Ciaran Moore

Effectiveness of prosthodontic interventions and survival of remaining teeth in adult patients with shortened dental arches – Protocol for a systematic review and meta-analysis

Aims/Objectives:To evaluate studies of the effectiveness of different tooth replacement strategies in adult patients with shortened dental arches (SDA). Specifically, the objectives of the proposed review are to determine the survival rates of different prosthodontic interventions; the risk of tooth loss with and without different prosthodontic interventions; and the impact of different tooth replacement strategies on oral-health related quality of life (OHRQoL).Materials and methods:The protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO), and was developed in accordance with the guidelines of the Preferred Reporting Items for Systematic Review and Meta-analyses Protocols (PRISMA-P). Studies will be selected according to outlined eligibility criteria including types of studies, participants, interventions, comparators and outcomes. Specific search strategies will be created and data collection and analysis will be undertaken by two independent reviewers.Discussion:The review will assess the body of evidence for clinical decision making in patients with SDA and reduced dentitions, by comparing the effectiveness of different tooth replacement strategies. In addition, it will assess the influence of patients in this decision making, help to inform subsequent cost-effectiveness analyses, identify areas of further research and hopefully inform future healthcare policy.

In patients with shortened dental arches do removable dental prostheses improve masticatory performance

Data sourcesPubMed, Medline, Cochrane Library, Embase and Science Direct.Study selectionStudies published in English providing data on patients with shortened dental arch (SDA) and extreme SDA (ESDA) and masticatory performance with removable dental prostheses (RDP) were included.Data extraction and synthesisTwo reviewers independently selected studies and abstracted data, with disagreements being resolved by discussion.ResultsEight studies were included; four reported on comminution studies, three on mixing ability and one included both. In patients with ESDA comminution or mixing ability was 28-39% lower compared to patients with a complete dentition. In two studies, comminution outcomes when chewing with an RDP ranged from 2% to 32% reduction, indicating better chewing function (smaller X50) compared to comminution without the RDP. One study reported 28-83% lower mixing ability when chewing at the RDP side than chewing at the dentulous side. Generally, more artificial teeth (or longer occlusal platform) in experimental RDPs resulted in better comminution and better mixing ability (significant in four out of five studies), indicating a ‘dose-effect’ relationship. Two of the eight studies reported on biting force with higher maximum occlusal force for biting with natural teeth than for biting with artificial teeth in a distal-extension RDP.ConclusionsWithin the limitations of this review it can be concluded that subjects with (E)SDA had a reduced masticatory performance in the order of 30-40%. Distal-extension RDPs compensated for this reduction only partially, namely in the order of 50%. RDP effects on chewing frequency were not conclusive.

Impact of oral rehabilitation on the quality of life of partially dentate elders in a randomised controlled clinical trial: 2 year follow-up

Objective This randomised clinical trial aimed to compare the impact of two different tooth replacement strategies for partially dentate older patients namely; removable partial dentures (RPDs) and functionally orientated treatment based on the shortened dental arch (SDA) concept, on Oral Health-related Quality of Life (OHrQOL). Methods 89 patients completed a randomised clinical trial. Patients were recruited in two centres: Cork University Dental Hospital (CUDH) and a Geriatric Day Hospital (SFDH). 44 patients were randomly allocated to the RPD group and 45 to the SDA group where adhesive bridgework was used to provide 10 pairs of occluding contacts. The impact of treatment on OHrQOL was used as the primary outcome measure. Each patient completed the Oral Health Impact Profile (OHIP-14) at baseline, 1, 6, 12 and 24 months after treatment. Results Both treatment groups reported improvements in OHIP-14 scores at 24 months (p<0.05). For the SDA group OHIP-14 scores improved by 8.0 scale points at 12 months (p<0.001) and 5.9 scale points at 24 months (p<0.05). For the RPD group OHIP-14 scores improved by 5.7 scale points at 12 months (p<0.05) and 4.2 scale points at 24 months (p<0.05). Analysis using ANCOVA showed that there were significant between group differences recorded in both treatment centres. 24 months after intervention the SDA group recorded better OHIP-14 scores by an average of 2.9 points in CUDH (p<0.0001) and by an average of 7.9 points in SFDH (p<0.0001) compared to the RPD group. Conclusions Patients in the SDA group maintained their improvements in OHrQOL scores throughout the 24 month study period. For the RPD group the initial improvement in OHrQOL score began to diminish after 6 months, particularly for those treated in SFDH. Thus, the benefits of functionally orientated treatment increased over time, particularly for the older, more systemically unwell cohort in SFDH.