Over the last few days we have been looking at various outcomes from a multicenter trial that compared the outcomes for two different treatment options for the shortened dental arch. The aim of this analysis was to assess the impact of missing posterior support on the risk for temporomandibular disorder (TMD) pain.
As outlined previously patients were randomised into two groups; a partial removable dental prosthesis (PRDP) group to replace missing molars and a shortened dental arch (SDA) group with no molar replacement. Sample size calculation was based on the primary outcome of the study, tooth loss.
TMD pain was assessed using components of a German translation of the Research Diagnostic Criteria for TMD (RDC/ TMD). The study did not focus on TMD diagnoses, but on the prevalence and intensity of TMD pain. 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.
- More than a third (36.2 %) of the participants reported having TMD pain on at least one follow-up. This was clinically verified in 12 % of patients.
- Tooth replacement (PRDP) did not significantly change the risk for
- self-reported TMD pain (OR 1.1; 95% CI 0.4 to 3.4) or
- clinically verified TMD pain (OR: 0.7; 95%CI: 0.1 to 4.3) compared to no tooth replacement (SDA).
- Mean characteristic pain intensity was virtually identical in both groups
The authors concluded
Retention or preservation of SDA is not a major risk factor for TMD pain over the course of 5 years when compared to molar replacement with RPDs.
There is a detailed discussion in this paper regarding some of the potential limitation of this study, the assessment method used and its potential limitation for comparisons with other related literature. However, the previous studies in this area not randomised or prospective. The authors also note that the studies sample size was calculated based on the primary outcome of tooth loss as not TMD outcomes so it could have been underpowered to detect differences between the two groups.
Reissmann DR, Heydecke G, Schierz O, Marré B, Wolfart S, Strub JR, Stark H, Pospiech P, Mundt T, Hannak W, Hartmann S, Wöstmann B, Luthardt RG, Böning KW, Kern M, Walter MH. The randomized shortened dental arch study: temporomandibular disorder pain. Clin Oral Investig. 2014 Jan 23. [Epub ahead of print] PubMed PMID: 24452826.