Knowledge, Attitudes, and Scenario-Based Treatment Decision-Making Regarding Implant-Supported Dental Rehabilitation in Patients with Special Healthcare Needs among Dental Professionals: A Cross-Sectional Study

Abstract

Background: Patients with special healthcare needs (SHCN) often present with behavioral, cognitive, communication, neuromuscular, and maintenance-related challenges that complicate dental treatment planning. While implant-supported rehabilitation offers significant functional and prosthetic benefits, clinicians frequently express concerns regarding patient cooperation, oral hygiene, caregiver support, and long-term maintenance. Evidence evaluating dental professionals’ knowledge, attitudes, and actual clinical decision-making regarding implant therapy in this population remains scarce.
Aim: To assess knowledge, attitudes, and scenario-based clinical decision-making regarding implant-supported dental rehabilitation in patients with special healthcare needs among dental professionals, and to identify factors associated with treatment recommendations and educational needs.
Materials and Methods: A cross-sectional questionnaire-based study was designed for practicing dental professionals. The instrument comprised five domains: professional characteristics, implant-related knowledge (10 items), attitudes and influencing factors (10 items), scenario-based clinical decision-making (3 standardized scenarios), and educational needs. Primary outcome measures focused on favorable clinical decision-making across distinct patient scenarios. Data from 250 dental professionals were analyzed using chi-square tests and multivariable logistic regression to establish statistical models.
Results: Among the 250 participants, the mean knowledge score was 6.2 ± 2.1 out of 10, with 38.0% demonstrating good knowledge. The mean attitude score was 38.1 ± 6.2 out of 50. Favorable clinical decision-making declined significantly as scenario complexity increased: 80.8% for a favorable candidate, 63.2% for a moderately challenging candidate, and 29.6% for a high-challenge candidate (p < 0.001). Previous implant training (OR: 2.21), SHCN clinical experience (OR: 1.88), formal special-care training (OR: 2.38), and higher knowledge scores (OR: 2.71) were factors independently associated with favorable decision-making. Overall, 79.2% expressed a need for structured continuing education.
Conclusion: Although dental professionals generally exhibit positive attitudes, clinical decision-making is heavily dictated by patient cooperation, oral hygiene, and caregiver reliability. Targeted educational programs integrating implantology and special-care dentistry are required to improve clinical decision-making and access to care.