Abstract
BackgroundVarious treatment options for the prosthetic treatment of jaws where all molars are lost are under discussion. Besides the placement of implants, two main treatment types can be distinguished: replacement of the missing molars with removable dental prostheses and non-replacement of the molars, i.e. preservation of the shortened dental arch. Evidence is lacking regarding the long-term outcome and the clinical performance of these approaches. High treatment costs and the long time required for the treatment impede respective clinical trials.Methods/designThis 14-center randomized controlled investigator-initiated trial is ongoing. Last patient out will be in 2010. Patients over 35 years of age with all molars missing in one jaw and with at least both canines and one premolar left on each side were eligible. One group received a treatment with removable dental prostheses for molar replacement (treatment A). The other group received a treatment limited to the replacement of all missing anterior and premolar teeth using fixed bridges (treatment B). A pilot trial with 32 patients was carried out. Two hundred and fifteen patients were enrolled in the main trial where 109 patients were randomized for treatment A and 106 for treatment B. The primary outcome measure is further tooth loss during the 5-year follow-up. The secondary outcome measures encompassed clinical, technical and subjective variables. The study is funded by the Deutsche Forschungsgemeinschaft (German Research Foundation, DFG WA 831/2-1, 2-2, 2-3, 2-4, 2-5).DiscussionThe particular value of this trial is the adaptation of common design components to the very specific features of complex dental prosthetic treatments. The pilot trial proved to be indispensable because it led to a number of adjustments in the study protocol that considerably improved the practicability. The expected results are of high clinical relevance and will show the efficacy of two common treatment approaches in terms of oral health. An array of secondary outcome measures will deliver valuable supplementary information. If the results can be implemented in the clinical practice, the daily dental care should strongly profit thereof.Trial registrationThe trial is registered at ClinicalTrials.gov under ISRCTN68590603 (pilot trial) and ISRCTN97265367 (main trial).
Highlights
Various treatment options for the prosthetic treatment of jaws where all molars are lost are under discussion
The particular value of this trial is the adaptation of common design components to the very specific features of complex dental prosthetic treatments
“The randomized shortened dental arch study” (RaSDA) was designed to evaluate the efficacy of the treatment with removable dental prostheses (RDPs) for molar replacement compared to the treatment limited to the replacement of all missing anterior and premolar teeth by means of fixed bridges
Summary
The treatment decisions in dentistry were based on empirical knowledge and in-vitro investigations of dental materials. While the majority of the previous studies had a retrospective design and relatively limited variable sets, this trial is aiming at a more comprehensive evaluation of the prosthetic treatment This approach required the collection of a large-scale variable set. The main inclusion criteria define a certain topography where all molars are missing in one jaw and at least both canines and one premolar are present on each side (Fig. 1) This is an appropriate condition to study the differential indication between removable (treatment A) and fixed (treatment B) restorations and an ideal field to gather comparable data on the clinical performance of these fundamentally differing treatment concepts. Considering the basic aim of the trial, it was vital to focus on those clinical findings that might offer an explanation for the success or failure of a treatment concept, the occurrence of TMD, and, not least important, patient satisfaction. List of abbreviations used ASA: American Society of Anesthesiologists; CART: Classification and Regression Trees; CDA: California Dental Association; DFG: Deutsche Forschungsgemeinschaft (German Research Foundation); EN: Europäische Norm (European Standard); ISO: International Organization for Standardization; OHIP: Oral Health Impact Profile; RaSDA: The Randomized Shortened Dental Arch Study; RDP: Removable Dental Prosthesis; RDPs: Removable Dental Prostheses; SDA: Shortened Dental Arch; SOP: Standardized Operating Procedure; TC: Treatment Coordinator; TMD: Temporomandibular Disorders
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