Title Replacing Missing Molars with Removable Prostheses Does Not Reduce or Prevent TMD Pain
Clinical Question In a patient with bilateral molar loss in either maxillary and/or mandibular arches, would replacing the missing molars with removable prostheses, reduce or prevent TMD pain compared to no treatment?
Clinical Bottom Line Over 5-year follow-up, TMD pain was statistically similar in patients who had bilateral missing molars replaced or not replaced with removable prostheses.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
24452826Reissman/2014152 patients with bilateral loss of molarsRandomized Controlled Trial
Key resultsReissmann et al found that the mean TMD pain intensity was identical between the group replacing and the group not replacing the missing molars. Over 5-year follow-up, there was no significant difference between the two groups, suggesting that molar replacement with a removable prosthesis is not a viable treatment for reducing TMD pain.
Evidence Search Pubmed search: "TMD and bilateral molar loss."
Comments on
The Evidence
The study by Reismann et al was a randomized controlled trial including 152 subjects, which indicates a high level of evidence. However, it should be noted that 63 subjects were excluded following randomization due to preference of an alternate solution or high costs. Furthermore, the mean TMD pain intensity was almost statistically equivalent between the group who had their missing molars replaced compared to the group who did not have their missing molars replaced.
Applicability For bilaterally edentulous patients who only occlude on posterior premolars, molar replacement using a removable prosthesis is equally effective as no treatment in reducing or preventing TMD pain. This information would be integral during treatment planning for a patient with missing molars, as a removable prosthesis should not be expected to reduce or prevent the patient's TMD pain. Additionally, the study is limited to molar replacement by a removable prosthesis and the results cannot be generalized to molar replacement by implant-supported prostheses.
Specialty (General Dentistry) (Prosthodontics) (Restorative Dentistry)
Keywords Kennedy Class II, TMD, molar replacement, RDP, RPD
ID# 2806
Date of submission 02/22/2015
E-mail attiam@livemail.uthscsa.edu
Author Monica Attia
Co-author(s) Pooja Sukumar
Co-author(s) e-mail sukumar@livemail.uthscsa.edu
Faculty mentor Edward F. Wright, DDS, MS
Faculty mentor e-mail wrightE2@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?)
None available
Comments and Evidence-Based Updates on the CAT
None available