Knowledge Gaps and Clinical Practice Patterns in Provisional Fixed Dental Prostheses Among Dentists in Saudi Arabia—A Cross-Sectional, Survey-Based Study

Abstract

Background/Purpose: Teeth prepared for fixed dental prostheses are subject to various types of insults in the oral cavity. Therefore, to protect the tooth, the pulp, and supporting structures, provisional restorations are mandatory. Our study aimed to evaluate the knowledge and clinical practices regarding provisional fixed dental prostheses (PFDPs) among dental professionals in Saudi Arabia. Materials and Methods: A cross-sectional study based on a self-administered online survey was conducted among 312 dentists (general practitioners and specialists) across Saudi Arabia. The questionnaire assessed participants’ knowledge (11 items) and clinical practices (9 items) related to PFDPs. Statistical analyses included descriptive statistics, chi-square tests, and multivariate logistic regression. Results: Only 46.5% of respondents demonstrated adequate knowledge of PFDPs. Knowledge was significantly higher among specialists than general practitioners (57.4% vs. 41.7%, p = 0.011), and specialists were more likely to recognize the influence of PFDPs on treatment outcomes. Clinical practice patterns indicated that even though 94.2% of respondents frequently placed PFDPs, only 66.0% always did so. Moreover, 21.2% of respondents rarely or never disinfect PFDPs. Public sector dentists and specialists were more likely to use custom-made PFDPs. Key gaps in knowledge were observed regarding the materials and equipment used in the fabrication of PFDPs, particularly concerning CAD/CAM technology. Conclusions: Although most dentists in Saudi Arabia provided PFDPs to their patients, significant gaps remain in their knowledge, particularly regarding fabrication materials and techniques. Targeted educational interventions, especially for general practitioners, are needed to enhance clinical outcomes.

1. Introduction

The clinical step of temporization is an integral part of the success or failure of most dental procedures. In the clinicians’ daily practice of dentistry, prepared tooth structure should always be protected against any type of insult in the oral cavity. The oral cavity comprises multiple factors such as mechanical, thermal, osmotic, and bacterial disease. To protect the tooth, the pulp, and supporting structures provisional restorations are mandatory [1,2,3,4,5].

Provisional Fixed Dental Prostheses (PFDPs) are fixed prostheses designed to enhance esthetics, stabilization and/or function for a limited period of time after which they are to be replaced by definitive dental prostheses [6]. Temporary dental restorations protect prepared teeth, pulp and periodontium, maintain function, prevent supra-eruption and drifting, and provide aesthetics between tooth preparation and the placement of the definitive prosthesis. Interim, transitional, or temporary restorations are all terms that are used interchangeably to describe provisional restorations. Unfortunately, some practitioners might bypass this crucial step in their clinical workflow. Therefore, concerns have been raised to highlight the importance of providing PFDPs in order to preserve natural dental tissue [7].

PFDPs which are required during full or partial coverage prosthetics are fabricated using different materials and techniques. Techniques are variable including direct, indirect, and indirect–direct techniques [8]. The quality and performance of the provisional restorations are affected by the dentists’ knowledge and perspectives, and clinical skills of the one performing the procedure [9]. The clinical sequence of events conducted by dental practitioners includes many variables, such as patient assessment and treatment planning, aesthetic analysis, and management of patients’ oral hygiene. Variable consequences might occur due to ignoring the step of temporization, for example, postoperative hypersensitivity, teeth drifting, overeruption, and even pulp necrosis. The open dentinal tubules are problematic after teeth preparation, as they provide a pathway for bacterial contamination which easily can reach the pulp. A systematic review investigating the factors affecting pulp necrosis and periapical necrosis following indirect restoration, suggested several contributing factors, including duration of temporization, type of temporary cement, and the practitioners’ training level [10].

Studies on knowledge, attitude, and practice of dental professionals regarding provisional restorations are very limited. Even the one that we had access to was carried out with only 100 participants [11]. The current study therefore aimed to assess the knowledge and clinical practice regarding the application of provisional fixed dental prosthesis (PFDPs) among dental professionals in Saudi Arabia. Our results will provide valuable information to policy and decision makers of dental institutions to tailor programs aimed at improving knowledge and clinical skills about PFDPs among dental professionals, which will have a direct influence on their provision and quality of care of PFDPs to their patients.

2. Materials and Methods

2.1. Study Design

A cross-sectional online self-administered survey was conducted from February to the middle of April 2021 among dental professionals in Saudi Arabia. Both general dentists and specialist dentists were included in the study. However, specialist dentists were not categorized based on their specialization. The questionnaire was prepared in consultation with experts in the field. A pilot study was initially carried out on 10 participants, after which expert opinion was taken from four specialists in the field. The survey questionnaire developed on Google Forms was distributed online. The current study employed a convenience sampling method. The questionnaire was distributed through social media platforms like WhatsApp and Facebook, and via email.

2.2. Ethical Considerations

Participation in the study was voluntary, and the participants provided informed consent on the survey platform before proceeding to the survey items. The participants’ anonymity was guaranteed during the data collection process. Participants were reminded only once, upon failure to complete the survey form. The respondents were free to withdraw at any stage of the study. They were not compensated for participating in the study. This study was approved by the Research Committee of College of Dentistry, Dar Al Uloom University, Saudi Arabia (COD/IRB/2022/3).

