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A SURVEY TO COMPARE THE SUCCESS AND TRENDS FOLLOWED BETWEEN THE

PRIVATE PRACTICE OF PROSTHODONTISTS AND NON-PROSTHODONTISTS IN
NORTHERN AND EASTERN STATES OF INDIA

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Reg. No: RJ17D0105798 ISSN NO: 2582-0362

HEB JOPD

Journal of Prosthodontics Dentistry

An Official Publication of Bureau for Health & Education Status Upliftment
(Constitutionally Entitled as Health-Education, Bureau)
A Survey to Compare the Success and Trends Followed between the Private
Practice of Prosthodontists and Non-Prosthodontists in Northern and Eastern
States of India

Dr. Khirod Sonar, Dr. Garima Agarwal, Dr. Swati Gupta, Dr. Anuradha P,
Dr. Kaushitaki Bhaumik, Dr. Amrita Upadhyay

Email Id: serviceheb@gmail.com

INTRODUCTION
Prosthodontics represents a highly developed body of knowledge and skills that spans multiple disciplines.
As stated by Elwood H. Stade1 in his study that clinical studies appear in the journals to provide information
of treatment successes and failures. Little is found, however, that addresses the financial rewards or the
typical practice profiles of successful prosthodontic practices. As stated by H.A.Young2 in his study that
successful prosthodontic practice must be predicated on success businesswise and professionally. This
study aims to evaluate and compare the success and trends followed in private practice of prosthodontists
versus non prosthodontist (MDS in a dental specialty except prosthodontics) in northern and eastern states
of India. The purpose of this study is to update and present additional information on the private practice
of prosthodontists and nonprosthodontists, related to prosthodontic treatment procedures only. As reported
by Nash3 et al, the American College of Prosthodontists sponsored and conducted surveys on the private
practice of prosthodontists. Starting in the year 2002, the ACP has sponsored surveys of prosthodontists
practicing in the United States. Five surveys have been conducted: in 2002, 2005, 2008, 2011, and 2014.
The first four surveys were conducted as mailed surveys, while the 2014 survey was conducted as an
internet survey. In this study the conditions and characteristics of private practice by prosthodontists and
non prosthodontist were reviewed and compared with the help of a Google form questionnaire. In their paper
Vasantha Raju N4 et al made an attempt to explore the potential advantages of web based survey tools for
data collections and analysis. It also explains how web-based survey can be designed and developed for
data collections using Google Forms. In this study several characteristics of practice were reviewed
including age, gender, patient visits and financial conditions including revenues, wages, expenses, and net
income from practice etc. Numerous authors have spoke about the adaptation of modern treatment tools
and technology in private practice of dentists. As Nishihara et al5 spoke about zirconia implants, Brecht7 et
al spoke about intraoral scanners with digital

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milling technology etc. In this study a section of questions is included to cover the adoptation of modern
treatment protocols. In the studies by Kabil et al and Omar8,9 et al they have emphasized about motivating
factors influencing dental students in choosing the specialty of prosthodontics in post graduate programmes.
The data and information from the survey can be used to assist with development of activities to enhance and
encourage dentists to consider the specialty of prosthodontics as a profession. In a study by David
W.Chambers10, it is suggested that dentists are among the top earners in the United States. However, the
income stream is not uniform across dentists’ careers. Virtually all dentists start their adult lives at an
economic disadvantage, compared with their peers in other profession, because they must investheavily in
their careers. In this study, data regarding income and expenses in a private practice of prosthodontists
compared to non prosthodontists is collected. It will help in better understanding of successof prosthodontists
in private practice and the profession as a whole. It will help to better equip the prosthodontists to face the
future challenges in private practice and motivate the dental students to opt
prosthodontics as a specialty.
Access this Article Online
Website:http://heb-nic.in/jopd
Received on 20/09/2024
Accepted on 24/09/2024 © HEB All rights reserved

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Reg. No: RJ17D0105798 ISSN NO: 2582-0362

AIMS AND OBJECTIVES:

Aims:
To compare the success and trends followed between the private practice of prosthodontists and non-
prosthodontists in northern and eastern states of India.
Objectives:
A. To compare the number of opd patients in practice of prosthodontists and non prosthodontists related
to prosthodontic cases with the help of a Google form questionnaire survey.
B. To evaluate and compare the adaptation of changing trends in different prosthodontic treatment
protocols by a prosthodontist and a non prosthodontist.
C. To evaluate and compare the expenditures of dental materials used in a prosthodontic practice of a
prosthodontist and non prosthodontist.
D. To evaluate and compare the dental laboratory expenditures in prosthodontic practice of a
prosthodontist and non prosthodontist.
E. To evaluate the revenue generated from prosthodontic practice of a prosthodontist and non
prosthodontist.
F. To evaluate and compare the net production (income) generated from prosthodontic practice of a
prosthodontist and non prosthodontist.

