Cochrane · intervention · CD003814

Interventions for replacing missing teeth: partially absent dentition

Cochrane Database of Systematic Reviews · 2012 · Cochrane Library

Oral Health Implants and prosthodontics2 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

current version

GRADE rated

No studies

Included studies

as reported

No studies 0 · 0%Ungraded 31 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Review question

Element	Planned (methods)	Found (results)
Population	Patients who require restoration due to partial lack of dentition in one or both jaws; no age limits; eligible participants have one or more missing teeth and/or a shortened dental arch due to absent posterior teeth	Participants who required replacement of missing teeth due to partial edentulism in one or both dental arches; no restrictions on age or gender (n=21 trials)
Intervention	Techniques for replacing one or more missing teeth: 1) Removable dental prostheses (RDPs) - tooth and tooth-tissue supported (different designs, materials, fabrication techniques); 2) Fixed dental prostheses (FDPs) - tooth supported (different designs, materials); 3) Treatment for shortened dental arch (FDP versus RDP); 4) Implant-supported FDPs versus tooth/implant-supported FDPs	Removable dental prostheses (n=5); Fixed dental prostheses (n=13); Shortened dental arch treatment (n=2); Implant-supported FDP versus tooth/implant-supported FDP (n=1)
Comparison	Removable dental prosthesis; Fixed dental prosthesis; Implant-supported FDP; Tooth/implant-supported FDP	Different designs (n=5); Different materials (n=11); FDP versus RDP (n=2); Implant-supported versus tooth/implant-supported FDP (n=1)
Outcomes	Longevity/survival, complications and treatment failures; Functional/physiologic impact (mastication, retention/mobility, function); Psychological impact (patient satisfaction, aesthetics, quality of life); Economic impact (direct and indirect costs)	Prosthetic complications / failure / success (n=21); Physiologic impact e.g. alveolar bone height, marginal integrity (n=21); Psychological impact / patient satisfaction (n=21); Cost of prosthesis (n=1)
Study designs	All randomized controlled clinical trials of treatment for partial edentulism in a jaw	Randomized controlled trials, including parallel-group, split-mouth and cross-over designs (n=21)
Timing	Within 2 years of treatment; between 2 and 5 years after treatment; more than 5 years after treatment	Follow-up ranged from 12 months to 10 years

Search date: 2011-03. Databases: The Cochrane Oral Health Group's Trials Register; CENTRAL; MEDLINE via OVID; EMBASE via OVID

Questions and results

Current version only

Fixed dental prosthesis (cantilever FDP) vs Removable dental prosthesis (RDP)

Population: Patients with a shortened dental arch (missing posterior teeth)

CD003814.PUB2 (current) · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Prosthesis survival same question in other reviews	HR 0.59 [0.27, 1.29]	1 study · 60 participants	Ungraded
Incidence-free survival (caries, endodontic treatment, tooth loss) 3 years same question in other reviews	HR 0.73 [0.06, 8.41]	1 study	Ungraded
Caries incidence (2 years) 2 years same question in other reviews	RR 0.43 [0.21, 0.87]	1 study · 50 participants	Ungraded
Patient satisfaction with prosthesis same question in other reviews	RR 1.22 [0.99, 1.51]	1 study · 54 participants	Ungraded

Fixed partial denture supported by root-formed implants and remaining teeth (tooth/implant-supported) vs Fixed partial denture supported only by root-formed implants (implant-supported)

Population: Partially edentulous patients (mandible) receiving FDPs; split-mouth, 10-year

CD003814.PUB2 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Prosthesis success (10 years) 10 years same question in other reviews	10-year success 85% (17/20) tooth/implant-supported versus 80% (16/20) implant-supported FDPs; not statistically significant; data not available in paired form	1 study · 23 participants	Ungraded
Alveolar bone loss 10 years same question in other reviews	No significant differences in alveolar bone loss: 0.6 to 0.7 mm for implant-supported versus 0.5 mm for tooth/implant FDPs (narrative)	1 study · 23 participants	Ungraded

Altered-cast technique RDP vs One-piece cast RDP

Population: Partially edentulous patients treated with a distal-extension RDP

CD003814.PUB2 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Patient satisfaction same question in other reviews	Patients were equally satisfied with the two types of RDP (narrative)	1 study · 57 participants	Ungraded
Patients with increased abutment tooth mobility same question in other reviews	RR 1.81 [0.91, 3.58]	1 study · 57 participants	Ungraded

Cemented implant crown vs Screw-retained implant crown

Population: Patients with single-tooth implants receiving implant crowns; split-mouth

CD003814.PUB2 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Mechanical complications / prosthesis failure (4 years) 4 years same question in other reviews	No reports of any mechanical complications or failures with either type of prosthesis (narrative)	1 study · 12 participants	Ungraded
Alveolar bone level 4 years same question in other reviews	Alveolar bone levels showed no significant differences between groups; insufficient information to estimate SDs (narrative)	1 study · 12 participants	Ungraded

