Cantilever bridges or removable partial dentures in geriatric patients: a two-year study

The purpose of this study was to compare prosthetic, functional and occlusal conditions in twenty-seven patients treated with distally extending cantilever bridges and twenty-six patients treated with removable partial dentures (RPD) in the mandible. All patients had a complete upper denture. Mean age of the patients in both groups was about 69 years. The patients were under a supervised oral hygiene care throughout the 2-year study period. There were 6.9 +/- 1.7 mandibular teeth left in the bridge group and 7.5 +/- 1.7 in the RPD group and the mean number of posterior teeth (natural teeth/denture teeth/pontics) in occlusion was 4.1 +/- 1.1 and 7.3 +/- 1.4, respectively. During the study period signs and symptoms of mandibular dysfunction became significantly aggravated in the RPD group, P less than 0.05. A balanced occlusion in the muscular contact position was observed in 90% of the patients in the bridge group and in 76% of the RPD wearers. During the study period the need for dental or prosthetic treatment was negligible in the patients treated with bridges. In the RPD group, twenty-two teeth were restored with fillings due to caries and in eight patients major adjustments of the sublingual bar were necessary due to irritation of the oral mucosa. This study has shown that treatment with distally extending cantilever bridges in the mandible is a favourable alternative to treatment with removable partial dentures in elderly patients with a reduced dentition.     

A 5-year longitudinal study of cantilevered fixed partial dentures compared with removable partial dentures in a geriatric population

Prosthesis function and dental conditions were observed for 5 years in 27 elderly patients treated with mandibular cantilevered fixed partial dentures (FPDs) and in 26 elderly patients treated with distal-extension removal partial dentures (RPDs). All patients were treated with a complete upper denture. The patients were assigned randomly into two treatment groups that had the same composition with regard to sex, age, and distribution of teeth. The patients were under supervised oral hygiene and prosthodontic care. Clinical examination of prostheses, masticatory system, periodontal status, and caries was carried out yearly. Oral hygiene was good, and the periodontal status was maintained in both groups. Caries was observed six times more frequently in the RPD group than in the group with fixed restorations, however. Occlusal and functional conditions deteriorated in the RPD group only. Eight of 42 fixed partial dentures (19%) failed; of these, six were recemented with composite resin. Generally the need for dental and prosthetic follow-up treatment was more pronounced in the RPD group than in the FPD group.     

老年人夹板式可摘局部义齿设计体会

目的：总结老年牙列缺损患者采用夹板式可摘局部义齿修复的设计体会，供临床工作参考。方法：针对老年人口腔生理、解剖特点，对89例老年牙列缺损患者分别采用3种形式的夹板式可摘局部义齿修复，并作1—3年追踪复查。检查项目为患者主观感觉、牙周情况、咀嚼功能。结果：患者主观感觉满意度为：93．26％；牙周情况正常率为：92．13％；咀嚼功能良好率为：98．88％；修复效果满意。结论：对老年牙列缺损患者采用夹板式可摘局部义齿修复，可在恢复缺失牙功能的同时，又对余留牙起到分散[牙合]儿、减轻牙周组织负荷的作用，有利于牙周组织恢复健康。     

Periodontal findings in patients 10 years after insertion of removable partial dentures

The purpose of this retrospective study was to evaluate the changes in the periodontal conditions of patients wearing different designs of removable partial dentures over long-term. Seventy-four patients treated with 101 mainly conical crown-retained dentures (CCRDs) or clasp-retained removable partial dentures (RPDs) or a combination of conical crown and clasp-retained dentures (CRPDs) were re-examined 10 years after insertion. Periodontal findings were compared with baseline values at insertion. A deterioration of the probing depths (PDs) and tooth mobility was found. The abutment teeth of the RPDs suffered more severe deterioration than the abutment teeth of the CCRDs and the CRPDs. The absence of a regular recall system for the patients may be responsible for this outcome.     

A survey of treatment outcomes with removable partial dentures

The patient's satisfaction with removable partial denture (RPD) therapy has become an increasingly important factor in prosthetic treatment. This study examined patients' satisfaction with RPDs in relation to some socio-economic variables, patients' habits of wearing and cleaning RPDs, comfort of wearing RPDs and different RPDs characteristics. A questionnaire was devised for the purpose. Two hundred and five patients were required to assess satisfaction with RPDs. They graded RPDs, depending on the level of satisfaction, on scale ranging from 1 to 5. A dentist determined Kennedy classification, material and denture support, denture base shape, number of missing teeth and evaluated denture construction. Majority of the patients were satisfied with the prosthesis. The patients of a higher education level gave lower grades (P < 0.05) to aesthetics of maxillary RPDs. Almost half of the patients were wearing RPDs during the day. Most of the patients cleaned RPDs three times a day. A significant difference was found between the patients' grades for comfort of wearing mandibular RPDs and number of missing teeth and between hygiene of mandibular RPDs and habits of cleaning them. Majority of the patients treated with RPDs were satisfied with the prosthesis. Dissatisfaction was related to mastication, esthetics, number of missing teeth and maintenance of oral hygiene.     

