Wolfgang Hannak

The Randomized Shortened Dental Arch Study Tooth Loss

The evidence concerning the management of shortened dental arch (SDA) cases is sparse. This multi-center study was aimed at generating data on outcomes and survival rates for two common treatments, removable dental prostheses (RDP) for molar replacement or no replacement (SDA). The hypothesis was that the treatments lead to different incidences of tooth loss. We included 215 patients with complete molar loss in one jaw. Molars were either replaced by RDP or not replaced, according to the SDA concept. First tooth loss after treatment was the primary outcome measure. This event occurred in 13 patients in the RDP group and nine patients in the SDA group. The respective Kaplan-Meier survival rates at 38 months were 0.83 (95% CI: 0.74-0.91) in the RDP group and 0.86 (95% CI: 0.78-0.95) in the SDA group, the difference being non-significant.

The Randomized Shortened Dental Arch Study 5-year Maintenance

The scientific evidence concerning prosthodontic care for the shortened dental arch (SDA) is sparse. This randomized multicenter study aimed to compare two common treatment options: removable partial dental prostheses (RPDPs) for molar replacement vs. no replacement (SDA). One of the hypotheses was that the follow-up treatment differs between patients with RPDPs and patients with SDAs during the 5-year follow-up period. Two hundred and fifteen patients with complete molar loss in one jaw were included in the study. Molars were either replaced by RPDPs or not replaced according to the SDA concept. A mean number of 4.2 (RPDP) and 2.8 (SDA) treatments for biological or technical reasons occurred during the 5-year observation time per patient. Concerning the biological aspect, no significant differences between the groups could be shown, whereas treatment arising from technical reasons was significantly more frequent for the RPDP group. When the severity of treatment was analyzed, a change over time was evident. When, at baseline, only follow-up treatment with minimal effort is required, over time there is a continuous increase to moderate and extensive effort observed for both groups (Controlled-trials.com number ISRCTN97265367).

The randomized shortened dental arch study (RaSDA): design and protocol

BackgroundVarious treatment options for the prosthetic treatment of jaws where all molars are lost are under discussion. Besides the placement of implants, two main treatment types can be distinguished: replacement of the missing molars with removable dental prostheses and non-replacement of the molars, i.e. preservation of the shortened dental arch. Evidence is lacking regarding the long-term outcome and the clinical performance of these approaches. High treatment costs and the long time required for the treatment impede respective clinical trials.Methods/designThis 14-center randomized controlled investigator-initiated trial is ongoing. Last patient out will be in 2010. Patients over 35 years of age with all molars missing in one jaw and with at least both canines and one premolar left on each side were eligible. One group received a treatment with removable dental prostheses for molar replacement (treatment A). The other group received a treatment limited to the replacement of all missing anterior and premolar teeth using fixed bridges (treatment B). A pilot trial with 32 patients was carried out. Two hundred and fifteen patients were enrolled in the main trial where 109 patients were randomized for treatment A and 106 for treatment B. The primary outcome measure is further tooth loss during the 5-year follow-up. The secondary outcome measures encompassed clinical, technical and subjective variables. The study is funded by the Deutsche Forschungsgemeinschaft (German Research Foundation, DFG WA 831/2-1, 2-2, 2-3, 2-4, 2-5).DiscussionThe particular value of this trial is the adaptation of common design components to the very specific features of complex dental prosthetic treatments. The pilot trial proved to be indispensable because it led to a number of adjustments in the study protocol that considerably improved the practicability. The expected results are of high clinical relevance and will show the efficacy of two common treatment approaches in terms of oral health. An array of secondary outcome measures will deliver valuable supplementary information. If the results can be implemented in the clinical practice, the daily dental care should strongly profit thereof.Trial registrationThe trial is registered at ClinicalTrials.gov under ISRCTN68590603 (pilot trial) and ISRCTN97265367 (main trial).

