Menú Principal

Salud Oral Integral: Tratamiento y Rehabilitación Oral en Personas Adultas y Personas Mayores con Edentulismo Parcial o Total

Problema de Salud AUGE N°47

juicio del panel y evidencia

En personas con edentulismo parcial unilateral, el Ministerio de Salud RECOMIENDA NO rehabilitar por medio de prótesis unilateral.
Comentarios del Panel de Expertos:
► Las recomendaciones fuertes basadas en certeza baja respecto de los efectos, son excepcionales. Sin embargo, la prótesis unilateral puede conllevar a riesgo vital o complicaciones de salud por aspiración o deglución del aparato protésico, y el panel considera que no proporciona beneficios clínicamente relevantes adicionales a los que entrega la prótesis con extensión contralateral.

El panel de expertos analizó y debatió cada uno de las preguntas de la “Tabla de la evidencia a la decisión”, considerando tanto la evidencia de investigación, experiencia clínica, conocimiento de gestión o experiencia de los pacientes. Una vez consensuada la postura del panel respecto a las preguntas, emitieron un juicio seleccionando la opción de respuesta que mejor representaba la opinión del conjunto (destacada con color). Finalmente, cuando el panel emitió su juicio sobre todas las preguntas, se emitió la recomendación.

A continuación, se presenta la “Tabla de la evidencia a la decisión” con el resumen de los juicios, la evidencia de investigación evaluada, consideraciones adicionales y comentarios planteados por el panel.

 1.- ¿El problema es una prioridad?
No Probablemente no Probablemente sí Varía No lo sé

El problema ha sido definido como prioritario en el marco de las Garantías Explícitas en Salud (GES), régimen integral de salud que prioriza un grupo de patologías o problemas de salud, garantizando el acceso a tratamiento oportuno y de calidad.

 2.- ¿Qué tan significativos son los efectos deseables anticipados?
Triviales Pequeños Moderados Grandes Varía No lo sé

Pequeños: El panel de expertos de la Guía estimó que los efectos deseables de «rehabilitar por medio de prótesis unilateral» en comparación a «rehabilitar con protesis con extensión contralateral» son pequeños. Considerando experiencia clínica del panel, las prótesis unilateral podría ser más cómoda, facilitar el manejo, es menos invasiva y puediese afectar menos la estética en algunos pacientes.
El tratamiento puediera requerir menos sesiones clínicas.

Evidencia de investigación

Rehabilitar por medio de prótesis unilateral comparado con rehabilitar con prótesis con extensión contralateral para edentulismo parcial unilateral.

 

Pacientes

Personas con edentulismo parcial unilateral.

 

Intervención

Rehabilitar por medio de prótesis unilateral.

 

Comparación

Rehabilitar con prótesis con extensión contralateral.

 

Desenlaces

Efecto

Certeza de la evidencia

(GRADE)

Mensajes clave en términos sencillos

Efectividad

No se identificaron estudios que comparen la efectividad de las intervenciones.

 

Efectos adversos

Si bien no existen estudios comparativos, un estudio reportó 64 prótesis dentales removibles unilaterales deglutidas e impactadas en el esófago. De ellas, 17 prótesis reemplazaban un solo diente, 32 a dos dientes, 5 a tres dientes y 8 a cuatro dientes. La mortalidad ocurrió en 3 casos (4,68%) como resultado de hemorragia masiva, fuga esofágica, empiema, peritonitis y septicemia.

 Debido a la mayor retención, soporte y estabilidad de la prótesis con extensión contralateral, este efecto adverso no debiera ocurrir. 

⊕⊕◯◯1,2,3

Baja

Rehabilitar por medio de prótesis unilateral probablemente aumenta el riesgo de deglución de la prótesis.

 

GRADE: Grados de evidencia Grading of Recommendations Assessment, Development and Evaluation.
1 Diseño observacional.
2 Se aumentó un nivel de certeza de evidencia por efecto grande, ya que si bien, corresponde a estudios de series de casos, este efecto adverso no debiera ocurrir en el otro tipo de prótesis por lo que la diferencia es grande.
3 Se disminuyó un nivel de certeza de evidencia por ser indirecta, ya que el estudio realiza un análisis retrospectivo de casos de prótesis unilaterales deglutidas y no se realiza una comparación entre el riesgo de deglución de prótesis con extensión lateral. Además, las prótesis incluidas en el estudio no cumplen con los estándares de calidad de las prótesis dentales removibles realizadas en Chile.
Fecha de elaboración de la tabla: Enero, 2019.

