Department of Prosthetic Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Evid Based Dent Pract. 2019 Mar;19(1):1-6. doi: 10.1016/j.jebdp.2019.01.003. Epub 2019 Jan 17.
For evidence-based dental treatment decision-making in prosthetic dentistry, evidence from scientific studies performed in the appropriate population with state-of-the-art interventions, reasonable controls, and relevant outcomes is required. This article will briefly review patient populations involved and interventions applied in prosthetic dentistry and more extensively review outcomes used for evidence-based dental treatment decision-making in prosthetic dentistry. Dental patient populations in prosthetic dentistry usually suffer from extensive loss of tooth substance and/or tooth loss. Typical interventions in prosthetic dentistry are replacement of a substantial amount of tooth structure and lost teeth with conventional or implant-supported fixed or removable dental protheses. Sufficient controls or comparisons should also involve no treatment for tooth loss as a legitimate option. For many years, prosthodontic treatment almost solely focused on disease-oriented outcomes such as numerical replacement of missing teeth to restore current oral health and prevent further deterioration, and now, dental patient-reported outcomes (dPROs), the outcomes that are directly reported by the patient, are gaining increasing attention. dPROs are what matters most for the patient, and dPRO measures have several advantages when applied in clinical practice and research settings compared with traditional disease-oriented measures such as ease of applicability and less burdensome for the clinicians. In evidence-based prosthetic dentistry, there should be a shift to fewer applied dPRO measures, with only one instrument becoming standard. Furthermore, dPROs will probably also become tools to assess patients' oral health status in clinical practice in a standardized manner. Finally, information on dPROs will become an integral part of evidence-based treatment decision-making in prosthetic dentistry.
为了在修复牙科中进行基于证据的治疗决策,需要有来自适当人群中进行的科学研究的证据,这些研究采用了最先进的干预措施、合理的对照和相关的结果。本文将简要回顾修复牙科中涉及的患者人群和应用的干预措施,并更广泛地回顾用于修复牙科中基于证据的治疗决策的结果。修复牙科中的牙科患者人群通常患有大量的牙齿实质和/或牙齿缺失。修复牙科中的典型干预措施是用传统或种植体支持的固定或可摘义齿来替代大量的牙齿结构和缺失的牙齿。充分的对照或比较也应该包括不治疗牙齿缺失作为一种合理的选择。多年来,修复治疗几乎完全专注于以疾病为导向的结果,例如用缺失的牙齿进行数字替代,以恢复当前的口腔健康并防止进一步恶化,而现在,牙科患者报告的结果(dPRO),即直接由患者报告的结果,越来越受到关注。dPRO 对患者来说是最重要的,与传统的以疾病为导向的措施(如易于应用和对临床医生的负担较小)相比,dPRO 措施在临床实践和研究环境中有几个优势。在基于证据的修复牙科中,应该减少应用的 dPRO 措施,只有一个仪器成为标准。此外,dPRO 可能也将成为评估患者口腔健康状况的工具,以标准化的方式应用于临床实践。最后,dPRO 信息将成为修复牙科中基于证据的治疗决策的一个组成部分。