Volume 9, Issue 11, November – 2024 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Ethical Considerations in Prosthodontic Treatments

Balancing Cost and Patient Care – A Review
Dr. B. Eswaran1; Dr. Ponsekar Abraham2; Dr. T. Sakthi Priya 3*; Dr. E.G. Ammu4
Professor1; HOD of Prosthodontics2; Junior Resident3; Junior Resident4
Department of Prosthodontics,
Thai Moogambigai Dental College And Hospital, Chennai.

Corresponding Author:- Dr. T. Sakthi Priya3*

Abstract:- Prosthodontics, a specialty focused on patient outcomes to achieve a balance between affordability
restoring oral function and aesthetics, encounters ethical and effectiveness.4 Despite the clinical success of treatments
challenges in balancing patient care, cost, and like implant-supported prostheses, economic barriers often
accessibility. Emphasis is placed on ensuring informed limit access for many patients, highlighting the importance of
patient decisions, delivering beneficial treatments, developing equitable solutions. However, the increasing
avoiding harm, and addressing disparities in care access. emphasis on cost-effectiveness raises concerns that financial
The integration of evidence-based practices, technological constraints may compromise the quality of patient care,
advancements, and financial management is discussed, leading to suboptimal treatment choices. 5 This article gives an
highlighting their impact on treatment quality and overview on ethical considerations in prosthodontic
affordability. Challenges such as high material costs, treatments focusing on balancing cost and patient care
limited insurance coverage, and patient expectations are
examined alongside strategies for ethical decision-  Beneficence in Prosthodontics
making, including transparent communication, phased Beneficence, rooted in the Hippocratic Oath, obligates
treatments, and advocacy for policy changes. Financial healthcare providers to act in the best interest of their patients.
management practices like cost analysis and revenue In prosthodontics, this principle encompasses ensuring that
optimization are vital for sustainable care. By balancing treatments improve oral health, aesthetics, and function while
ethical imperatives with economic realities, considering the patient's unique circumstances. Specific
prosthodontists can uphold professional standards while beneficence focuses on individual patients, such as
ensuring equitable, patient-centered care. recommending personalized prosthetic solutions based on
their oral health needs, financial constraints, and lifestyle. 6
Keywords:- Prosthodontics, Ethics, Autonomy, Beneficence, General beneficence involves contributing to broader societal
Non-maleficence, Justice, Evidence-Based Practice. well-being, such as advancing prosthodontic research or
providing community-based services to underserved
I. INTRODUCTION populations. Prosthodontists must stay updated on
advancements in materials, techniques, and technologies to
Prosthodontics, as a specialty focused on restoring oral ensure treatments align with current standards and deliver
function and aesthetics, often involves intricate treatments optimal outcomes. For example, mastering CAD/CAM
requiring significant financial, technical, and professional technology enables clinicians to offer precise and durable
resources. The field presents numerous ethical challenges, prosthetics, directly benefiting patients. Delegating complex
particularly in balancing patient care with the cost and procedures, such as full-mouth rehabilitation or implant-
accessibility of treatment.1 Ethical considerations in supported prostheses, to less experienced trainees or auxiliary
prosthodontic treatments require a careful balance between staff without proper supervision may compromise care
cost and patient care, guided by the principles of autonomy, quality. Ethical practice demands that prosthodontists oversee
beneficence, and non-maleficence. Practitioners must ensure critical aspects of treatment to ensure safety and
that patients are fully informed and actively involved in effectiveness.7
treatment decisions, respecting their preferences and
autonomy.2 At the same time, the obligations of beneficence  Non-Maleficence in Prosthodontics
and non-maleficence compel clinicians to provide treatments The principle of non-maleficence, meaning "First do no
that benefit patients while minimizing harm, emphasizing harm," underpins the responsibility of healthcare providers to
thorough treatment planning and careful examination to avoid causing harm to patients through their actions or
prevent complications. Professionalism and ethical omissions. Non-maleficence in prosthodontics involves
sensitivity are also critical, as evidenced by studies showing avoiding complications such as ill-fitting dentures, poorly
that a majority of newly graduated dentists demonstrate integrated implants, or prosthetics that cause undue
awareness of ethical principles in prosthodontic practice. 3 discomfort or harm. Meticulous planning, accurate
From a cost perspective, economic analyses are vital in diagnostics, and adherence to evidence-based practices are
evaluating the financial implications of various prosthodontic crucial to mitigating these risks. For example, recommending
interventions, weighing initial and maintenance costs against a full-mouth implant reconstruction to a medically

