Patient‐based outcome measures of mandibular implant assisted removable partial dentures in Kennedy Class I patients‐ A systematic review and meta‐analysis

Abstract

Background Distal-extension removable partial dentures (RPDs) were associated with several problems related to its limited stability, retention, and masticatory efficiency. The placement of a distal implant associated with a RPD has been reported to make this rehabilitation more stable. It has been suggested that it may overcome some of the common problems. However, no reports have proved the superiority of one treatment option over the other, especially in terms of patient-centric outcome measures. Aim/Hypothesis The purpose of this systematic review was to evaluate the evidence supporting the placement of a distal implant associated with a RPD to improve patient-based treatment outcome by meta-analysis. Material and Methods We used multiple comprehensive databases to find literature. This study is based on the Cochrane Review Methods. The focus question is “ Are implant assisted removable partial dentures (ISRPD) superior to conventional removable partial denture (CRPD) on mandibular Kennedy class I partial edentulous patients in terms of patient-reported outcome measures (patient quality of life and patient satisfaction) (PROMs)?” We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and Scopus in May 2017. The inclusion of all studies was independently decided by two reviewers (J.P. and H.K.) based on the selection criteria. The following studies were included in our meta-analysis – (1) Clinical studies (before and after study) of ISRPD reporting a comparison of patient-reported outcome measures, (2) patient with mandibular Kennedy class I PRDPs, and (3) articles to allow mining of quantitative data. Results In total, 5603 non-duplicate articles were identified from database searches. Of which 29 were eligible for full-text searching. The 24 articles that did not meet the inclusion criteria were excluded. Therefore a total of five studies were used for meta-analysis, including 4 studies reporting VAS and 2 studies reporting OHIP. As a result, general patient satisfaction (VAS) and the total OHIP index showed better results in ISRPD compared to conventional RPD. As for the detailed items, there were no statistical differences for esthetics and cleaning, but patient satisfaction was improved in comfort, chewing, and speaking. There was also a significant statistical improvement in the quality of life in terms of physical pain and physical disability. Conclusions and Clinical Implications The implant assisted removable partial dentures group performed better in regards to patient satisfaction as measured using the VAS and OHIP questionnaire. Further studies are required to identify superiority between the two treatment options. Acknowledgement This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number – HI17C2218).