RDP with I-bar clasps / mesial rests vs RDP with circumferential clasps / distal rests

Population: Partially edentulous patients treated with a removable dental prosthesis (RDP)

CD003814.PUB2 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Change in abutment tooth mobility at 60 months 60 months same question in other reviews	MD -0.01 [-0.12, 0.1]	1 study · 80 participants	Ungraded
Treatment success (5-year) 5 years same question in other reviews	HR 0.58 [0.25, 1.34]	1 study · 134 participants	Ungraded

RDP with lingual plate major connector vs RDP with sublingual bar major connector

Population: Partially edentulous patients treated with a mandibular RDP (major connector)

CD003814.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Abutment tooth mobility (Periotest) at 30 months 30 months same question in other reviews	MD -1.99 [-3.36, -0.62]	1 study · 36 participants	Ungraded

Tilting-type RDP (minor connector design) vs Functional and sanitary RDP designs

Population: Partially edentulous patients with a distal-extension RDP (minor connector); cross-over

CD003814.PUB2 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Alveolar bone height same question in other reviews	Difference in alveolar bone height was not statistically significant (P = 0.07); data narrative only	1 study · 25 participants	Ungraded
Patient satisfaction same question in other reviews	The tilting-type RDP significantly outscored the functional and sanitary designs for patient satisfaction; within-patient SDs not given, data narrative only	1 study · 25 participants	Ungraded

Titanium RDP framework vs Chromium-cobalt RDP framework

Population: Partially edentulous patients treated with an RDP framework

CD003814.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Framework fracture (2 years) 2 years same question in other reviews	RR 3.32 [1.19, 9.23]	1 study · 38 participants	Ungraded

Tooth/implant FDP with rigid connectors vs Tooth/implant FDP with non-rigid connectors

Population: Patients with tooth/implant-supported FDPs; split-mouth

CD003814.PUB2 (current) · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Prosthesis survival and crestal bone loss (5 years) 5 years same question in other reviews	No significant differences between the two types of connectors with regard to prosthesis survival or crestal bone loss at 5 years (narrative)	1 study · 42 participants	Ungraded
Natural tooth intrusion 5 years same question in other reviews	Intrusion occurred in 44% of FDPs with rigid connectors and 66% with non-rigid connectors (average 0.18 mm and 0.28 mm respectively)	1 study · 42 participants	Ungraded
Non-scheduled maintenance visits 5 years same question in other reviews	70 non-scheduled maintenance visits to treat problems with rigid connectors compared to 110 visits for non-rigid connectors; unclear if this difference was considered significant	1 study · 42 participants	Ungraded

Titanium framework FDP vs High-gold content alloy framework FDP

Population: Partially edentulous patients receiving tooth-supported FDPs

CD003814.PUB2 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Unacceptable restoration (poor marginal integrity / restoration removal) same question in other reviews	RR 10.23 [1.41, 74.44]	1 study · 47 participants	Ungraded
5-year prosthesis survival 5 years same question in other reviews	5-year prosthesis survival 84% (95% CI 0.79 to 0.89) titanium vs 98% (95% CI 0.96 to 1.00) high-gold alloy; statistically significant difference (P = 0.005)	1 study · 47 participants	Ungraded

Low-gold (Midas) or silver-palladium (Albacast) alloy FDP vs High-gold content control alloy (JS C) FDP

Population: Patients receiving single crowns and FDPs; split-mouth

CD003814.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Visual marginal discrepancy (3 years) 3 years same question in other reviews	RR 0.88 [0.06, 12.73]	1 study · 30 participants	Ungraded

Alternative alloy FDP (e.g., Ceramalloy II / base-metal / palladium-silver) vs High-gold content control alloy FDP (Olympia)

Population: Patients receiving crowns and FDPs; split-mouth, 10-year

CD003814.PUB2 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Restoration survival (Ceramalloy II versus Olympia) 10 years same question in other reviews	OR 3.5 [1.4, 8.7]	1 study	Ungraded
Laboratory cost per unit 10 years same question in other reviews	Gold costs significantly higher: USD 89 per unit for gold compared to USD 53 for palladium-silver alloy and USD 37 for base-metal alloy	1 study	Ungraded

Laser-welded titanium framework vs Cast gold framework

Population: Patients with implant-supported FDPs; split-mouth, 5-year

CD003814.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Framework survival (5 years) 5 years same question in other reviews	95% (20/21) titanium and 100% cast gold frameworks surviving 5 years; could not calculate an estimate of relative risk from the data as presented; non-significant differences in maintenance visits and alveolar bone loss	1 study · 21 participants	Ungraded

Titanium (Procera) abutment vs Gold-alloy (machined UCLA) abutment

Population: Patients with single-tooth implant crowns; split-mouth, 4-year

CD003814.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Success / prosthetic complications (4 years) 4 years same question in other reviews	100% success, no prosthetic complications, and a similar loss of marginal bone (0.4 mm) in both groups (narrative)	1 study · 20 participants	Ungraded