2.3. Sample

Participants included dental professionals (general dentists and specialist dentists from various specialties) from Saudi Arabia (Table 1). Dental students were not included in the study. The survey form was designed in such a way that only completed forms would qualify for submission.

2.4. Measures

2.4.1. Knowledge About PFDPs

Knowledge about PFDPs was measured using a set of 11 items. First, participants were asked if they thought PFDP is always mandatory after FDP preparation. They were then asked five questions about the clinical aspects of PFDPs. The following five questions focused mainly on the materials and equipment used for the fabrication of PFDPs. For most of the questions, respondents were asked to answer ‘yes’, ‘no’, or ‘do not know’.

Adequate knowledge of PFDPs was defined as correctly answering ≥60% (≥7 out of 11) of the knowledge items in Table 2, consistent with cognitive assessment frameworks and standards for validating cut-off scores in educational assessments [12,13].

2.4.2. Practice of PFDPs

Practice of PFDPs was measured using a set of nine items. First, participants were asked how often they placed PFDPs after finishing the preparation. They were then asked six questions about their clinical practice of PFDPs. The following two questions focused on the success of PFDPs in their clinical practice.

2.5. Exploratory Variables

Socio-demographic factors included gender, work sector (private/public), clinical experience, and qualification.

2.6. Statistical Analysis

Descriptive univariate analyses were conducted and were expressed as percentages and numbers for each item/survey question. The main outcome of this study was knowledge and practice of PFDPs. Bivariate statistical analysis of the relationship between the main outcome and factors was performed using the Chi-squared test for trend for ordinal factors, and Chi-squared test for categorical variables. A multivariate binary logistic regression model was used to determine the predictors for participants knowledge of PFDPs. The following factors were examined as potential predictors: gender, work sector, clinical experience, and qualification. All statistical analyses were performed using IBM SPSS Statistics version 25.0 (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. IBM Corp, Armonk, NY, USA). The significance level was set at p < 0.05.

3. Results

This study included 312 practicing dentists in Saudi Arabia. Most participants were aged 20–30 years (62.8%), male (65.1%), and Saudi nationals (77.9%). Approximately half worked in the public sector (51.6%) and half in the private sector (48.4%). The majority had 1–10 years of clinical experience (76.9%) and were general dental practitioners (69.9%), with 51.0% being based in the central region of Saudi Arabia. Full demographic details are presented in Table 1.

Knowledge of provisional fixed dental prostheses (PFDPs) was assessed in Table 2, revealing significant variation in correct responses. Most participants correctly recognized that PFDPs require good marginal fit, proper contour, and a smooth surface (95.5%) and assist in testing occlusion and phonetics (92.3%). However, only 9.9% understood that PMMA-based CAD/CAM-fabricated PFDPs do not have higher fracture strength than directly fabricated PFDPs, and 16.3% knew that PMMA-based PFDPs do not offer superior wear resistance compared to composite-based PFDPs. Overall, 46.5% of participants demonstrated adequate knowledge (≥60% correct answers per Bloom’s cut-off). Adequate knowledge was significantly associated with qualification (p = 0.011), with specialist dentists showing higher prevalence (57.4% vs. 41.7% for general dental practitioners). Public sector dentists outperformed private sector dentists on several questions (e.g., 84.5% vs. 72.2% on PFDP being mandatory, p = 0.008), and dentists with >10 years of experience had higher correct responses for technical questions, such as CAD/CAM PFDP longevity (68.1% vs. 54.6%, p = 0.042) and PMMA-based PFDP wear resistance (25.0% vs. 13.8%, p = 0.024).

Multivariate logistic regression (Table 3) identified qualification as the only significant predictor of adequate PFDP knowledge, with specialist dentists being more likely to have adequate knowledge than general dental practitioners (OR = 2.35, 95% CI: 1.23–4.49, p = 0.010).

Clinical practices related to PFDPs, reported in Table 4, showed that 94.2% of dentists frequently (always: 66.0%; often: 28.2%) placed PFDPs after tooth preparation, with higher frequency among female dentists (75.2% always vs. 61.1% for males, p = 0.041) and public sector dentists (73.3% always vs. 58.3% for private, p = 0.019). Custom-made PFDPs were the most common fabrication method (73.4%) compared to preformed/prefabricated methods (23.7%), with greater use among public sector dentists (80.1% vs. 66.2%, p = 0.020) and specialists (83.0% vs. 69.3%, p = 0.009). Among custom-made PFDP users, the direct technique was predominant (49.4%), followed by direct-indirect (34.6%) and indirect (16.0%) techniques. Technique choice varied by qualification (p = 0.006), with general dental practitioners favoring the indirect technique (19.7% vs. 7.4%) and specialists preferring direct–indirect (44.7% vs. 30.3%). Putty consistency elastomeric impression material was the primary method for creating indices for custom-made PFDPs (83.2%), with higher use among dentists with 1–10 years of experience (87.4% vs. 69.4% for >10 years, p = 0.002) and general dental practitioners (84.7% vs. 79.8%, p = 0.019). Study casts were frequently used (always: 31.1%; often: 34.3%) for putty index creation by 65.4% of participants, with greater frequency among dentists with 1–10 years of experience (67.5% vs. 58.4% for >10 years, p = 0.032) and general dental practitioners (67.0% vs. 61.7% for specialists, p = 0.020). Conversely, 21.5% created indices intraorally, and 12.5% rarely or never used study casts. Most dentists (71.8%) rarely or never used all-metal PFDPs, with 22.4% using them occasionally. Disinfection of PFDPs before placement was frequent (always: 61.9%), though 21.2% rarely or never disinfected. Cementation failure was occasionally reported (51.6%), with 44.9% indicating it rarely or never occurred. Reported PFDP longevity was most commonly 2–3 weeks (55.1%), with longer durations (1 month or ≥2 months) more frequently reported by public sector dentists (24.2% and 11.8% vs. 7.3% and 8.6%, p < 0.001) and specialist dentists (23.4% and 16.0% vs. 12.8% and 7.8%, p = 0.007).