Referencias

1. Ali Z, Baker SR, Shahrbaf S, Martin N, Vettore MV. Oral health-related quality of life after prosthodontic treatment for patients with partial edentulism: A systematic review and meta-analysis. The Journal of prosthetic dentistry. 2018;
2. De Kok IJ, Cooper LF, Guckes AD, McGraw K, Wright RF, Barrero CJ, Bak SY, Stoner LO. Factors Influencing Removable Partial Denture Patient-Reported Outcomes of Quality of Life and Satisfaction: A Systematic Review. Journal of prosthodontics : official journal of the American College of Prosthodontists. 2017;26(1):5-18.
3. Elliot Abt, Alan B Carr, Helen V Worthington. Interventions for replacing missing teeth: partially absent dentition. Cochrane Database of Systematic Reviews. 2012;2(2):CD003814.
4. Fueki, Kenji, Yoshida, Eiko, Igarashi, Yoshimasa. A systematic review of prosthetic restoration in patients with shortened dental arches. Japanese Dental Science Review. 2011;47(2):167-174.
5. Khan S, Musekiwa A, Chikte UM, Omar R. Differences in functional outcomes for adult patients with prosthodontically-treated and -untreated shortened dental arches: a systematic review. PloS one. 2014;9(7):e101143.
6. Liang S, Zhang Q, Witter DJ, Wang Y, Creugers NH. Effects of removable dental prostheses on masticatory performance of subjects with shortened dental arches: A systematic review. Journal of dentistry. 2015;43(10):1185-94.
7. Moldovan O, Rudolph H, Luthardt RG. Biological complications of removable dental prostheses in the moderately reduced dentition: a systematic literature review. Clinical oral investigations. 2018;22(7):2439-2461.
8. Moldovan O, Rudolph H, Luthardt RG. Clinical performance of removable dental prostheses in the moderately reduced dentition: a systematic literature review. Clinical oral investigations. 2016;20(7):1435-47.
9. Pommer B, Krainhöfner M, Watzek G, Tepper G, Dintsios CM. Relevance of variations in the opposing dentition for the functionality of fixed and removable partial dentures: a systematic review. International journal of dentistry. 2012;2012:876023.
10. Akaltan, F., Kaynak, D.. An evaluation of the effects of two distal extension removable partial denture designs on tooth stabilization and periodontal health. Journal of Oral Rehabilitation. 2005;32(11):823-829.
11. Andersson B, Taylor A, Lang BR, Scheller H, Schärer P, Sorensen JA, Tarnow D. Alumina ceramic implant abutments used for single-tooth replacement: a prospective 1- to 3-year multicenter study. The International journal of prosthodontics. 2002;14(5):432-8.
12. Au AR, Lechner SK, Thomas CJ, Mori T, Chung P. Titanium for removable partial dentures (III): 2-year clinical follow-up in an undergraduate programme. Journal of oral rehabilitation. 2000;27(11):979-85.
13. Bessadet M, Nicolas E, Sochat M, Hennequin M, Veyrune JL. Impact of removable partial denture prosthesis on chewing efficiency. Journal of applied oral science : revista FOB. 2013;21(5):392-6.
14. Budtz-Jørgensen E, Isidor F. Cantilever bridges or removable partial dentures in geriatric patients: a two-year study. Journal of oral rehabilitation. 1987;14(3):239-49.
15. Frank RP, Brudvik JS, Noonan CJ. Clinical outcome of the altered cast impression procedure compared with use of a one-piece cast. The Journal of prosthetic dentistry. 2004;91(5):468-76.
16. Gunne J, Astrand P, Lindh T, Borg K, Olsson M. Tooth-implant and implant supported fixed partial dentures: a 10-year report. The International journal of prosthodontics. 2000;12(3):216-21.
17. Hosman HJ. Influence of clasp design of distal extension removable partial dentures on the periodontium of the abutment teeth. The International journal of prosthodontics. 1991;3(3):256-65.
18. Jepson N, Allen F, Moynihan P, Kelly P, Thomason M. Patient satisfaction following restoration of shortened mandibular dental arches in a randomized controlled trial. The International journal of prosthodontics. 2003;16(4):409-14.
19. Jepson NJ, Moynihan PJ, Kelly PJ, Watson GW, Thomason JM. Caries incidence following restoration of shortened lower dental arches in a randomized controlled trial. British dental journal. 2001;191(3):140-4.
20. Kapur KK, Deupree R, Dent RJ, Hasse AL. A randomized clinical trial of two basic removable partial denture designs. Part I: Comparisons of five-year success rates and periodontal health. The Journal of prosthetic dentistry. 1994;72(3):268-82.
21. Kapur KK, Garrett NR, Dent RJ, Hasse AL. A randomized clinical trial of two basic removable partial denture designs. Part II: Comparisons of masticatory scores. The Journal of prosthetic dentistry. 1997;78(1):15-21.
22. Larsson C, Vult von Steyern P, Sunzel B, Nilner K. All-ceramic two- to five-unit implant-supported reconstructions. A randomized, prospective clinical trial. Swedish dental journal. 2006;30(2):45-53.
23. McKenna G, Allen PF, Flynn A, O’Mahony D, DaMata C, Cronin M, Woods N. Impact of tooth replacement strategies on the nutritional status of partially-dentate elders. Gerodontology. 2012;29(2):e883-90.
24. McKenna G, Allen PF, O’Mahony D, Cronin M, DaMata C, Woods N. The impact of rehabilitation using removable partial dentures and functionally orientated treatment on oral health-related quality of life: a randomised controlled clinical trial. Journal of dentistry. 2015;43(1):66-71.
25. Morris HF. Department of Veterans Affairs Cooperative Studies Project number 147: level of examiner reliability over seven years. Implant dentistry. 1993;2(4):245-9.
26. Morris HF. Veterans Administration Cooperative Studies Project No. 147. Part VI: Laboratory costs of castings from noble and alternative ceramic metal alloys. The Journal of prosthetic dentistry. 1988;60(2):164-71.
27. Moynihan PJ, Butler TJ, Thomason JM, Jepson NJ. Nutrient intake in partially dentate patients: the effect of prosthetic rehabilitation. Journal of dentistry. 2000;28(8):557-63.
28. Thomas CJ, Lechner S, Mori T. Titanium for removable dentures. II. Two-year clinical observations. Journal of oral rehabilitation. 1997;24(6):414-8.
29. Thomason JM, Moynihan PJ, Steen N, Jepson NJ. Time to survival for the restoration of the shortened lower dental arch. Journal of dental research. 2007;86(7):646-50.
30. Vigolo P, Givani A, Majzoub Z, Cordioli G. A 4-year prospective study to assess peri-implant hard and soft tissues adjacent to titanium versus gold-alloy abutments in cemented single implant crowns. Journal of prosthodontics : official journal of the American College of Prosthodontists. 2006;15(4):250-6.
31. Wolfart S, Marré B, Wöstmann B, Kern M, Mundt T, Luthardt RG, Huppertz J, Hannak W, Reiber T, Passia N, Heydecke G, Reinhardt W, Hartmann S, Busche E, Mitov G, Stark H, Pospiech P, Weber A, Gernet W, Walter MH. The randomized shortened dental arch study: 5-year maintenance. Journal of dental research. 2012;91(7 Suppl):65S-71S.
32. Abuzar MA, Kahwagi E, Yamakawa T. Investigating oral health-related quality of life and self-perceived satisfaction with partial dentures. Journal of investigative and clinical dentistry. 2012;3(2):109-17.
33. Aras K, Hasanreisoğlu U, Shinogaya T. Masticatory performance, maximum occlusal force, and occlusal contact area in patients with bilaterally missing molars and distal extension removable partial dentures. The International journal of prosthodontics. 2009;22(2):204-9.
34. Arce-Tumbay J, Sanchez-Ayala A, Sotto-Maior BS, Senna PM, Campanha NH. Mastication in subjects with extremely shortened dental arches rehabilitated with removable partial dentures. The International journal of prosthodontics. 2011;24(6):517-9.
35. Armellini DB, Heydecke G, Witter DJ, Creugers NH. Effect of removable partial dentures on oral health-related quality of life in subjects with shortened dental arches: a 2-center cross-sectional study. The International journal of prosthodontics. 2008;21(6):524-30.
36. AuAR, Lechner SK, Thomas CJ, Mori T, Chung P. Titanium for removable partial dentures (III): 2-year clinical follow-up in an undergraduate programme. 2000;
37. Bae KH, Kim C, Paik DI, Kim JB. A comparison of oral health related quality of life between complete and partial removable denture-wearing older adults in Korea. Journal of oral rehabilitation. 2006;33(5):317-22.
38. Balevi B. No difference in the 5-year survival rates between the resin-bonded cantilever bridge and the removable partial denture for the restoration of the shortened dental arch. Evidence-based dentistry. 2008;9(4):105-6.
39. Behr M, Kolbeck C, Lang R, Hahnel S, Dirschl L, Handel G. Clinical performance of cements as luting agents for telescopic double crown-retained removable partial and complete overdentures. nt J Prosthodont. 2009;
40. Bergman B, Ericson G. Cross-sectional study of patients treated with removable partial dentures with special reference to the caries situation. Scandinavian journal of dental research. 1986;94(5):436-42.
41. Bergman B, Ericson G. Cross-sectional study of the periodontal status of removable partial denture patients. The Journal of prosthetic dentistry. 1989;61(2):208-11.
42. Bergman B, Hugoson A, Olsson CO. A 25 year longitudinal study of patients treated with removable partial dentures. Journal of oral rehabilitation. 1995;22(8):595-9.
43. Bergman B, Hugoson A, Olsson CO. Caries and periodontal status in patients fitted with removable partial dentures. Journal of clinical periodontology. 1977;4(2):134-46.
44. Bergman B, Hugoson A, Olsson CO. Caries, periodontal and prosthetic findings in patients with removable partial dentures: a ten-year longitudinal study. The Journal of prosthetic dentistry. 1982;48(5):506-14.
45. Bergman B, Hugoson A, Olsson CO. Periodontal and prosthetic conditions in patients treated with removable partial dentures and artificial crowns. A longitudinal two-year study. Acta odontologica Scandinavica. 1971;29(6):621-38.
46. Budtz-Jørgensen E, Isidor F. A 5-year longitudinal study of cantilevered fixed partial dentures compared with removable partial dentures in a geriatric population. The Journal of prosthetic dentistry. 1990;64(1):42-7.
47. Celebić A, Knezović-Zlatarić D. A comparison of patient’s satisfaction between complete and partial removable denture wearers. Journal of dentistry. 2003;31(7):445-51.
48. de Siqueira GP, dos Santos MB, dos Santos JF, Marchini L. Patients’ expectation and satisfaction with removable dental prosthesis therapy and correlation with patients’ evaluation of the dentists. Acta odontologica Scandinavica. 2013;71(1):210-4.
49. Dittmann B, Rammelsberg P. Survival of abutment teeth used for telescopic abutment retainers in removable partial dentures. The International journal of prosthodontics. 2008;21(4):319-21.
50. Ericson A, Nilsson B, Bergman B. Clinical results in patients provided with conical crown retained dentures. The International journal of prosthodontics. 1990;3(6):513-21.
51. Frank RP, Brudvik JS, Leroux B, Milgrom P, Hawkins N. Relationship between the standards of removable partial denture construction, clinical acceptability, and patient satisfaction. The Journal of prosthetic dentistry. 2000;83(5):521-7.
52. Frank RP, Milgrom P, Leroux BG, Hawkins NR. Treatment outcomes with mandibular removable partial dentures: a population-based study of patient satisfaction. The Journal of prosthetic dentistry. 1998;80(1):36-45.
53. Fueki K, Igarashi Y, Maeda Y, Baba K, Koyano K, Akagawa Y, Sasaki K, Kuboki T, Kasugai S, Garrett NR. Factors related to prosthetic restoration in patients with shortened dental arches: a multicentre study. Journal of oral rehabilitation. 2011;38(7):525-32.
54. Fueki K, Igarashi Y, Maeda Y, Baba K, Koyano K, Sasaki K, Akagawa Y, Kuboki T, Kasugai S, Garrett NR. Effect of prosthetic restoration on oral health-related quality of life in patients with shortened dental arches: a multicentre study. Journal of oral rehabilitation. 2015;42(9):701-8.
