Interventions for replacing missing teeth: denture chewing surface designs in edentulous people

 

Abstract

Background

When constructing complete dentures for edentulous patients, ultimately patient satisfaction is key. Complete dentures can be produced with different types of occlusal schemes (chewing surfaces) and it is widely accepted that the occlusal scheme for complete dentures has a direct influence upon their success.

Objectives

To assess the relative effectiveness of differing occlusal schemes for complete dentures with regard to patient satisfaction. The null hypothesis is that there is no difference in terms of patient satisfaction between different designs of chewing surfaces for complete dentures.

Search methods

Several electronic databases were searched in order to identify relevant trials: Cochrane Oral Health Group Trials Register (to 29 April 2004), CENTRAL (The Cochrane Library 2004, Issue 2), MEDLINE (1966 to week 2 April 2004), OLDMEDLINE (1953 to 1965), EMBASE (1980 to week 16 2004), ZETOC (1993 to December 2003), SIGLE (1980 to December 2003), SCI (1945 to 4 April 2004 ). Reference lists of identified, relevant trials and review articles were scanned. Unpublished data were sought through personal contact with experts in the field. There was no language restriction.

Selection criteria

Randomised or quasi-randomised controlled clinical trials (RCTs), recruiting edentulous adults, and comparing complete dentures produced with different occlusal schemes with regard to patient satisfaction and masticatory function.

Data collection and analysis

The quality assessment of the included trials was undertaken independently and in duplicate by two reviewers based initially on what was written in the articles. Data were extracted by two reviewers independently. Disagreements were discussed and a third reviewer consulted as necessary. Authors were contacted for clarification or missing information. Data were excluded until further clarification if agreement could not be reached.

Main results

1076 titles and abstracts were identified through the electronic searches. Thirteen trials were thought to be potentially relevant. Ten of these studies were subsequently excluded following further analysis. Two trials require further information from the author before being considered eligible for inclusion. Only one cross-over trial (n = 30), comparing lingualised teeth and zero-degree teeth, fully met the review's inclusion criteria. Twenty patients preferred the lingualised denture, five the zero-degree denture and five patients had no preference. There was a statistically significant difference in favour of the lingualised denture with an odds ratio of 10 (95% confidence interval 2.04 to 48.96).

Authors' conclusions

There is weak evidence that it may be advantageous, for dentists providing a complete denture service, to prescribe prosthetic posterior teeth with cusps to improve patient satisfaction compared to providing cuspless teeth. However, this conclusion may only be made tentatively until further well conducted trials comparing different occlusal schemes for complete dentures are undertaken.

 

Plain language summary

Interventions for replacing missing teeth: denture chewing surface designs in edentulous people

No strong evidence to recommend any type of chewing surfaces (occlusal schemes) for complete dentures.
When patients have no remaining teeth they often have complete dentures as replacement teeth. Complete dentures are retained in the mouth by a number of factors, which can help prevent them from feeling loose and uncomfortable. One of the factors, which can affect a patient's satisfaction with complete dentures, is thought to be the design of the occlusal scheme. No reliable evidence of the effects of different occlusal schemes was found. However the available weak evidence suggests that it may be advantageous, for dentists providing a complete denture service, to prescribe prosthetic posterior teeth with cusps for improved patient satisfaction. These recommendations are based on the weak evidence from the review and on subjective clinical sense and experience.

 

摘要

背景

影響修補缺牙的因素：無牙患者的義齒咀嚼面設計

在製作無牙患者的全口義齒時，病人的滿意度是最終的關鍵。全口義齒可製作成不同類型的咬合平面(咀嚼面)，而rdquo;咬合平面直接影響到全口假牙的成功與否”這個論點被廣泛的接受。

目標

探討不同咬合平面對全口義齒患者滿意度所造成的相對影響。虛無假設為全口義齒患者滿意度不因不同的咀嚼面設計而有所差異。

搜尋策略

為確定相關試驗，搜尋了幾個電子資料庫：Cochrane Oral Health Group Trials Register、Cochrane Central Register of Controlled Trials(中央)(The Cochrane Library, Issue 2, 2004)、MEDLINE(1966 – 2004.04..)、OLDMEDLINE (1953 – 1965)、EMBASE(1980 – 2004第16週)、Zetoc(1993 – 2003.12)、SIGLE(1980～2003.12)，SCI(科學引文索引)(1945 – 2004.4.4)。瀏覽相關試驗和回顧性文章確定文獻表單。未出版資料經該領域專家審閱聯繫。沒有語言限制。

選擇標準

隨機或半隨機對照臨床試驗(RCTs)，納入研究的患者為無牙成年人，針對病人滿意度和咀嚼功能來比較不同咬合面的全口義齒。

資料收集與分析

根據本文一開始所寫的目標:由兩位評閱者獨立對納入的試驗做質量分析並製成一式兩份的資料。資料分別由兩位評委獨立取得。當有歧見發生時需進行討論並照會第三評閱者。聯繫作者，釐清遺漏的資訊。直至進一步釐清前，排除無法達成認可的數據。

主要結論

電子搜尋取得1076篇題目和摘要。 確認出13個潛在相關的試驗。 經過進一步分析，再排除10個試驗。在作者認為符合納入的研究前，有2個試驗需要從原作者取得進一步資訊。僅有1個比較舌側化排牙(lingualised teeth) 和零度牙(zerodegree teeth) 的交叉試驗(n = 30)，完全符合審查的篩選標準。20名患者偏好舌側化義齒，5名偏好零度牙，另5名患者無偏好。顯示舌側化義齒的偏好程度有統計顯著差異, 其odds ratio為10時(95％信賴區間： 2.04～48.96)。

作者結論

有一微弱的證明可能有助於牙醫師提高全口義齒的患者滿意度:採用具有咬頭的後牙而不是零度牙。然而，這一結論只是暫定的，必須進一步導入完善的臨床試驗來比較不同咬合平面的全口義齒。

翻譯人

本摘要由臺灣大學附設醫院王東美翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有強力證據建議任何類型的咀嚼面(咬合平面)適用全口義齒。當患者完全沒有牙齒時，往往需要使用全口義齒。全口義齒依賴許多條件以維持在口中，這些條件能幫助防止鬆動感和不舒適。其中一個影響患者對於全口假牙滿意度的條件，被認為是咬合平面的設計。沒有可靠證據證明不同咬合平面的影響力。但現有微弱的證據建議，牙醫師提供全口義齒的治療時，採用具有咬頭的後牙補綴物可改善患者的滿意度。這些建議來自於本文獻回顧的微弱證據與主觀的臨床感受及經驗。