Oral Health Technology Assessment of Unilateral Distal Extension

Objectives: The primary objective is to systematically review and analyze existing literature to determine the most suitable prosthesis in a unilateral distal extension situation based on clinical effectiveness and cost effectiveness.
Methods: The protocol has been registered in the International Prospective Register of Systematic Reviews ( CRD42017059474) . Systematic literature search was performed in multiple databases. No filters were applied and the publication date limit was 6th January 2019. Four reviewers in two groups carried out the review process independently. Among the selected studies, relevant data were extracted using priori form and critical appraisal was conducted using the Effective Public Health Practice Project tool. Summary estimates of the annual survival, failure, and event-free proportions were obtained using a random effects model with a 95% confidence interval. A Markov model simulated the lifetime of a patient and a decision tree over 20 years was developed to estimate the cost effectiveness and the unit was US$/event free years.
Results: 3151 abstracts and 430 full text articles were screened. 11 articles were included in the final review. The studies were reported on 4 major prosthesis types in 711 patients between the ages of 18 and 89. A total of 1062 prostheses with a total exposure time of 9232 years were analyzed. Annual clinical effectiveness of different prosthesis types range from 75.7%% to 80.4% . Incremental cost effectiveness ratio for different prosthesis designs ranges from 143$/event free year to 901$/event free year.
Conclusions: Cast removable partial denture was the most cost and clinical effective option in unilateral distal extension. This study highlights the value of health technology assessment to facilitate evidence-based clinical decision-making in selecting adequate prosthetic treatment for partial edentulism with unilateral distal extension.