OBJECTIVES:Although the shortened dental arch (SDA) concept is a widely accepted strategy to avoid overtreatment, little is known on its impact on oral health-related quality of life (OHRQoL). This multicenter randomized controlled trial aimed to investigate the OHRQoL for removable partial dental prostheses (RPDP) with molar replacement versus the SDA concept.MATERIAL AND METHODS:In both groups, missing anterior teeth were replaced with fixed dental prosthesis. Two hundred fifteen patients with bilateral molar loss in at least one jaw were included. The Oral Health Impact Profile (OHIP-49) was completed before; 6 weeks (baseline), 6 months, and 12 months after treatment; and thereafter annually until 5 years.RESULTS:Of the initial cohort, 81 patients were assigned to the RPDP group and 71 to the SDA group (age, 34 to 86 years). Before treatment, the median OHIP score was similar in both groups (RPDP, 38.0; SDA, 40.0; n.s.). Results indicate marked improvements in OHRQoL in both groups between pretreatment and baseline (RPDP, 27.0; SDA, 19.0; p ≤ 0.0001) which continued in the RPDP group until the 1-year follow-up (p = 0.0002). These significant reductions in OHIP scores are reflected in its subscales. No further differences were seen within and between groups during the remainder observation period.CONCLUSION:Both treatments show a significant improvement in OHRQoL which continued in the RPDP group until the 1-year follow-up. No significant differences were seen between groups.CLINICAL RELEVANCE:For improving OHRQoL, it is not necessary to replace missing molars with a RPDP.

In a multicentre randomised trial (German Research Association, grants DFG WA 831/2-1 to 2-6, WO 677/2-1.1 to 2-2.1.; controlled-trials.com ISRCTN97265367), patients with complete molar loss in one jaw received either a partial removable dental prosthesis (PRDP) with precision attachments or treatment according to the SDA concept aiming at pre-molar occlusion. The objective of this current analysis was to evaluate the influence of different treatments on periodontal health. Linear mixed regression models were fitted to quantify the differences between the treatment groups. The assessment at 5 years encompassed 59 patients (PRDP group) and 46 patients (SDA group). For the distal measuring sites of the posterior-most teeth of the study jaw, significant differences were found for the plaque index according to Silness and Löe, vertical clinical attachment loss (CAL-V), probing pocket depth (PPD) and bleeding on probing. These differences were small and showed a slightly more unfavourable course in the PRDP group. With CAL-V and PPD, significant differences were also found for the study jaw as a whole. For CAL-V, the estimated group differences over 5 years amounted to 0.27 mm (95% CI 0.05; 0.48; P = 0.016) for the study jaw and 0.25 mm (95% CI 0.05; 0.45; P = 0.014) for the distal sites of the posterior-most teeth. The respective values for PPD were 0.22 mm (95% CI 0.03; 0.41; P = 0.023) and 0.32 mm (95% CI 0.13; 0.5; P = 0.001). It can be concluded that even in a well-maintained.patient group statistically significant although minor detrimental effects of PRDPs on periodontal health are measurable.

PURPOSE:This study aimed to compare the long-term outcomes of two different nonimplant treatments in the bilateral shortened dental arch (SDA).MATERIALS AND METHODS:In a multicenter randomized controlled clinical trial, patients with complete molar loss in one arch were assigned to one of two different nonimplant treatments. In the partial removable dental prosthesis (PRDP) group, patients were provided with a distal-extension prosthesis retained with precision attachments. In the SDA group, patients were treated according to the SDA concept by preserving or restoring a premolar occlusion.RESULTS:Of the 152 treated patients, 82 reached the 10-year examination independent of their dental or prosthetic status. In the intention-to-treat analysis, the survival rates for tooth loss at 10 years were 0.44 (95% confidence interval [CI]: 0.30 to 0.56) in the PRDP group and 0.52 (95% CI: 0.37 to 0.65) in the SDA group. For tooth loss in the study arch, the survival rates were 0.67 (95% CI: 0.52 to 0.78) in the PRDP group and 0.60 (95% CI: 0.45 to 0.73) in the SDA group. The number of teeth lost was higher than expected. In a multivariate analysis using a multiple Cox regression model, the covariates age (unit: 1 year, Hazard Ratio [HR]: 1.033, P = .03) and DMFT value (unit: 1 tooth, HR: 1.121, P = .03) were significant for time to first tooth loss in the study arch.CONCLUSION:The results suggest an overestimation of the influence of the prosthetic management of the bilateral SDA. In treatment decisions, patient preferences should be considered with appropriate weight.