A 25 year longitudinal study of patients treated with removable partial dentures

summary A 25 year longitudinal study was carried out on a number of patients fitted with removable partial dentures (RPDs) in 1969. Before the prosthetic treatment all patients were given oral hygiene motivation and instructions in order to create a high level of co-operation. The RPDs, most of which were lower bilateral distal extension dentures, were carefully planned and designed. During the first 10 years the patients were examined in our clinic at yearly intervals at which time encouragement and reinstruction regarding oral hygiene were given and various treatment procedures were performed as required. After the initial 10 years the patients were advised, for practical reasons, to continue to have yearly controls on their own initiative. Of the initial 30 patients from 1969, 23 were still alive in 1994, all of whom were examined. In five of those 23 the original RPD situation had changed more or less due mainly to general illness contracted and/or change to other therapies. In the remaining 18 patients wearing in total 20 RPDs, 13 (65%) of the original RPDs were still functioning. Seven RPDs were new with principally the same design as the original ones. Among these 18 patients the number of lost teeth, the number of new DF surfaces and the increased number of endodontically treated teeth were few. No apparent changes took place regarding the periodontal condition during the follow-up period. These favourable biological conditions in the RPD jaws, in combination with the patients' satisfaction with the comfort and chewing ability, reinforce the conclusions drawn at our 10 year control – that an RPD is a valuable treatment procedure for patients with a markedly reduced number of teeth.     

Periodontal conditions with removable complete and partial dentures in the adult population aged 30 years and over

The periodontal conditions of subjects with different combinations of removable dentures were studied in a representative sample of 8000 subjects, of which 90% were used for the experiment. The number of subjects with removable dentures was 1468. Subjects with removable partial dentures had significantly more pockets and deeper pockets than did those without dentures. The periodontal condition of subjects with a complete denture in the opposite jaw was significantly better than that in other subjects. This was true in both men and women. The results indicated the importance of prophylactic and maintenance care in subjects with removable partial dentures.     

A clinical and physiological evaluation of prosthodontic treatment by removable partial dentures with free-end saddles--a 3.5-year follow-up study

The aim of this study was to evaluate the longitudinal clinical and physiological changes in jaw elevator muscle activity of partially edentulous patients, for approximately 3.5 years after treatment by removable partial dentures with free-end saddles. Seven patients (4 males and 3 females, aged 38-68 years) who visited a university dental hospital, and were found to have no signs and symptoms of TMJ disorders, participated in the follow-up study. The functional impression method with wax was used in the treatment process of these patients. At the follow-up times of 0.5, 1, 2, 3, and 3.5 years after denture deriverly, EMG activities using bipolar surface electrodes were recorded from masseter and anterior temporal muscle on both sides during maximal voluntary clenching and tapping, and at the same time the maximal bite force was also recorded using the Dental Prescale System. The integrated EMG, the correlation coefficient between muscle activities of both sides, bite force, and the location of the occlusal load center, were analyzed using repeated measured ANOVA. A comparison between each measuring session was carried out using Bonferroni's method. Results were as follows: i) The muscle function of partially edentulous patients was clearly activated by wearing a removable partial denture, and the activation was kept at the same level until 3.5 years after denture deriverly. ii) The activation of jaw elevator muscles by wearing a denture was greater in masseter muscle than in anterior temporal muscle. This finding reflected the effect of the recovered occlusal contact. iii) The occlusal load center of the recovered dentition by a removable partial denture shifted antero-posteriorly close to the end abutment teeth.     

Failures in the rehabilitation treatment with removable partial dentures

Abstract

Background. Despite being functional and having aesthetic benefits, the acceptance of patients regarding the use of removable partial dentures (RPDs) has been low. In part, this is due to the deleterious effects that causes discomfort to the patient. Success depends not only on the care expended by the patient, including daily care and oral hygiene, but also on common goals set by their professional and clinical staff, aiming beyond aesthetics, to incorporate issues of functionality and the well-being of patients. Methods and results. For rehabilitation treatment with RPDs to reach the desired level of success without damaging the support structure, all the steps (diagnose, cavity preparation, adaptation of the metal structures, functional of distal extension and posterior follow-up) in the rehabilitative treatment should be carefully developed. A literature review was carried out, searching through MEDLINE (PubMed) articles published between 1965 and December 2012 including clinical trials and reviews about the use of RPDs. Conclusions. This study describes factors that lead to failures and complications in oral rehabilitation through the use of RPDs and suggests possible solutions.     