MATERIALS AND METHODS STUDY DESIGN:

This study was conducted from department of Prosthodontic & Crown and Bridge, Babu Banarasi Das
College of Dental Sciences, Faizabad road Lucknow (UP), India. It was an internet based survey in which
a Google form questionnaire was sent to various dentists in private practice in northern and eastern states
of India.
Ethical clearance for the dissertation was obtained from the institutional ethical committee [(IEC code - 42)
BBDU/MDA/42/2024] Dated 27.02.2024
STUDY SAMPLE SIZE:
The study sample size was 300.
Divided into 2 groups. Which were 150 prosthodontists and 150 non prosthodontists.
ELIGIBILTY CRITERIA : Dentists with a recognized MDS degree.
EXCLUSION CRITERIA:
1. Dentists outside of Northern and Eastern states of India.
2. Dentist not in private practice.
3. Dentist without a MDS degree.

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INCLUSION CRITERIA: 1. Dentists in a private practice in northern and eastern states of India.
2. Dentist with recognized MDS degree.
SAMPLING METHOD: Convenience sampling method was followed.
METHODOLOGY: The Google form based questionnaire was sent online to selected participants
practicing in northern and eastern states of India. They were asked to fill the consent form provided in the
Google form itself by ticking yes option then further proceed to fill the form. Hence the survey was solely
voluntary and privacy of the participant was maintained. The form contained questions regarding place of
practice, age, gender, dental specialty, years of practice, various prosthodontic treatment procedure with
their respective charges viz. number of OPD patients, complete dentures, soft liners, tissue conditioners
used in complete dentures, removable partial dentures, fixed partial dentures: pfm and zirconia, implant
placement procedures, implant prosthesis, maxillofacial prosthesis, laminates and veneers, cast metal post
and core, pre-fabricated post and cores any other modern treatment procedures like BPS dentures, etc.
Questions also included regarding adaptation of advanced treatment tools and devices viz. intraoral
scanners, milling units, zirconia abutments, PEEK abutments, dental LASERS etc. The Google forms were
sent to the participants and the responses were received instantly. This method of survey was time saving
and very convenient. The data was automatically collected and stored. Further the data was arranged in
tables and charts and sent for statistical analysis.

RESULTS
1. AGE DISTRIBUTION OF STUDY SUBJECTS:
Based on the age distribution of the study sample 55.33% were of 25-34 years age group, 34% were of
35-44 years age group, 8.67% were of 45-54 years age group and 2% were of 54-65 yeas age group.
Frequency Percent:
25-34 years- (166) 55.33%.
35-44 years -(102) 34%.
45-54 years (26 ) 8.67% .
54-65 years (6) 2%.
Total (300)- 100%

2. GENDER DISTRIBUTION OF STUDY SUBJECTS :

Based on the gender distribution of the study subjects 34.67% were the females and 65.33% were the
males.

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3. YEARS OF PRACTICE:
Based on the years of practicing dentistry 6.67% were practicing since 0-2 years, 34% were
practicing since 3-5 years, 24% were practicing since 11-15 years and 1.33% were practicing since
16-25 years.

4. INTERGROUP COMPARISON OF MEAN NUMBER OF PATIENTS TREATED IN OPD

AMONG THE PROSTHODONTISTS AND NONPR0STHODONTISTS:
The mean number of patients in the OPD of non-prosthodontists was 263.92.
Whereas the mean number of patients in the OPD of prosthodontists was 184.11. The difference in
the number of patients treated by the non- prosthodontists and prosthodontists was statistically
significant(0.001).

5. INTERGROUP COMPARISON OF MEAN NUMBER OF (treatment procedures) viz

COMPLETE DENTURES,SOFT LINERS,TISSUE CONDITIONERS AND RPD
BETWEEN PROSTHOODNTISTS AND NON-PROSTHODONTITS:
The mean number of complete dentures completed by non- prosthodontists was 2.520/month,
whereas the mean number of dentures delivered by the prosthodontists was 4.693. The mean number
of dentures delivered by prosthodontsits was significantly higher than the non- prosthodontists. The
mean number of patients with application of tissue conditioners and soft liners were 0.160 and
0.226 by the non-prosthodontist. Whereas the mean number of patients with application of tissue
conditioners and soft liners by the prosthodontists were 0.853 and 1.013 respectively.