55. Germundsson B, Hellman M, Odman P. Effects of rehabilitation with conventional removable partial dentures on oral health–a cross-sectional study. Part II. A comparative study of treatment results at two Public Dental Clinics and the Faculty of Odontology in Gothenburg. Swedish dental journal. 1985;9(6):233-40.
56. Germundsson B, Hellman M, Odman P. Effects of rehabilitation with conventional removable partial dentures on oral health–a cross-sectional study. Swedish dental journal. 1984;8(4):171-82.
57. Gunne HS. The effect of removable partial dentures on mastication and dietary intake. Acta odontologica Scandinavica. 1985;43(5):269-78.
58. Hassel AJ, Rolko C, Grossmann AC, Ohlmann B, Rammelsberg P. Correlations between self-ratings of denture function and oral health-related quality of life in different age groups. The International journal of prosthodontics. 2007;20(3):242-4.
59. Hummel SK, Wilson MA, Marker VA, Nunn ME. Quality of removable partial dentures worn by the adult U.S. population. The Journal of prosthetic dentistry. 2002;88(1):37-43.
60. Isidor F, Budtz-Jorgensen E. [Periodontal conditions following treatment with cantilever bridges or removable partial dentures in geriatric patients. A 2-year study]. Gerodontics. 1987;3(3):117-21.
61. Isidor F, Budtz-Jørgensen E. Periodontal conditions following treatment with distally extending cantilever bridges or removable partial dentures in elderly patients. A 5-year study. Journal of periodontology. 1990;61(1):21-6.
62. Jemt T, Hedegård B, Wickberg K. Chewing patterns before and after treatment with completè maxillary and bilateral distal-extension mandibular removable partial dentures. The Journal of prosthetic dentistry. 1983;50(4):566-9.
63. Kapur KK. Veterans Administration Cooperative Dental Implant Study–comparisons between fixed partial dentures supported by blade-vent implants and removable partial dentures. Part II: Comparisons of success rates and periodontal health between two treatment modalities. The Journal of prosthetic dentistry. 1989;62(6):685-703.
64. Koyama S, Sasaki K, Yokoyama M, Sasaki T, Hanawa S. Evaluation of factors affecting the continuing use and patient satisfaction with Removable Partial Dentures over 5 years. Journal of prosthodontic research. 2010;54(2):97-101.
65. Kuboki T, Okamoto S, Suzuki H, Kanyama M, Arakawa H, Sonoyama W, Yamashita A. Quality of life assessment of bone-anchored fixed partial denture patients with unilateral mandibular distal-extension edentulism. The Journal of prosthetic dentistry. 1999;82(2):182-7.
66. Lassila V, Holmlund I, Koivumaa KK. Bite force and its correlations in different denture types. Acta odontologica Scandinavica. 1985;43(3):127-32.
67. Leake JL, Hawkins R, Locker D. Social and functional impact of reduced posterior dental units in older adults. Journal of oral rehabilitation. 1994;21(1):1-10.
68. Liedberg B, Stoltze K, Owall B. The masticatory handicap of wearing removable dentures in elderly men. Gerodontology. 2005;22(1):10-6.
69. Montero J, Bravo M, López-Valverde A. Development of a specific indicator of the well-being of wearers of removable dentures. Community dentistry and oral epidemiology. 2011;39(6):515-24.
70. Montero J, Castillo-Oyagüe R, Lynch CD, Albaladejo A, Castaño A. Self-perceived changes in oral health-related quality of life after receiving different types of conventional prosthetic treatments: a cohort follow-up study. Journal of dentistry. 2013;41(6):493-503.
71. Müller S, Eickholz P, Reitmeir P, Eger T. Long-term tooth loss in periodontally compromised but treated patients according to the type of prosthodontic treatment. A retrospective study. Journal of oral rehabilitation. 2013;40(5):358-67.
72. Peršić S, Čelebić A. Influence of different prosthodontic rehabilitation options on oral health-related quality of life, orofacial esthetics and chewing function based on patient-reported outcomes. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2015;24(4):919-26.
73. Piwowarczyk A, Köhler KC, Bender R, Büchler A, Lauer HC, Ottl P. Prognosis for abutment teeth of removable dentures: a retrospective study. Journal of prosthodontics : official journal of the American College of Prosthodontists. 2007;16(5):377-82.
74. Rehmann P, Orbach K, Ferger P, Wöstmann B. Treatment outcomes with removable partial dentures: a retrospective analysis. The International journal of prosthodontics. 2013;26(2):147-50.
75. Rehmann P. Retrospektive Longitudinalstudie über die langfristige Bewährung von Teleskopprothesen unter besonderer Berücksichtigung der Instandhaltungskosten. 2006;
76. Sanchez-Ayala A, Ambrosano GM, Rodrigues Garcia RC. Influence of length of occlusal support on masticatory function of free-end removable partial dentures. The International journal of prosthodontics. 2012;25(5):472-9.
77. Schmitt J, Wichmann M, Eitner S, Hamel J, Holst S. Five-year clinical follow-up of prefabricated precision attachments: a comparison of uni- and bilateral removable dental prostheses. Quintessence international (Berlin, Germany : 1985). 2011;42(5):413-8.
78. Shoi K, Fueki K, Usui N, Taira M, Wakabayashi N. Influence of posterior dental arch length on brain activity during chewing in patients with mandibular distal extension removable partial dentures. Journal of oral rehabilitation. 2014;41(7):486-95.
79. Shugars DA, Bader JD, White BA, Scurria MS, Hayden WJ, Garcia RI. Survival rates of teeth adjacent to treated and untreated posterior bounded edentulous spaces. Journal of the American Dental Association (1939). 1998;129(8):1089-95.
80. Stober T, Bermejo JL, Beck-Mussoter J, Seche AC, Lehmann F, Koob J, Rammelsberg P. Clinical performance of conical and electroplated telescopic double crown-retained partial dentures: a randomized clinical study. The International journal of prosthodontics. 2012;25(3):209-16.
81. Swelem AA, Gurevich KG, Fabrikant EG, Hassan MH, Aqou S. Oral health-related quality of life in partially edentulous patients treated with removable, fixed, fixed-removable, and implant-supported prostheses. The International journal of prosthodontics. 2014;27(4):338-47.
82. Szentpétery AG, John MT, Slade GD, Setz JM. Problems reported by patients before and after prosthodontic treatment. The International journal of prosthodontics. 2005;18(2):124-31.
83. Tada S, Ikebe K, Matsuda K, Maeda Y. Multifactorial risk assessment for survival of abutments of removable partial dentures based on practice-based longitudinal study. Journal of dentistry. 2013;41(12):1175-80.
84. Tumrasvin W, Fueki K, Yanagawa M, Asakawa A, Yoshimura M, Ohyama T. Masticatory function after unilateral distal extension removable partial denture treatment: intra-individual comparison with opposite dentulous side. Journal of medical and dental sciences. 2005;52(1):35-41.
85. Tuominen R, Ranta K, Paunio I. Wearing of removable partial dentures in relation to periodontal pockets. Journal of oral rehabilitation. 1989;16(2):119-26.
86. Van Waas M, Meeuwissen J, Meuwissen R, Käyser A, Kalk W, Van ‘t Hof M. Relationship between wearing a removable partial denture and satisfaction in the elderly. Community dentistry and oral epidemiology. 1994;22(5 Pt 1):315-8.
87. Vermeulen AH, Keltjens HM, van’t Hof MA, Kayser AF. Ten-year evaluation of removable partial dentures: survival rates based on retreatment, not wearing and replacement. The Journal of prosthetic dentistry. 1996;76(3):267-72.
88. Wagner B, Kern M. Clinical evaluation of removable partial dentures 10 years after insertion: success rates, hygienic problems, and technical failures. Clinical oral investigations. 2000;4(2):74-80.
89. Wayler AH, Muench ME, Kapur KK, Chauncey HH. Masticatory performance and food acceptability in persons with removable partial dentures, full dentures and intact natural dentition. Journal of gerontology. 1984;39(3):284-9.
90. Wenz HJ, Hertrampf K, Lehmann KM. Clinical longevity of removable partial dentures retained by telescopic crowns: outcome of the double crown with clearance fit. The International journal of prosthodontics. 2001;14(3):207-13.
91. Wickert M, John MT, Schierz O, Hirsch C, Aarabi G, Reissmann DR. Sensitivity to change of oral and general health-related quality of life during prosthodontic treatment. European journal of oral sciences. 2014;122(1):70-7.
92. Witter DJ, Creugers NH, Kreulen CM, de Haan AF. Occlusal stability in shortened dental arches. Journal of dental research. 2001;80(2):432-6.
93. Witter DJ, de Haan AF, Käyser AF, van Rossum GM. A 6-year follow-up study of oral function in shortened dental arches. Part I: Occlusal stability. Journal of oral rehabilitation. 1994;21(2):113-25.
94. Witter DJ, De Haan AF, Käyser AF, Van Rossum GM. A 6-year follow-up study of oral function in shortened dental arches. Part II: Craniomandibular dysfunction and oral comfort. Journal of oral rehabilitation. 1994;21(4):353-66.
95. Witter DJ, De Haan AF, Käyser AF, Van Rossum GM. Shortened dental arches and periodontal support. Journal of oral rehabilitation. 1991;18(3):203-12.
96. Witter DJ, Kreulen CM, Mulder J, Creugers NH. Signs and symptoms related to temporomandibular disorders–Follow-up of subjects with shortened and complete dental arches. Journal of dentistry. 2007;35(6):521-7.
97. Witter DJ, Van Elteren P, Käyser AF, Van Rossum GM. Oral comfort in shortened dental arches. Journal of oral rehabilitation. 1990;17(2):137-43.
98. Witter DJ, van Elteren P, Käyser AF, van Rossum MJ. The effect of removable partial dentures on the oral function in shortened dental arches. Journal of oral rehabilitation. 1989;16(1):27-33.
99. Wöstmann B, Balkenhol M, Weber A, Ferger P, Rehmann P. Long-term analysis of telescopic crown retained removable partial dentures: survival and need for maintenance. Journal of dentistry. 2007;35(12):939-45.
100. Yanagawa M, Fueki K, Ohyama T. Influence of length of food platform on masticatory performance in patients missing unilateral mandibular molars with distal extension removable partial dentures. Journal of medical and dental sciences. 2004;51(2):115-9.
101. Yli-Urpo A, Lappalainen R, Huuskonen O. Frequency of damage to and need for repairs of removable dentures. Proceedings of the Finnish Dental Society. Suomen Hammaslaakariseuran toimituksia. 1985;81(3):151-5.
102. Campbell SD, Cooper L, Craddock H, Hyde TP, Nattress B, Pavitt SH, Seymour DW. Removable partial dentures: The clinical need for innovation. J Prosthet Dent. 2017 Sep;118(3):273-280.
103. Metal versus Acrylic Partial Removable Dentures for Patients with Periodontal Disease: A Review of the Clinical Effectiveness and Guidelines. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2016 Feb 8.
104. Bhola S, Hellyer PH, Radford DR. The importance of communication in the construction of partial dentures. Br Dent J. 2018 Jun 8;224(11):853-856.
105. Efeoglu C, Coşkun G. Management Issues of a Patient who Ingested a Denture: a Case Report. Acta Stomatologica Croatica [Internet]. 2011 Jun [cited 2019 Jan 30];45(2):131–4.
106. Mohanty, H. S., Shirodkar, K., Patil, A. R., Mallarajapatna, G., Kumar, S., Deepak, K. C., & Nandikoor, S. Oesophageal perforation as a complication of ingested partial denture. BJR case reports. 2016, 2(4), 20150348.
107. Gallas M, Blanco M, Martinez-Ares D, Rivo E, García-Fontán E, Cañizares M. Unnoticed swallowing of a unilateral removable partial denture. Gerodontology. 2012 Jun;29(2):e1198-200.
108. R Singh, S Varshney, S Bist, N Gupta. An Iatrogenic esophageal perforation with dentures: How Does It Happen?. The Internet Journal of Head and Neck Surgery. 2007 Volume 2 Number 2.
109. D. Agrawal, T. K. Lahiri, Abhijot Parmar, Shweta Sharma. Swallowed Partial Dentures. Indian Journal of Dental Sciences. 2012 Issue:2, Vol.:4.