The scientific evidence concerning prosthodontic care for the shortened dental arch (SDA) is sparse. This randomized multicenter study aimed to compare two common treatment options: removable partial dental prostheses (RPDPs) for molar replacement vs. no replacement (SDA). One of the hypotheses was that the follow-up treatment differs between patients with RPDPs and patients with SDAs during the 5-year follow-up period.Two hundred and fifteen patients with complete molar loss in one jaw were included in the study. Molars were either replaced by RPDPs or not replaced according to the SDA concept.A mean number of 4.2 (RPDP) and 2.8 (SDA) treatments for biological or technical reasons occurred during the 5-year observation time per patient. Concerning the biological aspect, no significant differences between the groups could be shown, whereas treatment arising from technical reasons was significantly more frequent for the RPDP group. When the severity of treatment was analyzed, a change over time was evident. When, at baseline, only follow-up treatment with minimal effort is required, over time there is a continuous increase to moderate and extensive effort observed for both groups (Controlled-trials.com number ISRCTN97265367).

Despite the success in preventing oral diseases, the prevalence of tooth loss in the German population remains high and increases with age. Today, the advances in prosthetic dentistry allow necessary tooth replacement following preventive strategies-after considering benefits and risks. Modern treatment options improve the overall prognosis of the stomatognathic system and the quality of life of the affected patients significantly. Hereby, adverse iatrogenic effects can be minimized or even completely avoided by extending the traditional treatment spectrum, e.g., using adhesively fixed restorations and implant-supported restorations, and refraining from placing restorations that are unnecessary from the medical point of view. Generally, patients benefit greatly from prosthetic treatment and the achieved health gain is remarkably high. It encompasses not only the recovery of the impaired oral functions but also extends to the whole human organism, including nutrition, digestion, musculoskeletal system, as well as mental and social well-being.

Trotz aller Erfolge in der Prävention von Zahnerkrankungen hat der Zahnverlust auch heute noch eine hohe Prävalenz in der deutschen Bevölkerung, die mit zunehmendem Lebensalter kontinuierlich steigt. Der medizinische Fortschritt in der prothetischen Zahnmedizin ermöglicht heute den notwendigen Ersatz fehlender Zähne mit präventionsorientierten Strategien unter konsequenter Gegenüberstellung von Nutzen und Risiken. Hier verbessern moderne Therapiemittel die Gesamtprognose des Kauorgans und die Lebensqualität der betroffenen Patienten deutlich. Die iatrogene Schädigung wird dabei so gering wie möglich gehalten. Iatrogene Schädigungen werden vor allem durch die Erweiterung des konventionellen prothetischen Behandlungsspektrums mittels adhäsiv befestigter und implantatgetragener Therapiemittel sowie durch den Verzicht auf medizinisch nicht erforderlichen Zahnersatz minimiert oder sogar vermieden. Der Gesundheitsgewinn durch zahnärztlich-prothetische Therapiemittel ist für die betroffenen Patienten in der Regel außerordentlich hoch und beinhaltet nicht nur die Wiederherstellung der durch Zahnverlust eingeschränkten orofazialen Funktionen, sondern erstreckt sich auf den gesamten menschlichen Organismus. Dabei sind vor allem Ernährung, Verdauung, Bewegungsapparat und psychisches und soziales Wohlbefinden zu nennen.