Randomized multi-centre study on the effect of training on tooth shade matching

OBJECTIVES The aim of this study was to find out whether Toothguide Trainer, TT, and Toothguide Training Box, TTB, show any training effects, independent of the shade guide chosen. METHODS Students from four dental schools (N=78) were included in this study. The participants were randomized into a study, 42 students (age range: 19-27 years; 69% female, 31% male) and a control group of 36 students (age range: 19-30 years; 57% female, 43% male). The study group started with a double blind introduction test, followed by the TT and TTB training, finishing with the final test. The control group only passed the introduction and - after a break - the final test. Eight randomly chosen samples, seven of the Vita classical and one of the 3D-Master colour scale, were marked by barcodes. Colour matching was arranged by the Vita classical scale. RESULTS The results of the pre- and final tests of both groups were combined. For every sample, the value ΔE was determined. The summation of all eight samples from the introduction and final tests offered a summarized ΔE value. The differences between introduction and final tests revealed the individual learning success. 47.6% of the study group showed statistically significant better results than the control group, 33% (p=0.031). CONCLUSION TT and TTB show a positive effect of training on tooth shade matching independent of the colour scale used. CLINICAL SIGNIFICANCE Visual shade taking is the most frequent clinical method for shade determination. To increase better results in visual colour matching, TT and TTB training is used. This is the first study examining the training effect of TT and TTB using Vita classical scale.

Management of shortened dental arches and periodontal health: 5-year results of a randomised trial.

In a multicentre randomised trial (German Research Association, grants DFG WA 831/2-1 to 2-6, WO 677/2-1.1 to 2-2.1.; controlled-trials.com ISRCTN97265367), patients with complete molar loss in one jaw received either a partial removable dental prosthesis (PRDP) with precision attachments or treatment according to the SDA concept aiming at pre-molar occlusion. The objective of this current analysis was to evaluate the influence of different treatments on periodontal health. Linear mixed regression models were fitted to quantify the differences between the treatment groups. The assessment at 5 years encompassed 59 patients (PRDP group) and 46 patients (SDA group). For the distal measuring sites of the posterior-most teeth of the study jaw, significant differences were found for the plaque index according to Silness and Löe, vertical clinical attachment loss (CAL-V), probing pocket depth (PPD) and bleeding on probing. These differences were small and showed a slightly more unfavourable course in the PRDP group. With CAL-V and PPD, significant differences were also found for the study jaw as a whole. For CAL-V, the estimated group differences over 5 years amounted to 0.27 mm (95% CI 0.05; 0.48; P = 0.016) for the study jaw and 0.25 mm (95% CI 0.05; 0.45; P = 0.014) for the distal sites of the posterior-most teeth. The respective values for PPD were 0.22 mm (95% CI 0.03; 0.41; P = 0.023) and 0.32 mm (95% CI 0.13; 0.5; P = 0.001). It can be concluded that even in a well-maintained.patient group statistically significant although minor detrimental effects of PRDPs on periodontal health are measurable.

Impact of shortened dental arch on oral health-related quality of life over a period of 10 years – a randomized controlled trial

OBJECTIVES To compare oral health-related quality of life (OHRQoL) in patients with either molar replacement by partial removable dental prostheses (PRDP) or with restored shortened dental arches (SDA) over a period of 10 years. METHODS In this multi-center RCT, a consecutive sample of 215 patients with bilateral molar loss in at least one jaw was initially recruited in 14 prosthodontic departments. Of those patients, 150 could be randomly allocated to the treatment groups (SDA: n = 71; PRDP: n = 79), received the allocated treatment, and were available for follow-up assessments. OHRQoL was assessed using the 49-item version of the Oral Health Impact Profile (OHIP) before treatment (baseline) and at follow-ups after treatment (4-8 weeks and 6, 12, 24, 36, 48, 60, 96, and 120 months). To investigate the course of OHRQoL over time, we longitudinally modelled treatment and time effects using mixed-effects models. RESULTS OHRQoL substantially improved from baseline to first follow-up in both groups indicated by a mean decrease in OHIP scores of 20.0 points (95%-CI: 12.5-27.5). When compared to the SDA group, OHRQoL in the PRDP group was not significantly different (-0.6 OHIP points; 95%-CI: -7.1 to 5.9) during the study period when assuming a constant time effect. OHRQoL remained stable over the 10 years with a statistically insignificant time effect (p = 0.848). CONCLUSIONS For patients requesting prosthodontic treatment for their lost molars, treatments with SDA or PRDP improve clinically relevantly OHRQoL and maintain it over a period of 10 years with no option being superior to the other. CLINICAL SIGNIFICANCE Since there was no significant difference between the two treatment options over the observation period of 10 years, and since results have stayed stable over time, patients can be informed that both treatment concepts are equivalent concerning OHRQoL.

