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HERRERA ET AL .
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| CLINICAL RECOMMENDATIONS:
Effect sizes and their clinical relevance Based on three studies ( n = 165 patients), tooth loss over a period of 12.7 years was estimated at 4.9% (95% CI [2; 14]). Based on four studies ( n = 415 patients), loss of restoration over an observation period of 9.7 years was estimated at 4.6% (95% CI [2; 14]). During an observation period of 7.2 years in three studies ( n = 365 patients), the overall occurrence of technical complications at the restoration level was 8.0% (95% CI [6; 11]). Consistency Results were consistent across studies. The evidence considered has been generated by a small group of investigators and external applica- bility is unclear. Balance of benefit and harm High survival rates and low incidence of complications were observed. PROMs were not considered in the available studies. A tooth-supported fixed restoration may not address some functional and/or aesthetic needs in specific patients (e.g., when in need for facial tissue and lip sup- port, or in cases of soft tissue deficiencies or long abutment teeth). Overall certainty of the evidence The certainty of evidence is graded as low based on the observational, retrospective design of studies and the high risk of bias.
CASE TYPE 4
Case type 4: partially edentulous patients who need to be restored with full-arch rehabilitation, either tooth- or implant-retained. R10.1. In patients with a compromised dentition due to stage IV periodontitis with a sufficient number of adequately distributed teeth, what is the performance of tooth-supported full-arch fixed prostheses?
PICOS question addressed by a SR
R10.1: Evidence-based recommendation In patients with periodontitis stage IV with a sufficient number ( ≥ 4 abutment teeth) of periodontally maintainable , bilaterally distributed and restorable teeth in the maxilla and/or mandible , we suggest a tooth-supported full-arch fixed dental prosthesis . Supporting literature (Montero et al., 2021; Tomasi et al., 2021) Quality of evidence Low Grade of recommendation GradeB — " Strength of consensus Consensus (1.6% of the group abstained due to potential CoI)
From evidence to recommendation — additional considerations
Background
Intervention
Acceptability PROMs were not reported in the identified studies (Tomasi et al., 2021). Data summarized by Montero et al. (2021) on tooth-supported fixed par- tial and full-arch prostheses suggest a high rate of patient satisfaction.
Tooth-supported full-arch fixed prostheses were used to restore func- tion and aesthetics. The treatment strategy commonly included the use of a fixed interim restoration during the early steps of periodontal therapy.
Feasibility Related procedures are clinically and technically demanding.
Available evidence
Ethical considerations Not applicable.
Number and design of included studies Seven studies ( n = 522 patients), with a weighted mean follow-up period of 8.6 years, were included. All studies were of observational and retrospective design and outcome measures included tooth loss, loss of restoration and occurrence of technical complications. Biologi- cal complications, PROMs, health-economic parameters and adverse events were not consistently reported. Risk of bias All included studies were judged to have a high risk of bias, mainly due to confounding and outcome assessment.
Economic considerations Health-economic parameters were not evaluated in the identified studies. Different restorative materials and technical approaches may increase affordability. Due to the complexity of execution and cost of tooth-supported full-arch fixed prostheses, some patients may elect to proceed with palliative care consisting of a transitional denture retained by few residual teeth or a full denture.
Legal considerations Not applicable.
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