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

Abstract

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 Unpublished and published studies were sought in ClinicalTrials.gov and in the search engine 'Google' (Scholar) in English, French, German, Italian, Portuguese and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.

Differences in Functional Outcomes for Adult Patients with Prosthodontically-Treated and -Untreated Shortened Dental Arches: A Systematic Review

“…This entails directing the limited resources towards that part of the dentition that can be successfully preserved and in the most cost-effective manner, rather than on the remaining molar teeth that often have a poorer prognosis [5], [7], [31]–[58]. The minimum number of teeth or shortness of the arch will also depend on the periodontal condition of the remaining teeth, the age of the patient, occlusal activity, food types and adaptive capacity of the patients’ temporomandibular joints [3], [7], [9].…”

“…Other associated benefits of the SDA have been enumerated by several researchers [5]–[8], [10]–[20], [31]–[58]. A number of studies have been conducted in Tanzania where the evidence obtained was used to advise the government, medical and dental personnel to include the SDA concept within the prosthodontic management protocols for the country [12], [16], [50]–[52].…”

“…Thus a number of systematic reviews (SR) focusing on the SDA have been completed [8], [56]–[58]. A SR conducted by Gotfredsen and Walls (2007) focused on studies that reported on the assessment of normative needs only, although it did not include quality of life studies that considered the perceived oral health needs of partially dentate patients [8].…”

In patients with shortened dental arches do removable dental prostheses improve masticatory performance?

“…4 Multiple iterations of the SDA exist based on the number and distribution of occluding pairs of posterior teeth. 5 The aim of this systematic review was to summarise the impact of RPD provision on objective measures of masticatory function in SDA and extreme SDA patients (eSDA). The review question, inclusion criteria and search strategy were clearly defined and a reasonable publication-date restriction was applied.…”

Is the Evidence Supporting Dental Procedures Strong? A Survey of Cochrane Systematic Reviews in Oral Health

“…Because GRADE takes into account variables other than quality of evidence, it may be a good basis for more transparent and systematic decision making. 14,15 In summary, this work has revealed that, currently, the overall quality of evidence in dentistry is low. Researchers, clinicians, and all involved with dental treatment should combine efforts to improve the quality of evidence in the several disciplines of dentistry.…”