Oral health-related impact profile of patients treated with fixed, removable, and telescopic dental prostheses in student courses—a prospective bicenter clinical trial

Clinical Oral Investigations https://doi.org/10.1007/s00784-020-03532-w ORIGINAL ARTICLE Oral health-related impact profile of patients treated with fixed, removable, and telescopic dental prostheses in student courses—a prospective bicenter clinical trial Anja Liebermann 1 & K. Erdelt 1 & I. Lente 1 & D. Edelhoff 1 & M. Schmitter 2 & A. Winter 2 Received: 9 April 2020 / Accepted: 14 August 2020 # The Author(s) 2020 Abstract Objectives To analyze the oral health-related impact profile in patients treated with three different types of dental prosthesis in student courses. Materials and Methods This prospective bicenter clinical trial was conducted with 151 patients being treated with fixed (n = 70), removable (n = 61), or telescopic dental prostheses (n = 20) in clinical student courses of two German universities from October 2018 to October 2019. All patients completed three standardized German versions of the Oral Health Impact Profile (OHIP-G49/53) before prosthetic treatment (T0), at control after 1 week (T1), and after 3 months (T2), divided into five dimensions: (a) appearance, (b) oral function, (c) psychosocial impact, (d) linguistic limitations, and (e) orofacial pain. Data were analyzed with Kolmogorov–Smirnov, Wilcoxon signed-rank, Kruskal–Wallis, Mann–Whitney, and Cronbach’s alpha tests. Results Within T0–T1 and T0–T2, greater improvements were determined for removable compared with fixed dental prostheses for the dimensions’ oral function (p ≤ 0.014), linguistic limitations (p ≤ 0.016), and appearance (p ≤ 0.003). No significant differences were found between fixed and telescopic dental prostheses (p ≥ 0.104) or between removable (partial dental prosthesis with clasps and complete dental prosthesis) and telescopic dental prostheses (p ≥ 0.100). Within T1–T2, a significant improvement in orofacial pain could be determined (p = 0.007). Conclusions Restorations presented an improvement in oral health-related quality of life. Removable dental prostheses showed better improvement than fixed ones in various dimensions. Clinical relevance Knowledge about the influence of oral health-related quality of life on the three different types of prosthesis used in student courses can be of decisive help in dental consultations. Keywords OHIP-49 . OHIP-53 . Student course . Removable dental prosthesis . Fixed dental prosthesis . Telescopic dental prosthesis Introduction Overall quality of life (QoL) depends crucially on the oral health-related quality of life (OHRQoL) [1]. The individual analysis of OHRQoL and clarification of the influence of a prosthetic restoration on patients’ OHRQoL can usually be * Anja Liebermann 1 Department of Prosthetic Dentistry, LMU Munich, Goethestrasse 70, 80336 Munich, Germany 2 Department of Prosthetic Dentistry, Würzburg, Germany analyzed using an Oral Health Impact Profile (OHIP) questionnaire [2, 3]. OHIP questionnaires with varying numbers of subjective questions—OHIP-12 to OHIP-53—are available in the different national languages [2–14]. The oral healthrelated impact profile is considered multidimensional, and all questions are summarized by different dimensions to identify the specific influences and thus reference a higher-order factor [10]. These are usually subdivided into four highly correlated factors—oral function, orofacial pain, orofacial appearance, and psychological impact [2, 3, 10], but may also undergo modification [14, 15]. In general, an OHIP questionnaire represents a subjective evaluation of individual oral health and, in some cases, of patients’ expectations, feelings, and satisfaction with regard to a Clin Oral Invest prosthetic restoration [2, 3, 10, 16]. Consequently, depending on the study design, there may be great variations between different studies. The scientific literature generally shows an improvement in oral health-related impact profile through prosthetic restorations, although this appears to depend on the restoration type [11]. In two studies on prosthetic restorations, a significant improvement in oral health-related impact profile was recorded for patients with complete dental prostheses; one of the studies also investigated patients in student courses [4, 17]. In addition, treatment with different double crown removable dental prostheses improves the oral health-related impact profile [18]. Patients with removable dental prostheses, however, show a worse oral healthrelated impact profile than patients with fixed restorations [12]. To the best of the authors’ knowledge, there has been no comparable study of the oral health-related impact profile of patients who have been prosthetically restored with three different types of dental prosthesis in student courses and comparison between them. The hypotheses of the present study state that: 1. There is no change in patients’ oral health-related impact profile after prosthetic restoration in a student course in relation to specific questions and the dimensions. 2. There are no differences in patients’ oral health-related impact profile between prosthetic type after prosthetic treatment within a student course. Materials and methods The present prospective bicenter clinical trial was conducted in two prosthetic dentistry departments in Germany. The ethics committees of both universities approved the study (approval numbers 18-482 and 139/18). In advance, written informed consent was obtained from all patients participating. A Consort flow diagram is presented in Fig. 1, where eligible, excluded, and included patients are listed. A total of 151 patients were included (Munich n = 75; Würzburg n = 76); they were treated with fixed (n = 70), removable (n = 61), or telescopic (n = 20) dental prostheses (Table 1). All patients were treated in the clinical student courses (students in the 4th and 5th study year) in both centers from October 2018 to October 2019. Fixed dental prostheses included crowns and fixed dental prostheses, removable dental prostheses included partial dental prostheses with clasps and complete dental prostheses, and telescopic dental prostheses were fabricated with friction telescopes. The following inclusion criteria were defined: (1) The patient is at least 18 years old (2) The patient is suitable for treatment in the student course (3) The patient should have good oral hygiene (4) No relocation of the patient is planned within the next 6 months (5) The patient has no known allergies to dental materials OHIP-G49/G53 questionnaire All patients completed a total of three standardized German versions of the Oral Health Impact Profile (OHIP-G49/53). Patients who were treated with removable dental prostheses completed the entire questionnaire with all 53 questions. Patients with fixed dental prostheses completed only 49 questions, as the last three questions are only for removable dental prostheses. Only patients who completed all three questionnaires were included in the study. The first questionnaire (T0) was completed as (...truncated)