Department of Prosthodontics, University of Bern, Switzerland.
Int J Prosthodont. 2009 Sep-Oct;22(5):508-11.
On one side, prosthodontic reconstructions compensate for the sequelae of negative changes in the oral cavity; on the other side, they often enhance or accelerate them. As a consequence of negative changes in the oral cavity over time, treatment planning for RPDs becomes highly complex. A set of reliable criteria is necessary for decision-making and problem management It appears that the majority of published data on RPDs does not depict high effectiveness of this treatment modality. From a strict point of view of evidence-based dentistry, the level of evidence is low if not missing for RPDs. Randomized controlled trials on RPDs are difficult to design, they are not feasible for some questions due to the complexity of the material, or may remain without clinical relevance. The literature rarely gives information on the denture design, tooth selection, and management of the compromised structural integrity of teeth. So far treatment outcomes with RPDs must be considered under the aspect of bias due to the bias in indication and patient selection for RPDs. Better clinical models should be elaborated with more stringent concepts for providing RPDs. This encompasses: risk analysis and patient assessment, proper indications for maintenance or extraction of teeth, strategic placement of implants, biomechanical aspects, materials, and technology. Although there is a tendency to offer fixed prostheses to our patients, this might change again with demographic changes and with an increase in the ageing population, an increase in their reduced dentition, and low socioeconomic wealth in large parts of the world.
一方面，修复重建可以弥补口腔内负面变化的后果；另一方面，它们往往会加速或加剧这些变化。随着时间的推移，口腔内的负面变化会导致可摘局部义齿的治疗计划变得非常复杂。因此，需要一套可靠的标准来进行决策和问题管理。似乎大多数关于 RPD 的已发表数据并未描述这种治疗方式的高有效性。从循证牙科的严格角度来看，如果 RPD 的证据水平缺失，则其证据水平很低。RPD 的随机对照试验设计困难，由于材料的复杂性，某些问题可能无法进行，或者可能仍然与临床无关。文献很少提供关于义齿设计、牙齿选择以及牙齿结构完整性受损的管理的信息。到目前为止，由于 RPD 的适应证和患者选择存在偏倚，必须从偏倚的角度考虑 RPD 的治疗效果。应制定更好的临床模型，以更严格的概念提供 RPD，包括风险分析和患者评估、适当的保留或拔牙适应证、种植体的战略性放置、生物力学方面、材料和技术。尽管有向患者提供固定义齿的趋势，但随着人口结构的变化、老龄化人口的增加、其部分人口减少的义齿以及世界大部分地区的低社会经济财富，这种趋势可能会再次发生变化。