6. INTERGROUP COMPARISON OF MEAN CHARGE OF PATIENTS TREATED IN OPD

AMONG THE PROSTHODONTISTS AND NONPR0STHODONTISTS:
The mean charge of patients in the OPD of non-prosthodontist was 392.02. Whereas the mean
number of patients in the OPD of prosthodontists was 445.62. The difference in the number of
patients treated by the non- prosthodontists and prosthodontists was statistically significant (0.001)

7. INTERGROUP COMPARISON OF CHARGES OF COMPLETE DENTURES, SOFT

LINERS AND TISSUE CONDITIONERS BETWEEN PROSTHOODNTISTS AND NON-
PROSTHODONTITS:

The mean OPD charges of the non-prosthodontists were 392.02 and among the prosthodontists
was445.62. The mean OPD charge of the prosthodontists was significantly higher than non-
prosthodontists.

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prosthodontists. The charge for complete dentures among the non-prosthodontists was 18533.33
whereas the charge among the prosthodontists was significantly higher at 30053.30. The mean
charge for the tissue conditioners among the pon- Prosthodontists was 4600.02 and among the
prosthodontists was 5528.83. The mean charge for the non- prosthodontists was 4325.33 for the
soft liners and 6532.0 for the prosthodontists with significant difference between the non-
prosthodontists and prosthodontists when analyzed using independent t test.

8. INTERGROUP COMPARISON OF NUMBER OF RPD, PFM AND ZIRCONIA CROWNS

BETWEEN PROSTHOODNTISTS AND NON- PROSTHODONTISTS :
The mean number of rpd fabricated by the non- prosthodontists was 5.40 and among the
prosthodontists was significantly higher at 7.32.. The mean number of pfm crown fabricated by non-
prosthodontists was 10.68 and among the non prosthodontists was 23.66.The mean number of
zirconiumcrowns fabricated by non-prosthodontists was 6.24 and among the prosthodontists was
12.24.
The mean number of rpd, prm and zirconia crowns fabricated by the prosthodontists were
significantly higher than the non- prosthodontists.

9. INTERGROUP COMPARISON OF CHARGES OF RPD, PFM AND ZIRCONIA

CROWNS BETWEEN PROSTHOODNTIST AND NONPROSTHODONTITS:
The mean charge of rpd fabricated by the non- prosthodontists was 2134.73and among the
prosthodontists was significantly higher at 3460.13. The mean charge of pfm crowns fabricated by
non prosthodontists was 3054.23 and among the prosthodontists was 3586.03 .The mean charge
of zirconium crowns fabricated by non prosthodontists was 6558.13 and among the prosthodontists
was 6846.73 . The charge of rpd, pfm and zirconia crowns fabricated by the prosthodontists were
significantly higher than the non- prosthodontists.

10. INTERGROUP COMPARISON OF NUMBER OF OVER DENTURES, IMPLANT,

LAMINATES, CAST METAL POSTSS AND PRE FABRICATED POST BETWEEN
PROSTHOODNTISTS AND NON-PROSTHODONTISTS :
The mean number of over dentures fabricated by the non prosthodontists was 0.56 and among the
prosthodontists was significantly higher at 2.520.. The mean number of Implants placed by non-
prosthodontists was 2.520 and among the prosthodontist was 5.693 .The mean number of laminates
fabricated by non-prosthodontists was 1.67 and among the prosthodontists was

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4.346. The mean number of cast metal posts and core fabricated by non- prosthodontists was 0.224
and among the prosthodontists was 1.034. The mean number of pre fabricated post and core
fabricated by non- prosthodontist was 2.140 and among the prosthodontists was 4.259 .The mean
number of the prosthesis fabricated by the prosthodontists were significantly higher than the non-
prosthodontists.

11. RESPONSES TO ADOPTATION OF MODERN TREATMENT PROTOCOLS:

In response to question on availability of intraoral scanner in the practice. 6.80% of the non-
prosthodontists and 48% of the prosthodontists were having intraoral scanner in their clinics. In
response to question on the availability of milling machine in the clinics none of the non-
prosthodontists had milling unit in their clinic whereas 1.40% of the prosthodontists were having
milling unit in their practice. In response to question on the use of zirconia abutments in practice,
9.50% of the non-prosthodontists and 47.20% of the prosthodontists were using it in their clinics.
Inresponse to question on use of peek abutments, 5.23% of the non- prosthodontists and 16.70%
ofthe prosthodontists. On the question of availability of lasers in the clinics the 22.20% of non-
prosthodontists and 47.20% of the prosthodontists were using it. The difference between
prosthodontists and non-prosthodontists in response to questions on availability of intraoral
scanners, use of zirconia abutments use peek abutments and availability of lasers was statstitically
significant.