Table 1. Characteristics of participants (n = 312).

Demographics	Number	Percent
Age
20–30 years	196	62.8%
31–40 years	75	24.0%
>40 years	41	13.1%
Gender
Male	203	65.1%
Female	109	34.9%
Nationality
Saudi	243	77.9%
Non-Saudi	69	22.1%
Work sector
Public	161	51.6%
Private	151	48.4%
Clinical experience
1–10 years	240	76.9%
>10 years	72	23.1%
Qualification
General dental practitioner	218	69.9%
Specialist dentist	94	30.1%
Practice location in Saudi Arabia
Northern Region	21	6.7%
Central Region	159	51.0%
Southern Region	37	11.9%
Eastern Region	34	10.9%
Western Region	61	19.6%

Table 1. Characteristics of participants (n = 312).

Demographics	Number	Percent
Age
20–30 years	196	62.8%
31–40 years	75	24.0%
>40 years	41	13.1%
Gender
Male	203	65.1%
Female	109	34.9%
Nationality
Saudi	243	77.9%
Non-Saudi	69	22.1%
Work sector
Public	161	51.6%
Private	151	48.4%
Clinical experience
1–10 years	240	76.9%
>10 years	72	23.1%
Qualification
General dental practitioner	218	69.9%
Specialist dentist	94	30.1%
Practice location in Saudi Arabia
Northern Region	21	6.7%
Central Region	159	51.0%
Southern Region	37	11.9%
Eastern Region	34	10.9%
Western Region	61	19.6%

Table 2. Participants’ responses to questions about their knowledge of PFDPs, categorized by gender, work sector, clinical experience, and qualification.

	% of “Correct” Answers Based on Gender, Work Sector, Clinical Experience and Qualification
Correct Statement		Gender			Work Sector			Experience (Years)			Qualification
	Sample n = 312	Male n = 203	Female n = 109	p	Public n = 161	Private n = 151	p	1–10 n = 240	>10 n = 72	p	GP n = 218	SP n = 94	p
The PFDP is always mandatory after FDP preparation.	78.5%	78.3%	78.9%	0.906	84.5%	72.2%	0.008 *	80.0%	73.6%	0.247	74.8%	87.2%	0.014 *
The success or failure of a FDP is influenced by the PFDP.	48.4%	49.3%	46.8%	0.677	57.8%	38.4%	0.001 *	47.5%	51.4%	0.563	42.2%	62.8%	0.001 *
The PFDP helps in testing changes in occlusion and phonetics.	92.3%	93.1%	90.8%	0.472	95.7%	88.7%	0.022 *	91.7%	94.4%	0.438	91.3%	94.7%	0.302
The PFDP helps prevent the drifting of adjacent teeth after preparation.	82.7%	82.3%	83.5%	0.786	87.6%	77.5%	0.019 *	81.7%	86.1%	0.382	79.8%	89.4%	0.041 *
The PFDP helps prevent post-treatment sensitivity of the prepared teeth.	85.9%	85.2%	87.2%	0.640	86.3%	85.4%	0.818	86.7%	83.3%	0.476	85.8%	86.2%	0.928
The PFDP should have good marginal fit, proper contour, and a smooth surface.	95.5%	94.6%	97.2%	0.278	98.1%	92.7%	0.021 *	94.6%	98.6%	0.148	94.0%	98.9%	0.055
Methyl methacrylate cannot be used directly in the oral cavity to fabricate PFDPs.	28.8%	24.1%	37.6%	0.012 *	26.1%	31.8%	0.267	29.2%	27.8%	0.820	28.4%	29.8%	0.810
CAD/CAM-processed PFDPs have a higher longevity than conventional ones.	57.7%	60.6%	52.3%	0.157	59.6%	55.6%	0.475	54.6%	68.1%	0.042 *	53.2%	68.1%	0.015 *
PFDPs should be made aesthetically pleasing, depending on the patient.	27.9%	28.6%	26.6%	0.712	18.6%	37.7%	<0.001 *	30.8%	18.1%	0.034 *	33.0%	16.0%	0.002 *
PMMA-based PFDPs do not offer more advantages than composite-based PFDPs in regard to wear resistance.	16.3%	18.2%	12.8%	0.220	17.4%	15.2%	0.606	13.8%	25.0%	0.024 *	11.5%	27.7%	<0.001 *
PMMA-based CAD/CAM fabricated PFDPs do not show higher fracture strength than directly fabricated PFDPs.	9.9%	9.9%	10.1%	0.946	11.8%	7.9%	0.255	9.6%	11.1%	0.704	9.2%	11.7%	0.493
Overall Quality of Knowledge on PFDPs
Adequate knowledge	46.5%	44.3%	50.5%	0.301	48.4%	44.4%	0.471	45.4%	50%	0.494	41.7%	57.4%	0.011 *
Poor knowledge	53.5%	55.7%	49.5%		51.6%	55.6%		54.6%	50%		58.3%	42.6%

