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Available evidence
reported; however, it was not possible to attribute specific rates to a particular Kennedy class or type of RDP. In another RCT, specifically reporting on Kennedy class III or IV RDPs, an abutment failure rate of 9% – 15% was reported. However, it was not possible to attribute spe- cific rates to a particular Kennedy class; the risk for failure was higher at non-vital compared with vital abutment teeth (HR = 2.29). Consistency For iFDPs , sensitivity analysis indicated consistency. For tFDPs , a significant publication bias was observed for the main outcome measure (i.e., tooth loss). For RDPs , no analysis of the consistency was possible based on the available evidence. Balance of benefit and harm S pecific analyses on benefit/risk ratios, comparing different options for the rehabilitation of unilateral or bilateral posterior free-end edentulism, were not the focus of the SRs. For iFDPs , potential harms related to surgery (e.g., intra- and post-operative complications) and peri-implant health maintenance (e.g., higher risk of peri-implantitis and implant loss over time) should be considered. For tFDPs , technical complications (e.g., loss of retention, frame- work fracture, porcelain fracture, etc.) presented a WMI = 13.6% ( n = 10 studies; 95% CI [8.3; 18.9]) and seemed to be more frequent than biologic complications (e.g., caries, endodontic failure, root fracture, etc.) that presented a WMI = 5.1%( n = 7 studies, 95% CI [2.5; 7.8]). RDPs do not necessarily cause further periodontal breakdown or tooth loss. There is no information in the studies (having also included Kennedy class III or IV RDPs) on whether masticatory efficiency, including nutritional status, or OHRQoL were improved.
Number and design of included studies For implant-supported fixed dental prostheses (iFDPs) (Carra et al., 2021), evidence is based on 7 prospective and 10 retrospective studies, reporting on 1718 implants placed in patients with a history of periodontitis and 2879 implants placed in patients with no history of periodontitis. For tooth-supported fixed dental prostheses (tFDPs) (Montero et al., 2021), evidence is based on one RCT, one CCT, four prospective case series and 14 retrospective case series, including data from 1029 subjects at baseline, with a total of 1037 tFPDs, including 3186 abut- ment teeth. The follow-up ranged between 24 and 425 months. At the end of the follow-up period, 933 subjects with 915 tFPDs on 2989 abutment teeth were analysed. For removable dental prostheses (RDPs) (Gotfredsen et al., 2021), evidence is based on three prospective (one RCT/two non-randomized) and one retrospective study that specifically reported having also included Kennedy class III or IV RDPs (including minimum 175 to maximum 234, in total), and reporting on 1 – 5 years results, in either exclusively periodontitis patients or in mixed peri- odontitis/non-periodontitis study populations. Several studies did not specify the type of Kennedy class. Risk of bias For iFDPs , 10 of 17 studies (58.8%) were considered at low risk of bias (Newcastle – Ottawa scale). Funding sources and conflict of inter- est declaration were not reported in the majority of studies. For tFDPs , all investigations ( n = 20) presented an unclear or high risk of bias, using the RoB 2.0 tool, the ROBINS-I tool or the Newcastle – Ottawa scale. For RDPs , all four publications that specifically reported having also included Kennedy class III or IV RDPs were judged being of moderate risk of bias (the RCT with the RoB 2.0 tool and the three non- randomized studies with the Newcastle – Ottawa scale). Funding sources and conflict of interest declaration were inconsistently reported. Effect sizes and their clinical relevance For iFDPs , although the risk of peri-implantitis and implant loss is greater in patients with a history of periodontitis compared with sub- jects with no history of periodontitis, the overall mean implant survival rate at a follow-up of at least 5 years is favourable (94.7% [92.3% – 97.1%]) and acceptable to counterbalance the risks. For tFDPs , the incidence of abutment tooth loss after a follow-up period from 2 to 35.4 years was low ( n = 17 studies; weighted mean incidence (WMI) = 4.8%; 95% CI [3.2; 6.5]). The corresponding figure for prosthesis failure was WMI = 6.9% ( n = 18 studies; 95% CI [4.1; 9.7]). Therefore, tFDPs seemed to be a valid alternative to restore function in patients with stage IV periodontitis. For RDPs , in one publication (a prospective cohort study), out of the four publications that specifically reported having also included Ken- nedy class III or IV RDPs, an abutment tooth failure rate (defined as abutment tooth restoration or loss) ranging from 16% to 48% was
Overall certainty of the evidence For iFDPs , the certainty of evidence is moderate. For tFDPs , the certainty of evidence is low. For RDPs , the certainty of evidence is low.
From evidence to recommendation — additional considerations
Acceptability iFDPs are acceptable, and a widespread option for rehabilitation of partial edentulism in patients with stage IV periodontitis. Little is known about patients' preferences and satisfaction. Patient satisfaction was considered in seven studies evaluating tFDPs , using questionnaires related to chewing function, aes- thetics, phonetics, comfort and/or general satisfaction. In general, more than 85% of the patients were satisfied with the treatment provided or reported positive results for the different outcomes evaluated. RDPs are acceptable and a widespread option for rehabilitation of partial edentulism in patients with stage IV periodontitis. Little is known about patients' preferences and satisfaction.
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