63
HERRERA ET AL .
Available evidence
Ethical considerations The fact that dental implant-supported overdentures are more expensive than complete conventional removable prostheses, may raise some ethical concerns as there may be a gradient of improvement of OHRQoL, for implant-supported overdentures, while for some individuals there are problems with the affordabil- ity of the procedure, thereby impacting adversely upon social inequalities. Economic considerations Restoration of edentulous spaces with implant-retained prostheses is funded in many countries out-of-pocket with costly implications that may limit uptake.
Number and design of included studies The evidence for this recommendation is based on four RCTs (3 cohorts, 342 patients) evaluating implant-supported full-arch over- dentures versus conventional removable prostheses in fully edentu- lous patients. Quality of life was evaluated through OHIP-49 and social impact questionnaires. Risk of bias Risk of bias was evaluated through the Cochrane reviewers' Hand- book for interventional studies identifying two studies at high risk of bias and two with moderate risk of bias. Effect sizes and their clinical relevance Differences in outcome appear socially meaningful and statistically relevant. Consistency Three studies reported significantly greater improvements in quality of life for patients treated with implant-supported overdentures. Balance of benefit and harm Benefits and harms were not reported, although it is plausible that implant placement may be associated with some potential harms. Implant placement procedures may be associated with potential intra- and post-operative complications. Moreover, implants, especially in people previously affected by periodontitis, show higher risk of devel- oping peri-implantitis and implant loss.
Legal considerations Not applicable.
12.2.2 | In people with a minimum of five teeth missing for any reason (including stage IV periodontitis patients), does restoration of edentulous spaces improve systemic health?
R12.8. Is rehabilitation of partial/full edentulism associated with better systemic health (teeth lost for any reason, including stage IV periodontitis)?
PICOS question addressed by a SR
R12.8: Evidence-based recommendation (1), Expert consensus-based recommendation (2) 1. We recommend prosthetically treating fully edentulous people in order to improve nutritional status . 2. We do not know if treating full edentulism is associated with improvement of frailty , cognitive function or other systemic health benefits . Supporting literature (Gennai et al., 2021) Quality of evidence Low Grade of recommendation GradeA — "" (1); Grade O — $ Unclear, additional research needed (2) Strength of consensus Unanimous consensus (0% of the group abstained due to potential CoI)
Overall certainty of the evidence Moderate.
From evidence to recommendation — additional considerations
Acceptability Restoration of edentulism is widely advocated and accepted. How- ever, some patients may not be willing to undergo a surgical proce- dure for implant placement. Feasibility The restoration of edentulous spaces using implant-supported resto- rations is widely undertaken. However, in certain situations, access to surgical treatment may be limited as surgical facilities and skills may not be present in every dental setting. Furthermore, there are a high number of national healthcare systems that do not provide implant treatments. Moreover, implants require supportive maintenance care in all patients, but especially in those previously affected by periodon- titis, which may not always be accessible.
Background
Intervention
People with untreated edentulism exhibit a higher prevalence of malnutri- tion, frailty and cognitive impairment compared with those who have been treated for complete edentulism. Restoration of complete edentulism sig- nificantly reduces the number of patients at risk of malnutrition.
Made with FlippingBook Annual report