Efficacy and risks of tooth‐supported prostheses in the treatment of partially edentulous patients with stage IV periodontitis. A systematic review and meta‐analysis

Abstract

Aim The aim was to evaluate the efficacy and effectiveness of tooth‐supported fixed prostheses in partially edentulous patients with stage IV periodontitis. Material and Methods Randomized and controlled clinical trials (RCTs and CCTs) and prospective/retrospective cohort studies or case series were searched in three databases. Survival rate of abutment teeth was considered the primary outcome. Meta‐analyses were performed whenever possible. Results Twenty‐four publications were included. No RCTs or CCTs compared the efficacy of tooth‐supported fixed prostheses between patients with severe periodontitis or non‐periodontitis patients. Most of the data retrieved were derived from case series. The incidence of abutment‐tooth loss after a follow‐up period from 2 to 35.4 years was low (n = 17 studies; weighted mean incidence (WMI) = 4.8%; confidence interval (CI) [3.2, 6.5]). The corresponding figure for prostheses failure was WMI = 6.9% (n = 18; 95% CI [4.1, 9.7]). Technical complications seemed to be more frequent than biological complications (caries, endodontic failure, root fracture, etc.). Periodontal outcomes tended to remain stable over time. Conclusion Tooth‐supported fixed prostheses seemed to be a valid treatment approach to restore masticatory function in patients with stage IV periodontitis once periodontal therapy has been accomplished. However, the comparative efficacy of this treatment among periodontitis and non‐periodontitis patients is unclear due to the absence of clinical trials.

Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline

“…For this guideline, a total of 13 systematic reviews (SRs) were conducted to support the guideline development process (Carra et al, 2021; Dommisch et al, 2021; Donos et al, 2021; Gennai et al, 2021; Gotfredsen et al, 2021; Kloukos et al, 2021; Leow et al, 2021; Martín et al, 2021; Montero et al, 2021; Orlandi et al, 2021; Papageorgiou et al, 2021; Ramanauskaite et al, 2021; Tomasi et al, 2021). The corresponding manuscripts are published within this special issue of the Journal of Clinical Periodontology.…”

“…Supporting literature (Donos et al, 2021;Montero et al, 2021;Ramanauskaite et al, 2021;Tomasi et al, 2021) and Expert opinion R8.5. Which are the specific considerations when incorporating dental implants in stage IV periodontitis patients?…”

“…Data summarized by Montero et al (2021) on tooth-supported fixed partial and full-arch prostheses suggest a high rate of patient satisfaction.…”

“…In partially edentulous periodontitis patients (P), are removable dental prostheses (I), in comparison with no prosthetic treatment or treatment to a shortened dental arch, or with fixed dental prosthesis and comparison between different RDP designs (C), more efficacious in terms of tooth loss, periodontal parameters, mastication/chewing efficiency, and patient-related outcome measures (O), as evidenced in randomized controlled clinical trials (RCTs) or prospective and retrospective cohort controlled studies and with a follow-up period of ≥1 year (S)? Montero et al (2021) Efficacy and risks of tooth-supported prostheses in the treatment of partially edentulous patients with stage IV periodontitis. A systematic review and meta-analysis.…”

“…PROMs were not reported in the identified studies (Tomasi et al, 2021). Data summarized by Montero et al (2021) on tooth‐supported fixed partial and full‐arch prostheses suggest a high rate of patient satisfaction.…”