Búsqueda y Síntesis de Evidencia

 3.- ¿Qué tan significativos son los efectos indeseables anticipados?
Grandes Moderados Pequeños Triviales Varía No lo sé

Grandes: El panel de expertos de la Guía estimó que los efectos indeseables de «rehabilitar por medio de prótesis unilateral» en comparación a «rehabilitar con protesis con extensión contralateral» son grandes.

Según la evidencia y conocimiento clínica del panel, las prótesis unilaterales tiene mayores probabilidades de ser deglutidas o aspiradas, lo que podría implicar serias complicaciones del paciente, incluso la muerte, dado que pueden obstruir o perforar vías respiratorias o gastrointestinales. Por un lado, cuando las prótesis unilateral no llevan topes verticales (retenedores y apoyos), puede haber daño peridontal dado que se va incrustando en los tejidos blandos. Además son más inestable que las prótesis con extensión contralateral.

Evidencia de investigación

Rehabilitar por medio de prótesis unilateral comparado con rehabilitar con prótesis con extensión contralateral para edentulismo parcial unilateral.

 

Pacientes

Personas con edentulismo parcial unilateral.

 

Intervención

Rehabilitar por medio de prótesis unilateral.

 

Comparación

Rehabilitar con prótesis con extensión contralateral.

 

Desenlaces

Efecto

Certeza de la evidencia

(GRADE)

Mensajes clave en términos sencillos

Efectividad

No se identificaron estudios que comparen la efectividad de las intervenciones.

 

Efectos adversos

Si bien no existen estudios comparativos, un estudio reportó 64 prótesis dentales removibles unilaterales deglutidas e impactadas en el esófago. De ellas, 17 prótesis reemplazaban un solo diente, 32 a dos dientes, 5 a tres dientes y 8 a cuatro dientes. La mortalidad ocurrió en 3 casos (4,68%) como resultado de hemorragia masiva, fuga esofágica, empiema, peritonitis y septicemia.

 Debido a la mayor retención, soporte y estabilidad de la prótesis con extensión contralateral, este efecto adverso no debiera ocurrir. 

⊕⊕◯◯1,2,3

Baja

Rehabilitar por medio de prótesis unilateral probablemente aumenta el riesgo de deglución de la prótesis.

