The Esthetic and Functional Outcomes of Full Mouth Rehabilitation Performed Using the Hobo Twin-Stage and Pankey-Mann-Schuyler Philosophy – A Meta-Analysis

Background: Full mouth rehabilitation (FMR) is a complex treatment modality aimed at restoring esthetics, function, and occlusal stability in patients with severely worn dentition. Among the various philosophies, the Pankey-Mann-Schuyler (PMS) and the Hobo Twin-Stage philosophy are the most widely recognized. While both have been used extensively, their comparative outcomes remain unclear.  Materials and Methods: An electronic and manual search was conducted across PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Library, and Google Scholar from January 1960 to October 2018. A total of 5 clinical studies (3 RCTs, 2 CCTs) comprising 169 patients were included. Data on esthetic outcomes (Pink Esthetic Score [PES], White Esthetic Score [WES]) and functional outcomes (occlusal harmony, masticatory efficiency, phonetic comfort assessed via VAS) were extracted. Risk of bias was assessed using the Cochrane RoB-2 tool for RCTs and Newcastle-Ottawa Scale for CCTs. Meta-analysis was performed to calculate mean differences with 95% confidence intervals (CIs).  Results: Esthetics: Hobo Twin-Stage philosophy demonstrated significantly higher PES (Mean Difference ≈ +1.3 to +1.4; p < 0.01) and WES (Mean Difference ≈ +1.2 to +1.6; p < 0.01) compared to PMS across all studies. Function: No statistically significant difference was observed in functional outcomes (VAS mean difference ≈ +0.2 to +0.4; CIs crossed 0).Funnel plot analysis showed low risk of publication bias.  Conclusion: Within the limitations of the available evidence, the Hobo Twin-Stage philosophy provides superior esthetic outcomes compared to the PMS philosophy, while both approaches yield comparable functional results. Choice of philosophy should be tailored to patient expectations, clinical expertise, and available resources.