.2012.02546.x
Spear, F. (2022). Replacement of an existing maxillary anterior fixed dental prosthesis with an implant-supported prosthesis or a new tooth-supported fixed dental prosthesis. Journal of Esthetic and Restorative Dentistry, 34(1), 81–91. https://doi.org/10.1111/jerd.12852
De Bruyn, H., Raes, S., Matthys, C., & Cosyn, J. (2015). The current use of patient-centered/reported outcomes in implant dentistry: A systematic review. Clinical Oral Implants Research, 26(Suppl. 11), 45–56. https://doi.org/10.1111/clr.12634
Borges, G. A., Barbin, T., Dini, C., Maia, L. C., Magno, M. B., Barão, V. A. R., & Mesquita, M. F. (2022). Patient-reported outcome measures and clinical assessment of implant-supported overdentures and fixed prostheses in mandibular edentulous patients: A systematic review and meta-analysis. Journal of Prosthetic Dentistry, 127(4), 565–577. https://doi.org/10.1016/j.prosdent.2020.11.005
Mumcu, E., Dayan, S. C., Genceli, E., & Geckili, O. (2020). Comparison of four-implant-retained overdentures and implant-supported fixed prostheses using the All-on-4 concept in the maxilla in terms of patient satisfaction, quality of life, and marginal bone loss: A 2-year retrospective study. Quintessence International, 51(5), 388–396. https://doi.org/10.3290/j.qi.a44368
Daudt Polido, W., Aghaloo, T., Emmett, T. W., Taylor, T. D., & Morton, D. (2018). Number of implants placed for complete-arch fixed prostheses: A systematic review and meta-analysis. Clinical Oral Implants Research, 29(Suppl. 16), 154–183. https://doi.org/10.1111/clr.13312
Papaspyridakos, P., Chen, C. J., Chuang, S. K., Weber, H. P., & Gallucci, G. O. (2012). A systematic review of biologic and technical complications with fixed implant rehabilitations for edentulous patients. International Journal of Oral & Maxillofacial Implants, 27(1), 102–110.
Ahlholm, P., Sipilä, K., Vallittu, P., Jakonen, M., & Kotiranta, U. (2018). Digital versus conventional impressions in fixed prosthodontics: A review. Journal of Prosthodontics, 27(1), 35–41. https://doi.org/10.1111/jopr.12527
Afrashtehfar, K. I., Eimar, H., Yassine, R., Abi-Nader, S., & Tamimi, F. (2017). Evidence-based dentistry for planning restorative treatments: Barriers and potential solutions. European Journal of Dental Education, 21(4), e7–e18. https://doi.org/10.1111/eje.12208
Bishti, S., Lautensack, J., Türp, J. C., & Wolfart, S. (2018). Does professional experience save teeth? A survey among prosthodontists. Clinical Oral Investigations, 22(2), 1001–1008. https://doi.org/10.1007/s00784-017-2180-5
Deshpande, S., Chahande, J., & Rathi, A. (2017). Mobile learning app: A novel method to teach clinical decision making in prosthodontics. Education for Health, 30(1), 31–34. https://doi.org/10.4103/1357-6283.210514
