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Title: Oral health-related quality of life in partially dentate patients treated with removable partial dentures
Author: Ali, Zaid
ISNI:       0000 0004 7226 8057
Awarding Body: University of Sheffield
Current Institution: University of Sheffield
Date of Award: 2018
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Introduction: Though edentulousness has declined in developed nations, tooth loss remains prevalent both in lower socio-economic groups and in developing nations. The removable partial denture (RPD) offers a relatively lower cost alternative for tooth replacement compared to dental implant treatment. RDPs though may be used with un-predictable success. The use of person-centred outcome measures (PCOMs) investigating oral health-related quality of life (OHRQoL) in RPD wearers has increased in the last three decades. Quantification of the impact of RPDs compared to other interventions to replace teeth on OHRQoL, particular characteristics of RPD wearers associated with better OHRQoL outcomes and detail of people's experiences of tooth loss and RPD use require further examination. Further, novel high-performance poly-ether-ether-ketone (PEEK) polymers are being introduced as alternatives to conventional materials for RPDs; a field where these gaps in understanding already exist. The questions requiring further evaluation are as follows: • (a) How does the provision of RPDs impact on OHRQoL? Does this differ from the impact of other prosthodontic interventions? • (b) Which variables associated with RPD use can impact on OHRQoL? • (c) Are novel framework materials associated with improved outcomes compared to current practice? • (d) What are the common features and themes of people's subjective experiences with tooth loss and RPD use? The aims of the studies in this thesis were to answer these questions by investigating the impact of RPDs on patient-reported outcomes of OHRQoL, how initial presentation and treatment choice may influence this impact and to explore people's subjective experiences of tooth loss and RPDs. Methods: The impact of RPDs on OHRQoL compared to other tooth replacement methods was evaluated in a systematic review and meta-analysis. The effect of patient and RPD variables on OHRQoL was evaluated in an observational study using regression analysis. PEEK frameworks were compared to traditional cobalt chrome (CoCr) frameworks in a randomised crossover-controlled clinical trial. Finally, semi-structured interviews of patients with experience of RPD use were analysed with inductive thematic analysis. Results: RPDs, implant and tooth-supported fixed bridges all demonstrate improvements in OHRQoL at short-term follow-up of ≤ 9-months. At > 9-months RPD improvements on OHRQoL were not sustained. Implant supported-bridges seem to make the biggest contribution to OHRQoL. OHRQoL outcomes are significantly improved in patients wearing RPDs to replace anterior teeth. This theme also emerged from analysis of semi-structured interviews, suggesting the impact of anterior tooth loss is significant and these patients perceive the greatest improvement in OHRQoL from treatment. Other variables modifying OHRQoL outcome included age, number of missing teeth and gender. The adjusted pseudo R2 for this model was 0.39. Qualitative analysis of interviews also identified people's beliefs about dentistry and dentists and the availability of coping strategies modified their interpretation of tooth loss and RPD use. So too did various other attributes such as age, gender, financial situation and dental awareness. Both CoCr and PEEK RPDs made clinically and statistically significant improvements to OHRQoL at four-week, six-month and one-year follow-up (p < 0.001). There was no significant difference between materials (p=0.746). CoCr were almost £450 (39.6%) cheaper per minimum clinically important difference (MCID) in OHRQoL score than PEEK (p < 0.0001) after four-weeks. The difference was not statistically significant at one=year follow-up (p=0.332). There were no differences between materials in their effect on periodontal measures, masticatory efficiency, and denture satisfaction or denture preference. Conclusions: RPDs improve OHRQoL at short follow-up though this impact has not been proven over longer-term follow-up. Weaknesses in the literature base and quality of reporting OHRQoL outcomes may account for this. Nonetheless RPD providers should select cases with care to reduce failure rates. Patients with anterior tooth loss and increased numbers of missing teeth have been shown the greatest improvements OHRQoL following RPD provision. People should be made aware of potential difficulties associated with tooth loss and the impacts that many associate with RPD use. Further research is suggested to contextualise the impacts introduced by RPDs against impacts associated with other forms of tooth replacement. Novel PEEK and other polymers may show promise as alternatives to metals as RPD frameworks. Whilst they make similar improvements to OHRQoL, their increased cost remains a potential barrier to their uptake. Further research is required to understand how to design these frameworks to optimise their performance and to evaluate their clinical performance as frameworks in other fixed and removable prosthodontics interventions.
Supervisor: Martin, Nicolas ; Baker, Sarah R. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available