Department of Prosthodontics, Dental School, University of Heidelberg, Heidelberg, Germany.
J Oral Rehabil. 2011 Dec;38(12):940-9. doi: 10.1111/j.1365-2842.2011.02230.x. Epub 2011 Jun 27.
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 the management of SDA cases. In this work, therefore, an innovative system, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, was used to grade the evidence and strength of recommendations for clinical intervention. 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 Unpublished and published studies were sought in ClinicalTrials.gov and in the search engine 'Google' (Scholar) in English, French, German, Italian, Portuguese and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). Titles and abstracts of 133 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 the use of the GRADE system. 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.
临床医生必须经常决定是否治疗失去后牙的患者，这种情况称为缩短牙弓（SDA）。尽管已经有许多研究报告，但对于 SDA 病例的管理尚无明确的建议。因此，在这项工作中，使用了一种创新的系统，即推荐评估、制定和评估分级（GRADE）方法，对临床干预的证据和建议强度进行分级。2010 年 11 月 17 日，在 PubMed 和 LILACS 电子数据库中使用缩短牙弓一词对纵向研究进行了广泛的文献搜索。还采用了“滚雪球”策略，例如，对纳入文献的参考文献进行手动搜索。在 ClinicalTrials.gov 和搜索引擎“Google”（Scholar）中以英语、法语、德语、意大利语、葡萄牙语和西班牙语搜索未发表和已发表的研究。最后，在 OpenSIGLE（欧洲灰色文献信息系统）中搜索灰色文献。最初评估了 133 篇文章的标题和摘要。最终包括了 9 项研究。尽管修复和非修复方法对 SDA 的效果没有差异，但固定局部义齿似乎优于可摘义齿。然而，总体证据质量被评为低质量。使用 GRADE 系统，通过两种不同的临床情况来说明 SDA 病例管理中的建议。GRADE 方法可以在证据质量低或不明确的情况下，主要在共同决策过程中提高透明度。