 

GRADE: Grados de evidencia Grading of Recommendations Assessment, Development and Evaluation.
1 Diseño observacional.
2 Se aumentó un nivel de certeza de evidencia por efecto grande, ya que si bien, corresponde a estudios de series de casos, este efecto adverso no debiera ocurrir en el otro tipo de prótesis por lo que la diferencia es grande.
3 Se disminuyó un nivel de certeza de evidencia por ser indirecta, ya que el estudio realiza un análisis retrospectivo de casos de prótesis unilaterales deglutidas y no se realiza una comparación entre el riesgo de deglución de prótesis con extensión lateral. Además, las prótesis incluidas en el estudio no cumplen con los estándares de calidad de las prótesis dentales removibles realizadas en Chile.
Fecha de elaboración de la tabla: Enero, 2019.

Referencias

1. Ali Z, Baker SR, Shahrbaf S, Martin N, Vettore MV. Oral health-related quality of life after prosthodontic treatment for patients with partial edentulism: A systematic review and meta-analysis. The Journal of prosthetic dentistry. 2018;
2. De Kok IJ, Cooper LF, Guckes AD, McGraw K, Wright RF, Barrero CJ, Bak SY, Stoner LO. Factors Influencing Removable Partial Denture Patient-Reported Outcomes of Quality of Life and Satisfaction: A Systematic Review. Journal of prosthodontics : official journal of the American College of Prosthodontists. 2017;26(1):5-18.
3. Elliot Abt, Alan B Carr, Helen V Worthington. Interventions for replacing missing teeth: partially absent dentition. Cochrane Database of Systematic Reviews. 2012;2(2):CD003814.
4. Fueki, Kenji, Yoshida, Eiko, Igarashi, Yoshimasa. A systematic review of prosthetic restoration in patients with shortened dental arches. Japanese Dental Science Review. 2011;47(2):167-174.
5. Khan S, Musekiwa A, Chikte UM, Omar R. Differences in functional outcomes for adult patients with prosthodontically-treated and -untreated shortened dental arches: a systematic review. PloS one. 2014;9(7):e101143.
6. Liang S, Zhang Q, Witter DJ, Wang Y, Creugers NH. Effects of removable dental prostheses on masticatory performance of subjects with shortened dental arches: A systematic review. Journal of dentistry. 2015;43(10):1185-94.
7. Moldovan O, Rudolph H, Luthardt RG. Biological complications of removable dental prostheses in the moderately reduced dentition: a systematic literature review. Clinical oral investigations. 2018;22(7):2439-2461.
8. Moldovan O, Rudolph H, Luthardt RG. Clinical performance of removable dental prostheses in the moderately reduced dentition: a systematic literature review. Clinical oral investigations. 2016;20(7):1435-47.
9. Pommer B, Krainhöfner M, Watzek G, Tepper G, Dintsios CM. Relevance of variations in the opposing dentition for the functionality of fixed and removable partial dentures: a systematic review. International journal of dentistry. 2012;2012:876023.
10. Akaltan, F., Kaynak, D.. An evaluation of the effects of two distal extension removable partial denture designs on tooth stabilization and periodontal health. Journal of Oral Rehabilitation. 2005;32(11):823-829.
11. Andersson B, Taylor A, Lang BR, Scheller H, Schärer P, Sorensen JA, Tarnow D. Alumina ceramic implant abutments used for single-tooth replacement: a prospective 1- to 3-year multicenter study. The International journal of prosthodontics. 2002;14(5):432-8.
12. Au AR, Lechner SK, Thomas CJ, Mori T, Chung P. Titanium for removable partial dentures (III): 2-year clinical follow-up in an undergraduate programme. Journal of oral rehabilitation. 2000;27(11):979-85.
13. Bessadet M, Nicolas E, Sochat M, Hennequin M, Veyrune JL. Impact of removable partial denture prosthesis on chewing efficiency. Journal of applied oral science : revista FOB. 2013;21(5):392-6.
14. Budtz-Jørgensen E, Isidor F. Cantilever bridges or removable partial dentures in geriatric patients: a two-year study. Journal of oral rehabilitation. 1987;14(3):239-49.
15. Frank RP, Brudvik JS, Noonan CJ. Clinical outcome of the altered cast impression procedure compared with use of a one-piece cast. The Journal of prosthetic dentistry. 2004;91(5):468-76.
16. Gunne J, Astrand P, Lindh T, Borg K, Olsson M. Tooth-implant and implant supported fixed partial dentures: a 10-year report. The International journal of prosthodontics. 2000;12(3):216-21.
17. Hosman HJ. Influence of clasp design of distal extension removable partial dentures on the periodontium of the abutment teeth. The International journal of prosthodontics. 1991;3(3):256-65.
18. Jepson N, Allen F, Moynihan P, Kelly P, Thomason M. Patient satisfaction following restoration of shortened mandibular dental arches in a randomized controlled trial. The International journal of prosthodontics. 2003;16(4):409-14.
19. Jepson NJ, Moynihan PJ, Kelly PJ, Watson GW, Thomason JM. Caries incidence following restoration of shortened lower dental arches in a randomized controlled trial. British dental journal. 2001;191(3):140-4.
20. Kapur KK, Deupree R, Dent RJ, Hasse AL. A randomized clinical trial of two basic removable partial denture designs. Part I: Comparisons of five-year success rates and periodontal health. The Journal of prosthetic dentistry. 1994;72(3):268-82.
21. Kapur KK, Garrett NR, Dent RJ, Hasse AL. A randomized clinical trial of two basic removable partial denture designs. Part II: Comparisons of masticatory scores. The Journal of prosthetic dentistry. 1997;78(1):15-21.
22. Larsson C, Vult von Steyern P, Sunzel B, Nilner K. All-ceramic two- to five-unit implant-supported reconstructions. A randomized, prospective clinical trial. Swedish dental journal. 2006;30(2):45-53.
23. McKenna G, Allen PF, Flynn A, O’Mahony D, DaMata C, Cronin M, Woods N. Impact of tooth replacement strategies on the nutritional status of partially-dentate elders. Gerodontology. 2012;29(2):e883-90.
24. McKenna G, Allen PF, O’Mahony D, Cronin M, DaMata C, Woods N. The impact of rehabilitation using removable partial dentures and functionally orientated treatment on oral health-related quality of life: a randomised controlled clinical trial. Journal of dentistry. 2015;43(1):66-71.
25. Morris HF. Department of Veterans Affairs Cooperative Studies Project number 147: level of examiner reliability over seven years. Implant dentistry. 1993;2(4):245-9.
26. Morris HF. Veterans Administration Cooperative Studies Project No. 147. Part VI: Laboratory costs of castings from noble and alternative ceramic metal alloys. The Journal of prosthetic dentistry. 1988;60(2):164-71.
27. Moynihan PJ, Butler TJ, Thomason JM, Jepson NJ. Nutrient intake in partially dentate patients: the effect of prosthetic rehabilitation. Journal of dentistry. 2000;28(8):557-63.
28. Thomas CJ, Lechner S, Mori T. Titanium for removable dentures. II. Two-year clinical observations. Journal of oral rehabilitation. 1997;24(6):414-8.
29. Thomason JM, Moynihan PJ, Steen N, Jepson NJ. Time to survival for the restoration of the shortened lower dental arch. Journal of dental research. 2007;86(7):646-50.
30. Vigolo P, Givani A, Majzoub Z, Cordioli G. A 4-year prospective study to assess peri-implant hard and soft tissues adjacent to titanium versus gold-alloy abutments in cemented single implant crowns. Journal of prosthodontics : official journal of the American College of Prosthodontists. 2006;15(4):250-6.
31. Wolfart S, Marré B, Wöstmann B, Kern M, Mundt T, Luthardt RG, Huppertz J, Hannak W, Reiber T, Passia N, Heydecke G, Reinhardt W, Hartmann S, Busche E, Mitov G, Stark H, Pospiech P, Weber A, Gernet W, Walter MH. The randomized shortened dental arch study: 5-year maintenance. Journal of dental research. 2012;91(7 Suppl):65S-71S.
32. Abuzar MA, Kahwagi E, Yamakawa T. Investigating oral health-related quality of life and self-perceived satisfaction with partial dentures. Journal of investigative and clinical dentistry. 2012;3(2):109-17.
33. Aras K, Hasanreisoğlu U, Shinogaya T. Masticatory performance, maximum occlusal force, and occlusal contact area in patients with bilaterally missing molars and distal extension removable partial dentures. The International journal of prosthodontics. 2009;22(2):204-9.
