Shared Decision-Making for Periodontally Compromised Teeth: Study Protocol for an Ongoing Prospective Multicenter Before-and-After Clinical Trial

Abstract

Treatment decisions for teeth with poor periodontal prognosis are often complicated, requiring careful balancing of clinical evidence and patient values. Shared decision-making (SDM) is increasingly recognized as a beneficial approach to align clinical judgment with patient preferences. However, structured SDM implementation in dental settings remains limited. This study was designed to evaluate the effectiveness of a structured SDM protocol compared to usual care decision-making for patients with severe periodontitis and hopeless prognosis teeth. A multicenter, before-and-after clinical trial will be conducted across 12 dental centers in South Korea. Each center will apply usual care decision-making for the first six months, followed by the SDM intervention for the subsequent six months. The SDM process involves a three-step model: team talk, option talk (aided by web-based decision aids), and decision talk. Eligible participants include patients with stage III or IV periodontitis and at least one hopeless-prognosis tooth. Each patient follows a three-visit schedule. Primary outcome is the rate of tooth preservation decisions. Secondary outcomes include measures related to SDM (SDM-Q-9, SDM-Q-Doc), patient experience (Perceived Involvement in Care Scale [PICS], Decisional Regret Scale [DRS], treatment adherence), and clinical measures (periodontal condition and treatment costs). Data are collected via Research Electronic Data Capture, and statistical analyses include McNemar's test for binary outcomes and repeated-measures analysis of variance for continuous data. This study is expected to provide evidence supporting the integration of structured SDM protocols in dental practice. By evaluating both patient-centered and clinical outcomes, the research aims to advance personalized, participatory approaches in managing severe periodontitis.