Zirconia framework FDP vs Metal framework FDP

Population: Patients receiving FDPs; parallel group, 3-year

CD003814.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Survival / framework fracture (3 years) 3 years same question in other reviews	100% survival and no framework fractures in either group after 3 years; no significant differences between groups with respect to porcelain fractures and mean survival time (narrative)	1 study	Ungraded

Zirconia abutment vs Titanium abutment

Population: Patients with single-tooth implant crowns; split-mouth, 3-year

CD003814.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Abutment/crown fracture and marginal bone level (3 years) 3 years same question in other reviews	No fractures of any abutments or crowns; non-significant differences in mean marginal bone levels, which ranged from 1.6 to 2.1 mm (narrative)	1 study · 22 participants	Ungraded

Denzir all-ceramic FDP vs In-Ceram Zirconia all-ceramic FDP

Population: Patients with all-ceramic implant FDP reconstructions; parallel group, 12-month

CD003814.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Reconstruction failure / chip fractures (12 months) 12 months same question in other reviews	None of the 25 reconstructions had failed; significantly more chip fractures in the Denzir group, but as none required repair this outcome was deemed not clinically significant (narrative)	1 study · 18 participants	Ungraded

Ketac-cem (glass ionomer) cement vs Zinc phosphate cement

Population: Patients receiving cemented FDPs; split-mouth

CD003814.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Post-operative hypersensitivity, tooth vitality, prosthesis retention and secondary caries same question in other reviews	No difference in post-operative hypersensitivity, tooth vitality, prosthesis retention, and secondary caries; paired data not provided in the correct form; trial at high risk of bias (narrative)	1 study	Ungraded

Ceramic implant abutment vs Titanium implant abutment

Population: Patients receiving implant-supported single crowns / short-span FDPs

CD003814.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Success rate same question in other reviews	Andersson 2003: 94% (16/17) ceramic vs 100% (12/12) titanium; Andersson 2001: 93% (28/30) ceramic vs 100% (35/35) titanium; no statistical analysis provided; no measurable / non-significant differences in alveolar bone…	2 studies · 107 participants	Ungraded

Fixed partial denture cemented to conventionally prepared teeth vs Crown supported by a single root-formed implant

Population: Patients with a single missing tooth

CD003814 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	Planned comparison (null hypothesis) stated in the protocol; no results at protocol stage (single tooth absence).	0 studies	No studies

Fixed partial denture (FDP) vs Removable partial denture (RDP)

Population: Patients requiring restoration due to partial lack of dentition in one or both jaws (partially edentulous); no age limits

CD003814 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	Planned comparison (null hypothesis) stated in the protocol: removable versus fixed partial dentures cemented to conventionally prepared teeth; no results at protocol stage.	0 studies	No studies

Fixed partial denture vs Fixed prosthesis supported by implants

Population: Patients requiring restoration due to partial lack of dentition in one or both jaws (partially edentulous); no age limits

CD003814 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	Planned comparison (null hypothesis) stated in the protocol; no results at protocol stage.	0 studies	No studies

Removable partial denture vs Fixed prosthesis supported by implants

Population: Patients requiring restoration due to partial lack of dentition in one or both jaws (partially edentulous); no age limits

CD003814 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	Planned comparison (null hypothesis) stated in the protocol; no results at protocol stage.	0 studies	No studies

Fixed partial denture supported by root-formed implants and remaining teeth (tooth/implant-supported) vs Fixed partial denture supported only by root-formed implants (implant-supported)

Population: Patients requiring restoration due to partial lack of dentition in one or both jaws (partially edentulous); no age limits

CD003814 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	Planned comparison (null hypothesis) stated in the protocol; no results at protocol stage.	0 studies	No studies

Prosthesis made using one fabrication procedure vs Identical prosthesis made using a different fabrication procedure

Population: Patients requiring restoration due to partial lack of dentition in one or both jaws (partially edentulous); no age limits

CD003814 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	Planned comparison (null hypothesis) stated in the protocol: identical prostheses using different fabrication procedures; no results at protocol stage.	0 studies	No studies

Prosthesis made from one material / design / component vs Identical prosthesis made from a different material / design / component

Population: Patients requiring restoration due to partial lack of dentition in one or both jaws (partially edentulous); no age limits

CD003814 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	Planned comparison (null hypothesis) stated in the protocol: identical prostheses made from different materials or incorporating different designs or components; no results at protocol stage.	0 studies	No studies

Cemented crown supported by implants vs Screw-retained crown supported by implants

Population: Patients requiring restoration due to partial lack of dentition in one or both jaws (partially edentulous); no age limits

CD003814 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	Planned comparison (null hypothesis) stated in the protocol; no results at protocol stage.	0 studies	No studies