IMPACT OF SHORTENED DENTAL ARCH ON ORAL HEALTH-RELATED QUALITY OF LIFE

Oliver Schierz; Daniel R Reissmann; Angelika Rauch; Mike T John; Birgit Marré; Ralph Gunnar Luthardt; Torsten Mundt; Wolfgang Hannak; Ralf Kohal; Matthias Kern; Frank Nothdurft; Sinsa Hartmann; Klaus Böning; Julian Boldt; Helmut Stark; Daniel Edelhoff; Bernd Wöstmann; Stefan Wolfart; Florentine Jahn; Michael Horst Walter

doi:10.1016/j.jebdp.2021.101622

IMPACT OF SHORTENED DENTAL ARCH ON ORAL HEALTH-RELATED QUALITY OF LIFE

J Evid Based Dent Pract. 2021 Dec;21(4):101622. doi: 10.1016/j.jebdp.2021.101622. Epub 2021 Aug 8.

Authors

Oliver Schierz¹, Daniel R Reissmann², Angelika Rauch³, Mike T John⁴, Birgit Marré⁵, Ralph Gunnar Luthardt⁶, Torsten Mundt⁷, Wolfgang Hannak⁸, Ralf Kohal⁹, Matthias Kern¹⁰, Frank Nothdurft¹¹, Sinsa Hartmann¹², Klaus Böning⁵, Julian Boldt¹³, Helmut Stark¹⁴, Daniel Edelhoff¹⁵, Bernd Wöstmann¹⁶, Stefan Wolfart¹⁷, Florentine Jahn¹⁸, Michael Horst Walter⁵

Affiliations

¹ Department of Prosthodontics and Materials Science, Medical Faculty University of Leipzig, Leipzig, Germany. Electronic address: oliver.schierz@medizin.uni-leipzig.de.
² University Medical Center Eppendorf, Department of Prosthodontics, Hamburg, Germany.
³ Department of Prosthodontics and Materials Science, Medical Faculty University of Leipzig, Leipzig, Germany.
⁴ Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, United States.
⁵ Department of Prosthetic Dentistry, Technische Universität Dresden, University Hospital Carl Gustav Carus Dental School, Dresden, Germany.
⁶ Department of Prosthetic Dentistry, Center of Dentistry, Universitätsklinikum Ulm, Ulm, Germany.
⁷ Department of Prosthodontics, Gerodontology and Biomaterials, Dental School, University of Greifswald, Greifswald, Germany.
⁸ Charité, Center for Dental and Craniofacial Sciences, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Campus Benjamin Franklin, Berlin, Germany.
⁹ Department of Prosthetic Dentistry, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
¹⁰ Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts University, Kiel, Germany.
¹¹ Department of Prosthetic Dentistry and Dental Materials Science, Medical Center, Dental School and Clinics, Saarland University, Campus Homburg, Homburg/Saar, Germany.
¹² Department of Prosthetic Dentistry, Johannes-Gutenberg University of Mainz, Mainz, Germany.
¹³ Department of Prosthetic Dentistry, Julius-Maximilians University of Würzburg, Würzburg, Germany.
¹⁴ Department of Prosthodontics, Preclinical Education and Dental Materials Science, University of Bonn, Bonn, Germany.
¹⁵ Department of Prosthetic Dentistry, University Hospital, LMU Ludwig-Maximilians-University, Munich, Germany.
¹⁶ Department of Prosthetic Dentistry, Justus-Liebig University of Gießen, Gießen, Germany.
¹⁷ Department of Prosthodontics and Biomaterials, Medical Faculty, RWTH Aachen University, Aachen, Germany.
¹⁸ Department of Prosthetic Dentistry and Dental Material Science, Friedrich-Schiller University of Jena, Jena, Germany.

PMID: 34922713
DOI: 10.1016/j.jebdp.2021.101622

Abstract

Background: A shortened dental arch (SDA) is an established treatment concept for patients with missing molars. However, little is known regarding long-term course of oral health-related quality of life (OHRQoL) in patients with SDA and the benefits from replacement of missing molars.

Objective: Purpose of this multi-center randomized clinical trial was to assess OHRQoL over a period of 15 years in patients with molar replacement by a removable partial denture (RPD) compared to patients with a restored SDA without molar replacement.

Methods: Patients at least 35 years of age with all molars missing in 1 jaw and at least the canine and one premolar present on each side were included. Patients received either a precision attachment-retained, RPD for replacement of missing molars (n = 79), or the dental arch ended with the second premolar (SDA) that had to be present or replaced by a cantilever fixed dental prosthesis (n = 71). Follow-up examinations continued for 15 years. OHRQoL was assessed with the 49-item Oral Health Impact Profile (OHIP). OHIP summary and dimension scores were longitudinally modeled in the statistical analyses to assess course of OHRQoL over time applying an intention-to-treat approach. In addition, scores for the OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact were analyzed.

Results: After an initial improvement in OHRQoL indicated by a mean decrease of 20.0 OHIP points with an effect size of 0.61 in the entire study population, OHRQoL stayed relatively constant over the entire follow-up period. Assuming a constant time and treatment effects over the study period, OHRQoL did not differ statistically significant between the 2 treatments (0.4 OHIP points; 95%-CI: 7.1 - 6.2). OHRQoL after treatment did not change notably over 15 years and was statistically nonsignificant as well (P = .872). Similar findings were observed in all 4 OHRQoL dimensions.

Conclusions: In patients, missing all molars in one jaw OHRQoL improved providing RPD or restoring SDA to a clinically relevant degree. Treatment-related improvement remained mostly stable over a period of at least 15 years. Therefore, patients can be informed that both treatment concepts are equivalent concerning long-term OHRQoL. Accordingly, patients' preferences regarding treatment options should be granted priority in treatment decision making with the SDA treatment option being the default.

Keywords: Adult; Denture precision attachment; Humans; Oral health; Oral rehabilitation; Quality of life; Randomized clinical trials.

Publication types

Multicenter Study
Randomized Controlled Trial

MeSH terms

Dental Arch
Denture, Partial, Removable*
Humans
Oral Health
Quality of Life*
Surveys and Questionnaires