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HERRERA ET AL .
(Continued) PICOS question addressed by a SR
For the shortened dental arch , five out of seven RCTs present some concerns regarding risk of bias (RoB 2.0 tool), while among the five non-randomized studies, one was judged of high risk, four were judged of moderate risk, and only one was judged of low risk (Newcastle – Ottawa scale). For RDPs , in 10 out of 12 RCTs, some concerns regarding risk of bias (RoB 2.0 tool) were found, while in the nine non-randomized studies, two were judged of high risk, six were judged of moderate risk, and only one was judged of low risk (Newcastle – Ottawa scale). Funding sources and conflict of interest declaration were inconsis- tently 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 patients with no history of periodontitis, the overall mean implant survival rate at a follow-up of at least 5 years is favourable (94.7%, 95% CI [92.3 – 97.1]) and acceptable to counterbalance the risks. For the shortened dental arch , two studies show a lower risk for tooth loss compared with patients with an RDP (odds ratio, OR = 1.92; HR = 1.24), but it was not consistently significant. In a few studies, the shortened dental arch is associated with significantly lower plaque values and/or gingival inflammation compared with RDPs, and less gingival recession, comparing to abutment teeth of RDPs. A shortened dental arch does not necessarily imply lower mas- ticatory efficiency, including nutritional status, or worse OHRQoL compared with patients with RDPs. For RDPs , abutment tooth failure rates of 9% – 48% have been reported in two studies comparing different types of RDPs, but these were not possible to attribute to specific Kennedy class and the differ- ences were not significant. Two studies show a higher risk for tooth loss in patients with an RDP compared with no treatment (OR = 1.92; HR = 1.24), but it was not consistently significant. In a few studies, RDPs are associated with significantly more plaque values and/or gin- gival inflammation, and more recession at abutment teeth with clasps, but not necessarily with more significant other periodontal problems. RDPs do not necessarily increase masticatory efficiency, including nutritional status, or improved OHRQoL compared with a short dental arch. Consistency For iFDPs , sensitivity analysis indicated consistency. For the shortened dental arch , no analysis was possible. For RDPs , no analysis was possible. Balance of benefit and harm Specific analyses on the 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
R9.5: Evidence-based recommendation dental arch , implant-supported restorations or removable dental prostheses) may be considered . Supporting literature (Carra et al., 2021; Gotfredsen et al., 2021; Montero et al., 2021) Quality of evidence Low Grade of recommendation GradeO — $ Strength of consensus Strong consensus (0% of the group abstained due to potential CoI)
Background
Intervention
Interventions include planning towards a shortened dental arch, implant-supported fixed dental prostheses (iFDPs) or RDPs, in peri- odontitis stage IV patients with unilateral or bilateral posterior free-end edentulism. See also the background text of Recommendation R9.1.
Available evidence
Number and design of included studies For iFDPs , evidence is based on 7 prospective and 10 retrospective studies, including accounting for 1718 implants placed in patients with a history of periodontitis and 2879 implants placed in patients with no history of periodontitis. For the shortened dental arch , the evidence is based on seven RCTs and five non-randomized studies (four prospective and one ret- rospective), including from 10 to 79 patients per group at final exami- nation, either having shortened dental arch or restored to shortened dental arch; however, most of the publications included <50 patients/ RPDs per group. Publications report mostly on 1-year data (one study presents 10-year results), in either periodontitis patients or mixed periodontitis/non-periodontitis study populations. For RDPs , evidence is based on 12 RCTs including from 19 to 79 patients/RDP per group at the final evaluation, six prospective cohort studies including from 10 to 703 patients/RDP per group at the final evaluation, and three retrospective studies, including from 15 to 25 patients/RPD per treatment group; however, most of the publica- tions included <50 patients/RPD per group. Most studies reported on Kennedy class I and II. The studies reported on 1 to 10-year results, with several reporting on 5-year data, in either periodontitis patients or peri- odontitis/non-periodontitis study populations. Risk of bias For iFDPs , 10/17 studies (58.8%) were considered at low risk of bias (Newcastle – Ottawa scale). Funding sources and conflict of interest declaration were not reported in the majority of studies.
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