45
HERRERA ET AL .
(Continued) PICOS question addressed by a SR
Balance of benefit and harm High survival rates of restorations and implants were observed. The high rate of technical complications over short observation periods should be considered, as should be the limited information on PROMs. An implant-supported fixed restoration may not address some func- tional and/or aesthetic needs in specific patients (e.g., when in need for facial tissue and lip support, or in cases of soft tissue deficiencies). Overall certainty of the evidence The certainty of evidence is graded as low based on study design and limited follow-up periods.
R10.3: Evidence-based recommendation Supporting literature (Ramanauskaite et al., 2021; Tomasi et al., 2021) Quality of evidence Low Grade of recommendation GradeB — " Strength of consensus Consensus (33.3% of the group abstained due to potential CoI)
Background
From evidence to recommendation — additional considerations
Intervention
Implant-supported full-arch fixed prostheses were used to restore function and aesthetics on ≥ 4 implants in the same jaw. Prosthetic restorations were predominantly screw-retained and installation pro- tocols, that is, immediate versus delayed implant installation, varied across studies.
Acceptability PROMs were reported in two studies ( n = 22 patients), indicating a high level of patient satisfaction. Feasibility Related procedures are demanding in terms of professional compe- tence and resources.
Available evidence
Number and design of included studies Nineteen studies ( n = 1189 patients) with a weighted mean follow-up period of 3.6 years were included. The majority of studies were obser- vational and designed as prospective case series. Consistently reported outcome measures included loss of implants, loss of restorations and occurrence of technical and biological complications. Data on PROMs and health-economic parameters were not consistently reported. Risk of bias All included studies were judged to present with a high risk of bias, mainly due to confounding and outcome assessment. Effect sizes and their clinical relevance Based on 15 studies ( n = 670 patients), implant loss over an observa- tion period of 3.9 years was estimated at 3.5% (95% CI [2; 7]). Loss of restorations, as reported in nine studies ( n = 766 patients), was esti- mated to be 4.6% (95% CI [1; 18]) during an observation period of 3.2 years. Over a follow-up period of 2.6 years (9 studies, 723 patients), technical complications affected 41.7% (95% CI [25; 68]) of all restora- tions. Biological complications were evaluated in 12 studies ( n = 984 patients), covering a time period of 3.1 years and 8.5% (95% CI [5; 13]) of all implants developed at least one biological complication. Consistency Results were consistent across studies. The evidence considered has been generated by a small group of investigators and external applica- bility is unclear.
Ethical considerations Not applicable.
Economic considerations Health-economic parameters were evaluated in one ( n = 56 patients) of the identified studies.
Legal considerations Not applicable.
R10.4. 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 removable prostheses?
PICOS question addressed by a SR
R10.4: Evidence-based recommendation In periodontitis stage IV patients in whom tooth preservation was deemed impossible and adequately sized dental implants can be used , albeit not in sufficient number and/or adequate position to support a full-arch fixed dental prosthesis , an implant-supported full-arch removable dental prosthesis (overdenture) may be considered . Supporting literature (Donos et al., 2021; Ramanauskaite et al., 2021) Quality of evidence Very low Grade of recommendation GradeO — $ Strength of consensus Strong consensus (37.0% of the group abstained due to potential CoI)
Made with FlippingBook Annual report