|Year : 2012 | Volume
| Issue : 2 | Page : 104-107
An assessment of prosthodontists' attitudes to the shortened dental arch concept
Pradeep C Kumar1, Seema George2
1 Department of Prosthodontics, KMCT Dental College, Calicut, India
2 Indira Gandhi Institute of Dental Sciences, Kothamangalam, Kerala, India
|Date of Web Publication||4-Sep-2012|
Pradeep C Kumar
Department of Prosthodontics, KMCT Dental College, Calicut
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aim: To assess the attitudes and experiences on the Shortened Dental Arch (SDA) concept from an exclusive sample of specialist prosthodontists. Materials and Methods: A questionnaire containing different statements with regard to the SDA concept was designed for this study. This was prefaced by a short explanation of the SDA concept. It was sent to a random sample of 51 specialist prosthodontists. Results: The response rate was 64%. Most of the respondents indicated experience with the SDA concept ranging from recent to ten years. Patients' reactions on the proposal of shortening their dental arch were quite varied, from either clear objections to no objections, or, initial objections that were withdrawn on explanation. Chewing ability, appearance, and oral comfort consequent to an SDA were rated as sufficient or satisfactory by the respondents. Conclusion: Overall, the specialist prosthodontists had a positive attitude toward the SDA concept. However, they had reservations about the management outcome of SDA.
Clinical Relevance to Interdisciplinary Dentistry
- Prosthodontists had an overall positive attitude toward the SDA concept. In patients with caries and periodontal disease confined mainly to molar regions, active shortening of the dental arch should be considered.
- The SDA concept could be considered as a strategy to reduce the need for complex restorative treatment in the posterior regions of the mouth.
- Periodontally healthy and intact or restored anterior and premolar regions are a prerequisite to the success of SDA concept application.
Keywords: Functional occlusion, SDA concept, shortened dental arch
|How to cite this article:|
Kumar PC, George S. An assessment of prosthodontists' attitudes to the shortened dental arch concept. J Interdiscip Dentistry 2012;2:104-7
| Introduction|| |
The Shortened Dental Arch (SDA) is defined as a specific type of dentition with an intact anterior region and a reduction in the occluding pairs of posterior teeth, starting posteriorly. ,, This was first described by the Dutch prosthodontist Arnd Kayser and coworkers at the Dental School of the University of Nijmegan, the Netherlands, in 1981. ,, This concept was proposed as a treatment strategy in the management of reduced dentitions in middle-aged and elderly patients.
The SDA concept is based on the rationale and considerations that: (i) The treatment goals are changing from the preservation of complete dental arches; (ii) anterior and premolar regions are functionally and esthetically strategic parts of the dentition, and are considered a priority in rehabilitation; (iii) it is based on circumstantial evidence; (iv) it does not contradict current theories of occlusion; (v) it fits well with a problem-solving approach; (vi) it meets the requirements of the normal oral function; (vii) molars are high-risk teeth for caries and periodontal diseases; and (viii) it reduce the need for complex restorative treatment in the posterior region. ,
The SDA concept has been extensively researched, for the last almost three decades, on its various aspects, such as, (i) attitudes of dental practitioners, (ii) esthetics, (iii) chewing ability, (iv) oral function, (v) oral comfort, (vi) occlusal stability, (vii) temporomandibular disorders, and (viii) tooth migration.
Only a few reports are available in the literature describing the attitudes among dental clinicians toward the SDA concept. ,,,, Reports eliciting views exclusively from specialist prosthodontists on their attitude on SDA concept are scarce. , The aim of this study,was therefore, to assess the attitude toward the SDA concept among specialist prosthodontists.
| Materials and Methods|| |
This study was conducted in 2010. A questionnaire was designed for this study [Table 1] based on the model used in a study by Witter et al.  It was prefaced by a short explanation of the SDA concept and objectives of this survey. The questionnaire contained 15 close-ended questions, with the number of options set at four (Q. Nos. 9, 10, 12) and five (Q. Nos. 11,13,14,15). The reliability of the questionnaire was checked by sending the sample questionnaire to three subject experts for vetting and remarks. The modifications suggested by them were incorporated to ensure the content validity.
Assuming that the attitudes of the prosthodontists to the SDA concept were 90% positive, to assess the same with a plus or minus 8% variation in the survey, the minimum sample size required was estimated to be 50. The sample frame was the addresses of prosthodontists in Karnataka and Kerala, as available from the Members Directory of the Indian Prosthodontic Society. A simple random technique was employed to select 51 prosthodontists from the sample frame.