Oral conditions and aptitude to receive implants in patients with removable partial dentures: a cross-sectional study. Part I. Oral conditions

summary The relationship between a removable partial denture (RPD) and damage caused to residual oral structures is the subject of on-going research. A group of patients wearing RPD, treated in the same way in the same department, were recalled to evaluate their oral hygiene and to compare the clinical condition of abutment teeth with that of non-abutment teeth. The study shows that most patients were unable to maintain high standards of oral hygiene. In the group of patients with non-optimal hygiene the clinical condition of abutment teeth was worse than that of non-abutment teeth. In the group of patients with optimal oral hygiene the condition of abutment teeth and non-abutment teeth was almost identical. To increase the standards of oral hygiene it is strongly advisable to recall and follow up patients on a regular basis.     

Other dental treatment needs in patients who requested removable partial dentures

The aims of this study were to determine the dental and periodontal status and the associated treatment needs, other than that for prosthetic care, in patients who requested removable partial dentures. Forty-six patients who had never worn removable partial dentures before were examined for plaque index, tooth status, gingival index, loss of periodontal attachment and tooth mobility. Prior to prosthetic treatment, 15% of the teeth needed conservative treatment and 1% needed extractions. From the periodontal point of view, 65% of the teeth needed some form of related therapy, and 2% of the teeth were at risk of extraction due to advanced mobility.     

Oral rehabilitation with implant-supported fixed partial dentures in periodontitis-susceptible subjects. A 5-year prospective study

BACKGROUND: Comparatively few studies with at least 5 years of follow-up are available that describe the use of implants in prosthetic rehabilitation of partially edentulous patients. Randomized, controlled clinical studies that evaluated the effect of different surface designs of screw-shaped implants on the outcome of treatment are also sparse. OBJECTIVE: To determine, in a prospective randomized, controlled clinical trial, the outcome of restorative therapy in periodontitis-susceptible patients who, following basic periodontal therapy, had been restored with implants with either a machined- or a rough-surface topography. MATERIAL AND METHODS: Fifty-one subjects (mean age, 59.5 years), 20 males and 31 females who, following treatment of moderate-to-advanced chronic periodontitis, required implant therapy for prosthetic rehabilitation were recruited. Seventeen of the patients were current smokers. Following the active treatment, all subjects were included in an individually designed maintenance program. A total of 56 fixed partial dentures (FPDs) and a total of 149 screw-shaped, and self-tapping implants (Astra Tech implants) -- 83 in the maxilla and 66 in the mandible -- were installed in a two-stage procedure. Each patient received a minimum of two implants and by randomization every second implant that was installed had been designed with a machined surface and the remaining with a roughened Tioblast surface. Abutment connection was performed 3-6 months after implant installation. Clinical and radiographical examinations were performed following FPD connection and once a year during a 5-year follow-up period. The analysis of peri-implant bone-level alterations was performed on subject, FPD and implant levels. RESULTS: Four patients and four FPDs were lost to the 5 years of monitoring. One implant (machined surface) did not properly integrate (early failure), and was removed at the time of abutment connection. Three implants were lost during function and a further eight implants could not be accounted for at the 5-year follow-up examination. The overall failure rate at 5 years was 5.9% (subject level), 5.3% (FPD level) and 2.7% (implant level). Radiographic signs of loss of osseointegration were not found at any of the implants during the 5-year observation period. During the first year in function there was on average 0.33 (SD, 0.61) mm loss of peri-implant marginal bone on the subject and FPD levels and 0.31 (0.81) mm on the implant level. During the subsequent 4 years, the peri-implant bone-level alterations were small. The calculated annual change in peri-implant bone level was -0.02 (0.15) on subject and FPD levels and -0.03 (0.20) on the implant level. Thus, the mean total bone-level change over the 5-year interval amounted to 0.41 mm on all three levels of analysis. In the interval between baseline and 5 years, the machined and the Tioblast implants lost on average 0.33 and 0.48 mm, respectively (p>0.05). CONCLUSION: The present randomized, controlled clinical trial that included partially edentulous periodontitis-susceptible subjects demonstrated that bone loss (i) during the first year of function as well as annually thereafter was small and (ii) did not vary between implants with machined- or rough-surface designs.     

