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Herrera D, Sanz M, Kebschull M, Jepsen S, Sculean A, Berglundh T, Papapanou PN, Chapple I, Tonetti MS. Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline. J Clin Periodontol 2022; 49 Suppl 24:4-71. [PMID: 35688447 DOI: 10.1111/jcpe.13639] [Citation(s) in RCA: 87] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/22/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND The recently published clinical practice guideline (CPG) for the treatment of periodontitis in stages I-III provided evidence-based recommendations for the treatment of periodontitis patients, defined according to the 2018 classification. Stage IV periodontitis shares the severity and complexity characteristics of stage III periodontitis, but includes the anatomical and functional sequelae of tooth and periodontal attachment loss (tooth flaring and drifting, bite collapse, etc.), which require additional interventions following completion of active periodontal therapy. AIM To develop an S3 Level CPG for the treatment of stage IV periodontitis, focusing on the implementation of inter-disciplinary treatment approaches required to treat/rehabilitate patients following associated sequelae and tooth loss. MATERIALS AND METHODS This S3 Level CPG was developed by the European Federation of Periodontology (EFP), following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process. A rigorous and transparent process included synthesis of relevant research in 13 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and a structured consensus process with leading experts and a broad base of stakeholders. RESULTS The S3 Level CPG for the treatment of stage IV periodontitis culminated in recommendations for different interventions, including orthodontic tooth movement, tooth splinting, occlusal adjustment, tooth- or implant-supported fixed or removable dental prostheses and supportive periodontal care. Prior to treatment planning, it is critically important to undertake a definitive and comprehensive diagnosis and case evaluation, obtain relevant patient information, and engage in frequent re-evaluations during and after treatment. The periodontal component of therapy should follow the CPG for the treatment of periodontitis in stages I-III. CONCLUSIONS The present S3 Level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat patients with stage IV periodontitis and to maintain a healthy dentition over lifetime, according to the available evidence at the time of publication.
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Affiliation(s)
- David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Moritz Kebschull
- Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK.,Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK.,Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, New York, USA
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University Hospital Bonn, Bonn, Germany
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Tord Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Panos N Papapanou
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, New York, USA
| | - Iain Chapple
- Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK.,Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Maurizio S Tonetti
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Centre for Oral Diseases, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Anterior occlusion in shortened dental arches. Clin Oral Investig 2021; 26:3487-3492. [PMID: 34889979 PMCID: PMC8979867 DOI: 10.1007/s00784-021-04317-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022]
Abstract
Objectives The aim of this study was to examine the occlusion of anterior teeth in individuals with shortened dental arch (SDA). Material and methods In a case–control clinical study, 41 individuals with SDA and 41 individuals with complete dental arch (CDA) participated. The CDA control group was matched for age and gender. Testing for occlusal contacts of anterior maxillary teeth was conducted by biting on foil strips (8 µm) with subjectively normal bite force (NBF) and maximal bite force (MBF). The data was analyzed on individual and tooth levels. Results The median rates of anterior maxillary teeth with occlusal contacts were 0.67 (NBF) and 0.83 (MBF) in the SDA group and 0.50 (NBF) and 0.83 (MBF) in the CDA group. Within both groups, the contact rates were significantly higher in MBF. The group difference with NBF was significant. A generalized linear model showed that the odds of an anterior maxillary tooth to have an occlusal contact were greater in the SDA both for NBF with an odds ratio (OR) 2.277 and MBF with an OR 1.691. Conclusions The findings suggest effective compensatory mechanisms relative to the occlusal function in individuals with SDA. Clinical relevance The study delivers further evidence regarding the SDA concept as a viable option in the management of posterior tooth loss.
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Gotfredsen K, Rimborg S, Stavropoulos A. Efficacy and risks of removable partial prosthesis in periodontitis patients: A systematic review. J Clin Periodontol 2021; 49 Suppl 24:167-181. [PMID: 34761421 DOI: 10.1111/jcpe.13519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/27/2021] [Accepted: 06/08/2021] [Indexed: 01/24/2023]
Abstract
AIM The aim of this systematic review was to answer the following focused question: "In partially edentulous patients with periodontitis, are removable dental prostheses (RDPs) more efficacious than no prosthetic treatment, treatment to a shortened dental arch (SDA), or tooth-supported fixed dental prostheses (FDPs)?" MATERIALS AND METHODS A systematic literature search was performed electronically for the period 1966-2020. Two authors independently assessed the studies for eligibility according to the PRISMA guidelines. Risk assessment was performed using RoB 2.0 and the Newcastle-Ottawa Scale. RESULTS Two retrospective studies indicated that RDPs increased the risk of tooth loss compared to FDPs in patients with a history of periodontitis. Prospective studies found that RDPs could be maintained without any significant periodontal destruction on a long-term basis. Owing to the heterogeneity of the data, no meta-analysis could be performed. Several studies indicated that RDP increased plaque accumulation. RDPs had only a limited effect on masticatory efficiency and nutritional status. RDPs may improve oral-health-related quality of life (OHRQoL), but to a lesser extent compared with that of patients treated to an SDA. CONCLUSIONS There is no strong evidence that RDPs per se will cause periodontal destruction including tooth loss. RDPs do not inevitably improve masticatory efficiency but improve OHRQoL, although less than for patients treated with FDPs including resin-bonded FDPs.
