Occlusion and Temporomandibular Function among Subjects with Mandibular Distal Extension Removable Partial Dentures

Parafunctional Behaviors and Its Effect on Dental Bridges

Parafunctional behaviors, especially bruxism, are not uncommon among patient visiting dentists’ clinics daily and they constitute a major dental issue for almost all dentists. Many researchers have focused on the definition, pathophysiology, and treatment of these behaviors. These parafunctional behaviors have a considerable negative impact on teeth and dental prothesis. In this review, we focused on the impact of parafunctional behaviors on dental bridges. We summarized the definitions, epidemiology, pathophysiology, and consequences of parafunctional behaviors. In addition, we reviewed previous dental literature studies that demonstrated the effect of bruxism or other parafunctional behaviors on dental bridges and dental prothesis. In conclusion, parafunctional behaviors are common involuntary movements involving the masticatory system. They are more prevalent among children. These behaviors have deleterious effects on dental structures. Causes of parafunctional behaviors include anxiety, depression, smoking, caffeine intake, sleep disorders, or central neurotransmitter dysfunction. Bruxism and other similar masticatory system activity cause dental fracture, loss, and weardown of enamel or teeth. They can also affect different types of dental protheses both fixed and removable types. Parafunctional behaviors shorten the life expectancy of these protheses, and damage residual dentition and denture-bearing tissues.

Differences in functional outcomes for adult patients with prosthodontically-treated and -untreated shortened dental arches: a systematic review

This review examined differences in functional outcomes and patient satisfaction when shortened dental arches are left untreated compared to their restoration to complete arch lengths with different prosthodontic interventions.

METHODS

A protocol was developed according to the criteria for a systematic review. All relevant databases were searched to identify appropriate clinical trials regardless of language or publication status. Predetermined eligibility criteria were applied, trial quality assessed and data extracted for each study. Relevant outcomes assessed were: functioning ability, patient satisfaction and harmful effects on oral structures.

RESULTS

Searches yielded 101 articles: 81 from electronic databases and 20 from reference lists of retrieved articles (PEARLing searches). Sixty-nine citations were assessed for eligibility after removing 32 duplicate records. After reading titles and abstracts, a total of 41 records were excluded and the full-texts of the remaining 28 records were read. Only 21 records were included for the SR because 7 records were excluded after reading the full-text reports. These 21 records report the outcomes of four randomized controlled trials (RCTs) and one non-randomized clinical trial (CT) which were pre-specified and used for this review. No on-going studies were found and no eligible studies were excluded for failure to report the reviewer's pre-specified outcomes. Outcomes were reported in the retrieved 21 articles. A narrative explanation of the pre-specified outcomes is reported for the 3 comparison groups (which were based on the different interventions used for the individual clinical trials). The shortened dental arch as a treatment option is encouraging in terms of functioning, patient satisfaction and cost-effectiveness. By using only high quality studies it was expected that the results would be more reliable when making conclusions and recommendations, but some of the included studies had to be downgraded due to methodological errors.

Increased risk for premolar tooth loss in shortened dental arches

OBJECTIVES

To assess sustainability of shortened dental arches (SDA) by determining time to 'first restorative intervention' of teeth and time to 'tooth loss' and comparing these outcomes with complete dental arches (CDA) and SDA plus removable dental prostheses (RDP).

METHODS

Data (follow-up time ranged from 27.4 (SD 7.1) to 35.0 (SD 5.6) years; max. follow up: 45.8 years) from patient records of 59 subjects (23 SDA, 23 CDA, and 13 SDA plus RDP) participating in a prospective cohort study on shortened dental arches (SDA) were analysed. Group effects on survival were analysed using Cox regression models; where appropriate Kaplan-Meier analyses were done.

RESULTS

Compared to SDA subjects, CDA subjects had a lower risk to receive a first restorative intervention in anterior teeth (HR=0.377; 95% CI [0.205-0.695]) and premolars (HR=0.470; 95% CI [0.226-0.977]). CDA subjects had a lower risk to lose premolars compared to SDA subjects (HR=0.130; 95% CI [0.053-0.319]). Risk for 'first restorative intervention' and for 'tooth loss' did not significantly differ between SDA with and without RDP.

CONCLUSIONS

SDA subjects had an increased risk to lose premolars and to receive a first time restoration in anterior teeth and premolars compared to CDA subjects. SDA subjects with RDP had no increased risk to receive a first restorative intervention or for tooth loss compared to SDA without RDP.

CLINICAL RELEVANCE

Subjects with shortened dental arches can be discerned as enduring at-risk patients. It is therefore recommended that shortened dental arch subjects receive intensive and continuous care to prevent further tooth loss.

