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.
Bibliographical noteFunding Information:
This study was supported by the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG) grant DFG WA 831/2 –1 to 2 –6, grant DFG WO 677/2 –1.1 to 2 –2.1., grant WA 831/3 –1 and grant Lu 723/8 –1. During the course of the study, further funding was acquired through Cendres & Metaux SA (grant Nr. 0442v11), the German Association for Prosthetic Dental Medicine and Biomaterials (Deutsche Gesellschaft für Prothetische Zahnmedizin und Biomaterialien e.V., DGPRO), and the German Society of Dentistry and Oral Medicine (Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde, DGZMK).
The authors thank Annett Schrock for data preparation and Dr. Eckhard Busche for support with data acquisition. We thank Kathleen Patka for language editing. This study was supported by the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG) grant DFG WA 831/2 ?1 to 2 ?6, grant DFG WO 677/2 ?1.1 to 2 ?2.1. grant WA 831/3 ?1 and grant Lu 723/8 ?1. During the course of the study, further funding was acquired through Cendres & Metaux SA (grant Nr. 0442v11), the German Association for Prosthetic Dental Medicine and Biomaterials (Deutsche Gesellschaft f?r Prothetische Zahnmedizin und Biomaterialien e.V. DGPRO), and the German Society of Dentistry and Oral Medicine (Deutsche Gesellschaft f?r Zahn-, Mund- und Kieferheilkunde, DGZMK).
© 2021 Elsevier Inc.
- Denture precision attachment
- Oral health
- Oral rehabilitation
- Quality of life
- Randomized clinical trials