What is the best attachment system used in Kennedy classes I and II removable partial dentures? A systematic review with meta-analysis

• Ano de defesa: 2022
• Autor(a) principal: Carneiro, Camila Alves
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: eng
• Instituição de defesa: Biblioteca Digitais de Teses e Dissertações da USP
• Palavras-chave em Português: Denture Precision Attachment; Encaixe de Precisão de Dentadura; Fixed Partial Prosthesis; Meta-analysis; Metanálise; Partial Removable Prosthesis; Prótese Parcial Fixa; Prótese Parcial Removível; Revisão sistemática; Systematic review
• Link de acesso: https://www.teses.usp.br/teses/disponiveis/25/25146/tde-01092022-094959/

Partially edentulous individuals require a lot of attention during rehabilitation planning and the dentist must use his knowledge and skill to provide an esthetic and functional prosthesis, using the support of the remaining teeth and the ridge. The use of removable partial dentures (RPDs) in conjunction with fixed partial dentures (FPD), through attachment systems can be considered beneficial for the patient, as it gives a more aesthetic and functional aspect to the finished denture. Thus, the use of attachments increased the requirements of retention, function and aesthetics when compared to conventional RPDs. However, there are doubts about its correct indication and predictability over the years, since there is a diversity of options for its use. The aim of this systematic review was to evaluate the published literature on dentalmucossupported prostheses, evaluating which attachment system can present the best biomechanical and esthetic results in RPDs. A comprehensive search of studies published up to November 2021 was performed in PubMed/MEDLINE, Web of Science, Cochrane Library databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria and was approved and registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42021268449). The PICO question (population, intervention, comparison, and outcome) formulated was: What is the best attachment system used in Kennedy class I and II removable partial dentures?. Based on the stipulated inclusion criteria, a total of 21 out of 871 articles were selected. The evaluation period of the studies ranged from 3 to 282 months. In total, 1,357 patients were found, of which 526 users of RPDs retained by attachments were listed, and no significant differences were identified in the survival rate between the systems (p>0.05). The Mini SG (extracoronal) attachment was the most used among the studies. The survival rate ranged from 37% to 98.1% in 10 studies. In the 10 studies selected for quantitative analysis, the meta-analysis indicated a total failure rate of 16.6% (95% confidence interval CI: 10.4-25.4%), Q value: 26.258, P = 0.002 and heterogeneity of I²=65.725. There was a scarcity of clinical studies evaluating and comparing different attachment systems. However, the data obtained indicated that extracoronary types are the most viable treatment choice in cases of free end. In general, attachment-retained RPD has good retention and better esthetics compared to conventional RPD, as complications and failures can be controlled with proper planning. Therefore, it represents a viable and safe option for oral rehabilitation treatment.