34. Arce-Tumbay J, Sanchez-Ayala A, Sotto-Maior BS, Senna PM, Campanha NH. Mastication in subjects with extremely shortened dental arches rehabilitated with removable partial dentures. The International journal of prosthodontics. 2011;24(6):517-9.
35. Armellini DB, Heydecke G, Witter DJ, Creugers NH. Effect of removable partial dentures on oral health-related quality of life in subjects with shortened dental arches: a 2-center cross-sectional study. The International journal of prosthodontics. 2008;21(6):524-30.
36. AuAR, Lechner SK, Thomas CJ, Mori T, Chung P. Titanium for removable partial dentures (III): 2-year clinical follow-up in an undergraduate programme. 2000;
37. Bae KH, Kim C, Paik DI, Kim JB. A comparison of oral health related quality of life between complete and partial removable denture-wearing older adults in Korea. Journal of oral rehabilitation. 2006;33(5):317-22.
38. Balevi B. No difference in the 5-year survival rates between the resin-bonded cantilever bridge and the removable partial denture for the restoration of the shortened dental arch. Evidence-based dentistry. 2008;9(4):105-6.
39. Behr M, Kolbeck C, Lang R, Hahnel S, Dirschl L, Handel G. Clinical performance of cements as luting agents for telescopic double crown-retained removable partial and complete overdentures. nt J Prosthodont. 2009;
40. Bergman B, Ericson G. Cross-sectional study of patients treated with removable partial dentures with special reference to the caries situation. Scandinavian journal of dental research. 1986;94(5):436-42.
41. Bergman B, Ericson G. Cross-sectional study of the periodontal status of removable partial denture patients. The Journal of prosthetic dentistry. 1989;61(2):208-11.
42. Bergman B, Hugoson A, Olsson CO. A 25 year longitudinal study of patients treated with removable partial dentures. Journal of oral rehabilitation. 1995;22(8):595-9.
43. Bergman B, Hugoson A, Olsson CO. Caries and periodontal status in patients fitted with removable partial dentures. Journal of clinical periodontology. 1977;4(2):134-46.
44. Bergman B, Hugoson A, Olsson CO. Caries, periodontal and prosthetic findings in patients with removable partial dentures: a ten-year longitudinal study. The Journal of prosthetic dentistry. 1982;48(5):506-14.
45. Bergman B, Hugoson A, Olsson CO. Periodontal and prosthetic conditions in patients treated with removable partial dentures and artificial crowns. A longitudinal two-year study. Acta odontologica Scandinavica. 1971;29(6):621-38.
46. Budtz-Jørgensen E, Isidor F. A 5-year longitudinal study of cantilevered fixed partial dentures compared with removable partial dentures in a geriatric population. The Journal of prosthetic dentistry. 1990;64(1):42-7.
47. Celebić A, Knezović-Zlatarić D. A comparison of patient’s satisfaction between complete and partial removable denture wearers. Journal of dentistry. 2003;31(7):445-51.
48. de Siqueira GP, dos Santos MB, dos Santos JF, Marchini L. Patients’ expectation and satisfaction with removable dental prosthesis therapy and correlation with patients’ evaluation of the dentists. Acta odontologica Scandinavica. 2013;71(1):210-4.
49. Dittmann B, Rammelsberg P. Survival of abutment teeth used for telescopic abutment retainers in removable partial dentures. The International journal of prosthodontics. 2008;21(4):319-21.
50. Ericson A, Nilsson B, Bergman B. Clinical results in patients provided with conical crown retained dentures. The International journal of prosthodontics. 1990;3(6):513-21.
51. Frank RP, Brudvik JS, Leroux B, Milgrom P, Hawkins N. Relationship between the standards of removable partial denture construction, clinical acceptability, and patient satisfaction. The Journal of prosthetic dentistry. 2000;83(5):521-7.
52. Frank RP, Milgrom P, Leroux BG, Hawkins NR. Treatment outcomes with mandibular removable partial dentures: a population-based study of patient satisfaction. The Journal of prosthetic dentistry. 1998;80(1):36-45.
53. Fueki K, Igarashi Y, Maeda Y, Baba K, Koyano K, Akagawa Y, Sasaki K, Kuboki T, Kasugai S, Garrett NR. Factors related to prosthetic restoration in patients with shortened dental arches: a multicentre study. Journal of oral rehabilitation. 2011;38(7):525-32.
54. Fueki K, Igarashi Y, Maeda Y, Baba K, Koyano K, Sasaki K, Akagawa Y, Kuboki T, Kasugai S, Garrett NR. Effect of prosthetic restoration on oral health-related quality of life in patients with shortened dental arches: a multicentre study. Journal of oral rehabilitation. 2015;42(9):701-8.
55. Germundsson B, Hellman M, Odman P. Effects of rehabilitation with conventional removable partial dentures on oral health–a cross-sectional study. Part II. A comparative study of treatment results at two Public Dental Clinics and the Faculty of Odontology in Gothenburg. Swedish dental journal. 1985;9(6):233-40.
56. Germundsson B, Hellman M, Odman P. Effects of rehabilitation with conventional removable partial dentures on oral health–a cross-sectional study. Swedish dental journal. 1984;8(4):171-82.
57. Gunne HS. The effect of removable partial dentures on mastication and dietary intake. Acta odontologica Scandinavica. 1985;43(5):269-78.
58. Hassel AJ, Rolko C, Grossmann AC, Ohlmann B, Rammelsberg P. Correlations between self-ratings of denture function and oral health-related quality of life in different age groups. The International journal of prosthodontics. 2007;20(3):242-4.
59. Hummel SK, Wilson MA, Marker VA, Nunn ME. Quality of removable partial dentures worn by the adult U.S. population. The Journal of prosthetic dentistry. 2002;88(1):37-43.
60. Isidor F, Budtz-Jorgensen E. [Periodontal conditions following treatment with cantilever bridges or removable partial dentures in geriatric patients. A 2-year study]. Gerodontics. 1987;3(3):117-21.
61. Isidor F, Budtz-Jørgensen E. Periodontal conditions following treatment with distally extending cantilever bridges or removable partial dentures in elderly patients. A 5-year study. Journal of periodontology. 1990;61(1):21-6.
62. Jemt T, Hedegård B, Wickberg K. Chewing patterns before and after treatment with completè maxillary and bilateral distal-extension mandibular removable partial dentures. The Journal of prosthetic dentistry. 1983;50(4):566-9.
63. Kapur KK. Veterans Administration Cooperative Dental Implant Study–comparisons between fixed partial dentures supported by blade-vent implants and removable partial dentures. Part II: Comparisons of success rates and periodontal health between two treatment modalities. The Journal of prosthetic dentistry. 1989;62(6):685-703.
64. Koyama S, Sasaki K, Yokoyama M, Sasaki T, Hanawa S. Evaluation of factors affecting the continuing use and patient satisfaction with Removable Partial Dentures over 5 years. Journal of prosthodontic research. 2010;54(2):97-101.
65. Kuboki T, Okamoto S, Suzuki H, Kanyama M, Arakawa H, Sonoyama W, Yamashita A. Quality of life assessment of bone-anchored fixed partial denture patients with unilateral mandibular distal-extension edentulism. The Journal of prosthetic dentistry. 1999;82(2):182-7.
66. Lassila V, Holmlund I, Koivumaa KK. Bite force and its correlations in different denture types. Acta odontologica Scandinavica. 1985;43(3):127-32.
67. Leake JL, Hawkins R, Locker D. Social and functional impact of reduced posterior dental units in older adults. Journal of oral rehabilitation. 1994;21(1):1-10.
68. Liedberg B, Stoltze K, Owall B. The masticatory handicap of wearing removable dentures in elderly men. Gerodontology. 2005;22(1):10-6.
69. Montero J, Bravo M, López-Valverde A. Development of a specific indicator of the well-being of wearers of removable dentures. Community dentistry and oral epidemiology. 2011;39(6):515-24.
70. Montero J, Castillo-Oyagüe R, Lynch CD, Albaladejo A, Castaño A. Self-perceived changes in oral health-related quality of life after receiving different types of conventional prosthetic treatments: a cohort follow-up study. Journal of dentistry. 2013;41(6):493-503.
71. Müller S, Eickholz P, Reitmeir P, Eger T. Long-term tooth loss in periodontally compromised but treated patients according to the type of prosthodontic treatment. A retrospective study. Journal of oral rehabilitation. 2013;40(5):358-67.