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Affiliation(s)
- Klaus Gotfredsen
- Section of Oral Rehabilitation, Department of Odontology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Susie Rimborg
- Copenhagen University Library, Faculty Library of Natural and Health Sciences, Copenhagen University, Copenhagen, Denmark
| | - Andreas Stavropoulos
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine (CUMD), University of Geneva, Geneva, Switzerland.,Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
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Cimões R, Pinho RCM, Gurgel BCDV, Borges SB, Marcantonio Júnior E, Marcantonio CC, Melo MARDC, Piattelli A, Shibli JA. Impact of tooth loss due to periodontal disease on the prognosis of rehabilitation. Braz Oral Res 2021; 35:e101. [PMID: 34586215 DOI: 10.1590/1807-3107bor-2021.vol35.0101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/31/2021] [Indexed: 01/21/2023] Open
Abstract
When periodontal disease is diagnosed, it is difficult to predict the clinical response of treatment of a tooth over time because the result of treatment is affected by several factors and will depend on the maintenance and support of periodontal treatment. Rehabilitation with removable dental prostheses, fixed prostheses, and dental implants makes it possible to restore the function and esthetics of patients with tooth loss due to periodontal disease. The predictive factors of tooth loss in periodontitis patients should be assessed by dentists to inform their clinical decision-making during dental treatment planning. This will provide detailed individualized information and level of risk of patients considered suitable for dental rehabilitation. Therefore, the aim of this article was to review the subject of "Impact of tooth loss due to periodontal disease on the prognosis of rehabilitation" and the effect of fixed, removable, and implant-supported prostheses in periodontal patients.
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Affiliation(s)
- Renata Cimões
- Universidade Federal de Pernambuco - UFPE, Health Sciences Centre, Department of Prosthesis and Oral and Maxillofacial Surgery, Recife, PE, Brazil
| | | | | | - Samuel Batista Borges
- Universidade Federal do Rio Grande do Norte - UFRN, Health Sciences Centre, Department of Dentistry, Natal, RN Brazil
| | - Elcio Marcantonio Júnior
- Universidade Estadual Paulista Júlio de Mesquita Filho - Unesp, Faculdade de Odontologia de Araraquara, Department of Diagnosis and Surgery, Araraquara, SP, Brazil
| | - Camila Chierici Marcantonio
- Universidade Estadual Paulista Júlio de Mesquita Filho - Unesp, Faculdade de Odontologia de Araraquara, Department of Diagnosis and Surgery, Araraquara, SP, Brazil
| | | | - Adriano Piattelli
- University of Chieti, Dental School, Department of Medical, Oral and Biotechnological Sciences, Chieti, Italy
| | - Jamil Awad Shibli
- Universidade de Guarulhos - UnG, Dental Research Division, Department of Periodontology and Oral Implantology, Guarulhos, SP, Brazil
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Walter MH, Marré B, Dreyhaupt J, Heydecke G, Rauch A, Mundt T, Hannak W, Kohal RJ, Kern M, Nothdurft F, Hartmann S, Böning K, Boldt J, Stark H, Edelhoff D, Wöstmann B, Wolfart S, Jahn F, Luthardt RG. Rehabilitation of shortened dental arches: A fifteen-year randomised trial. J Oral Rehabil 2021; 48:738-744. [PMID: 33713361 DOI: 10.1111/joor.13167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/04/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Few long-term studies on treatments in the shortened dental arch (SDA) are available. OBJECTIVE The objective of this trial was to analyse the long-term success of two different treatment concepts. METHODS Patients over 35 years of age with missing molars in one jaw and at least the canine and one premolar present on both sides were eligible. In the partial removable dental prosthesis (PRDP) group (N = 81), molars and missing second premolars were replaced by a precision attachment retained prosthesis. In the SDA group (N = 71), the dental arch ended with the second premolar that had to be present or replaced by a cantilever fixed dental prosthesis. Follow-up examinations were carried out over 15 years. RESULTS A comprehensive outcome variable comprised four failure categories for which Kaplan-Meier survival (success) analyses were conducted. Half of the patients exhibited a continuous preservation of the per protocol prosthetic status that remained totally unaffected by complications for more than 10 years. The event-free success rates for moderate or worse failure implied a loss of the per protocol prosthetic status. The respective survival rates fell below 50% at 14.2 years in the PRDP group and 14.3 years in the SDA group. In none of the analyses, a significant group difference was found. CONCLUSIONS In patients with an SDA condition, changes in the prosthetic status have to be expected. The affected proportion increases almost linearly from shortly after treatment and comprises the majority after 15 years. The influence of the examined treatments on success appears to be low.
