Abstract
Objectives
The study was designed to provide clinical outcome data for two treatments of the shortened dental arch (SDA).
Material and Methods
In a multicenter randomized controlled clinical trial, patients with complete molar loss in one jaw were provided with either a partial removable dental prosthesis (PRDP) retained with precision attachments or treated according to the SDA concept preserving or restoring a premolar occlusion. No implants were placed. The primary outcome was tooth loss.
Results
Of 152 treated patients, 132 patients reached the 5-year examination. Over 5 years, 38 patients experienced tooth loss. For the primary outcome tooth loss, the Kaplan–Meier survival rates at 5 years were 0.74 (95 % CI 0.64, 0.84) in the PRDP group and 0.74 (95 % CI 0.63, 0.85) in the SDA group. For tooth loss in the study jaw, the survival rates at 5 years were 0.88 (95 % CI 0.80, 0.95) in the PRDP group and 0.84 (95 % CI 0.74, 0.93) in the SDA group. The differences were not significant. No Cox regression models of appropriate fit explaining tooth loss on the patient level could be found.
Conclusions
The overall treatment goals of a sustainable oral rehabilitation and the avoidance of further tooth loss over longer periods were not reliably achievable. The influence of the type of prosthetic treatment on tooth loss might have been overestimated.
Clinical Relevance
Regarding our results, the patient’s view will gain even more importance in the clinical decision between removable and fixed restorations in SDAs.
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References
Käyser AF (1981) Shortened dental arches and oral function. J Oral Rehabil 8(5):457–462
Owall B, Jonsson L (1998) Precision attachment-retained removable partial dentures. Part 3. General practitioner results up to 2 years. Int J Prosthodont 11(6):574–579
Rissin L, Feldman RS, Kapur KK, Chauncey HH (1985) Six-year report of the periodontal health of fixed and removable partial denture abutment teeth. J Prosthet Dent 54(4):461–467
Ettinger RL, Qian F (2004) Abutment tooth loss in patients with overdentures. J Am Dent Assoc 135(6):739–746
Bergman B (1987) Periodontal reactions related to removable partial dentures: a literature review. J Prosthet Dent 58(4):454–458
Vanzeveren C, D’ Hoore W, Bercy P (2002) Influence of removable partial denture on periodontal indices and microbiological status. J Oral Rehabil 29(3):232–239
Cabanilla LL, Neely AL, Hernandez F (2009) The relationship between periodontal diagnosis and prognosis and the survival of prosthodontic abutments: a retrospective study. Quintessence Int 40(10):821–831
Carnevale G, Cairo F, Tonetti MS (2007) Long-term effects of supportive therapy in periodontal patients treated with fibre retention osseous resective surgery. II: tooth extractions during active and supportive therapy. J Clin Periodontol 34(4):342–348
Preshaw PM, Walls AWG, Jakubovics NS, Moynihan PJ, Jepson NJA, Loewy Z (2011) Association of removable partial denture use with oral and systemic health. J Dent 39(11):711–719. doi:10.1016/j.jdent.2011.08.018
Barghi N, dos Santos Jr J, Narendran S (1992) Effects of posterior teeth replacement on temporomandibular joint sounds: a preliminary report. J Prosthet Dent 68(1):132–136
Barghi N, Aguilar T, Martinez C, Woodall WS, Maaskant BA (1987) Prevalence of types of temporomandibular joint clickings in subjects with missing posterior teeth. J Prosthet Dent 57(5):617–620
Applegate OC (1954) Loss of posterior occlusion. J Prosthet Dent 4:197–199
al-Ali F, Heath MR, Wright PS (1998) Chewing performance and occlusal contact area with the shortened dental arch. Eur J Prosthodont Restor Dent 6(3):127–132
De Backer H, Van Maele G, De Moor N, Van den Berghe L (2007) Survival of complete crowns and periodontal health: 18-year retrospective study. Int J Prosthodont 20(2):151–158
Bragger U, Aeschlimann S, Burgin W, Hammerle CH, Lang NP (2001) Biological and technical complications and failures with fixed partial dentures (FPD) on implants and teeth after four to five years of function. Clin Oral Implants Res 12(1):26–34
Creugers NH, Käyser AF, van ’t Hof MA (1994) A meta-analysis of durability data on conventional fixed bridges. Community Dent Oral Epidemiol 22(6):448–452
Scurria MS, Bader JD, Shugars DA (1998) Meta-analysis of fixed partial denture survival: prostheses and abutments. J Prosthet Dent 79(4):459–464
Knoernschild KL, Campbell SD (2000) Periodontal tissue responses after insertion of artificial crowns and fixed partial dentures. J Prosthet Dent 84(5):492–498
Valderhaug J, Ellingsen JE, Jokstad A (1993) Oral hygiene, periodontal conditions and carious lesions in patients treated with dental bridges. A 15-year clinical and radiographic follow-up study. J Clin Periodontol 20(7):482–489
