Oral health–related quality of life of conventional removable partial dentures, unilateral nonmetal clasp dentures, and shortened dental arch with 2- or 3-tooth unilateral distal extension tooth loss in the mandible: A randomized, crossover, clinical trial
Abstract
Statement of problem
Conventional removable partial dentures with metal clasps are still a common option
for patients with distal-extension tooth loss. However, unilateral nonmetal clasp
dentures fabricated by using a thermoplastic denture base resin are increasingly being
used. Furthermore, the shortened dental arch concept remains controversial, in spite
of being advocated for many years. Nevertheless, these treatment options remain controversial,
particularly in patients with the loss of a few distal teeth unilaterally.
Purpose
The purpose of this randomized, crossover, clinical trial was to investigate the oral
health–related quality of life of participants who requested a new dental prosthesis
(unilateral nonmetal clasp dentures or conventional removable partial dentures) at
a private practice.
Material and methods
A 3-period, randomized, crossover design was used in a within-subject, controlled,
clinical trial. Twenty-four participants (mean age 59.0 years [7 men: 62.6 {45–85}
years; 17 women: 57.5 {24–75} years]) were enrolled. All experimental procedures were
approved by the Ethics Committee of Nagasaki University Hospital (#15022313) and registered
in the International Standard Randomized Controlled Trial Number registry (ISRCTN49105064).
All participants were fully dentate in the maxilla and had unilateral distal-extension
loss of 2 or 3 teeth in the mandible. Participants were allocated to 1 of 6 groups
and treated with prescribed options in accordance with their allocated sequences and
used a dental prosthesis or nothing for 2-week periods. At the end of each intervention,
the participants were asked to answer the Oral Health Impact Profile questionnaire.
Differences in Oral Health Impact Profile scores among groups were estimated with
a mixed-effects model (α=.05).
Results
Total Oral Health Impact Profile scores were higher for unilateral nonmetal clasp
dentures (P=.002) and shortened dental arch (P=.049) than for conventional removable partial dentures, with medium and small effects.
The unilateral nonmetal clasp dentures had a similar effect compared with shortened
dental arch (P>.05). unilateral nonmetal clasp dentures (P=.011) and shortened dental arch (P=.005) demonstrated medium effects in the oral function dimension compared with conventional
removable partial dentures. Unilateral nonmetal clasp dentures exhibited large and
medium effects in the orofacial appearance dimension compared with conventional removable
partial dentures (P=.001) and shortened dental arch (P=.006). In the orofacial pain dimension, shortened dental arch showed effects similar
to those of conventional removable partial dentures and unilateral nonmetal clasp
dentures (P>.05), and no significant differences were observed in the psychosocial impact dimension
(P>.05), but the unilateral nonmetal clasp denture score was lower than the conventional
removable partial denture score, with a small effect. Men had significantly lower
total Oral Health Impact Profile scores for shortened dental arch than women (P=.033).
Conclusions
Unilateral nonmetal clasp dentures and shortened dental arch were better than conventional
removable partial dentures for the oral health–related quality of life of individuals
with unilateral distal-extension tooth loss in the mandible, and sex had a significant
effect on removable prosthetic planning.
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