Does replacement of missing dental units with resin-retained bridges improve oral health-related quality of life?: A systematic review

Objectives To assess the current literature in regard to two research questions:

• Does placement of a 2-unit cantilever RRB to replace a missing dental unit improve oral health-related quality of life (OHRQoL) in patients over 18 years old?

• Are there any differences in OHRQoL between different methods of replacing missing teeth?

Methods Systematic review following the Preferred Reporting Items for Systemic Reviews and Meta-Analysis statement (PRISMA) statement.

Data/sources MEDLINE via Ovid, Scopus, PsycINFO via Ovid, Cochrane Library, Web of Science and clinicaltrials.gov were searched (Jan 1980 to Nov 2018) using high-level MeSH terms for studies published in English, investigating OHRQoL, using valid indices.

Risk of bias (RoB) Determined using Cochrane RoB tool and ROBINS-I.

Evidence certainty Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group tool.

Results Study Selection: 280 articles were identified; 270 were excluded after abstract review, 7 after examining full text, leaving 3 articles (3 studies, 188 participants, 172 analysed) included in this review; one RCT and two observational studies.

Synthesis of results: There was significant heterogeneity and no meta-analysis was possible.

Description of effect: One pre-post study design found provision of 2-unit RRBs significantly reduced the total OHIP-49 score (effect size 0.67), compared with an untreated control. One case-control study found no differences in total OHIP-49 between individuals treated with RRB or implant-supported crown. Major complications related to a worse OHRQoL.

Discussion Quality of evidence: The overall RoB assessments were one study “some concerns” and two studies “serious”. The GRADE assessment was “moderate” for one comparison and “low” for two comparisons.

Clinical significance: A 2-unit cantilever RRB to replace one missing tooth probably results in a large improvement in oral health-related quality of life. Clinicians should ensure that the correct investigations and design of prosthesis are prescribed to help reduce any failures that may impact on OHRQoL.