Tooth Replacement Strategies in Adults With Missing Teeth: a Modified Delphi Analysis.
Objectives: The aim of this analysis was to develop consensus from experts in Restorative Dentistry on the most appropriate tooth replacement strategies in adult patients with 10 or less functional mandibular teeth. A secondary objective aimed to determine the effect a patient’s age has on the appropriateness of various tooth replacement strategies.
Methods: Replacement strategies were approved via an initial pilot study of 7 Restorative Specialists. Restorative Dentistry experts were recruited from the British Society of Restorative Dentistry. International clinicians with previous research experience on shortened dental arch were also invited to participate. Participants were asked to rank the appropriateness of various tooth replacement strategies on a 1-9 Likert scale for patients with differing patterns of missing teeth in 2 age groups, 18-64 and 65+. This was carried out over two rounds. The results indicate a consensus on various treatment options as ‘appropriate’ or ‘inappropriate’ within the individual age groups.
Results: Following round 1, four tooth replacement strategies were considered appropriate with consensus, and nineteen were considered inappropriate with consensus. Following round 2, a further nine tooth replacement strategies were considered appropriate with consensus, and a further five tooth replacement strategies were considered inappropriate with consensus. There was consensus amongst study participants on the appropriateness of 37 tooth replacement strategies (37%) across 10 clinical scenarios. Of these, 13 were considered appropriate (13%) and 24 considered inappropriate (24%).
Conclusions: The results indicate that providing no intervention to those missing all mandibular molars in the 65+ group was deemed appropriate with consensus amongst the experts. Acrylic removable partial dentures were deemed inappropriate with consensus for adult patients with this pattern of tooth loss, regardless of age group. Age was not a determinant for dental implant treatment, which was considered appropriate in patients younger and older than 65 years, depending on the pattern of tooth loss. Whilst this analysis may indicate a credible or reasonable opinion, it is important to note that ‘consensus’ does not mean that the correct answer, judgement or opinion has been reached.