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Available evidence
Ethical considerations Restoration of edentulous spaces should be advocated, especially in elderly populations, to improve masticatory function, improve nutri- tional status and reduce the likelihood of frailty. Economic considerations Restoration of edentulous spaces/edentulism incurs a wide range of costs dependent upon the type of restoration provided.
Number and design of included studies Evidence for malnutrition derives from one RCT (34 patients), one pro- spective cohort study (51 patients), and one cross-sectional study (343 patients) utilizing the Mini Nutritional Assessment (MNA), a vali- dated instrument covering numerous aspects of the patient's general health, nutritional state and habits. Evidence for frailty derives from a cross-sectional study (1026 patients) assessing frailty with the Groening Frailty Indicator. Cognitive Impairment was assessed in 240 patients with Mini-Mental Status Examination in a cross-sectional study. Risk of bias Risk of bias was evaluated through the Cochrane and Newcastle – Ottawa scale according to study design. A moderate to high risk of bias was detected. Intervention studies showed 50% of items as ade- quate, generating a moderate risk of bias. Observational studies were judged as moderate to high risk of bias as they reported a range of adequate items varying from 4 to 7. Effect sizes and their clinical relevance Treatment reduces the proportion of people at risk of malnutrition to a significant extent. Consistency Studies are limited in number but consistent in detecting enhance- ment of nutritional status after rehabilitation. Levels of frailty, cogni- tive impairment and malnutrition are higher in untreated edentulous subjects. Balance of benefit and harm The potential harms of any restoration are outweighed by the benefits of reducing malnutrition.
Legal considerations Not applicable.
ACKNOWLEDGEMENTS The authors express their gratitude to all reviewers involved in the preparation of the systematic reviews and sincerely thank those orga- nizations that participated in the guideline development process: Council of European Chief Dental Officers, Council of European Den- tists, European Association for Osseointegration, European Dental Students' Association, European Federation of Conservative Den- tistry, European Prosthodontic Association, European Society for Endodontology, Platform for Better Oral Health in Europe. CONFLICT OF INTEREST Individual potential conflict of interest forms were completed by all participants and are available on file at the European Federation of Periodontology and extracted in the Supporting Information, available online ( CPGstage4- Potential conflict of interest ). Potential conflicts of interest, in the previous 36 months, reported by the chairs of the workshop (in alphabetic order) are listed here: Tord Berglundh (Chair) reports — Grants or contracts from any entity: Dentsply Implants IH AB (Institution grants); Consulting fees: Dentsply Implants IH AB (Personal); Payment or honoraria for lec- tures, presentations, speakers bureaus, manuscript writing or educa- tional events: Dentsply Implants IH AB, Straumann (Lecture, personal); Leadership or fiduciary role in other board, society, commit- tee or advocacy group, paid or unpaid: National Board of Health and Welfare, Sweden, National guidelines in dentistry — periodontal and peri-implant diseases (Institution grant). Iain Chapple (Chair) reports — Grants or contracts from any entity: GSK (Three grants for clinical research); Unilever (One grant for clinical research); Royalties or licences: Quintessence Book (Royalties); Consulting fees: J&J, GSK, Unilever (Consultancy fees); Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: P&G, Philips Oral Healthcare, Unilever (Sponsored Lecture Fees); Patents planned, issued or pending: Patents (Filed with Philips Oral Healthcare); Lead- ership or fiduciary role in other board, society, committee or advo- cacy group, paid or unpaid: British Society of Periodontology, EFP, UK Oral and Dental Research Trust; Other financial or non-financial interests: Non-financial (my wife runs Oral Health Innovations that has the licence for PreViser and DEPPA risk assessment software in theUK).
Overall certainty of the evidence Low.
From evidence to recommendation — additional considerations
Acceptability Restoration of edentulism is widely accepted and requested by patients to enhance masticatory function and improve nutritional status. Feasibility The restoration of edentulous spaces/edentulism is widely under- taken and techniques and methods vary significantly among different countries, dental settings and healthcare systems. Overall, the vast majority of the population in many countries benefit from restoration of their edentulous spaces/edentulism.
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