Early Maintenance and Change of Planned Removable Prosthodontic Treatment Pathways in Patients With Functional Limitations: The Role of Impression Feasibility and Caregiver Support

BACKGROUND: Oral rehabilitation in adults with functional limitations is increasingly encountered in prosthodontic practice; however, evidence on whether planned removable pathways can be maintained in this population is limited. OBJECTIVES: To evaluate early maintenance of planned removable prosthodontic treatment pathways in adults with functional limitations and to identify factors associated with early pathway change. METHODS: This retrospective cohort study included adults with functional limitations who underwent removable prosthodontic treatment planning at a tertiary referral centre. Treatment pathways were classified as maintenance, conversion to implant-based rehabilitation, or abandonment. Early pathway change was defined as conversion or abandonment during the early treatment phase. Clinical, functional, and caregiver-related variables were analysed using logistic regression models, and time-to-event patterns were evaluated using Kaplan-Meier analysis and the log-rank test. RESULTS: Early pathway change occurred in 45 of 201 patients (22.4%). Functional limitation categories were associated with early pathway change in univariate analysis but not after multivariable adjustment. In multivariable analysis, impression feasibility under outpatient conditions (OR 0.07, 95% CI 0.02-0.17, p < 0.001) and high caregiver support (OR 0.14, 95% CI 0.03-0.48, p = 0.003) were independently associated with a lower likelihood of early pathway change. Dual-arch (vs. single-arch) rehabilitation showed a borderline protective association in the parsimonious model (OR 0.45, 95% CI 0.17-1.15, p = 0.094). CONCLUSION: Early treatment pathway change was more closely associated with procedural feasibility and caregiver support than with structural clinical variables. These findings may help identify patients in whom modification of the planned treatment pathway should be considered early.