GP: General dental practitioner, SP: Specialist dentist, PFDP: Provisional fixed dental prosthesis, FDP: Fixed dental prosthesis, PMMA: Polymethyl methacrylate; Participants were classified as having adequate knowledge if they correctly answered ≥60% of the listed questions, and poor knowledge if the score was <60% (Bloom’s cut-off point for knowledge categorization). * Denotes significant difference at p < 0.05 as indicated by chi-square statistics.

Table 2. Participants’ responses to questions about their knowledge of PFDPs, categorized by gender, work sector, clinical experience, and qualification.

	% of “Correct” Answers Based on Gender, Work Sector, Clinical Experience and Qualification
Correct Statement		Gender			Work Sector			Experience (Years)			Qualification
	Sample n = 312	Male n = 203	Female n = 109	p	Public n = 161	Private n = 151	p	1–10 n = 240	>10 n = 72	p	GP n = 218	SP n = 94	p
The PFDP is always mandatory after FDP preparation.	78.5%	78.3%	78.9%	0.906	84.5%	72.2%	0.008 *	80.0%	73.6%	0.247	74.8%	87.2%	0.014 *
The success or failure of a FDP is influenced by the PFDP.	48.4%	49.3%	46.8%	0.677	57.8%	38.4%	0.001 *	47.5%	51.4%	0.563	42.2%	62.8%	0.001 *
The PFDP helps in testing changes in occlusion and phonetics.	92.3%	93.1%	90.8%	0.472	95.7%	88.7%	0.022 *	91.7%	94.4%	0.438	91.3%	94.7%	0.302
The PFDP helps prevent the drifting of adjacent teeth after preparation.	82.7%	82.3%	83.5%	0.786	87.6%	77.5%	0.019 *	81.7%	86.1%	0.382	79.8%	89.4%	0.041 *
The PFDP helps prevent post-treatment sensitivity of the prepared teeth.	85.9%	85.2%	87.2%	0.640	86.3%	85.4%	0.818	86.7%	83.3%	0.476	85.8%	86.2%	0.928
The PFDP should have good marginal fit, proper contour, and a smooth surface.	95.5%	94.6%	97.2%	0.278	98.1%	92.7%	0.021 *	94.6%	98.6%	0.148	94.0%	98.9%	0.055
Methyl methacrylate cannot be used directly in the oral cavity to fabricate PFDPs.	28.8%	24.1%	37.6%	0.012 *	26.1%	31.8%	0.267	29.2%	27.8%	0.820	28.4%	29.8%	0.810
CAD/CAM-processed PFDPs have a higher longevity than conventional ones.	57.7%	60.6%	52.3%	0.157	59.6%	55.6%	0.475	54.6%	68.1%	0.042 *	53.2%	68.1%	0.015 *
PFDPs should be made aesthetically pleasing, depending on the patient.	27.9%	28.6%	26.6%	0.712	18.6%	37.7%	<0.001 *	30.8%	18.1%	0.034 *	33.0%	16.0%	0.002 *
PMMA-based PFDPs do not offer more advantages than composite-based PFDPs in regard to wear resistance.	16.3%	18.2%	12.8%	0.220	17.4%	15.2%	0.606	13.8%	25.0%	0.024 *	11.5%	27.7%	<0.001 *
PMMA-based CAD/CAM fabricated PFDPs do not show higher fracture strength than directly fabricated PFDPs.	9.9%	9.9%	10.1%	0.946	11.8%	7.9%	0.255	9.6%	11.1%	0.704	9.2%	11.7%	0.493
Overall Quality of Knowledge on PFDPs
Adequate knowledge	46.5%	44.3%	50.5%	0.301	48.4%	44.4%	0.471	45.4%	50%	0.494	41.7%	57.4%	0.011 *
Poor knowledge	53.5%	55.7%	49.5%		51.6%	55.6%		54.6%	50%		58.3%	42.6%

GP: General dental practitioner, SP: Specialist dentist, PFDP: Provisional fixed dental prosthesis, FDP: Fixed dental prosthesis, PMMA: Polymethyl methacrylate; Participants were classified as having adequate knowledge if they correctly answered ≥60% of the listed questions, and poor knowledge if the score was <60% (Bloom’s cut-off point for knowledge categorization). * Denotes significant difference at p < 0.05 as indicated by chi-square statistics.

Table 3. Factors associated with participants’ adequate knowledge of provisional fixed dental prosthesis.

Associated Factors (Predictors)	Adequate Knowledge of PFDPs
	Odds Ratio (95% CI)	p
Gender   • Male   • Female	[Reference] 1.35 (0.84–2.18)	0.212
Work Sector   • Public   • Private	[Reference] 0.97 (0.61–1.55)	0.897
Clinical experience (years)   • 1–10   • >10	[Reference] 0.71 (0.35–1.42)	0.333
Qualification   • General dental practitioner   • Specialist dentist	[Reference] 2.35 (1.23–4.49)	0.010 *

PFDP: Provisional fixed dental prosthesis; The odds ratio and 95% confidence interval were calculated by a multivariate binary logistic model. * Significance in this analysis was defined at p < 0.05.