Muller HP (1986) The effect of artificial crown margins at the gingival margin on the periodontal conditions in a group of periodontally supervised patients treated with fixed bridges. J Clin Periodontol 13(2):97–102
Broadbent JM, Williams KB, Thomson WM, Williams SM (2006) Dental restorations: a risk factor for periodontal attachment loss? J Clin Periodontol 33(11):803–810
Albandar JM, Buischi Y, Axelsson P (1995) Caries lesions and dental restorations as predisposing factors in the progression of periodontal diseases in adolescents. A 3-year longitudinal study. J Periodontol 66(4):249–254
Minguez C, Lyons K (2007) Failure of crowns and bridges—a review of the literature. N Z Dent J 103(1):7–13
Mojon P, Rentsch A, Budtz-Jorgensen E (1995) Relationship between prosthodontic status, caries, and periodontal disease in a geriatric population. Int J Prosthodont 8(6):564–571
Thomason JM, Moynihan PJ, Steen N, Jepson NJ (2007) Time to survival for the restoration of the shortened lower dental arch. J Dent Res 86(7):646–650
Holm-Pedersen P, Lang NP, Muller F (2007) What are the longevities of teeth and oral implants? Clin Oral Implants Res 18(Suppl 3):15–19
Luthardt RG, Marre B, Heinecke A, Gerss J, Aggstaller H, Busche E, Dressler P, Gitt I, Hannak W, Hartmann S, Heydecke G, Jahn F, Kern M, Mundt T, Pospiech P, Stark H, Wostmann B, Walter MH (2010) The Randomized Shortened Dental Arch study (RaSDA): design and protocol. Trials 11:15. doi:10.1186/1745-6215-11-15
Walter MH, Weber A, Marre B, Gitt I, Gerss J, Hannak W, Hartmann S, Heydecke G, Huppertz J, Jahn F, Ludwig A, Mundt T, Kern M, Klein V, Pospiech P, Stumbaum M, Wolfart S, Wostmann B, Busche E, Boning K, Luthardt RG (2010) The randomized shortened dental arch study: tooth loss. J Dent Res 89(8):818–822. doi:10.1177/0022034510366817
Wolfart S, Heydecke G, Luthardt RG, Marre B, Freesmeyer WB, Stark H, Wostmann B, Mundt T, Pospiech P, Jahn F, Gitt I, Schadler M, Aggstaller H, Talebpur F, Busche E, Bell M (2005) Effects of prosthetic treatment for shortened dental arches on oral health-related quality of life, self-reports of pain and jaw disability: results from the pilot-phase of a randomized multicentre trial. J Oral Rehabil 32(11):815–822
ASA (1963) New classification of physical status. Anesthesiology 24:111
Löe H, Silness J (1963) Periodontal disease in pregnancy. I Prevalence and severity. Acta Odontol Scand 21:533
Worthington H, Clarkson J, Davies R (1999) Extraction of teeth over 5 years in regularly attending adults. Community Dent Oral Epidemiol 27(3):187–194
Copeland LB, Krall EA, Brown LJ, Garcia RI, Streckfus CF (2004) Predictors of tooth loss in two US adult populations. J Public Health Dent 64(1):31–37
Klein BE, Klein R, Knudtson MD (2004) Life-style correlates of tooth loss in an adult Midwestern population. J Public Health Dent 64(3):145–150
Schatzle M, Loe H, Lang NP, Burgin W, Anerud A, Boysen H (2004) The clinical course of chronic periodontitis. J Clin Periodontol 31(12):1122–1127. doi:10.1111/j.1600-051X.2004.00634.x
Chambrone L, Chambrone D, Lima LA, Chambrone LA (2010) Predictors of tooth loss during long-term periodontal maintenance: a systematic review of observational studies. J Clin Periodontol 37(7):675–684. doi:10.1111/j.1600-051X.2010.01587.x
Müller F, Naharro M, Carlsson GE (2007) What are the prevalence and incidence of tooth loss in the adult and elderly population in Europe? Clin Oral Implants Res 18(Suppl 3):2–14
Eickholz P, Kaltschmitt J, Berbig J, Reitmeir P, Pretzl B (2008) Tooth loss after active periodontal therapy. 1: patient-related factors for risk, prognosis, and quality of outcome. J Clin Periodontol 35(2):165–174. doi:10.1111/j.1600-051X.2007.01184.x
Locker D, Ford J, Leake JL (1996) Incidence of and risk factors for tooth loss in a population of older Canadians. J Dent Res 75(2):783–789
Burt BA, Ismail AI, Morrison EC, Beltran ED (1990) Risk factors for tooth loss over a 28-year period. J Dent Res 69(5):1126–1130
Acknowledgments
This study was supported by the Deutsche Forschungsgemeinschaft (German Research Association), grant DFG WA 831/2-1 to 2-6 and grant DFG WO 677/2-1.1 to 2-2.1.
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The authors declare that they have no conflict of interest.
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Walter, M.H., Hannak, W., Kern, M. et al. The randomized shortened dental arch study: tooth loss over five years. Clin Oral Invest 17, 877–886 (2013). https://doi.org/10.1007/s00784-012-0761-x
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DOI: https://doi.org/10.1007/s00784-012-0761-x