Für die Rehabilitation der verkürzten Zahnreihe eignen sich fest- sitzender, auf natürlichen Zähnen oder Implantaten verankerter Zahnersatz, herausnehmbare Teilprothesen unterschiedlicher Komplexität oder der Erhalt und die Sicherung einer Prämolare- nokklusion. Innerhalb der Pilotphase dieser randomisierten mul- tizentrischen Studie wurden 32 Patienten prothetisch versorgt. Dabei wurde bei 15 Patienten die vorhandene Prämolaren- okklusion (PO) rehabilitiert, die restlichen 17 Patienten wurden mit einer kombiniert festsitzend-herausnehmbaren Teilprothese (TP) zum Molarenersatz versorgt. Einschlusskriterien waren das Fehlen aller Molaren, sowie das Vorhandensein beider Eckzähne und bilateral mindestens eines Prämolaren im Studienkiefer. Das primäre Ziel war, die Auswirkungen der zwei Therapieoptionen auf die Kriterien Zahnverlust, sowie Kariesinzidenz und Vitalität zu untersuchen. Drei Jahre nach der Behandlung wurden 28 Pa- tienten nachuntersucht und 4 Patienten als Drop-out gewertet. Das Durchschnittsalter der PO-Gruppe (n = 14) betrug 65,9 Jahre, das der TP-Gruppe (n = 14) 66,9 Jahre. In der PO-Gruppe war nach 36 Monaten bei drei Patienten an je einem Zahn Karies ent- standen. Die TP-Gruppe wies über denselben Zeitraum bei zwei Patienten an insgesamt drei Zähnen Karies auf, es gab drei end- odontische Komplikationen und ein Zahn musste extrahiert wer- den. Es ergaben sich keine statistisch signifikanten Unterschiede zwischen den Versorgungsarten für die Inzidenzen der drei Ereig- nisse Karies, Wurzelbehandlung und Zahnextraktion (p > 0,05, Gray-Test). Die ereignisfreien Überlebenswahrscheinlichkeiten waren nach 36 Monaten 78% in der PO-Gruppe und 67 % in der TP-Gruppe (P = 0,44, Log-rank Test). Schlüsselwörter: Zahnreihe, verkürzte; Molarenersatz; Teilpro- thesen Influence of different prosthetic treatment concepts for the shortened dental arch on the target criteria of caries, vitality and tooth loss. 3-year results of the pilot phase of a multicenter study. Shortened dental arches can be restored using fixed restorations retained by teeth or implants, remov- able partial dentures of varying complexity or by conserving or restoring premolar occlusion. In the pilot phase of this ran- domized multicenter study 32 patients were treated with pros- thetic restorations. The existing premolar occlusion (PO) was restored in 15 patients, and the other 17 patients were fitted with a fixed/removable partial denture (RPD) to replace the molars. Inclusion criteria were the absence of all molars and the presence of both canines and at least one set of bilateral premolars in the study jaw. The primary aim was to evaluate the impact of the two treatment options on the criteria of tooth loss, incidence of caries and vitality. Three years following treatment, 28 patients were available for recall examination and 4 patients had dropped out. The average age in the PO group (n=14) was 65.9 years and in the RPD group (n=14) 66.9 years. After 36 months three patients in the PO group each had caries in one tooth. Over the same period two pa- tients in the RPD group had caries in a total of three teeth; there were three cases that required endodontic treatment and one tooth had to be extracted. There were no statistically significant differences between the types of treatment for the criteria of caries incidence, root canal treatment and tooth ex- traction (p>0.05, Gray test). The incidence-free survival proba- bility after 36 months was 78% in the PO group and 67% in the RPD group (P=0.44, log-rank test).

A multi-centre randomized clinical trial is under way at 14 university dental schools in Germany to compare prosthodontic treatments for the shortened dental arch (SDA). One of the aims of this pilot-study was to measure the effect of two treatment options of the SDA on oral health-related quality of life and on the Research Diagnostic Criteria (RDC) for temporomandibular disorders (TMD). Thirty-four patients participated in the pilot-study. Inclusion criteria were: all molars were missing and the presence of at least both canines and one premolar in each quadrant. Participants were randomly assigned to receive either removable partial dentures including molar replacement (RPD_group) or retain a premolar occlusion (PROC_group). The Oral Health Impact Profile (OHIP-49) and the RDC for TMD were completed by participants before treatment (pre-treatment), 6 weeks (6wks), 6 months (6m) and 12 months (12m) after treatment. At the 12-month follow up, data of 10 women and 11 men (mean age: 62 +/- 10 years) were available. Medians of the OHIP total-scores were as follows: RPD (n = 10), 43.5 (pre-treatment), 18.2 (6wks), 13.3 (6m), 14.7 (12m). PROC (n = 11): 31.8 (pre-treatment), 27.1 (6wks), 8.8 (6m), 8.3 (12m). Significant differences were shown for RPD_group between pre-treatment and 6m/12m and for PROC_group between pre-treatment and 6m. There were no significant differences between treatment groups at any time. Within each group, an improvement of life-quality was observed. No significant difference could be reported between the two therapy concepts. This may be due to the low sample size within the pilot study.