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Affiliation(s)
- Michael Horst Walter
- Department of Prosthetic Dentistry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Birgit Marré
- Department of Prosthetic Dentistry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Guido Heydecke
- Department of Prosthodontics, University Medical Center Eppendorf, Hamburg, Germany
| | - Angelika Rauch
- Department of Prosthodontics and Materials Science, University of Leipzig, Leipzig, Germany
| | - Torsten Mundt
- Department of Prosthodontics, Gerodontology and Biomaterials, Dental School, University of Greifswald, Greifswald, Germany
| | - Wolfgang Hannak
- Department of Prosthodontics, Geriatic Dentistry and Craniomandibular Disorders, Center for Dental and Craniofacial Sciences, Charité - Universitätsmedizin Berlin CC3 - Charité, Berlin, Germany
| | - Ralf Joachim Kohal
- Department of Prosthetic Dentistry, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Matthias Kern
- School of Dentistry, Department of Prosthodontics, Propaedeutics and Dental Materials, Christian-Albrechts University, Kiel, Germany
| | - Frank Nothdurft
- Department of Prosthetic Dentistry and Dental Materials Science, Medical Center, Dental School and Clinics, Saarland University, Homburg, Germany
| | - Sinsa Hartmann
- Department of Prosthetic Dentistry, Johannes-Gutenberg University of Mainz, Mainz, Germany
| | - Klaus Böning
- Department of Prosthetic Dentistry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Julian Boldt
- Department of Prosthetic Dentistry, Julius-Maximilians University of Würzburg, Würzburg, Germany
| | - Helmut Stark
- Department of Prosthodontics, Preclinical Education and dental Materials Science, University of Bonn, Bonn, Germany
| | - Daniel Edelhoff
- Department of Prosthetic Dentistry, University Hospital, LMU Ludwig-Maximilians-University, Munich, Germany
| | - Bernd Wöstmann
- Department of Prosthetic Dentistry, Justus-Liebig University of Gießen, Gießen, Germany
| | - Stefan Wolfart
- Department of Prosthodontics and Biomaterials, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Florentine Jahn
- Department of Prosthetic Dentistry and Dental Material Science, Friedrich-Schiller University of Jena, Jena, Germany
| | - Ralph Gunnar Luthardt
- Department of Prosthetic Dentistry, Center of Dentistry, Universitätsklinikum Ulm, Ulm, Germany
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Pihlstrom BL. Selections from the current literature. J Am Dent Assoc 2021. [DOI: 10.1016/j.adaj.2020.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Khan SB. Translation of the shortened dental arch research into clinical practice: a stakeholder mapping approach. BDJ Open 2020; 6:10. [PMID: 32793391 PMCID: PMC7387451 DOI: 10.1038/s41405-020-0039-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/08/2022] Open
Abstract
AIM To identify key participants that can ensure implementation of the SDA or PRDA as a prosthodontic management option using a stakeholder mapping approach. METHODS A stakeholder mapping approach is employed which is a strategic method to identify, rate the importance of input and the influence, highlighting how clinical implementation can be ensured. A stakeholder map was used as the research tool. Stakeholders were classified according to their level of influence in either assisting with change or obstructing progress as well as the impact of their input within the dental organization and the broader South African environment. RESULTS Several stakeholders were identified and were classified in two ways: Primary or secondary and according to their affiliation with the organization where change needs to occur. Initially, a lecture on the shortened dental arch was included in 4th year of undergraduate study, after consultation with the head of the department. This was abandoned as students misunderstood the use of the concept related to clinical requirements; thus, the location of where this concept must be taught, was reconsidered. The role of other key stakeholders that could effect change was also highlighted with this approach. CONCLUSION This strategic analysis allowed identification of key stakeholders and their roles that can assist with implementation of the SDA or PRDA, some of whom should be addressed further to ensure alignment of practices to health policies. KEY POINTS Knowledge translation consists of multiple stages from design to implementation which includes diffusion, dissemination (such as publishing) and implementation of evidence into clinical practice (application of concepts or procedures to improve patient care).Only quality research, as stipulated on the evidence pyramid, can be used to change curricula and clinical practices.The strategic approach with stakeholder mapping allows identification of key stakeholders in prosthodontics (knowledge brokers or communities of practice) that have the interest and influence to change curricula and clinical practice; including a combined approach with researchers which may enable easier application of quality care to patients.
