Abstract

Shortened dental arches: which teeth need replacement and how?

M. H. Walter, R. G. Luthardt
The assessment and estimation of potential risks (progressive break down of the dentition, extensive overeruption, craniomandibular disorders) and benefits should lay the foundations for clinical decision-making on tooth replacement in shortened dental arch cases. Randomized clinical trials comparing respective treatment options are lacking. There is an ongoing study of this type in Germany which is funded by the German Research Foundation (www.zahnreihe.de). Because of a sometimes limited benefit to be expected in terms of physical health gain, the patient's subjective perception deserves thorough consideration in decision-making. In elder patients with premolar occlusion and sound oral function who do not experience impairments, tooth replacement can hardly be recommended. However, in other patients who experience psycho-social discomfort, impairment or handicap, the indication for tooth replacement may be given in the same clinical situation. Is there a need of tooth replacement, the decision focuses on how many teeth are to be replaced and which prosthetic approach should be used. This article encompasses a critical appraisal of risks and benefits of different treatment options with removable and fixed partial dentures and with or without implants. Full replacement of missing premolars and molars and treatment targets limiting replacement to the anterior and premolar teeth following the shortened dental arch concept are discussed.

Considering the shortened dental arch concept as a dynamic strategy over a longer period of time, the mid and long term aspect of the concept gains importance. Then, the question about a long term strategy stands already when single molars get lost. The shortened dental arch concept can be used to define preservation targets in risk groups when in patients with accumulating dental problems, limited finances, poor compliance, or general risk factors new priorities have to be set. In cases of doubt, a wait and see approach may be suitable to monitor the dentition looking for first signs of progressive damage, then resulting in molar replacement.