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.     

Periodontal conditions following treatment with distally extending cantilever bridges or removable partial dentures in elderly patients. A 5-year study

The aim of the present study was to evaluate the periodontal conditions following treatment with distally extending cantilever bridges or removable partial dentures (RPDs) in elderly patients. All participants had a complete denture in the maxilla and moderate-to-advanced bone loss around the teeth present in the mandible. After undergoing periodontal treatment, 27 patients were treated with distally extending cantilever bridges and 25 patients with a RPD. During the first 2 years following prosthetic treatment, the patients were recalled twice a year and during the last 3 years once a year for oral prophylaxis and assessment of the periodontal status. The patients treated with a RPD showed higher mean Plaque and Gingival Indexes than the patients treated with cantilever bridges. No change in probing pocket depths was observed in either group, and only a small decrease in radiographic alveolar bone height was revealed. In conclusion, only minor changes in the periodontal conditions were recorded during the 5 years of observation after treatment with cantilever bridges or RPDs.     

Veterans Administration Cooperative Dental Implant Study--comparisons between fixed partial dentures supported by blade-vent implants and removable partial dentures. Part III: Comparisons of masticatory scores between two treatment modalities

Five Veterans Administration Medical Centers participated in a study to determine the comparative influence of fixed partial dentures (FDPs) supported by endosteal blade implants and removable partial dentures (RPDs) on masticatory performance. The study design, methodology, and success rates have been described in Parts I and II. A total of 232 patients received comprehensive dental care, including RPDs for 118 patients and FPDs for 114. Three standardized masticatory tests were made with peanuts and carrots before treatment. These tests were repeated at 16 weeks following RPD or implant insertion and thereafter at 6, 18, 36, and 60 months. At entry, there were no significant differences in performance scores and chewing time and strokes taken to reach the swallowing threshold between the RPD and FPD groups (p greater than 0.05). After treatment completion, FPDs and RPDs significantly improved the masticatory ability of patients with Kennedy class I or class II edentulous conditions (p less than 0.001). The improvements in performance scores for both test foods were slightly better in the RPD group than in the FPD group, although none of the 30 mean differences was significant (p greater than 0.05). After the baseline period to 60 months, only slight changes in performance scores were observed for both groups. RPDs and FPDs were comparable in improving the chewing efficiency of patients with Kennedy class I and class II partially edentulous conditions.     

Veterans Administration Cooperative Dental Implant Study — Comparisons between fixed partial dentures supported by blade-vent implants and removable partial dentures. Part I: Methodology and comparisons between treatment groups at baseline

This study was conducted to determine whether fixed partial dentures supported by dental implants provide an acceptable alternative to conventional removable partial dentures in patients with Kennedy class I or class II edentulous conditions. The acceptability of the new treatment will be based on success rates, impact on the health of the remaining dentition, masticatory performance, patient satisfaction, and maintenance care and cost. The study was planned also to provide comparisons between two designs commonly used by dentists for fabricating removable partial dentures. The designs differed only in terms of the type of the retainer (clasp type) and tooth support (rest location).A total of 272 patients with Kennedy class I and class II edentulous conditions were assigned on a random basis to one of the treatment groups, 134 to receive a removable partial denture and 138 a fixed partial denture supported by a blade-vent implant. All of the patients were medically screened and met prespecified criteria for oral hygiene, bone support for abutment teeth, and size of the residual ridge.Thirty-four patients were eliminated from the study before completion of their treatment. An additional six patients with early implant failures were reentered in the study and followed up as a separate group. The remaining 232 patients received comprehensive dental care, including removable partial dentures for 118 and fixed partial dentures for 114 patients.A series of examinations, radiographs, masticatory performance tests, patient satisfaction, food selection questionnaires, and dietary history were completed before initiation of the treatment, 16 weeks after the insertion of an RPD or an implant, and thereafter at 6-, 18-, 36-, and 60-month intervals. In addition, patients were seen at 6-month intervals for a recall dental examination, oral prophylaxis, plaque instructions, radiographic survey of the implant, and any needed dental treatment.The randomization stratification approach produced two treatment groups with comparable age, number of remaining maxillary and mandibular teeth, type of opposing dentition, and percent of patients with Kennedy class I and class II edentulous conditions. The mean scores of bone support, tooth mobility, and sulcular depths of abutment teeth were also similar. Significant but comparable improvements in oral hygiene and sulcular depth occurred in the two groups after treatment. The periodontal health scores at the 16-week interval serve as the baseline to measure subsequent changes in periodontal health. This prospective longitudinal study with prespecified criteria for implant and removable partial denture failure should provide reliable estimates of failure rates, number and types of complications, maintenance care needs, and total costs for the two treatment modalities and the two RPD designs.     

Oral health status of patients 5-6 years after placement of cobalt-chromium removable partial dentures

This study is a clinical survey of cobalt-chromium (Co-Cr) removable partial denture (RPD) wearers that aimed to investigate the effects of denture wearing on oral tissues. A random sample of patients who had received their dentures 5-6 years previously from a dental teaching hospital in Hong Kong was selected. Those who had been constantly wearing the RPDs were examined by one calibrated examiner under an optimal clinical setting. The patients' dental, periodontal and mucosal status were assessed. A total of 87 patients were examined. Mucosal lesions under the Co-Cr RPDs were uncommon in this study sample. However, there was a high prevalence of plaque, gingivitis and gingival recession, especially in dento-gingival surfaces in close proximity (within 3 mm) to the dentures. Thus, there is a special need for regular oral hygiene reinforcement, scaling and prophylaxis among RPD wearers. Despite a low caries incidence in the study sample, root caries were found to be associated with contact with the RPDs (P < 0.05) but coronal caries were not. It is recommended that coverage of the exposed root surfaces by RPD components should be avoided. Also, topical fluorides should be regularly applied onto exposed root surfaces as a preventive measure.     