IJISRT24NOV1960 www.ijisrt.com 2047

Volume 9, Issue 11, November – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
compromised patient without considering alternative  Implant Related - Outcomes
solutions like removable dentures may pose unnecessary The ethical considerations surrounding dental implants
risks. A responsible approach would involve evaluating the are diverse and intricate, involving key aspects such as patient
patient’s health, preferences, and financial constraints to autonomy, informed consent, professional responsibility, and
minimize harm while ensuring satisfactory outcomes. the long-term implications of treatment decisions. With the
Ensuring patients fully understand the potential risks and rapid advancements in dental implantology, practitioners are
benefits of procedures, such as implant surgery or tasked with addressing these ethical dilemmas to provide
maxillofacial prosthetics, helps align clinical decisions with responsible care and ensure the best possible patient
ethical standards. Inadequate disclosure of risks may lead to outcomes. Respecting patient autonomy remains paramount,
emotional distress, financial burdens, or litigation if adverse requiring open, transparent communication that enables
outcomes occur.7,8 patients to understand their treatment options fully and
participate in shared decision-making. Informed consent must
 Autonomy in Prosthodontics be comprehensive, detailing not only the potential benefits of
Autonomy emphasizes the patient’s right to make dental implants but also the associated risks, complications,
informed and voluntary decisions regarding their healthcare. and limitations of the treatment. Professional responsibility
In prosthodontics, respecting autonomy requires transparent extends to staying well-versed in ethical standards and legal
communication and a participatory approach to treatment requirements, as studies indicate that a significant number of
planning. Autonomy extends beyond obtaining a patient’s dental professionals lack adequate knowledge of current
signature on a consent form. It involves educating patients legislation. Ethical practice also demands meticulous
about the nature of prosthodontic treatments, such as fixed documentation and an obligation to inform patients about all
prostheses, implant-supported restorations, or full-mouth viable treatment options. The longevity of dental implants
rehabilitations. Patients should understand the risks, benefits, presents unique ethical challenges, particularly when
alternatives, and costs associated with each option. Providing recommending them for younger patients, given the limited
patients with visual aids, mock-ups, or models of proposed long-term success data currently available. Dentists must
prosthetics can enhance their understanding, allowing them to carefully weigh the potential benefits against the
make confident decisions. For instance, showing patients uncertainties, ensuring decisions are made in the patient’s
digital renderings of their planned restorations helps them best interest. Another critical consideration is the balance
visualize outcomes. A paternalistic approach, where between treatment costs and patient benefits. Practitioners
clinicians override patient preferences in favor of what they must manage financial discussions with transparency to
believe is best, undermines autonomy. Modern prosthodontic maintain trust, avoiding scenarios where costs overshadow
practice advocates for shared decision-making, ensuring the potential advantages of implants. While the emphasis on
patients feel respected and involved in their care.9 ethical considerations is essential, there is an ongoing debate
that excessive caution driven by ethical concerns may
 Justice in Prosthodontics inadvertently restrict access to implants for patients who
The principle of justice in prosthodontics emphasizes could significantly benefit from them. Thus, achieving an
fairness in the distribution of healthcare resources and equilibrium between ethical rigor and practical accessibility
equitable access to treatment, addressing disparities in access is vital to advancing implantology while upholding patient-
to high-quality prosthetic care. Prosthodontic treatments, centered care.7,10
such as implant-supported prostheses or full-mouth
rehabilitations, are often expensive and inaccessible to A multidisciplinary approach in dental implantology is
marginalized populations, necessitating the exploration of essential for addressing the diverse needs of patients and
options to make care more affordable. Clinicians can adopt managing potential complications effectively. Dental implant
strategies such as phased treatment plans or offering low-cost treatment often involves complex clinical scenarios that
alternatives like resin-based removable partial dentures to extend beyond the expertise of a single practitioner, requiring
ensure inclusivity. Addressing socioeconomic inequities is collaboration among various specialists, including
critical, and ethical prosthodontists can bridge these gaps by prosthodontists, oral and maxillofacial surgeons,
providing sliding-scale fees, participating in community periodontists, orthodontists, and sometimes medical
outreach programs, and advocating for broader access to care. professionals. Complications can arise at any stage of
Justice in prosthodontics can be understood through various treatment, making a team-based approach invaluable. Early
theoretical lenses: utilitarianism focuses on maximizing complications, such as surgical site infections or implant
benefits for the greatest number by developing affordable, failure due to inadequate osseointegration, benefit from input
scalable prosthetic solutions; egalitarianism emphasizes from surgeons and periodontists to manage tissue health and
creating policies that ensure basic prosthetic care for all healing. Prosthetic complications, including improper load
individuals, regardless of financial status; and libertarianism distribution or misalignment, require the expertise of
highlights the importance of patient autonomy in allocating prosthodontists to refine and adjust the prosthesis. Long-term
resources for elective treatments. By adhering to the principle complications, such as peri-implantitis, necessitate regular
of justice, prosthodontists contribute to a fair and equitable maintenance and intervention by periodontists to prevent
healthcare system, ensuring no patient is disadvantaged due implant loss. By adopting a multidisciplinary approach,
to financial or societal constraints, and fostering trust and clinicians ensure a holistic treatment plan that minimizes
integrity in the practice.10 risks, addresses complications proactively, and provides
patients with optimal functional and aesthetic outcomes. This

