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HERRERA ET AL .
Legal considerations Not applicable.
(e.g., higher risk of peri-implantitis and implant loss over time) should be considered. Preserving- or restoring to a shortened dental arch , does not nec- essarily cause further periodontal breakdown or tooth loss, but is also not necessarily associated with reduced masticatory efficiency or nutritional status, or reduced OHRQoL. RDPs do not necessarily cause further periodontal breakdown or tooth loss but are also not necessarily associated with increased masticatory efficiency, including nutritional status, or improve OHRQoL. Overall certainty of the evidence For iFDP , the certainty of evidence is moderate. For the shortened dental arch , the certainty of evidence is low. For RDPs , the certainty of evidence is low.
R9.6. For question, see R9.5
PICOS question addressed by a SR
R9.6: Evidence-based recommendation In stage IV periodontitis patients with a shortened dental arch with sufficient occluding/masticatory units (e.g., from second pre-molar to second pre-molar , no evident risk for flaring or tooth elongation and adequate patient comfort) no tooth replacement may be considered in the free-end situation . Supporting literature (Kayser, 1981; Walter et al., 2018; Walter et al., 2020; Gotfredsen et al., 2021) Quality of evidence Low Grade of recommendation GradeO — $ Strength of consensus Simple majority (0% of the group abstained due to potential CoI)
From evidence to recommendation — additional considerations
Background
Acceptability iFDPs are acceptable, and a widespread option for rehabilitation of partial edentulism in patients with periodontitis. Little is known about patients' preferences and satisfaction. No restorative treatment or restoring to a shortened dental arch intervention is an acceptable treatment option associated with little risks. Little is known about patients' preferences and satisfaction. RDPs are acceptable and a widespread option for rehabilitation of partial edentulism in patients with periodontitis. Little is known about patients' preferences and satisfaction. Feasibility iFDPs are demanding in terms of professional competency and resources. Restoring to a shortened dental arch may not be a very demand- ing treatment option. RDPs are less demanding comparing to tooth- or implant- supported fixed dental prostheses.
Intervention
No restorative treatment in situations with sufficient occluding/ masticatory units. See the background text for Recommendation R9.5.
R9.7. For question, see R9.5
PICOS question addressed by a SR
R9.7: Evidence-based recommendation In stage IV periodontitis patients with free-end situations who require additional occluding units , we suggest implant-supported fixed dental prostheses . When implants are not an option , we suggest removable dental prostheses with a metal-based framework . Supporting literature (Carra et al., 2021; Gotfredsen et al., 2021) Quality of evidence Low Grade of recommendation GradeB — " /GradeB — " Strength of consensus Strong consensus (1.9% of the group abstained due to potential CoI)
Ethical considerations Not applicable.
Background
Intervention
Economic considerations iFDPs imply additional costs that are not covered by healthcare sys- tems in most countries and may be source of inequality. No restorative treatment or restoring to a shortened dental arch may be the most economical solution. RDPs are more economical comparing to tooth- or implant- supported fixed dental prostheses and often covered (at least par- tially) from most healthcare systems.
Interventions include implant-supported fixed dental prostheses or RDPs with a metal-based framework, to restore free-end partial edentulism in periodontitis stage IV patients. See the background text of Recommendation R9.1 for information on implant-supported fixed dental prostheses, and the background text of Recommendation R9.5 for information on RDPs, respectively.
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