The questionnaires were mailed to a random sample of 51 specialist prosthodontists working as faculty in various designations in dental colleges in the South Indian States of Karnataka and Kerala. As all the prosthodontists who responded to the questionnaire answered all the questions, there was no incomplete questionnaire. The data from the completed questionnaires were analyzed for results.
| Results|| |
Of 51 prosthodontists to whom the questionnaires were sent, 33 (64%) responded. The distribution of prosthodontists according to years of teaching experience, designations, and average number of patients they treated annually, in their own practice, are summarized in [Table 2].
|Table 2: Distribution of prosthodontists according to years of experience, academic designation, and the average number of patients treated annually|
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[Table 3] shows the distribution of prosthodontists according to their experience with the SDA concept, and the estimated percentage of patients on whom this concept was applied. Most of the prosthodontists (79%) indicated experience with the SDA concept ranging from recent to more than ten years back. Also, most of them (57%) had applied this concept in up to 25% of their patients.
|Table 3: Distribution of prosthodontists according to their experience with the SDA concept and the percentage of patients in whom this concept was applied|
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[Table 4] shows the distribution of prosthodontists according to their views about clinical situations most apt to propose SDA to patients. The major share of participants (42.5%) indicated the limited possibilities of restorative care as the most apt situation to propose SDA. It is noteworthy that none of the respondents indicated SDA for patients of young age.
|Table 4: Distribution of prosthodontists according to their views about clinical situations most apt to propose SDA to patients|
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[Table 5] shows the patients' reactions to proposals for shortening of the dental arch. A good share of prosthodontists (36%) felt that patients had clear objections to shortening their dental arch. However, in about 57% of the cases, either there were no objections or initial objections were withdrawn on detailed explanation.
|Table 5: Distribution of prosthodontists according to patients' reactions after proposing to shorten the dental arch|
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[Table 6] shows the distribution of prosthodontists according to their judgment concerning chewing function, dental appearance, and oral comfort. These aspects were marked as sufficient or satisfactory by the respondents, as follows: Chewing Ability (58%); Appearance (67%); and Oral Comfort (58%).
|Table 6: Distribution of prosthodontists according to their assessment about chewing function, dental appearance, and oral comfort after shortening the dental arch|
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[Table 4], [Table 5], and [Table 6] present the views of all the 33 prosthodontists who responded to the questionnaire. These include the 21 prosthodontists who actually applied the concept clinically. The responses by the 33 prosthodontists were hence views based on their knowledge and observation, but not as an exclusive assessment based on the experience after applying the concept.
| Discussion|| |
Generally the results resemble the findings of similar studies. ,,,,, However, the percentage of positive responses in favor of the SDA concept was less in all aspects included in this study. Particularly notable was the intensity of objections from patients after proposing to shorten their dental arch, which in this study was 36% against that of only 7% in a study by Witter et al.  Also noteworthy was the comparatively discouraging assessment (sufficient or satisfactory) by prosthodontists in this study, with regard to the chewing function - 57%, appearance - 66%, and oral comfort - 57% after shortening the dental arch, while the assessment on the above aspects in a study by: (a) Witter et al.  were 92, 80, and 90% respectively; (b) Allen et al.  were 87, 80, and 82%, respectively; and (c) Allen et al.  were chewing function was 92% and appearance was 81%. Hence, it was observed that the findings of this study, even though they were in general agreement with that of other similar studies, did not have the same measure of intensity of responses. This could be due to the variations in the SDA mindset of prosthodontists in this part of India.
The limitations of the study are its limited sample size (51) and limited response rate (64%). As all the studies to date assessing the views of general dental practitioners and specialist restorative dentists on the various aspects of the SDA concept have been carried out in other countries, similar elaborate studies are desirable in our country.
The clinical implication of this study is that once the merits of untreated SDA are determined and a treatment plan is finalized for an SDA patient, caution is to be exercised by the attending dentist. This is because, even though the requirements of functional dentition can be met with SDA, the operator has to keep in mind that as the functional requirements may vary considerably from one patient to the next, the therapy in each case must be adjusted to the individual conditions of the patient, and to the patient's needs and ability to adapt.
| Conclusion|| |
Within the limitations of the study, it was concluded that specialist prosthodontists had an overall positive opinion toward the SDA concept. However, a good share among them observed that the patients considered for SDA expressed reservations. Also the percentage of respondents judging the outcome of SDA management as sufficient or satisfactory was just reasonable.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]