Table 3. Factors associated with participants’ adequate knowledge of provisional fixed dental prosthesis.

Associated Factors (Predictors)	Adequate Knowledge of PFDPs
	Odds Ratio (95% CI)	p
Gender   • Male   • Female	[Reference] 1.35 (0.84–2.18)	0.212
Work Sector   • Public   • Private	[Reference] 0.97 (0.61–1.55)	0.897
Clinical experience (years)   • 1–10   • >10	[Reference] 0.71 (0.35–1.42)	0.333
Qualification   • General dental practitioner   • Specialist dentist	[Reference] 2.35 (1.23–4.49)	0.010 *

PFDP: Provisional fixed dental prosthesis; The odds ratio and 95% confidence interval were calculated by a multivariate binary logistic model. * Significance in this analysis was defined at p < 0.05.

Table 4. Participants’ responses to questions about their clinical practice with PFDPs, categorized by gender, work sector, clinical experience, and qualification.

	% of “n” Based on Gender, Work Sector, Clinical Experience, and Qualification
Questions		Gender			Work Sector			Experience (Years)			Qualification
	Sample n = 312	Male n = 203	Female n = 109	p	Public n = 161	Private n = 151	p	1–10 n = 240	>10 n = 72	p	GP n = 218	SP n = 94	p
How often do you place PFDPs after finishing the preparation?
Always	66.0%	61.1%	75.2%	0.041 *	73.3%	58.3%	0.019 *	68.8%	56.9%	0.068	63.8%	71.3%	0.151
Often	28.2%	32.5%	20.2%		21.7%	35.1%		25.0%	38.9%		28.9%	26.6%
Rare/Never	5.8%	6.4%	4.6%		5.0%	6.6%		6.3%	4.2%		7.3%	2.1%
What is your method for fabricating PFDPs?
Preformed/Prefabricated	23.7%	25.1%	21.1%	0.632	17.4%	30.5%	0.020 *	25.4%	18.1%	0.429	28.4%	12.8%	0.009 *
Custom made	73.4%	72.4%	75.2%		80.1%	66.2%		71.7%	79.2%		69.3%	83.0%
Both	2.9%	2.5%	3.7%		2.5%	3.3%		2.9%	2.8%		2.3%	4.3%
If custom-made, what technique do you use to fabricate PFDPs?
Direct technique	49.4%	53.7%	41.3%	0.092	52.8%	45.7%	0.174	48.3%	52.8%	0.251	50.0%	47.9%	0.006 *
Indirect technique	16.0%	13.8%	20.2%		12.4%	19.9%		17.9%	9.7%		19.7%	7.4%
Direct-indirect technique	34.6%	32.5%	38.5%		34.8%	34.4%		33.8%	37.5%		30.3%	44.7%
If custom-made, what method do you use to create an index for PFDPs?
Putty consistency elastomeric impression material	83.2%	79.7%	89.8%	0.149	84.4%	82.0%	0.683	87.4%	69.4%	0.002 *	84.7%	79.8%	0.019 *
Vacuum adapted thermoplastic sheet	6.8%	7.9%	4.6%		6.9%	6.7%		4.6%	13.9%		5.6%	9.6%
Alginate impression material	5.8%	7.4%	2.8%		4.4%	7.3%		5.0%	8.3%		6.5%	4.3%
I do not prefer to make indices, I’ll do it free hand or indirect	2.9%	3.0%	2.8%		2.5%	3.3%		2.5%	4.2%		3.2%	2.1%
Other	1.3%	2.0%	0.0%		1.9%	0.7%		0.4%	4.2%		0.0%	4.3%
Do you use a study cast to create a putty index for fabricating PFDPs?
Always	31.1%	29.1%	34.9%	0.058	31.7%	30.5%	0.087	35.0%	18.1%	0.032 *	35.3%	21.3%	0.020 *
Often	34.3%	38.9%	25.7%		39.1%	29.1%		32.5%	40.3%		31.7%	40.4%
Rare/Never	12.5%	13.8%	10.1%		9.3%	15.9%		10.4%	19.4%		11.0%	16.0%
I make the index inside the patients mouth	21.5%	17.7%	28.4%		18.6%	24.5%		21.7%	20.8%		22.0%	20.2%
Other	0.6%	0.5%	0.9%		1.2%	0.0%		0.4%	1.4%		0.0%	2.1%
Do you use all-metal PFDPs (stainless steel or aluminum crowns) in your dental practice?
Always	5.8%	3.9%	9.2%	0.099	5.6%	6.0%	0.989	5.4%	6.9%	0.838	6.0%	5.3%	0.916
Sometimes	22.4%	24.6%	18.3%		22.4%	22.5%		22.1%	23.6%		22.9%	21.3%
Rare/Never	71.8%	71.4%	72.5%		72.0%	71.5%		72.5%	69.4%		71.1%	73.4%
Do you disinfect PFDPs before placing them in the patient’s mouth?
Always	61.9%	59.1%	67.0%	0.290	64.6%	58.9%	0.517	60.8%	65.3%	0.568	58.7%	69.1%	0.205
Sometimes	17.0%	19.2%	12.8%		14.9%	19.2%		16.7%	18.1%		18.8%	12.8%
Rare/Never	21.2%	21.7%	20.2%		20.5%	21.9%		22.5%	16.7%		22.5%	18.1%
How often do your PFPDs experience cementation failure?
Always	3.5%	3.4%	3.7%	0.455	1.2%	6.0%	0.076	4.6%	0.0%	0.114	4.6%	1.1%	0.301
Sometimes	51.6%	54.2%	46.8%		52.2%	51.0%		49.6%	58.3%		50.9%	53.2%
Rare/Never	44.9%	42.4%	49.5%		46.6%	43.0%		45.8%	41.7%		44.5%	45.7%
How long does your provisional prosthesis usually last in the patient’s mouth?
≤1 week	18.6%	19.2%	17.4%	0.645	12.4%	25.2%	<0.001 *	19.6%	15.3%	0.263	20.6%	13.8%	0.007 *
2–3 weeks	55.1%	53.2%	58.7%		51.6%	58.9%		56.7%	50.0%		58.7%	46.8%
1 month	16.0%	17.7%	12.8%		24.2%	7.3%		15.0%	19.4%		12.8%	23.4%
≥2 months	10.3%	9.9%	11.0%		11.8%	8.6%		8.8%	15.3%		7.8%	16.0%