Periodontal conditions in patients treated with dental bridges

The periodontal condition of 162 splinted approximal abutment tooth surfaces was compared with that of 162 contralateral tooth surfaces which were not fastened together. The Plaque Index (Silness & Löe 1964), the Gingival Index (Löe & Silness 1963), and the Margin Index (Silness 1970a) were recorded. Pocket depths were measured as explained by Glavind and Löe (1967). In bridge recipients who had received periodontal treatment and instruction to improve oral hygiene and who had no subgingival retainer margins in the embrasure areas between the splinted teeth, the periodontal condition was no better or worse than that of the contralateral area with which it was compared. Bridge recipients who had not been systematically influenced to change the tooth cleansing habits and who had subgingival retainer margins in the embrasure area between the splinted teeth, showed a considerable deterioration of the periodontal condition as compared to that of the contralateral area.     

Periodontal conditions in patients treated with dental bridges

The periodontal condition of 362 proximal abutment tooth areas facing bridge pontics were compared with that of 362 contralateral tooth surfaces which were in contact with the neighbouring teeth. The Plaque Index (Silness & Löe 1964). the Gingival Index (Löe & Silness 1963) and the Margin Index (Silness 1970a) were recorded. Pocket depths were measured according to Glavind and Löe (1967). The pontics seemed to increase the index values (PII., GI), but had apparently little influence on the pocket depths of the proximal abutment tooth surfaces in the case of non-subgingival retainer margins. Proximal abutment tooth surfaces with subgingival retainer margins showed a marked increase of the index values (PII, GI) and the depth of the pockets seemed to have increased. The increase of the index values should probably be interpreted as being the accumulated effects of the presence of pontics and the subgingival margins. The increase in pocket depth seemed mainly to result from the subgingival retainer margins.     

Periodontal conditions in patients treated with dental bridges

The periodontal condition of 242 abutment teeth carrying full and partial crowns used for retaining dental bridges was compared with the periodontal condition of 242 contralateral teeth in the same patients. The periodontal condition was assessed by recording the Plaque Index (Silness and Löe 1964), Gingival Index (Löe and Silness 1963) and by measuring pocket depth according to Glavind and Löe (1967). The position of the retainer margins in relation to the gingival crest was recorded according to the Margin Index (Silness 1970). Abutments carrying complete crowns with full coverage showed larger amounts of soft deposits, more severe gingivitis and increased depth of the periodontal pockets compared to the contralateral teeth. This was the case whether or not patients had received instruction in methods to improve the oral hygiene. In instructed patients, the periodontal condition of abutments carrying complete crowns with limited coverage did not differ significantly from those of the control teeth. This was also the case for teeth carrying partial crowns with limited coverage in instructed patients.     

Periodontal conditions in patients treated with dental bridges

The periodontal condition of 385 lingual abutment tooth areas with varying location of the retainer margins was compared with that of 385 contralateral tooth surfaces which were caries-free and devoid of fillings. The periodontal condition was assessed by recording the Plaque Index (Silness and Löe 1964), Gingival Index (Löe and Silness 1963) and by measuring pocket depth by the method of Glavind and Löe (1967). The location of the retainer margins was recorded according to the Margin Index (Silness 1970a). A supragingival position of the crown margins seemed to be the most favourable location, whereas retainer margins at and below the gingival crest interfered significantly with gingival health. The most harmful effects upon the gingival condition seemed to be produced by retainer margins located subgingivally.     

Periodontal conditions in patients treated with dental bridges

The investigation was undertaken to evaluate the effect on the periodontal conditions of fixed unilateral bridges which had been in the mouth 1 to 3 years. Seventy-three bridges in 73 patients (50 women, 23 men) were examined. One group of 35 individuals had been instructed in methods for improving their oral hygiene, whereas another group (38 individuals) had not.
In all, 146 abutment teeth were examined. An equal number of homologus teeth in the same patients served as controls. The gingival state and oral hygiene were recorded according to index systems proposed by Löe and Silness (1963) and Silness and Löe (1964). Pocket depth measurements were made as explained by Glavind and Löe (1967). The location of the crown margins of the bridge retainers was recorded according to a Margin Index System proposed by the author. The distribution of soft deposits and the location of gingivitis were similar around the abutment teeth and the homologous teeth. The average pocket depth of the abutment teeth was not deeper than that of the controls. In areas with crown margins below the gingival crest, more severe gingivitis was registered than in the control areas. The periodontal conditions were better in the individuals who had been instructed to practice oral hygiene measures as compared to the non-instructed individuals. Possible reasons why soft deposits remain undetected on clinical examination of subgingival restorations are discussed. It is suggested that the gingival inflammation around the abutment teeth and the homologous teeth is caused by the usual bacterial mechanisms.