Abstract
Objectives
The aim of this multi-center, randomized controlled trial was to assess the impact of missing posterior support on the risk for temporomandibular disorder (TMD) pain by comparing patients with either shortened dental arches (SDA) or molar replacement by removable dental prostheses (RDP).
Methods
A sample of 215 patients with bilateral molar loss in at least one jaw was consecutively recruited in 14 prosthodontic departments of dental schools in Germany. Of the initial sample, 152 patients (mean age: 59.7 years; 53.9 % female) received randomly allocated interventions (SDA: n = 71; RDP: n = 81). Presence of TMD pain was assessed using patients’ self-reports and was verified by physical examination and by pain intensity, as the mean of current pain, worst pain, and average pain in the last 6 months, with 10-point ordinal rating scales. Assessments were performed before treatment and at follow-ups until 60 months after treatment. Impact of interventions on TMD risk and pain intensity was computed by applying logistic and linear random-intercept models.
Results
Tooth replacement (RDP) did not significantly change the risk for self-reported (odds ratio [OR]: 1.1; confidence interval [CI]: 0.4 to 3.4) or clinically verified (OR: 0.7; CI: 0.1 to 4.3) TMD pain compared to no tooth replacement (SDA). Mean characteristic pain intensity was virtually identical in both groups (Coeff: 0.01; CI: −0.30 to 0.32).
Conclusion
Retaining or preservation of an SDA is not a major risk factor for TMD pain over the course of 5 years when compared to molar replacement with RPDs.
Clinical relevance
Seemingly, missing molars do not have to be replaced in order to prevent TMD pain.
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Acknowledgements
This study was supported by the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG), grant DFG WA 831/2-1 to 2-6 and grant DFG WO 677/2-1.1 to 2-2.1. We acknowledge the contribution of the following members of the RaSDA-study group: W. Reinhardt, F. Jahn (Department of Prosthetic Dentistry and Dental Material Science, University of Jena), W. Gernet (Department of Prosthetic Dentistry, Ludwig-Maximilians University Munich), E.-J. Richter (Department of Prosthetic Dentistry, Julius-Maximilians University of Würzburg), E. Busche (Department of Prosthetic Dentistry, Witten-Herdecke University) in study design, study implementation and data collection.
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Reissmann, D.R., Heydecke, G., Schierz, O. et al. The randomized shortened dental arch study: temporomandibular disorder pain. Clin Oral Invest 18, 2159–2169 (2014). https://doi.org/10.1007/s00784-014-1188-3
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DOI: https://doi.org/10.1007/s00784-014-1188-3