GP: General dental practitioner, SP: Specialist dentist, PFDP: Provisional fixed dental prosthesis, FDP: Fixed dental prosthesis, PMMA: Polymethyl methacrylate; * Denotes significant difference at p < 0.05 as indicated by chi-square statistics.

Table 4. Participants’ responses to questions about their clinical practice with PFDPs, categorized by gender, work sector, clinical experience, and qualification.

	% of “n” Based on Gender, Work Sector, Clinical Experience, and Qualification
Questions		Gender			Work Sector			Experience (Years)			Qualification
	Sample n = 312	Male n = 203	Female n = 109	p	Public n = 161	Private n = 151	p	1–10 n = 240	>10 n = 72	p	GP n = 218	SP n = 94	p
How often do you place PFDPs after finishing the preparation?
Always	66.0%	61.1%	75.2%	0.041 *	73.3%	58.3%	0.019 *	68.8%	56.9%	0.068	63.8%	71.3%	0.151
Often	28.2%	32.5%	20.2%		21.7%	35.1%		25.0%	38.9%		28.9%	26.6%
Rare/Never	5.8%	6.4%	4.6%		5.0%	6.6%		6.3%	4.2%		7.3%	2.1%
What is your method for fabricating PFDPs?
Preformed/Prefabricated	23.7%	25.1%	21.1%	0.632	17.4%	30.5%	0.020 *	25.4%	18.1%	0.429	28.4%	12.8%	0.009 *
Custom made	73.4%	72.4%	75.2%		80.1%	66.2%		71.7%	79.2%		69.3%	83.0%
Both	2.9%	2.5%	3.7%		2.5%	3.3%		2.9%	2.8%		2.3%	4.3%
If custom-made, what technique do you use to fabricate PFDPs?
Direct technique	49.4%	53.7%	41.3%	0.092	52.8%	45.7%	0.174	48.3%	52.8%	0.251	50.0%	47.9%	0.006 *
Indirect technique	16.0%	13.8%	20.2%		12.4%	19.9%		17.9%	9.7%		19.7%	7.4%
Direct-indirect technique	34.6%	32.5%	38.5%		34.8%	34.4%		33.8%	37.5%		30.3%	44.7%
If custom-made, what method do you use to create an index for PFDPs?
Putty consistency elastomeric impression material	83.2%	79.7%	89.8%	0.149	84.4%	82.0%	0.683	87.4%	69.4%	0.002 *	84.7%	79.8%	0.019 *
Vacuum adapted thermoplastic sheet	6.8%	7.9%	4.6%		6.9%	6.7%		4.6%	13.9%		5.6%	9.6%
Alginate impression material	5.8%	7.4%	2.8%		4.4%	7.3%		5.0%	8.3%		6.5%	4.3%
I do not prefer to make indices, I’ll do it free hand or indirect	2.9%	3.0%	2.8%		2.5%	3.3%		2.5%	4.2%		3.2%	2.1%
Other	1.3%	2.0%	0.0%		1.9%	0.7%		0.4%	4.2%		0.0%	4.3%
Do you use a study cast to create a putty index for fabricating PFDPs?
Always	31.1%	29.1%	34.9%	0.058	31.7%	30.5%	0.087	35.0%	18.1%	0.032 *	35.3%	21.3%	0.020 *
Often	34.3%	38.9%	25.7%		39.1%	29.1%		32.5%	40.3%		31.7%	40.4%
Rare/Never	12.5%	13.8%	10.1%		9.3%	15.9%		10.4%	19.4%		11.0%	16.0%
I make the index inside the patients mouth	21.5%	17.7%	28.4%		18.6%	24.5%		21.7%	20.8%		22.0%	20.2%
Other	0.6%	0.5%	0.9%		1.2%	0.0%		0.4%	1.4%		0.0%	2.1%
Do you use all-metal PFDPs (stainless steel or aluminum crowns) in your dental practice?
Always	5.8%	3.9%	9.2%	0.099	5.6%	6.0%	0.989	5.4%	6.9%	0.838	6.0%	5.3%	0.916
Sometimes	22.4%	24.6%	18.3%		22.4%	22.5%		22.1%	23.6%		22.9%	21.3%
Rare/Never	71.8%	71.4%	72.5%		72.0%	71.5%		72.5%	69.4%		71.1%	73.4%
Do you disinfect PFDPs before placing them in the patient’s mouth?
Always	61.9%	59.1%	67.0%	0.290	64.6%	58.9%	0.517	60.8%	65.3%	0.568	58.7%	69.1%	0.205
Sometimes	17.0%	19.2%	12.8%		14.9%	19.2%		16.7%	18.1%		18.8%	12.8%
Rare/Never	21.2%	21.7%	20.2%		20.5%	21.9%		22.5%	16.7%		22.5%	18.1%
How often do your PFPDs experience cementation failure?
Always	3.5%	3.4%	3.7%	0.455	1.2%	6.0%	0.076	4.6%	0.0%	0.114	4.6%	1.1%	0.301
Sometimes	51.6%	54.2%	46.8%		52.2%	51.0%		49.6%	58.3%		50.9%	53.2%
Rare/Never	44.9%	42.4%	49.5%		46.6%	43.0%		45.8%	41.7%		44.5%	45.7%
How long does your provisional prosthesis usually last in the patient’s mouth?
≤1 week	18.6%	19.2%	17.4%	0.645	12.4%	25.2%	<0.001 *	19.6%	15.3%	0.263	20.6%	13.8%	0.007 *
2–3 weeks	55.1%	53.2%	58.7%		51.6%	58.9%		56.7%	50.0%		58.7%	46.8%
1 month	16.0%	17.7%	12.8%		24.2%	7.3%		15.0%	19.4%		12.8%	23.4%
≥2 months	10.3%	9.9%	11.0%		11.8%	8.6%		8.8%	15.3%		7.8%	16.0%

