How strong is the evidence for the need to restore posterior bounded edentulous spaces in adults? Grading the quality of evidence and the strength of recommendations

BackgroundIt is unclear whether or not untreated bounded edentulous spaces (BES) can cause patients problems because of migration of unopposed and adjacent teeth.ObjectivesTo quantitatively assess BES-related occlusal changes and the level of evidence available.Material and methodsA systematic search of the literature was conducted in triplicate in the PubMed and Cochrane Register of Controlled Trials (CENTRAL) databases up to and including February 2010 to assess studies related to the topic. The LILACS database also was searched by one of the authors (CMF). Quantitative mesio–distal changes and overeruption were the outcome measures. Manual searching of the reference lists of studies retrieved from the electronic databases was also conducted. Google Scholar in English, French, German, Greek, Italian, Portuguese, and Spanish was also searched to retrieve potential studies. Grey literature was searched in OpenSIGLE (System for Information on Grey Literature in Europe) for more potential papers. The quality of the retrieved literature and the strength of recommendations were assessed by use of the GRADE system. A decision-tree-like scheme was produced to depict treatment options.ResultsThe available evidence demonstrated that for most cases occlusal changes in BES after tooth loss might be limited (on average up to 2 mm). The quality of evidence was regarded as very low, however.ConclusionsTooth replacement should not necessarily be regarded as the mainstay of therapy for posterior BES, although more robust studies are necessary to clarify the long-term effects of non-treatment. The GRADE approach may be useful for enhancing the transparency of the decision-making process in dentistry, especially when evidence of only limited quality is available.