26 January 2021

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The Shortened Dental Arch: a solution for the elders

Alessandra Abbà

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Oral health care aims at the maintenance of at least a functional and natural dentition throughout life, but although edentulism registered a great decrease, management of elders with partial teeth loss is still a current practice for dentists. This condition commonly is the results of microbial‐mediated caries, periodontal disease or trauma.
Patients with partial teeth loss have several treatment options available to them, but the conventional care to replace missing teeth for older patients still involves provision of removable partial dentures (RPDs). Nonetheless, RPDs have been associated with increased incidence of caries and periodontal degradation.
There are less complex, functionally orientated treatment solutions which are very applicable to partially dentate older patients. These include the Shortened Dental Arch (SDA) concept. First described in 1981, the SDA is a minimal treatment approach based on the notion that satisfactory oral function can be achieved without full dentition and that all lost teeth do not necessarily require replacement. SDA, comprising all anterior teeth and three to five occluding units, provide a stable and functional dentition with respect to chewing ability, aesthetics and oral comfort. 

Evidence has shown that SDA in older patients can have positive impacts on nutritional status and is more cost-effective to deliver and maintain than RPDs. However, evidence remains extremely limited, with very few randomised trials reported. Therefore the aim of this study is to compare the impact of this two different tooth replacement strategies for partially dentate older patients on Oral Health-related Quality of Life (OHrQOL).

Materials and Methods 
89 patients completed a randomised clinical trial. Patients were recruited in two centres.  Randomisation was performed using a computer-generated schedule. Patients were randomly allocated to two different treatment groups: 

-the RPDs group (44 patients) where missing natural teeth were replaced with RPDs fabricated with cobalt–chromium frameworks;
-the SDA group (45 patients) where adhesive resin bonded bridgework (RBB) was used to provide 10 pairs of occluding contacts. 

Initially all patients received standardized dental care including extraction of hopeless teeth, restoration of caries and non surgical management of periodontal disease.
The primary outcome measure was to evaluate the impact of the treatments on OHrQOLmeasured using the short form of the Oral Health Impact Profile (OHIP-14). OHIP-14 was completed at baseline, 1, 6, 12 and 24 months after treatment.

Results
After 24 months, 89 participants completed the randomised controlled clinical trial. Both treatment groups reported improvements in OHIP-14 scores at 24 months (p<0.05). The initial improvement in mean OHIP-14 score after 1 and 6 months was maintained in the SDA group through to 24 months. In comparison, the initial improvements observed in the RPDs group began to be reversed after 6 months.

Conclusions
The benefits of functionally orientated treatment increased over time particularly for the older, more systemically unwell patient cohort.

For additional information: Impact of oral rehabilitation on the quality of life of partially dentate elders in a randomised controlled clinical trial: 2 year follow-up