ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title There Is No Conclusive Advantage for Single Tooth Implants over Fixed Partial Dentures in Replacing Congenitally Missing Maxillary Lateral Incisors
Clinical Question Is there a functional and esthetic advantage to implant restoration versus fixed partial denture (FPD) to replace congenitally missing maxillary lateral incisors, when compared by an independent observer?
Clinical Bottom Line At this time, the evidence points to implant therapy as being the best option by reason of conserving adjacent tooth structure. There is no discernible advantage as far as performance or esthetics over FPD. However, to use implants, there has to be adequate space for the implant and adequate bone density. In cases without adequate space or density, other therapies will have to be explored.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 23406509Andrade/ 2013     Males 21 and over; Females 15 and overSystematic review of randomized and quesi-randomized controlled trials
Key resultsThe systemic review conducted research on the EMBASE, MEDLINE, LILACS, BBO, and CENTRAL database and pulled 1272 studies that were considered eligible for the review; of the 1272 studies, 23 were on implants, 195 on prostheses, and 1054 on orthodontics. Upon further review of the 1272 studies, all of the studies were deemed irrelevant. Therefore, the authors concluded that there was no scientific evidence to indicate that one treatment was superior to the other.
#2) 18437792Salinas/200751 articles on single-implant restorations; 41 articles on FPDsSystematic review & meta-analysis
Key resultsThe investigators pulled studies from the EMBASE, MEDLINE, and Cochrane databases with the criteria of: a minimum 2-year study, English language publication, a minimum of 12 implants that were designed to osseointegrate, and data about survival and performance. Based on the stated criteria a total of 92 articles were identified (51 for implants, and 41 for FPD).The results of the research failed to identify articles comparing implants versus FPD. The authors did a meta-analysis of the prognosis of each treatment separately using the included articles. This showed that the success rate of single implant restoration at 60 months to be 95.1%, while the success rate of the FPD was 84.0%. When resin-bonded FPDs were excluded, the 60-month survival rate of FPDs was 94.0%.
Evidence Search Treatment[Title] AND agenesis[Title] AND maxillary[Title] AND lateral[Title] AND incisors[Title] AND systematic[Title] AND review[Title] (((((("Age Factors"[Mesh] AND "Anodontia"[Mesh]) AND "Cuspid"[Mesh]) AND "Dental Implantation, Endosseous"[Mesh]) AND "Dental Prosthesis, Implant-Supported"[Mesh]) AND "Denture, Partial, Fixed"[Mesh]) AND "Humans"[Mesh]) AND "Orthodontic Space Closure"[Mesh]
Comments on
The Evidence
Validity: The first article has a high level of validity as a systematic review. Two independent observers evaluated the eligibility of articles and excluded articles that were not related to the research question: treatment of agenesis of maxillary lateral incisors. The second article is a systemic review and meta-analysis and used similar methods for their investigation. The researcher performed meta-analysis on the implant articles and on the FPD articles and compared them head-to-head in order to determine the results. The data that was extrapolated from the comparison supported the conclusions of the first article. Perspective: Currently the best method for treating this condition is based solely on the clinical presentation of the patient, and there is not enough evidence to support one method over the other.
Applicability The main advantage of implants over FPDs is conservation of adjacent tooth structure. In the patient born without a maxillary lateral incisor, there is a high probability that there will be insufficient bone depth, width and density for an implant to be placed with a high probability of success; therefore the patient will probably need bone grafting in order to achieve sufficient bone volume. The patient should be informed that if they choose this option that there is the possibility of a bone grafting procedure and the possibility of the implant failing and needing further treatment.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Orthodontics) (Pediatric Dentistry) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords Congenitally, Missing, Maxillary, Lateral, Incisors, Implants, FPD
ID# 2894
Date of submission: 04/06/2015spacer
E-mail jimenezma@livemail.uthscsa.edu
Author Michael Jimenez
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Kevin M. Gureckis, DMD
Faculty mentor/Co-author e-mail gureckis@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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Comments on the CAT
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