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Affiliation(s)
- Saadika B. Khan
- Department of Restorative Dentistry, Faculty of Dentistry, University of the Western Cape, Cape Town, South Africa
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Walter MH, Dreyhaupt J, Mundt T, Kohal R, Kern M, Rauch A, Nothdurft F, Hartmann S, Böning K, Boldt J, Stark H, Edelhoff D, Wöstmann B, Luthardt RG, Hannak W, Wolfart S, Heydecke G, Jahn F, Pospiech P, Marré B. Periodontal health in shortened dental arches: A 10-year RCT. J Prosthodont Res 2020; 64:498-505. [PMID: 32063531 DOI: 10.1016/j.jpor.2020.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/18/2019] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE This analysis focused on periodontal health in shortened dental arches (SDAs). METHODS In a randomized controlled clinical trial, patients with missing molars in one jaw and at least one premolar and canine on both sides were eligible for participation. In the partial removable dental prosthesis (PRDP) group (n = 79), molars were replaced with a precision attachment retained PRDP. In the SDA group (n == 71), the SDA up to the second premolars was either left as is or restored with fixed dental prostheses. Outcome variables were vertical clinical attachment loss (CAL-V), pocket probing depth (PPD), bleeding on probing (BOP) and plaque index (PLI). For CAL-V and PPD, the changes at six measuring points per tooth were analyzed. For BOP and PLI, patient related rates were calculated for each point in time. Statistical methods included linear regression analyses. RESULTS In the intention-to-treat (ITT) analysis for CAL-V in the study jaw, the 10 year patient related mean changes were 0.66 mm in the PRDP group and -0.13 mm in the SDA group. The resulting mean patient related group difference of 0.79 mm (95% CI: 0.20 mm-1.38 mm) was significant (p = 0.01). There were no significant differences in the ITT analyses for PPD. For BOP and PLI, significant group differences with more favorable results for the SDA group were found. CONCLUSIONS In view of lacking substantial differences for CAL-V and PPD, the overall differences were considered of minor clinical relevance. The results add confirmatory evidence to the shortened dental arch concept and its clinical viability (controlled-trials.com ISRCTN97265367).
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Affiliation(s)
- Michael H Walter
- Department of Prosthetic Dentistry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, Dresden 01307, Germany.
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, Ulm University, Schwabstraße 13, Ulm 89075, Germany
| | - Torsten Mundt
- Department of Prosthodontics, Gerodontology and Biomaterials, Dental School, University of Greifswald, Rotgerberstr. 8, Greifswald 17487, Germany
| | - Ralf Kohal
- Department of Prosthetic Dentistry, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, Freiburg im Breisgau 79106, Germany
| | - Matthias Kern
- Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts University, Christian-Albrechts-Platz 4, Kiel 24118, Germany
| | - Angelika Rauch
- Department of Prosthodontics and Materials Science, University of Leipzig, Liebigstr. 18, Leipzig 04103, Germany
| | - Frank Nothdurft
- Department of Prosthetic Dentistry and Dental Materials Science, Medical Center, Dental School and Clinics, Saarland University, Campus Homburg, Kirrberger Str. 100, Homburg/Saar 66421, Germany
| | - Sinsa Hartmann
- Department of Prosthetic Dentistry, Johannes-Gutenberg University of Mainz, Langenbeckstr. 1, Mainz 55131, Germany
| | - Klaus Böning
- Department of Prosthetic Dentistry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, Dresden 01307, Germany
| | - Julian Boldt
- Department of Prosthetic Dentistry, Julius-Maximilians University of Würzburg, Pleicherwall 2, Würzburg 97070, Germany
| | - Helmut Stark
- Department of Prosthodontics, Preclinical Education and dental Materials Science, University of Bonn, Welschnonnenstr.17, Bonn 53111, Germany
| | - Daniel Edelhoff
- Department of Prosthetic Dentistry, University Hospital, LMU Ludwig-Maximilians-University, Goethestraße 70, Munich 80336, Germany
| | - Bernd Wöstmann
- Department of Prosthetic Dentistry, Justus-Liebig University of Gießen, Rudolf-Buchheim-Str. 8, Gießen 35392, Germany
| | - Ralph Gunnar Luthardt
- Department of Prosthetic Dentistry, Center of Dentistry, Universitätsklinikum Ulm, Albert-Einstein-Allee 11, Ulm 89081, Germany
