The role of evidence-based health care (EBHC) in clinical decision-making, especially in medicine and dentistry, has been advocated as necessary for ensuring that the best available evidence is implemented and for providing quality patient care. In modern health care, integrating clinical expertise, patient values, and the most relevant research findings forms the cornerstone of evidence-based practice. Using this approach ensures that practitioners can offer treatments that are scientifically validated and tailored to individual patient needs and preferences. The following is an analysis of the role of EBHC in clinical decisions, its implications, and its applications in dentistry and prosthodontics.
Key points
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Evidence-based dentistry integrates the best available evidence, clinical expertise, and patients’ needs and values. Practitioners need to have access to fast and reliable evidence for practice.
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Well-constructed reviews of the evidence can assist in expediting summarizing the evidence for practice.
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Artificial intelligence used with caution might assist in expediting the process of summarizing evidence for practice.
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The authors still need to find better ways to dissemination and implementation of known evidence-based therapies and interventions.
Introduction
In the last decades, evidence-based practice (EBP) has emerged as a key approach guiding the profession and clinicians in making evidence-based informed decisions by integrating the best available evidence, clinical expertise, and patient preferences1. Like other dental specialties and general dentistry, prosthodontics can also greatly benefit from these principles.
This study explores EBP’s significance, its evolution, current trends, challenges, future directions, and possible uses in prosthodontics.
Understanding evidence-based health care
The Foundations of Evidence-Based Practice
How is EBP defined? EBP integrates clinical expertise, patient values, and relevant scientific evidence to deliver care.
When making clinical decisions, health care professionals should consider the best available research evidence, their clinical expertise, and the individual patient’s preferences and values. All 3 factors are important in the decision-making process.
EBP began shaping modern clinical decision-making in the 1990s and continues evolving despite criticism across all medical and dental fields. ,
To implement evidence-based decision-making, the practitioner needs to understand essential concepts such as the hierarchy of the evidence, research study designs, and the grading system of the evidence, as all related to assessing the quality and consistency of the available evidence for practice.
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Hierarchy of evidence : Research evidence is ranked based on reliability, from systematic reviews and meta-analyses at the top to expert opinions at the bottom. All this relates to the quality of the available evidence and the application to patient care.
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Research, evidence, study design strengths, and limitations : Understanding the value and limitations of the quality of systematic reviews, randomized controlled trials, cohort studies, and case-control studies is crucial for evidence understanding and appraisal for practice.
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Grading systems : Frameworks such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and others are used to assess the strength of recommendations and the certainty of evidence in health care. Authors use it in their reviews to help clinicians/consumers evaluate the quality of research evidence and guide their application for clinical practice. ,
When it is necessary to find the “best evidence,” the search should start at the top of the pyramid. However, there is not always a systematic review or synthesis of the evidence for all the topics encountered in practice, and the best available evidence could be found in primary original research.
Evidence-based prosthodontics
Like in other specialties, research and evidence for practice evolve, and research findings need to be analyzed and interpreted for practice and clinical applications.
There has been an exponential increase in the number of studies conducted in medicine and dentistry and respective reports published ; despite that, the evidence is scarce or insufficient to generalize the results in many topics.
Another challenge of the available evidence in dentistry, particularly in prosthodontics, is that studies that evaluate the duration of treatments vary in terms of follow-up time and the definition of outcomes such as success or survival.
As mentioned earlier, using evidence-based findings allows practitioners to improve treatment planning and decision-making, ensuring optimal patient outcomes, which is important in prosthodontics.
In dental care, interpreting evidence and adapting it to individual patient needs are crucial for success. For that reason, practitioners need to be knowledgeable about how their expertise and the interpretation of the evidence can be applied in specific clinical scenarios, which is important in dentistry, particularly prosthodontics.
Systematic reviews and summaries of evidence have influenced clinical protocols in dentistry, shaping and guiding practices for restorative procedures. ,
Several dental organizations advocate using evidence-based dental practice in response to the rapid advance of technology; the large number of studies, which also implies a wide variability in the quality of available dental literature, and recognizing reliable evidence to incorporate into practice is becoming more challenging.
Materials, technique advancements, emergency trends, and technology used in prosthodontics, such as scanning, 3 dimensional (3D) printing, and digital workflows, and their research have transformed dental practice ,
Challenges and opportunities
Bridging the Research–Practice Gap
Barriers to implementing evidence-based dental practice are always a concern. Clinicians often face time constraints and limited access to the latest evidence, making it challenging to translate research into practice. For some current practitioners, understanding the language used in research remains a problem for accepting and implementing evidence into practice.
Some solutions are encouraging continuous professional development and improving access to evidence-based summaries, and research is suggested to help bridge the gap between research and practice.
Research found that incorporating patient values into decision-making ensures that the delivery of care aligns with individual goals and enhances patient satisfaction.
Involving the collaboration between patients and practitioners in treatment planning is a core principle of prosthodontics and relates to EBP.
In the last few years, patient feedback on satisfaction and quality of life has been the focus of treatment outcomes and claims that can refine treatment protocols and improve long-term outcomes. ,
Future directions
Technological Innovations in Dentistry and Prosthodontics
The new advancements during the last decade, like computer aid design (CAD)/computer aid manufacturing (CAM) and 3D printing, are revolutionizing prosthodontics by increasing precision, efficiency, and cost-effectiveness.
Despite the potential of digital technologies, resistance to change due to cost, learning curves, and the need for supporting evidence remains challenging.
There is a need for advancing evidence generation and synthesis for which a closer collaboration among academia, researchers, and clinicians is essential to generate high-quality evidence that directly impacts patient care.
Big data and artificial intelligence (AI) prosthodontics : The analysis of large datasets holds the potential to advance evidence generation and support clinical decisions but requires careful integration into practice.
Artificial Intelligence and Dentistry
Challenges in evidence-based dentistry are the availability of research, time constraints, and interpreting vast amounts of data; now, it may be possible to do it using AI.
Integrating AI into dentistry significantly shifts how clinical evidence is processed, applied, and generated. AI’s potential to revolutionize various aspects of prosthodontic care is profound, with applications ranging from diagnostics and treatment planning to optimizing clinical workflows.
Artificial intelligence in synthesizing evidence
AI has shown that it can automate and expedite processes like literature reviews and even systematic reviews, curating and grading evidence, and providing real-time clinical decision support. There are currently different programs that can accelerate and optimize the systematic review process and deliver faster results. ,
A systematic review often takes more than 15 months to complete, and the long conception–completion interval may render a systematic review outdated by the time they are ready to be submitted and published.
Accelerating systematic reviews and meta-analyses time-saving potential
AI can streamline workflows, helping clinicians spend less time reading multiple articles.
One of the most time-consuming aspects of evidence-based dentistry is conducting systematic reviews, which require rigorous appraisal of large datasets. AI can dramatically reduce the time needed for these reviews by automatically screening, categorizing, and analyzing large volumes of scientific literature. Table 1 synthesizes the differences between traditional systematic reviews to AI-assisted systematic reviews.