Reappraisal of the removable partial denture as a treatment option for the shortened dental arch

For patients with shortened dental arches, many treatment options are available. The existing situation can be maintained by stabilizing the present dentition and improving the occlusion without extending the arch. Alternatively, the shortened dental arch can be extended by either a free-end saddle removable partial denture, cantilevered fixed bridge, or by an implant-supported prosthesis. The free-end saddle removable partial denture can be considered a simple, non-invasive, and relatively cheap treatment option for the shortened dental arch. It was believed that such prosthodontic rehabilitation would be beneficial for the patients in terms of improving oral functions. However, the existing literature indicates that the prognosis of free-end saddle removable partial denture is not predictable, it is problematic, and its contribution to oral functions in patients with shortened dental arches is considered to be dubious. This paper reviews and summarizes the current literature about the outcome of extending the shortened dental arch by a free-end saddle removable partial denture. It also outlines factors that may affect the prognosis of this prosthetic treatment.

Desordens temporomandibulares em usuários de prótese parcial removível: prevalência de acordo com a classificação de Kennedy

OBJETIVO: O objetivo deste estudo foi determinar a prevalência das desordens temporomandibulares em pacientes com prótese parcial removível, de acordo com a classificação de Kennedy. MÉTODO: A população estudada consistiu de pacientes que procuraram tratamento na Universidade Estadual de Ponta Grossa. Os pacientes selecionados eram usuários de prótese total superior e prótese parcial removível inferior, e esse uso, à época do estudo, fazia entre 1 e 5 anos. Os pacientes foram divididos em cinco grupos (n = 15): G1: usuários de prótese total superior e prótese parcial removível inferior Classe I (Kennedy); G2: usuários de prótese total superior e prótese parcial removível inferior Classe II (Kennedy); G3: usuários de prótese total superior e prótese parcial removível inferior Classe III (Kennedy); G4: usuários de prótese total superior e prótese parcial removível inferior Classe IV (Kennedy), e G5: pacientes totalmente dentados (grupo controle). O questionário de Fonseca foi aplicado para verificar o grau de DTM. O teste qui-quadrado (α = 0,05) foi usado para avaliar a associação entre as variáveis. RESULTADO: Nenhuma diferença estatística (P > 0,05) foi encontrada entre os grupos. Em todos os grupos, os pacientes apresentaram DTM leve ou moderada. CONCLUSÃO: Os resultados deste estudo clínico mostraram que a presença de DTM em pacientes usuários de prótese não pôde ser correlacionada ao uso de prótese, já que a presença de DTM para pacientes desdentados e dentados apresentou-se semelhante.

An observational cohort study on shortened dental arches--clinical course during a period of 27-35 years

Objectives

The objective of this study was to investigate the clinical course of shortened dental arches (‘SDA group’) compared to SDAs plus removable denture prosthesis (‘SDA plus RDP group’) and complete dental arches (‘CDA group’, controls).

Materials and methods

Data (numbers of direct and indirect restorations, endodontic treatments, tooth loss and tooth replacements) were extracted from patient records of subjects attending the Nijmegen Dental School who previously participated in a cohort study on shortened dental arches with three to four posterior occluding pairs (POPs).

Results

Records of 35 % of the original cohort were retrievable. At the end of the follow-up (27.4 ± 7.1 years), 20 out of 23 SDA subjects still had SDA with 3–4 POPs compared to 6 out of 13 for SDA plus RDP subjects (follow-up 32.6 ± 7.3 years). Sixteen out of 23 CDA subjects still had CDA; none of them lost more than one POP (follow-up 35.0 ± 5.6 years). SDA group lost 67 teeth: 16 were not replaced, 16 were replaced by FDP and 35 teeth (lost in three subjects) replaced by RDP. Mean number of treatments per year in SDA subjects differed not significantly compared to CDA subjects except for indirect restorations in the upper jaw.

Conclusion

Shortened dental arches can last for 27 years and over. Clinical course in SDA plus RDP is unfavourable, especially when RDP-related interventions are taken into account.

Clinical relevance

The shortened dental arch concept seems to be a relevant approach from a cost-effective point of view. Replacement of absent posterior teeth by free-end RDP cannot be recommended.

The shortened dental arch revisited: from evidence to recommendations by the use of the GRADE approach

Clinicians must frequently decide whether or not to treat patients with loss of posterior teeth, a condition called the shortened dental arch (SDA). Although many studies have been reported, there are no clear recommendations for the management of SDA cases. In this work, therefore, an innovative system, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, was used to grade the evidence and strength of recommendations for clinical intervention. An extensive literature search for longitudinal studies was conducted on 17 November 2010 in the PubMed and LILACS electronic databases using the term shortened dental arch. A 'snowballing' strategy, for example, manual searching of the reference lists of included papers, was also conducted. Unpublished and published studies were sought in ClinicalTrials.gov and in the search engine 'Google' (Scholar) in English, French, German, Italian, Portuguese and Spanish. Finally, grey literature was searched in OpenSIGLE (System for Information on Grey Literature in Europe). Titles and abstracts of 133 articles were initially assessed. Nine studies were finally included. Although there was no difference between the effectiveness of restorative and non-restorative approaches for SDA, fixed partial dentures seem better than removable prostheses. The overall body of evidence was, however, graded as low quality. Two different clinical scenarios are used to illustrate recommendations in the management of SDA cases by the use of the GRADE system. The GRADE approach may improve transparency in a shared decision-making process, mainly under conditions in which the quality of evidence is low or unclear.