Shortened dental arch revisited: going from evidence to recommendations

Background/Objectives: Clinicians must frequently decide whether or not to treat patients with loss of posterior teeth, a condition called the shortened dental arch (SDA). Although many studies have been reported, there are no clear recommendations for management of SDA cases. Therefore, the objective of this work was to assess the quality of the body of evidence and the strength of recommendations, and propose some guidance for dealing with SDA. Methods: An extensive literature search for longitudinal studies was conducted on 17 November 2010 in the PubMed and LILACS electronic databases using the term shortened dental arch. A “snowballing” strategy, for example manual searching of the reference lists of included papers, was also conducted. Unpublished and published studies were sought in ClinicalTrials.gov and in the search engine ‘Google' (Scholar) in English, French, German, Italian, Portuguese, and Spanish. Finally, grey literature was searched in OpenSIGLE (System for Information on Grey Literature in Europe). The quality of evidence and the strength of recommendations were determined by the GRADE (grading of recommendations assessment, development and evaluation) system. Results: Titles and abstracts of one-hundred and thirty-three articles were initially assessed. Nine studies were finally included. Although there was no difference between the effectiveness of restorative and non-restorative approaches for SDA, fixed partial dentures seem better than removable prostheses. The overall body of evidence was, however, graded as low-quality. Two different clinical scenarios are used to illustrate recommendations in the management of SDA cases by use of the GRADE system. Conclusions: Restorative treatment should not necessarily be regarded as the mainstay of therapy for SDA. The GRADE approach may improve transparency in a shared decision-making process, mainly under conditions in which the quality of evidence is low or unclear.