The randomized shortened dental arch study: temporomandibular disorder pain.
OBJECTIVE
The aim of this multi-center, randomized controlled trial was to assess the impact of missing posterior support on the risk for temporomandibular disorder (TMD) pain by comparing patients with either shortened dental arches (SDA) or molar replacement by removable dental prostheses (RDP).


METHODS
A sample of 215 patients with bilateral molar loss in at least one jaw was consecutively recruited in 14 prosthodontic departments of dental schools in Germany. Of the initial sample, 152 patients (mean age: 59.7 years; 53.9 % female) received randomly allocated interventions (SDA: n = 71; RDP: n = 81). Presence of TMD pain was assessed using patients' self-reports and was verified by physical examination and by pain intensity, as the mean of current pain, worst pain, and average pain in the last 6 months, with 10-point ordinal rating scales. Assessments were performed before treatment and at follow-ups until 60 months after treatment. Impact of interventions on TMD risk and pain intensity was computed by applying logistic and linear random-intercept models.


RESULTS
Tooth replacement (RDP) did not significantly change the risk for self-reported (odds ratio [OR]: 1.1; confidence interval [CI]: 0.4 to 3.4) or clinically verified (OR: 0.7; CI: 0.1 to 4.3) TMD pain compared to no tooth replacement (SDA). Mean characteristic pain intensity was virtually identical in both groups (Coeff: 0.01; CI: -0.30 to 0.32).


CONCLUSIONS
Retaining or preservation of an SDA is not a major risk factor for TMD pain over the course of 5 years when compared to molar replacement with RPDs.


CONCLUSIONS
Seemingly, missing molars do not have to be replaced in order to prevent TMD pain.
Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany, d.reissmann@uke.de.
Daniel R
DR
Reissmann
Guido
G
Heydecke
Oliver
O
Schierz
Birgit
B
Marré
Stefan
S
Wolfart
Joerg R
JR
Strub
Helmut
H
Stark
Peter
P
Pospiech
Torsten
T
Mundt
Wolfgang
W
Hannak
Sinsa
S
Hartmann
Bernd
B
Wöstmann
Ralph G
RG
Luthardt
Klaus W
KW
Böning
Matthias
M
Kern
Michael H
MH
Walter
D003724:Dental Arch / Q000473:pathology*; D003832:Denture, Partial, Removable; D005260:Female; D005858:Germany; D006801:Humans; D007576:Jaw, Edentulous, Partially / Q000473:pathology* / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D008963:Molar; D010147:Pain Measurement; D018570:Risk Assessment; D012307:Risk Factors; D013705:Temporomandibular Joint Disorders / Q000209:etiology*