12(A). EXPENDITURE INCURRED BY PRSOTHODONTISTS AND

NONPROSTHODONTISTS IN PRIVATE PRACTICE :
The mean expenditure related to dental lab charges per month was 19162.40 by the non-
prosthodontists and 27877.14 by the prosthodontists. The mean expenditure on dental materials per
month was 13426.24 by non prosthodontists and 14110.24 by prosthodontists. The mean
expenditure related to staff salary per month was 14849.54 by the non-prosthodontists and
16274.64 by the prosthodontists. The mean expenditure related to rent per month was 11340.27 by
non-prosthodontists and 14014.27 by prosthodontists. The mean expenditure related to service and
maintenance of equipment per month was 3199.33 among the non prosthodontists and 3002.14
among the prosthodontists. The difference between the prosthodontists and non- prosthodontists
was statistically non-significant in terms of expenditure related to dental materials,salaries and rent
payments. The mean expenditure on the dental laboratory charges were significantly higher in the
case of prosthodontists as compared to non-prosthodontists.

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12. OVERALL PROFIT AMOMG PROSTHODONTISTS AND

NON PROSTHDONTISTS:
The mean overall profit among the prosthodontists was significantly higher as compared to non-
prosthodontists.

DISCUSSION:
In this study apart from collecting information on income and expenses of a private practice,
questions were included regarding modern treatment procedures. Example - lasers and intraoral
scanners. Verma and Kumar et al.14 suggested the importance of lasers in dentistry in their article .
Almari et al.15 suggested the importance of CBCT (cone beam computerized tomography).
Diogaurdi M et al.16 suggested the importance of guided implant surgery in their article. But CBCT
and guided implant surgery software are not used routinely in private practices in northern and
eastern states of India due to their increased cost. Although there were few independent CBCT and
radiological centers where CBCT was available. These modern diagnostic tools and softwares can
be included in questionnaires of future survey.
Based on the age distribution of the study sample 55.33% were of 25-34 years age group, 34% were
of 35-44 years age group, 8.67% were of 45-54 years age group and 2% were of 54-65 yeas age
group. This trend is explained by the fact that more number of dental specialists including
prosthodontists are graduating from dental schools compared to the last decade.
Based on the years of practicing dentistry 6.67% were practicing since 0-2 years, 34% were
practicing since 3-5 years, 24% were practicing since 11-15 years and 1.33% were practicing since
16-25 years. The mean number of patients in the OPD of non-prosthodontists was 263.92 whereas
the mean number of patients in the OPD of prosthodontists was 184.11.The difference in thenumber
of patients treated by the non-prosthodontists and prosthodontists was statistically significant. Non-
prosthodontists attend to more number of patients in the OPD because their practicemay span to
more than one discipline of dentistry. Some non-prosthodontists may include multiple disciplines
in their practice. But not necessarily more rewarding economically.
The mean number of prosthodontic treatment procedures and their charges were higher in case of
prosthodontists compared to non prosthodontists.

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CONCLUSION:
Following are the conclusions drawn from the study:
a) Based on the age distribution of the study sample 55.33% were of 25-34 years age group,
34% were of 35-44 years age group.
b) Based on the gender distribution of the study subjects 34.67% were females and
65.33% were males.
c) Based on the years of practicing dentistry 6.67% were practicing since 0- 2 years, 34% were
practicing since 3-5 years, 24% were practicing since 11-15 years and 1.33% were practicing
since 16-25 years.
d) The mean number of patients in the OPD of non prosthodontist was 263.92 whereas the mean
number of patients in the OPD of prosthodontists was 184.11, which was found significant.
e) The mean number of complete dentures delivered, tissue conditioner and soft liner
application by the prosthodontists was significantly higher compared to non prosthodontists.
f) The mean OPD charges of the prosthodontists were significantly higher than the non
prosthodontists. The mean charge for complete dentures soft liners and tissue
conditioners of prosthodontists was significantly higher than the non prosthodontists.
g) The mean number of rpd fabricated and the mean charges of rpd done by the prosthodontists
were significantly higher compared to non prosthodontists.
h) The mean number and charge of pfm and zirconia crowns/fpd done by the prosthodontists
were significantly higher compared to non prosthodontists.
i) The mean number and charges of dentures, implant case, laminate and veneers done by
the prosthodontists was significantly higher than the non prosthodontists.
j) In response to question on availability of intraoral scanner, lasers, milling machine use of
zirconia and peek abutments, the prosthodontists were significantly higher in possession of
these tools compared to non prosthodontists.
k) The mean monthly expenditure related to dental lab charges and dental materials of the
prosthodontists was non significantly higher compared to non prosthodontists. The
expenditure related to service and maintenance paid by the non prosthodontists was non
significantly higher than the prosthodontists.

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l) The mean overall profit among the prosthodontists was significantly higher as compared to
nonprosthodontists. The mean monthly profit of prosthodontists was found to be Rs 228277 and
of non-prosthodontist it was Rs.118162. Hence it can be concluded that prosthodontists aremore
successful in performing prosthodontic procedures compared to non-prosthodontists.
Prosthodontists are also better equipped in terms of adopting modern treatment protocols in their
private practice.

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