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83.3 months) and from 38% to 100% at prosthesis level (weighted mean follow-up 75.2 months).
R10.2. In patients with a compromised dentition due to stage IV periodontitis, what is the performance of tooth-supported full-arch removable prostheses?
Consistency Treatment strategies varied across studies and sensitivity analyses were not feasible. The evidence considered has been generated by a small group of investigators and external validity is unclear. Balance of benefit and harm The evidence suggests heterogeneous outcomes in terms of prosthe- sis and tooth survival. The lack of information on complications should be considered. Overall certainty of the evidence The certainty of evidence is graded as very low based on study design, heterogeneous outcomes and high risk of bias.
PICOS question addressed by a SR
R10.2: Evidence-based recommendation In periodontitis stage IV patients with an insufficient number/distribution of periodontally maintainable teeth to support a tooth-supported full- arch fixed dental prosthesis , a tooth-supported full-arch removable dental prosthesis (overdenture) may be considered . Supporting literature (Donos et al., 2021) Quality of evidence Very low Grade of recommendation GradeO — $ Strength of consensus Strong consensus (0% of the group abstained due to potential CoI)
From evidence to recommendation — additional considerations
Background
Intervention
Acceptability PROMs were reported in nine of the included studies. The tools used to assess PROMs were not validated and inconsistent across studies.
In patients with an insufficient number and/or distribution of peri- odontally maintainable teeth to support a full-arch fixed prosthesis in the maxilla/mandible, clinicians may consider a tooth-supported removable full-arch prosthesis (TSRP). TSRP can be performed through different retention/attachment systems (e.g., ball-cap, mag- netic) and the abutment teeth may or may not be splinted.
Feasibility Related procedures are clinically and technically demanding.
Ethical considerations The preservation of abutment teeth might offer a psychological bene- fit for patients who are transitioning to edentulism. Economic considerations Health-economic parameters were not evaluated in the identified stud- ies. TSRPs entail costs related to periodontal and prosthetic treatment.
Available evidence
Number and design of included studies Twenty-two studies (10 prospective and 12 retrospective studies) were included reporting on 4579 abutment teeth and 1660 TSRPs. The pro- spective studies had a weighted mean follow-up of 36.9 months for tooth survival and 86.5 months for prosthesis survival, while the retro- spective studies had a weighted mean follow-up of 83.3 months for tooth survival and 75.2 months for prosthesis survival. Outcome mea- sures included tooth loss and loss of restoration. Occurrence of techni- cal and biological complications as well as PROMs and health-economic parameters and adverse events were not consistently reported. Risk of bias All included studies were judged to present with a high risk of bias. Effect sizes and their clinical relevance The prospective studies suggested a tooth survival rate (tooth level) ranging from 86% to 100% over a weighted mean follow-up of 36.9 months. The retrospective studies showed a range of survival from 34% to 94% at tooth level (weighted mean follow-up
Legal considerations Not applicable.
R10.3. In patients with a compromised dentition due to stage IV periodontitis in whom tooth preservation was deemed impossible, what is the performance of implant-supported full-arch fixed prostheses?
PICOS question addressed by a SR
R10.3: Evidence-based recommendation In periodontitis stage IV patients in whom tooth preservation was deemed impossible , and a sufficient number ( ≥ 4) of bilaterally distributed and adequately sized dental implants are planned in the maxilla and/or mandible , we suggest an implant-supported full-arch fixed dental prosthesis .
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