| | - Wolfgang Hannak
- Charité - Universitätsmedizin Berlin, CC3 - Charité, Center for Dental and Craniofacial Sciences, Department of Prosthodontics, Geriatic Dentistry and Craniomandibular Disorders, Campus Benjamin Franklin, Aßmannshauser Straße 4-6, Berlin 14197, Germany
| | - Stefan Wolfart
- Department of Prosthodontics and Biomaterials, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen 52074, Germany
| | - Guido Heydecke
- Department of Prosthodontics, University Medical Center Eppendorf, Zahnärztliche Prothetik, Martinistr. 52, Hamburg 20246, Germany
| | - Florentine Jahn
- Department of Prosthetic Dentistry and Dental Material Science, Friedrich-Schiller University of Jena, Poliklinik für Zahnärztliche Prothetik und Werkstoffkunde, An der Alten Post 4, Jena 07743, Germany
| | | | - Birgit Marré
- Department of Prosthetic Dentistry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, Dresden 01307, Germany
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PANNUTI CM, SENDYK DI, GRAÇAS YTD, TAKAI SL, SABÓIA VDPA, ROMITO GA, MENDES FM. Clinically relevant outcomes in dental clinical trials: challenges and proposals. Braz Oral Res 2020; 34 Suppl 2:e073. [DOI: 10.1590/1807-3107bor-2020.vol34.0073] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/22/2019] [Indexed: 12/13/2022] Open
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Reissmann DR, Wolfart S, John MT, Marré B, Walter M, Kern M, Kohal R, Nothdurft F, Stark H, Schierz O, Wöstmann B, Hannak W, Mundt T, Pospiech P, Boldt J, Edelhoff D, Busche E, Jahn F, Luthardt RG, Hartmann S, Heydecke G. Impact of shortened dental arch on oral health-related quality of life over a period of 10 years - A randomized controlled trial. J Dent 2018; 80:55-62. [PMID: 30355509 DOI: 10.1016/j.jdent.2018.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/20/2018] [Accepted: 10/17/2018] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Daniel R Reissmann
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Stefan Wolfart
- Department of Prosthodontics and Biomaterials, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Mike T John
- Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Birgit Marré
- Department of Prosthetic Dentistry, Technische Universität Dresden, University Hospital Carl Gustav Carus Dental School, Dresden, Germany
| | - Michael Walter
- Department of Prosthetic Dentistry, Technische Universität Dresden, University Hospital Carl Gustav Carus Dental School, Dresden, Germany
| | - Matthias Kern
- Department of Prosthetic Dentistry, Christian-Albrechts University, Kiel, Germany
| | - Ralf Kohal
- Department of Prosthetic Dentistry, Albert-Ludwig University of Freiburg, Freiburg, Germany
| | - Frank Nothdurft
- Department of Prosthetic Dentistry and Dental Materials Sciences, Saarland University, Homburg, Saar, Germany
| | - Helmut Stark
- Department of Prosthodontics, Preclinical Education and Dental Materials Science, University of Bonn, Bonn, Germany
| | - Oliver Schierz
- Department of Prosthodontics and Materials Science, University of Leipzig, Leipzig, Germany
| | - Bernd Wöstmann
- Department of Prosthetic Dentistry, Justus-Liebig University of Giessen, Giessen, Germany
| | - Wolfgang Hannak
- Department of Prosthodontics, Geriatic Dentistry and Craniomandibular Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Torsten Mundt
- Department of Prosthodontics, Gerodontology and Biomaterials, Dental School, Ernst-Moritz-Arndt University of Greifswald, Greifswald, Germany
| | - Peter Pospiech
- Department of Prosthodontics, Geriatic Dentistry and Craniomandibular Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julian Boldt
- Department of Prosthodontics, University of Würzburg, Würzburg, Germany
| | - Daniel Edelhoff
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany
| | - Eckhard Busche
- Department of Prosthetic Dentistry, Witten-Herdecke University, Witten, Germany
| | - Florentine Jahn
- Department of Prosthetic Dentistry and Dental Material Science, Friedrich-Schiller University of Jena, Jena, Germany
| | - Ralph G Luthardt
- Department of Prosthetic Dentistry, Center of Dentistry, Ulm University, Ulm, Germany
| | - Sinsa Hartmann
- Department of Prosthetic Dentistry, Johannes- Gutenberg University of Mainz, Mainz, Germany
| | - Guido Heydecke
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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