Priority 19 from the Oral and Dental Health PSP

UNCERTAINTY: What is the best way to manage teeth missing for any reason (e.g tooth decay, trauma, developmental conditions) and at any age? (JLA PSP Priority 19)
Overall ranking 19
JLA question ID 0079/19
Explanatory note

Not available for this PSP

Evidence

Implants

Oral administration of two grams of amoxicillin one hour before placement of dental implants is effective in reducing implant failures. Unclear whether postoperative antibiotics are beneficial, or which antibiotics work best.

Weak evidence that flapless placement of dental implants reduces postoperative discomfort (pain and swelling). 
Insufficient evidence to recommend any specific flap or suturing technique.
Insufficient evidence regarding soft tissue grafts from the palate improving gum thickness and aesthetics. 
Insufficient evidence to determine which is the most effective way to treat peri‐implantitis. 
Insufficient evidence to demonstrate superiority of any particular type of implant characteristic or implant system over another. 
Insufficient evidence to determine the possible advantages or disadvantages of immediate, immediate-delayed or delayed implants
Various techniques can augment bone horizontally and vertically, but it is unclear which are the most efficient.
Insufficient evidence to determine when sinus lift procedures are needed.

Implants following radiotherapy
Insufficient evidence to determine the effect of HBO therapy in preventing failure of dental implants or other serious complications such as the death of bone in the jaw caused by radiotherapy treatment.


Dental prostheses
Insufficient evidence to determine whether one type of removable dental prosthesis (RDP) is better or worse than another. 
With fixed dental prostheses (FDPs), there was no evidence that high gold alloys are better or worse than other alloys, nor that gold alloys or frameworks are better or worse than titanium. 
Insufficient evidence to determine whether zirconia is better or worse that other FDP materials, that ceramic abutments are better or worse than titanium, or that one cement was better or worse than another in retaining FDPs. 
Insufficient evidence to determine the relative effectiveness of FDPs and RDPs in patients with shortened dental arch or to determine the relative advantages of implant supported FDPs versus tooth/implant supported FDPs.

Avulsed teeth
Insufficient evidence regarding the management of Avulsed front teeth. However, available evidence suggests that extra‐oral endodontics is not detrimental for teeth replanted after more than 60 minutes dry time

For full details of the evidence checked, please see the spreadsheet of data held on the JLA website.

Health Research Classification System category  Oral and gastrointestinal
Extra information provided by this PSP
Original uncertainty examples Original questions concentrated on the use of implants in an aging population. How will this growing trend affect the aged, their dental health routines and their overall quality of life? Why is it difficult for older patients to get a well fitting lower denture?
Submitted by  2 x patients, carers or members of public, 2 x health professionals, 1 x other
PSP information
PSP unique ID 0079
PSP name Oral and Dental Health
Total number of uncertainties identified by this PSP. 38  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 12 December 2019