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HERRERA ET AL .
R9.3. For question, see R9.1
abutment teeth. Depending on the occlusal situation and the available space, abutment teeth should be provided with a shallow occlusal rest preparation. On the resulting situation model, which is used to fabricate the interim RDP, teeth to be extracted are removed in plaster, and clasps are manually bent. These clasps with occlusal rests ensure sufficient sta- bility during the phase of tissue remodelling, after which relining of the prosthesis basis or fabrication of a definitive RDP is frequently indicated. After successful periodontal therapy and when post-extraction tissue changes have occurred, the interim prosthesis can be replaced by a defini- tive RDP. For retention of the RDP, 2 – 4 abutment teeth with good prog- nosis and a wide spread (distributed anterior and posterior) are used. The retention element is selected depending on the condition of the coronal tooth substance, aesthetic demands and financial conditions: • An intact, caries-free tooth is best provided with a clasp or an adhe- sive attachment (Zitzmann et al., 2009). While a clasp abutment tooth can have fillings of small extent, a tooth intended for an adhesive ele- ment with an extra-coronal attachment should have sound enamel surfaces to ensure adhesive cementation. These resin-bonded attach- ments for precision-retained RPD are compatible with periodontal health, ensure occlusal rests, require minimal tooth preparation and provide very good aesthetics results. To ensure periodontal health, clasps are designed with vertical support by an occlusal rest (ideally located on sound tooth structure), and a stiff reciprocal part neutraliz- ing lateral forces during prosthesis insertion and removal. • Decayed teeth and those with extended fillings are better restored with telescopes or crowns with clasps (Zitzmann et al., 2009). • For abutment teeth with a destroyed clinical crown, root canal treatment is frequently required and the root cap provided with a post and a retentive element is the most appropriate solution to retain the RDP (overdenture).
PICOS question addressed by a SR
R9.3: Evidence-based recommendation We suggest using implant-supported fixed dental prostheses when abutment teeth are not periodontally maintainable and restorable . Supporting literature (Carra et al., 2021) Quality of evidence Low Grade of recommendation GradeB — " Strength of consensus Strong consensus (2.1% of the group abstained due to potential CoI)
Background
Intervention
Rehabilitation with iFDP, in periodontitis stage IV partially edentulous patients, with one or multiple tooth-delimited gaps, and abutment teeth that are not periodontally maintainable and restorable. For further detail, see the sections dealing with implant-supported fixed dental prostheses in the background text for Recommendation R9.1.
R9.4. For question, see R9.1
PICOS question addressed by a SR
R9.4: Evidence-based recommendation Metal-based frame removable dental prostheses may be considered as transitional or definitive treatment options when a fixed solution is not a consideration . Supporting literature (Gotfredsen et al., 2021) Quality of evidence Low Grade of recommendation GradeO — $ Strength of consensus Consensus (0% of the group abstained due to potential CoI)
For further detail, see the sections dealing with RDP in the back- ground text for Recommendation R9.1.
9.2 | Clinical recommendations for case type 3 with unilateral or bilateral posterior free-end edentulism
Background
R9.5. In patients with a periodontally compromised dentition due to stage IV periodontitis or equivalent, what is the efficacy of various prosthetic restorative options for the rehabilitation of unilateral or bilateral posterior free-end edentulism?
Intervention
Patients diagnosed with stage IV periodontitis frequently require an interim RDP to ensure chewing function by increasing the number of occlusal units (antagonistic pairs in pre-molar and molar region) and/or to replace anterior teeth for aesthetic reasons. Steps 1 and 2 of periodontal therapy are accompanied by a reduction in inflammation and swelling, which becomes frequently visible as gingival recession, while tooth extractions lead to remodelling of the alveolar bone associated with morphological tissue changes. In the light of this back- ground, any interim RDP has to be designed with an occlusal rest on the residual dentition to prevent the prosthesis from sinking into the mucosal tissue and subsequent trauma to periodontal tissues and teeth. Before taking the initial impression or intra-oral scan, the inter-maxillary situation needs to be evaluated and teeth with a good prognosis are considered as
(Common question for Recommendations R9 . 5 , R9 . 6 , R9 . 7)
PICOS question addressed by a SR
R9.5: Evidence-based recommendation For the rehabilitation of partially edentulous stage IV periodontitis patients with free-end situations , different options (namely shortened
(Continues)
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