IJISRT24NOV1960 www.ijisrt.com 2048

Volume 9, Issue 11, November – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
approach not only improves the success rate of dental evidence with clinical expertise and patient needs. However,
implants but also enhances patient satisfaction and trust in the the assessment of prosthodontic treatment success, such as
care process. the longevity of prostheses, requires long-term observation,
and many studies rely on weaker evidence such as case
 Informed Consent reports or cross-sectional studies. The hierarchy of evidence
Informed consent is a cornerstone of prosthodontic care, in traditional medicine places randomized controlled trials
ensuring that patients fully understand their treatment (RCTs) at the top, offering minimal bias, while case reports
options, including risks, benefits, alternatives, and potential and expert opinions are at the bottom due to higher
outcomes, before proceeding with interventions such as susceptibility to bias.12 However, lower-level studies can still
removable partial dentures (RPD), fixed partial dentures provide valid evidence, especially when RCTs are not feasible
(FPD), implants, complete dentures (CD), or maxillofacial for certain procedures. Evidence-based prosthodontics aims
prostheses. The process involves assessing the patient’s to compile and critically analyze existing scientific data,
mental capacity to make informed decisions, providing clear seeking improvements and adherence to robust research
and thorough explanations, and documenting the consent protocols. For fixed partial dentures (FPDs), evidence
either in writing or verbally. Explicit consent is necessary for suggests an 89% survival rate over 10 years for tooth-
complex or high-risk procedures, while implied consent may supported FPDs, with digital impressions outperforming
suffice for routine treatments, though less common in surgical conventional methods in marginal and internal fit.
settings.3 Longitudinal studies have reported high survival rates for
porcelain-fused metal (PFM) and zirconia restorations.
Prosthodontists must clearly communicate the cost of Similarly, advancements in removable denture fabrication
treatment, specifying whether the amount is fixed or an techniques have been scrutinized, though significant
estimate. For example, if the cost is approximate, scientific evidence is still lacking for single-impression
practitioners should inform patients about factors that could methods, face-bow registrations, or balanced occlusion
influence the final expense, such as unforeseen complications models. Evidence-based research in prosthodontics is
or additional procedures. This transparency ensures patients implemented through frameworks like CONSORT, PRISMA,
can make informed financial decisions, safeguarding their and TREND, and the focus is shifting towards knowledge
autonomy and maintaining trust.1,4 translation, ensuring research findings are effectively
incorporated into clinical practice. Strategies like designing
 Evidence-Based Prosthodontics relevant hypotheses, presenting findings, and emphasizing
Prosthodontics relies increasingly on evidence-based evidence-based protocols are essential for maintaining
practices (EBP) despite challenges unique to the field. Unlike clinical relevance and improving patient care. Prosthodontics
other medical and dental specialties, prosthodontics often continues to evolve by applying evidence-based frameworks
deals with studies of limited duration, small sample sizes, and to refine treatment protocols, validate innovative techniques,
inconsistent clinical outcomes, which complicates the and ensure that practices are scientifically justified and
generation of high-quality evidence.11 Evidence-based aligned with patient-centered care.13,14
dentistry is defined as the judicious integration of scientific

