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universally accessible and associated with lower costs than implant- supported overdentures.
they are safe and effective and the positive changes in quality of life reported improve their acceptability. In some patients, however, the lack of retention associated with the prosthesis may constitute an important psychological issue. Feasibility Complete conventional RDPs are routinely provided by dentists worldwide. The design and provision of these prostheses are practical, time-effective and safe. Importantly, the relatively modest costs asso- ciated with this type of rehabilitation significantly allow its widespread feasibility.
Available evidence
Number and design of included studies The evidence supporting this recommendation is based on a system- atic review and meta-analysis (Gennai et al., 2021), 44 studies, of which eight were interventional and 36 observational. Risk of bias Risk of bias was evaluated through the Cochrane reviewers' Handbook for interventional studies and the Newcastle – Ottawa scale for observa- tional studies. Overall, studies were judged to be of moderate to high risk of bias and none of the manuscripts included were found to be at low risk of bias. Interventional studies were judged to be of moderate to high risk of bias as these studies showed on average 45% of items that were considered adequate. The observational studies showed 57% of items judged positively, thereby indicating a moderate overall risk of bias. Effect sizes and their clinical relevance The effect measured through psychometric questionnaires was both statistically significant and clinically meaningful as significant changes of GOHAI, OHIP-14 and OHIP-49 were noticed after rehabilitation. Based on the analysis, the magnitude of the effect is considered as relevant for the patient, since it was superior, on average, to the value of the “ minimally important difference ” , as explained before (Tsakos et al., 2012). Consistency There is a high level of consistency throughout the selected studies. None of the studies reported an absence of effect. Indeed, all the studies reported significant improvements in the various psychometric questionnaires used. Balance of benefit and harm Harms associated with treatment of edentulism with complete conven- tional removable prostheses are negligible. Patients may have temporary difficulties in adapting to new prostheses. Moreover, poorly fitting com- plete conventional removable prostheses may be a cause of discomfort.
Ethical considerations Not applicable.
Economic considerations Complete conventional RDPs are the least expensive form of treatment to rehabilitate fully edentulous patients. Many national health systems cover/reimburse the costs of treating edentulism. However, in some countries, treatment fees may have to be borne entirely by the patient.
Legal considerations Not applicable.
R12.7. Are implant-supported full-arch removable dental prosthesis (overdenture) superior to conventional full-arch removable prostheses in terms of improvement of quality of life?
Additional question raised by the WG
R12.7: Expert consensus-based recommendation We suggest treating fully edentulous people (including those affected by periodontitis) with implant-supported full-arch removable dental prosthesis (overdenture) , rather than conventional full-arch removable prostheses , to improve quality of life . Supporting literature (Awad et al., 2000; Heydecke et al., 2005; Allen et al., 2006; Harris et al., 2013; Muller et al., 2013), included in the systematic review (Gennai et al., 2021) Quality of evidence Moderate Grade of recommendation GradeB — " Strength of consensus Unanimous consensus (14.6% of the group abstained due to potential CoI)
Overall certainty of the evidence High.
Background
From evidence to recommendation — additional considerations
Intervention
Implant-supported full-arch RDPs ( “ overdentures ” ) are frequently advocated to overcome complications associated with complete conventional removable prostheses, such as fit, aesthetics and masti- catory function.
Acceptability Complete conventional RDPs are traditionally the most commonly used method of rehabilitation for fully edentulous patients. In general,
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