61
HERRERA ET AL .
Available evidence
Feasibility Approaches to restoring edentulous spaces vary according to the knowledge and skills of individual dental practitioners, dental prac- tice/office protocols, and healthcare funding systems which vary widely from country to country. There seem to be challenges, how- ever, for frail populations and the elderly living in care homes. More- over, surgical options as pre-treatment for the restorations (e.g., for implant placement) are not universally available, and may reflect healthcare funding and the financial circumstances of individuals, thereby also reflecting health inequalities. Ethical considerations Many national health systems cover/reimburse the costs for treat- ment of edentulism. However, in some countries, fees for treatment are borne entirely by the individual patient. Economic considerations The costs associated with the restoration of edentulous spaces vary widely according to the type of restoration provided, with removable options (removable dental prostheses) generally costing significantly less than fixed restorations (tooth/implant-supported fixed partial dental prostheses).
Number and design of included studies The evidence underpinning this recommendation includes five RCTs (465 patients), one cross-sectional study, a case – control trial (14 patients) and one prospective case series (248 patients), with all studies consistently highlighting that the restoration of partial edentulism led to an improvement in quality of life. Risk of bias Risk of bias was evaluated via the Cochrane reviewers' Handbook for interventional studies identifying three studies at high risk of bias and three with moderate risk of bias. One case – control study was at low risk of bias (5 stars out of 6) on the Newcastle – Ottawa scale. Effect sizes and their clinical relevance Improvements were consistently statistically significant and the magnitude of improvement was superior to the “ minimally impor- tant difference ” when available, suggesting clinically meaningful effect sizes. There were no randomized studies evaluating treatment, versus no treatment. Thus, pre-operative to post-operative differences were eval- uated in order to assess the impact of the treatment protocol studied. Consistency Overall, studies reported that restoration of partial edentulism with tooth-supported restorations led to an improvement in quality of life. Balance of benefit and harm Benefits and harms were not reported, although it may be speculated that tooth-supported fixed restorations, may be associated with some potential harm due to complications associated with the endodontic and prosthodontic components of the treatment. In the case of implant- supported restorations, potential harms associated with implant place- ment (potential intra- and post-operative complications) and mainte- nance (especially in people affected by periodontitis showing higher risk of peri-implantitis and implant loss) should be carefully considered. However, overall, the perceived benefits in terms of masticatory function and improvements in quality of life appear to exceed the potential harms. Overall certainty of the evidence High (consistency and effect size) to Moderate (quality of the included studies).
Legal considerations Not applicable.
R12.6. Does provision of conventional complete removable prostheses, in one or in both dental arches, improve quality of life in fully edentulous patients when compared with no rehabilitation?
PICOS question addressed by a SR
R12.6: Evidence-based recommendation We recommend providing complete conventional removable prostheses to treat fully edentulous patients (including those who have lost teeth due to periodontitis) , in one or both arches , to improve quality of life . Supporting literature (Gennai et al., 2021) Quality of evidence Moderate Grade of recommendation GradeA — "" Strength of consensus Strong consensus (0% of the group abstained due to potential CoI)
Background
From evidence to recommendation — additional considerations
Intervention
Acceptability Restoration of edentulism is broadly accepted by both patients and institutions and widely requested by patients.
The traditional approach to treating complete edentulism involves rehabilitation with complete conventional removable prostheses. Overall, this approach to treatment is technically less demanding,
Made with FlippingBook Annual report