Avinash S. Bidra, BDS, MS,     Department of Reconstructive Sciences, University of Connecticut Health Center, 263 Farmington Avenue, L6078, Farmington, CT 06030, USA. Email: avinashbidra@yahoo.com

Evidence-based dentistry is rapidly emerging to become an integral part of patient care, dental education, and research. Prosthodontics is a unique dental specialty that encompasses art, philosophy, and science and includes reversible and irreversible treatments. It not only affords good applicability of many principles of evidence-based dentistry but also poses numerous limitations. This article describes the epidemiologic background, fundamental considerations, scrutiny of levels of evidence, limitations, guidelines, and future perspectives of evidence-based prosthodontics. Understanding these principles can aid clinicians in appropriate appraisal of the prosthodontics literature and use the best available evidence for making confident clinical decisions and optimizing patient care.

Keywords

Evidence-based dentistry

Prosthodontics

Guidelines

Systematic reviews

Randomized controlled clinical trials

Prospective studies

Retrospective studies

Key points

Introduction

The traditional model of care in dentistry involves use of individual clinical expertise and patient treatment needs to provide dental care (Fig. 1). This model of care has been used for centuries across the world and is primarily based on observations, beliefs, and personal and expert opinions. Although this model has not led to any devastating effects in dentistry, it precludes systematic assimilation, acceptance, and assessment of new treatment effects. Furthermore, it provides minimal confidence to clinicians for making clinical decisions for new scenarios and new treatments. The term, evidence-based practice, is defined as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”1 This definition stems from the medical perspective, and dentistry is more familiar with the term, EBD.

Currently, there is no definition for evidence-based prosthodontics but it is understood that it encompasses the application of EBD with respect to prosthodontics. According to the American Dental Association (ADA), EBD is defined as “an approach to oral healthcare that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences.”2 Therefore, the EBD process is not a rigid methodologic evaluation of scientific evidence that dictates what practitioners should or should not do but also relies on the role of individual professional judgment and patient preference in this process (Fig. 2).3

Need for evidence-based prosthodontics

With rapid advancements in dental materials and dental technology and improved understanding of clinical outcomes, a surfeit of research has been published in prosthodontics and dental implant–focused literature (Box 1). Furthermore, a surplus amount of published research exists in interdisciplinary fields that are of critical importance to prosthodontics. It is well known that not all published literature is scientifically valid and clinically useful. Therefore, a critical analysis of the quality of published research and consolidation of the excess scientific information is necessary to render them significant and useful. In an extensive analysis of scientific publications between 1966 and 2005, Harwood4 noted that there were 44,338 published articles in prosthodontics. Of these, there were 955 randomized controlled clinical trials (RCTs) (2%). Nishimura and colleagues5 identified 10,258 articles on prosthodontic topics between 1990 and 1999 and estimated that to stay current in the year 2002 would require reading and absorbing approximately 8 articles per week, 52 weeks per year, and across 60 different journals. These numbers do not include published articles on implant dentistry. Russo and colleagues6 identified 4655 articles published between 1989 and 1999 dedicated to implant dentistry and estimated that to stay current in the year 2000 would require reading and absorbing approximately 1 to 2 articles per week, 52 weeks per year. It is not difficult to assume that these numbers are significantly higher in the year 2013 and will continue to grow due to increased growth in the number of journals and publications, underscoring the need for computer-based clinical knowledge systems and for clinicians to acquire new skills to use the best available scientific evidence (BASE) (Box 2).

Epidemiologic background

The epidemiologic background for evidence-based practice dates back to the nineteenth century, to the work of John Snow, who is widely regarded as the father of modern epidemiology.7 Snow rejected the popular miasma theory as the cause of the cholera outbreaks in England. Through a systematic method of data collection and analysis, Snow established a classic case-control study and traced the cholera outbreaks to drinking water contamination from the sewage systems. His ideas were rejected, criticized, and not embraced...