Challenges in Balancing Cost and Care Strategies for Ethical Decision-Making

High Material Costs: Advanced materials like zirconia and titanium Transparent Communication: Discuss treatment
increase treatment expenses. Balancing these costs with ethical care options, including lower-cost alternatives, without
involves considering alternative materials or staged treatment plans. compromising essential care standards.
Technological Advancements: Digital dentistry, including CAD/CAM Tailored Treatment Planning: Design plans that
technology, enhances precision but raises costs. Clinicians must weigh align with patient needs and financial capacity, such
the benefits against the patient's financial constraints. as phased treatments.
Insurance and Reimbursement Issues: Limited coverage for Advocacy for Policy Changes: Work towards
prosthodontic treatments restricts accessibility. Educating patients on insurance reforms to include prosthodontic
insurance options or collaborating with policymakers can address these procedures, improving access for underprivileged
issues. populations.
Patient Expectations: Patients often expect affordable yet premium- Interprofessional Collaboration: Coordinate with
quality care. Ethical considerations demand realistic discussions about dental technicians, insurance providers, and other
treatment outcomes and costs.15 professionals to optimize care delivery.16,17

 Financial Management in Prosthodontics including key performance indicators (KPIs) and financial
Financial management is paramount in prosthodontics, ratios, provides valuable insights into practice health.
as it directly impacts practice profitability and sustainability. Implementing comprehensive budgeting strategies aligns
A comprehensive cost analysis is essential, encompassing revenue with expenses, facilitating growth and asset
materials, labor, and overhead to establish a robust financial accumulation. Revenue optimization can be achieved through
foundation. This analysis informs strategic pricing, balancing effective fee structuring and diversifying income streams,
competitive rates with the need for profitability. Insurance such as membership plans or advanced technologies.
coordination is crucial, optimizing revenue while ensuring Standardized financial processes enhance operational
patient access to care. Regular financial monitoring, efficiency and overall financial health. However, challenges