GP: General dental practitioner, SP: Specialist dentist, PFDP: Provisional fixed dental prosthesis, FDP: Fixed dental prosthesis, PMMA: Polymethyl methacrylate; * Denotes significant difference at p < 0.05 as indicated by chi-square statistics.

4. Discussion

Restorative dental preparations for indirect restorations, especially for FDPs often leave vital tooth structure exposed to the oral environment for prolonged periods of time, potentially leading to complications, including tooth sensitivity, loss of vitality of the tooth itself, tooth movement, loss of gingival contour, etc. Therefore, provisional restorations are considered mandatory to temporarily protect the tooth and supporting structures [14]. Our study aimed to assess the knowledge and pattern of clinical practice related to PFDPs among dental professionals in Saudi Arabia.

The results of the current study indicate that only 46.5% of the study population demonstrated an adequate level of knowledge about PFDPs, with participants showing varying degrees of knowledge across different aspects of PFDPs. Similar to the findings of a study in India, 78 percent of the participants in our study agreed that PFDPs are always mandatory after tooth preparation for FDPs [10]. However, only 48% of the participants in our study agreed that the success or failure of an FDP is influenced by the PFDP and therefore fail to understand the importance of PFDPs as a crucial step in achieving reliable success in both functional and aesthetic outcomes in fixed prosthodontics. The reason for this could be related to their overall poor knowledge. Specialist dentists’ agreement that PFDP is always mandatory after FDP preparation and their agreement that the success or failure of an FDP is influenced by the PFDP was significantly higher than general dentists. This could be due to the fact that specialist dentists are more likely to attend continuous education programs and workshops and therefore be more knowledgeable than general dental professionals. This has been proven by their better knowledge of PFDPs than general dental practitioners.

PFDPs protect the altered tooth surface from sensitivity, prevent drifting of adjacent teeth, and serve as a guide to achieve proper occlusion, phonetics, and aesthetics [15]. The majority of the participants in our study had adequate knowledge of these aspects of PFDPs, with specialist dentists and those working in the public sector indicating better knowledge than general dentists and those in the private sector. A previous study in Saudi Arabia and Egypt also indicated that most of the participants used the PFDPs as a mock to achieve predictable success in functional and aesthetic outcomes. Finishing and polishing PFDPs is essential for optimizing the function and aesthetics of the final restoration. This process helps ensure that the restoration closely resembles natural teeth in shape, color, and contour, ultimately enhancing the overall outcome. Similar to another study in Saudi Arabia, the majority of the participants in our study (95.5%) agreed that PFDPs should have good marginal fit, proper contour, and a smooth surface [16].

As anticipated, specialist dentists in our study demonstrated significantly higher levels of knowledge compared to general practitioners. An interesting finding of our study is that there was a significant difference between knowledge of the clinical aspects of the use of PFDPs and the materials and equipment used in their fabrication. This trend was similar for both general dental practitioners and specialist dentists. Even though knowledge on the clinical aspects of PFDPs was high in general, as compared to the materials involved in their fabrication, specialist dentists indicated better knowledge in both aspects as compared to general dental practitioners. A possible explanation for this could be that specialist dentists attend continuous dental education programs, workshops, conferences, etc., more often than general dental practitioners.