72. Peršić S, Čelebić A. Influence of different prosthodontic rehabilitation options on oral health-related quality of life, orofacial esthetics and chewing function based on patient-reported outcomes. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2015;24(4):919-26.
73. Piwowarczyk A, Köhler KC, Bender R, Büchler A, Lauer HC, Ottl P. Prognosis for abutment teeth of removable dentures: a retrospective study. Journal of prosthodontics : official journal of the American College of Prosthodontists. 2007;16(5):377-82.
74. Rehmann P, Orbach K, Ferger P, Wöstmann B. Treatment outcomes with removable partial dentures: a retrospective analysis. The International journal of prosthodontics. 2013;26(2):147-50.
75. Rehmann P. Retrospektive Longitudinalstudie über die langfristige Bewährung von Teleskopprothesen unter besonderer Berücksichtigung der Instandhaltungskosten. 2006;
76. Sanchez-Ayala A, Ambrosano GM, Rodrigues Garcia RC. Influence of length of occlusal support on masticatory function of free-end removable partial dentures. The International journal of prosthodontics. 2012;25(5):472-9.
77. Schmitt J, Wichmann M, Eitner S, Hamel J, Holst S. Five-year clinical follow-up of prefabricated precision attachments: a comparison of uni- and bilateral removable dental prostheses. Quintessence international (Berlin, Germany : 1985). 2011;42(5):413-8.
78. Shoi K, Fueki K, Usui N, Taira M, Wakabayashi N. Influence of posterior dental arch length on brain activity during chewing in patients with mandibular distal extension removable partial dentures. Journal of oral rehabilitation. 2014;41(7):486-95.
79. Shugars DA, Bader JD, White BA, Scurria MS, Hayden WJ, Garcia RI. Survival rates of teeth adjacent to treated and untreated posterior bounded edentulous spaces. Journal of the American Dental Association (1939). 1998;129(8):1089-95.
80. Stober T, Bermejo JL, Beck-Mussoter J, Seche AC, Lehmann F, Koob J, Rammelsberg P. Clinical performance of conical and electroplated telescopic double crown-retained partial dentures: a randomized clinical study. The International journal of prosthodontics. 2012;25(3):209-16.
81. Swelem AA, Gurevich KG, Fabrikant EG, Hassan MH, Aqou S. Oral health-related quality of life in partially edentulous patients treated with removable, fixed, fixed-removable, and implant-supported prostheses. The International journal of prosthodontics. 2014;27(4):338-47.
82. Szentpétery AG, John MT, Slade GD, Setz JM. Problems reported by patients before and after prosthodontic treatment. The International journal of prosthodontics. 2005;18(2):124-31.
83. Tada S, Ikebe K, Matsuda K, Maeda Y. Multifactorial risk assessment for survival of abutments of removable partial dentures based on practice-based longitudinal study. Journal of dentistry. 2013;41(12):1175-80.
84. Tumrasvin W, Fueki K, Yanagawa M, Asakawa A, Yoshimura M, Ohyama T. Masticatory function after unilateral distal extension removable partial denture treatment: intra-individual comparison with opposite dentulous side. Journal of medical and dental sciences. 2005;52(1):35-41.
85. Tuominen R, Ranta K, Paunio I. Wearing of removable partial dentures in relation to periodontal pockets. Journal of oral rehabilitation. 1989;16(2):119-26.
86. Van Waas M, Meeuwissen J, Meuwissen R, Käyser A, Kalk W, Van ‘t Hof M. Relationship between wearing a removable partial denture and satisfaction in the elderly. Community dentistry and oral epidemiology. 1994;22(5 Pt 1):315-8.
87. Vermeulen AH, Keltjens HM, van’t Hof MA, Kayser AF. Ten-year evaluation of removable partial dentures: survival rates based on retreatment, not wearing and replacement. The Journal of prosthetic dentistry. 1996;76(3):267-72.
88. Wagner B, Kern M. Clinical evaluation of removable partial dentures 10 years after insertion: success rates, hygienic problems, and technical failures. Clinical oral investigations. 2000;4(2):74-80.
89. Wayler AH, Muench ME, Kapur KK, Chauncey HH. Masticatory performance and food acceptability in persons with removable partial dentures, full dentures and intact natural dentition. Journal of gerontology. 1984;39(3):284-9.
90. Wenz HJ, Hertrampf K, Lehmann KM. Clinical longevity of removable partial dentures retained by telescopic crowns: outcome of the double crown with clearance fit. The International journal of prosthodontics. 2001;14(3):207-13.
91. Wickert M, John MT, Schierz O, Hirsch C, Aarabi G, Reissmann DR. Sensitivity to change of oral and general health-related quality of life during prosthodontic treatment. European journal of oral sciences. 2014;122(1):70-7.
92. Witter DJ, Creugers NH, Kreulen CM, de Haan AF. Occlusal stability in shortened dental arches. Journal of dental research. 2001;80(2):432-6.
93. Witter DJ, de Haan AF, Käyser AF, van Rossum GM. A 6-year follow-up study of oral function in shortened dental arches. Part I: Occlusal stability. Journal of oral rehabilitation. 1994;21(2):113-25.
94. Witter DJ, De Haan AF, Käyser AF, Van Rossum GM. A 6-year follow-up study of oral function in shortened dental arches. Part II: Craniomandibular dysfunction and oral comfort. Journal of oral rehabilitation. 1994;21(4):353-66.
95. Witter DJ, De Haan AF, Käyser AF, Van Rossum GM. Shortened dental arches and periodontal support. Journal of oral rehabilitation. 1991;18(3):203-12.
96. Witter DJ, Kreulen CM, Mulder J, Creugers NH. Signs and symptoms related to temporomandibular disorders–Follow-up of subjects with shortened and complete dental arches. Journal of dentistry. 2007;35(6):521-7.
97. Witter DJ, Van Elteren P, Käyser AF, Van Rossum GM. Oral comfort in shortened dental arches. Journal of oral rehabilitation. 1990;17(2):137-43.
98. Witter DJ, van Elteren P, Käyser AF, van Rossum MJ. The effect of removable partial dentures on the oral function in shortened dental arches. Journal of oral rehabilitation. 1989;16(1):27-33.
99. Wöstmann B, Balkenhol M, Weber A, Ferger P, Rehmann P. Long-term analysis of telescopic crown retained removable partial dentures: survival and need for maintenance. Journal of dentistry. 2007;35(12):939-45.
100. Yanagawa M, Fueki K, Ohyama T. Influence of length of food platform on masticatory performance in patients missing unilateral mandibular molars with distal extension removable partial dentures. Journal of medical and dental sciences. 2004;51(2):115-9.
101. Yli-Urpo A, Lappalainen R, Huuskonen O. Frequency of damage to and need for repairs of removable dentures. Proceedings of the Finnish Dental Society. Suomen Hammaslaakariseuran toimituksia. 1985;81(3):151-5.
102. Campbell SD, Cooper L, Craddock H, Hyde TP, Nattress B, Pavitt SH, Seymour DW. Removable partial dentures: The clinical need for innovation. J Prosthet Dent. 2017 Sep;118(3):273-280.
103. Metal versus Acrylic Partial Removable Dentures for Patients with Periodontal Disease: A Review of the Clinical Effectiveness and Guidelines. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2016 Feb 8.
104. Bhola S, Hellyer PH, Radford DR. The importance of communication in the construction of partial dentures. Br Dent J. 2018 Jun 8;224(11):853-856.
105. Efeoglu C, Coşkun G. Management Issues of a Patient who Ingested a Denture: a Case Report. Acta Stomatologica Croatica [Internet]. 2011 Jun [cited 2019 Jan 30];45(2):131–4.
106. Mohanty, H. S., Shirodkar, K., Patil, A. R., Mallarajapatna, G., Kumar, S., Deepak, K. C., & Nandikoor, S. Oesophageal perforation as a complication of ingested partial denture. BJR case reports. 2016, 2(4), 20150348.
107. Gallas M, Blanco M, Martinez-Ares D, Rivo E, García-Fontán E, Cañizares M. Unnoticed swallowing of a unilateral removable partial denture. Gerodontology. 2012 Jun;29(2):e1198-200.
108. R Singh, S Varshney, S Bist, N Gupta. An Iatrogenic esophageal perforation with dentures: How Does It Happen?. The Internet Journal of Head and Neck Surgery. 2007 Volume 2 Number 2.
109. D. Agrawal, T. K. Lahiri, Abhijot Parmar, Shweta Sharma. Swallowed Partial Dentures. Indian Journal of Dental Sciences. 2012 Issue:2, Vol.:4.