IJISRT24NOV1960 www.ijisrt.com 2049

Volume 9, Issue 11, November – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
like patient variability and treatment complexity can impact [12]. Venkatesan S, Krishnamoorthi D, Raju R, Mohan J,
revenue consistency and forecasting. By addressing these key Thomas PA, Rubasree B. Evidence-Based
aspects, prosthodontic practices can effectively manage Prosthodontics. J Pharm Bioallied Sci. 2022
financial resources, ensuring long-term success and patient Jul;14(Suppl 1):S50-S59. doi:
care.18,19,20 10.4103/jpbs.jpbs_149_22. Epub 2022 Jul 13. PMID:
36110755; PMCID: PMC9469236.
II. CONCLUSION [13]. Lisa, A., Tedesco., Davis, A., Garlapo. (1994). 5.
Social and economic factors in prosthodontic practice
Prosthodontists must balance ethical principles with education and.
practical challenges when providing high-quality care. [14]. Kenneth, Boyd., Peter, Hall. (2016). 6. Can Clinical
Transparent communication, individualized treatment Guidelines Afford to Ignore Cost Effectiveness? An
planning, and advocacy for systemic improvements are Ethical Perspective. PharmacoEconomics, doi:
crucial in addressing cost-related ethical dilemmas. By 10.1007/S40273-016-0391-2
prioritizing patient well-being while considering financial [15]. Satoshi, Yamaguchi. (2023). 9. Clinical and ethical
realities, prosthodontists can uphold the profession's ethical considerations for prosthetic treatment for older adults
standards and ensure equitable care. in need of care. Annals of Japan Prosthodontic Society,
doi: 10.2186/ajps.15.288
REFERENCES [16]. Hartshorne J, van Zy A. Dental malpractice and its
liabilities: Ethical and legal considerations every
[1]. https://www.researchgate.net/post/What-is-the-role- dentist should know. Int Dent Afr Ed. 2020;10(2):46.
of-ethics-in-Prosthodontic-Treatment [17]. Ladley B, Finkbeiner C, Allan Finkbeiner. Practice
[2]. Worthington, P. (1995). Medicolegal aspects of oral management for the dental team. 1991.
implant surgery [18]. Financial Analysis and Control in the Dental Office.
[3]. Mohammad, Ali, Chughtai., Syed, Nasir, Shah., 2023;4. doi:10.1002/9781119892885.ch20
Mariya, Khalid., Amjid, Naseer. (2017). 1. Fixed and [19]. Dental ROI. The prosthodontic marketing landscape
removable prosthodontics ethical sensitivity scale- has changed significantly. Available from:
farpess. https://www.dentalroi.com/Prosthodontist-
[4]. Nash DA. Professional ethics and aesthetic dentistry. J Marketing#:~:text=The%20prosthodontic%20market
Am Dent Assoc 1988; 117(4) 7E-9E ing%20landscape%20has,in%20urban%20and%20su
[5]. Dick, J., Witter., W.G., Brands., R.A., Hoefnagel., burban%20markets.
Nico, H., J., Creugers. (2012). 2. [Medico-ethical [20]. Kashyap P. Strategies for financial growth in dentistry:
considerations when indicating single-tooth fixed exploring revenue streams and business models for
prosthesis, multi-teeth fixed prosthesis, and oral maximizing profitability. Int J Adv Res. 2024.
implants].. Nederlands Tijdschrift Voor doi:10.21474/ijar01/19148.
Tandheelkunde, doi: 10.5177/NTVT.2012.12.12244
[6]. Donald, W., Lewis. (1998). 3. Optimized therapy for
the edentulous predicament: Cost-effectiveness
considerations. Journal of Prosthetic Dentistry, doi:
10.1016/S0022-3913(98)70200-8
[7]. Bylaws., Judicial, Affairs. (1990). 4. American Dental
Association Principles of Ethics and Code of
Professional Conduct. Journal of the American Dental
Association, doi:
10.14219/JADA.ARCHIVE.1990.0093
[8]. Upendra, Singh, Bhadauria., Pralhad, L, Dasar., N,
Sandesh., Prashant, Mishra., Shaijal, Godha. (2018).
4. Medico-legal Aspect of Dental Practice. doi:
10.15386/CJMED-764
[9]. Mohammad, Zakaria, Nassani. (2017). 5. Aspects of
Malpractice in Prosthodontics.. Journal of
Prosthodontics, doi: 10.1111/JOPR.12636
[10]. Manas, Gupta., Kirti, Shrivastava., Sunil, Kumar,
Mishra., Ravish, Ahuja., Pankaj, Mishra., Shail,
Kumari. (2018). 6. Importance and awareness of
medico legal issues in dental practice… Alarm call.
Annals of Tropical Medicine and Public Health, doi:
10.4103/ATMPH.ATMPH_317_17
[11]. John M. Basic principles of maximizing dental office
productivity. Gen Dent. 2012.

IJISRT24NOV1960 www.ijisrt.com 2050