The Randomized Shortened Dental Arch Study: Tooth Loss Over 10 Years

PURPOSE This study aimed to compare the long-term outcomes of two different nonimplant treatments in the bilateral shortened dental arch (SDA). MATERIALS AND METHODS In a multicenter randomized controlled clinical trial, patients with complete molar loss in one arch were assigned to one of two different nonimplant treatments. In the partial removable dental prosthesis (PRDP) group, patients were provided with a distal-extension prosthesis retained with precision attachments. In the SDA group, patients were treated according to the SDA concept by preserving or restoring a premolar occlusion. RESULTS Of the 152 treated patients, 82 reached the 10-year examination independent of their dental or prosthetic status. In the intention-to-treat analysis, the survival rates for tooth loss at 10 years were 0.44 (95% confidence interval [CI]: 0.30 to 0.56) in the PRDP group and 0.52 (95% CI: 0.37 to 0.65) in the SDA group. For tooth loss in the study arch, the survival rates were 0.67 (95% CI: 0.52 to 0.78) in the PRDP group and 0.60 (95% CI: 0.45 to 0.73) in the SDA group. The number of teeth lost was higher than expected. In a multivariate analysis using a multiple Cox regression model, the covariates age (unit: 1 year, Hazard Ratio [HR]: 1.033, P = .03) and DMFT value (unit: 1 tooth, HR: 1.121, P = .03) were significant for time to first tooth loss in the study arch. CONCLUSION The results suggest an overestimation of the influence of the prosthetic management of the bilateral SDA. In treatment decisions, patient preferences should be considered with appropriate weight.

Influence of tongue position on the determination of tooth shade

Statement of problem Dentists frequently use electronic devices to determine tooth color. However, neither the instructions for these devices nor the accompanying brochures refer to the environmental conditions required at the point of measurement. Purpose The purpose of this multicenter prospective clinical study was to reveal whether a change in the oral background influences tooth color determination. Material and methods Students (N=42) at the dental clinic in Berlin, Leipzig, Greifswald and Olomouc (women n=27, men n=15) participated in this study. It was their first contact with the spectral photometer (Easyshade Advance 4.0; VITA Zahnfabrik). After a short introduction on how to use the device, the students made 1‐point measurements on the same patient on the maxillary central incisor. In the first measurement, the patients mouth was open, and the palatal surface uncovered. In the second measurement, the patients mouth was closed slightly, and the tongue pressed on the lingual surface of the maxillary central incisor. The mean ±SD and the 95% confidence interval (95 % CI) were calculated using the Student t test for each test series (&agr;=.05). Results Statistical evaluation of the 2 measurements revealed changes in the L*a*b* values with a mean L*=0.204, a*=‐0.351, and b*=0.02; a median of 0.4, ‐0.3, and ‐0.1, respectively; a ±SD of 2.37, 0.64, and 0.89, respectively; and 95% CIs of L*=‐0.476 to 0.884, a*=‐0.531 to ‐0.702, and b*=‐0.23 to 0.52, respectively. These differences were not statistically significant (P>.05). The measurements of L*, a*, and b* with and without tongue coverage of the lingual surfaces of the maxillary teeth did not show any statistically significant differences (P=.663). Conclusions The results demonstrate that the position of the tongue does not influence measurement accuracy during the application of the Easyshade Advance device.