Knowledge about the latest materials and equipment used in the fabrication of PFDPs can guide dental professionals in choosing the most appropriate options to improve treatment outcomes. This is especially true considering the significant advancements in dental treatment outcomes as a result of the application of digital dentistry [17]. Even though specialist dentists and those working in the public sector had better knowledge than their counterparts on this aspect, unfortunately, the overall knowledge was poor. These findings indicate that dental schools should provide further training and education on the materials and equipment used in the fabrication of PFDPs. This can be achieved by incorporating more theoretical material during their dental materials courses in their bachelor’s degree programs, and also continuous education programs and hands-on workshops focusing on both the theoretical and practical/clinical aspects of PFDPs.

Our findings indicated that only 66 percent of the participants always provide PFDPs to their patients and only about 6 percent rarely or never do. However, another study in Saudi Arabia showed an even lower percentage (45 percent) of participants agreeing to provide PFDPs after tooth preparation [18]. The reason for this low percentage could be due to the fact that the participants were either dental interns or general dental practitioners. A study in Sudan also indicated that more than a third of the participating dentists (36%) never provided PFDPs to their patients, and the majority (two-thirds) did not provide always it [19]. Their demographic data did not differentiate between dental interns, general dental practitioners, or specialist dentists. Our results indicate statistically significant differences in the pattern of clinical practice between general dental practitioners and specialist dentists. This could be due to the fact that specialist dentists are exposed more to workshops, continuous dental education programs, etc. Moreover, although we did not categorize specialist dentists based on field of practice, there is a possibility that some of the specialist dentists are from fields like prosthodontics, who are more inclined towards provision of PFDPs in their daily practice.

Our results indicate that female dentists and dentists who worked in the public sector were more likely to provide PFDPs in their practice. Evidence suggests differences in patterns of clinical practice between male and female dentists. It has been reported that female dentists typically employ a preventive philosophy, employ conservative restorative techniques, and promote preventive interventions [20]. Dentists working in the public sector may be more encouraged to follow standard clinical protocols than those working in the private sector. This could be a motivating factor for them to provide PFDPs for their patients. Further qualitative studies will provide more insights into these findings.

The majority of the respondents (73.4%) in our study preferred custom-made PFDPs over the prefabricated ones, with a notable preference among public sector dentists (80.1%) and specialists (83.0%). Custom PFDPs are known for better marginal fit and aesthetics, which supports their preference among specialized practitioners [8,21]. Moreover, the standard and most widely accepted technique, which is using the putty consistency elastomeric impression material in making an index for PFDP, was used by the majority of the respondents (83.2%) in our study [22]. Although 61.9% of respondents in our study always disinfect PFDPs, no significant differences were found based on demographics. However, the 21.2% who rarely or never disinfect highlights a potential area for improving infection control protocols, as emphasized in studies by ADA and CDC guidelines [23].

Dental professionals’ attitudes toward PFDPs are shaped by their clinical experiences during university education and their perceived importance of these restorations. Several times, the terms provisional or temporary are used interchangeably to refer to PFDPs. Some clinicians might be inclined to underestimate the significance of temporization because of its transitional nature. Consequently, labeling provisional restorations as “temporary” can be misleading, as this terminology diminishes their essential therapeutic value and the strategic role they play in successful treatment outcomes [24,25]. Our findings indicate the importance universities should place in providing adequate theoretical education on not just the importance of PFDPs but also the latest materials used for their fabrication and proper clinical training in their fabrication during their college years. Moreover, learning is a lifelong process, especially in health-related fields, where technology and innovation pave the way for the discovery of newer materials and techniques. Oral health educators/policymakers and dental societies must encourage dental professionals to stay abreast of latest updates by attending workshops, conferences, seminars, etc., in order to provide best treatment modalities to their patients.

Our study has a few strengths. To our knowledge, it is the first study on the knowledge and clinical practices for provisional fixed dental prostheses among dentists in Saudi Arabia. The study population comprised dentists from various regions of Saudi Arabia, including general dental practitioners and specialist dentists, with a range of ages and clinical experience. It included both males and females, Saudis and non-Saudis, and dentists from both the public and private sectors. This diversity adds to the representativeness and generalizability of the findings.

It is also one of the very few studies conducted globally on this important topic. Moreover, the participants in our study comprised a wide distribution of dental professionals from various specialties. However, our study is not without limitations. Since the participants were recruited using convenience sampling the representativeness of the samples is relatively low. Moreover, the web-based self-administration of the survey could result in potential bias among the participants in responding to the survey questions. Additionally, we did not categorize dental professionals based on their specialty, which would have provided further insights. Considering the large number of dental professionals in Saudi Arabia, a higher sample size would have provided more robust results. Since our results are specific to the Saudi Arabian context, it is possible that they cannot be generalized globally. Therefore, future studies in different geographic contexts will provide useful information.

5. Conclusions

Our results indicate that the overall knowledge of PFDPs was inadequate among the majority of the study population, especially related to the materials and equipment used in their fabrication. Our results also indicate the need for incorporating more theoretical and practical/clinical educative material during the undergraduate programs. Moreover, since only 66 percent of the participants always placed PFDPs after finishing the preparation, policymakers could consider incorporating continuous dental education programs and workshops on the importance of PFDPs in the success of FDPs.