Búsqueda y Síntesis de Evidencia

 4.- ¿Cuál es la certeza general de la evidencia sobre efectos?
Muy baja Baja Moderada Alta Ningún estudio incluido

Baja: Existe cierta incertidumbre respecto del efecto de «rehabilitar por medio de prótesis unilateral» en comparación a «rehabilitar con protesis con extensión contralateral». La certeza general de la evidencia se establece en función del único desenlace reportado: efectos adversos.

Evidencia de investigación

Desenlaces

Importancia

Certeza de la evidencia

(GRADE)

Efectividad

Desenlace no reportado en la evidencia

 

Efectos adversos

Crítico 

⊕⊕◯◯1,2,3

Baja

 

1 Diseño observacional.
2 Se aumentó un nivel de certeza de evidencia por efecto grande, ya que si bien, corresponde a estudios de series de casos, este efecto adverso no debiera ocurrir en el otro tipo de prótesis por lo que la diferencia es grande.
3 Se disminuyó un nivel de certeza de evidencia por ser indirecta, ya que el estudio realiza un análisis retrospectivo de casos de prótesis unilaterales deglutidas y no se realiza una comparación entre el riesgo de deglución de prótesis con extensión lateral. Además, las prótesis incluidas en el estudio no cumplen con los estándares de calidad de las prótesis dentales removibles realizadas en Chile.

 5.- ¿Hay incertidumbre importante o variabilidad sobre qué tanto valora la gente los desenlaces principales?
Incertidumbre o variabilidad importantes Posiblemente hay incertidumbre o variabilidad importantes Probablemente no hay incertidumbre ni variabilidad importantes No hay variabilidad o incertidumbre importante

Probablemente no hay incertidumbre ni variabilidad importantes: En función de la evidencia de investigación, experiencia clínica, conocimiento de gestión o experiencia de las personas con la condición o problema de salud, el panel de expertos de la Guía consideró que probablemente no hay incertidumbre ni variabilidad importante respecto a lo que escogería una persona informada de los efectos deseables e indeseables de «rehabilitar por medio de prótesis unilateral» y «rehabilitar con protesis con extensión contralateral». La mayoría de los pacientes informados optaría por prótesis con extensión contralateral dado su seguridad, sin embargo podría haber algunos pacientes que priorizarían lo estético o facilidad de manejo de la protesis unilateral.

Evidencia de investigación

No se encuentra evidencia que compare rehabilitar por medio de prótesis unilateral en comparación con rehabilitar con prótesis con extensión contralateral en personas con edentulismo parcial.

Búsqueda y Síntesis de Evidencia

 6.- El balance entre efectos deseables e indeseables favorece la intervención o la comparación?
Favorece la comparación Probablemente favorece la comparación No favorece la intervención ni la comparación Probablemente favorece la intervención Favorece la intervención Varía No lo sé

Favorece la comparación: Considerando que la intervención es «rehabilitar por medio de prótesis unilateral» y la comparación es «rehabilitar con protesis con extensión contralateral», el panel de expertos de la Guía opinó que el balance entre efectos deseables e indeseables claramente favorece «rehabilitar con protesis con extensión contralateral». Lo anterior, considerando que, a pesar de que existe baja certeza de la evidencia general, la evidencia reporta 3 casos de muerte (4,68%) asociada al uso de prótesis parcial unilateral como resultado de hemorragia masiva, fuga esofágica, empiema, peritonitis y septicemia, mientras que la mayor retención, soporte y estabilidad de la prótesis con extensión contralateral, este efecto adverso no debiera ocurrir.

 7.- ¿Qué tan grandes son los recursos necesarios (costos)?
Costos extensos Costos moderados Costos y ahorros despreciables Ahorros moderados Ahorros extensos Varía No lo sé

Costos y ahorros despreciables: El panel de expertos de la Guía consideró que los costos y ahorros de «rehabilitar por medio de prótesis unilateral» son despreciables si se compara con «rehabilitar con protesis con extensión contralateral», el panel indica que los costos de realizar una u otra intervención son similares, aunque la prótesis unilateral pudiese ser más barata y requierir de un menor número de sesiones de instalación.

Evidencia de investigación

Se presentó una tabla de costos referenciales al panel, pero este estimó que no eran costos representativos, por lo que la desestimó como antecedente.

Búsqueda y Síntesis de Evidencia

 8.- ¿La costo-efectividad de la intervención beneficia la intervención o la comparación?
Favorece la comparación Probablemente favorece la comparación No favorece la intervención ni la comparación Probablemente favorece la intervención Favorece la intervención Varía Ningún estudio incluido

Ningún estudio incluido: No se realizó la búsqueda de evidencia que abordaran la costo-efectividad ya que las intervenciones evaluadas no es considerado de alto costo, según el Decreto 80 «Determinar umbral nacional de costo anual al que se refiere el artículo 6° de la Ley 20.850».

1. Anual $2.418.399 y Mensual $201.533. Ministerio de Salud. Decreto 80: Determinar umbral nacional de costo anual al que se refiere el artículo 6° de la Ley 20.850 [Internet]. Santiago; 2015 Nov.

 9.- ¿Cuál sería el impacto en equidad en salud?
Reducido Probablemente reducido Probablemente ningún impacto Probablemente aumentado Aumentado Varía No lo sé

Probablemente ningún impacto: El panel de expertos de la Guía consideró que probablemente no tendría ningún impacto en la equidad en salud si se recomendase «rehabilitar por medio de prótesis unilateral».

 10.- ¿La intervención es aceptable para las partes interesadas?
No Probablemente no Probablemente sí Varía No lo sé

Probablemente no: El panel de expertos de la Guía consideró que «rehabilitar por medio de prótesis unilateral» probablemente NO es aceptable para las partes interesadas (profesionales de la salud, gestores de centros de salud, directivos de centros de salud, pacientes, cuidadores, seguros de salud, otros). Probablemente en profesionales clínicos y pacientes podría haber cierta variabilidad en términos de aceptar la prótesis unilateral, mentras que pagadores y directivos no la aceptarían por sus antecedentes.

 11.- ¿Es factible implementar la intervención?
No Probablemente no Probablemente sí Varía No lo sé

Probablemente sí: El panel de expertos de la Guía consideró que «rehabilitar por medio de prótesis unilateral» probablemente SÍ es factible implementar, contemplando la capacidad de la red asistencial, los recursos humanos disponibles a nivel país, recursos financieros, etc.