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.     

Comparisons of tactile thresholds between implant-supported fixed partial dentures and removable partial dentures.

This study compared the tactile sensitivity of splinted abutment and denture teeth of 16 fixed partial dentures (FPD) supported by blade implants and 16 removable partial dentures (RPD) in patients with Kennedy Class I and Class II edentulous conditions. No significant differences were noted between the tactile thresholds of the natural abutment teeth and artificial teeth in the FPD and RPD groups. The splinted abutment teeth required 45.4 g, or 5.4 to 5.8 times higher occlusal loads than did those needed for the comparable nonsplinted teeth, to detect the stimulus. A further increase of 54% in thresholds with the FPD and over 100% with the placement of the RPD indicated the superiority of the RPD in terms of load distribution as a result of the cross-arch splinting and mucosal support. Moderate positive correlations (r = 0.37 to 0.46; P < .05) between tactile thresholds and masticatory performance were found, signifying that reduced tactile perception was not responsible for the incomplete restoration of the masticatory function with RPDs or FPDs but might be contributing to increased masticatory performance within both treatment groups.     

Late results of treatment with partial dentures

Ninety-nine people who were fitted with partial dentures in 1959 were invited to take part in an investigation 13 years later. A questionnaire was answered by fifty-eight, which means a frequency of 81% if allowance is made for an explainable loss. Of the sixty-eight partial dentures in these fifty-eight patients, twenty-three were still being used, fourteen patients had had their original partial dentures replaced by new ones and three by a fixed bridge, while seven had been replaced by complete dentures. Twenty-one were no longer used and had not been replaced. Of the fifty-four patients who originally had a complete upper denture and a partial lower denture, thirty were still available. Following an invitation to take part in a clinical review, twenty-seven (90%) co-operated. Most of the patients were in need of treatment (for caries, periodontitis and/or prosthetic treatment). The periodontal injuries were rarely serious. A correlation was found between good oral hygiene and good results of treatment.     

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

summary The aim of this study was to evaluate the possibility of replacing removable partial denture (RPD) with fixed partial dentures on osseointegrated implants in a selective group of patients with partially edentulous lower jaws. Forty patients were evaluated to receive implants. Twenty-three patients showed a precarious oral hygiene, five patients refused the treatment (being satisfied with their RPD), six refused for economic reasons, three patients refused for fear and scepticism, one for long duration of therapy, and one was not treated because of a very marked atrophy of the alveolar crest. Finally, one patient was treated with implants. For these reasons, at the present time implants are not an appropriate treatment for introduction into large-scale public health programmes and RPD must still be considered a valid therapeutic procedure.     

弹性义齿与传统可摘局部义齿对牙周情况影响的比较

目的比较弹性义齿与传统可摘局部义齿对牙周组织健康的影响。方法选择12例牙列缺损病人。每例受试者同时制作一件铸造卡环活动桥修复体和一件弹性义齿。先后戴用两种义齿，对基牙临床检查和龈下茵斑检查。结果戴用铸造卡环活动桥后PLI高于戴用弹性义齿后。戴用弹性义齿后BI及龈下菌宽螺旋体比例略高于戴用铸造卡环活动桥后。其他指标两者无差别。结论弹性义齿卡环设计时应尽量减少覆盖牙龈的面积，避免卡环边缘终止于龈缘处。     

Caries and periodontal status in patients fitted with removable partial dentures

A 6-year follow-up study was carried out on 28 patients fitted with removable partial dentures. Prior to the prosthetic treatment all patients were given oral hygiene instruction and periodontal therapy where indicated. The removable partial dentures were carefully planned and designed. During the follow-up period the patients were examined at yearly intervals when remotivation, scalings, conservation and prosthetic adjustments were carried out as required. Patient cooperation was excellent and no significant deterioration of the periodontal status of the remaining teeth could be found. In addition the number of newly registered carious lesions was low. A certain degree of deterioration of occlusion, articulation, stability and clasp retention of the dentures fitted did occur, however.     

A clinical study of the periodontal status of abutment teeth supporting swinglock removable partial dentures—A pilot study

Eleven patients wearing mandibular swinglock bilateral distal extension removable partial dentures opposing maxillary complete dentures were studied for a period up to 2 years. They had moderate to advanced periodontal disease with retrograde mobility patterns. Periodontal therapy, as well as treatment of dental carious lesions, was completed before fabrication of the prosthesis. Recordings of the gingival status, pocket depth, plaque score, tooth mobility, and dental caries were made at the time of the placement of the prosthesis and thereafter at 6-month intervals. Final results were obtained at the end of 2 years in six patients (group A) and at 1/12 years in five patients (group B).Our findings show that both groups had a statistically significant increase in gingival inflammation. However, no differences in degree of inflammation were observed between the two groups with regard to the status of gingival tissues that were covered and uncovered by the components of the swinglock removable partial denture. Also, no statistically significant differences in pocket depths and plaque scores were found between the time of placement of the swinglock removable partial denture and the final recall visit. Of the 61 abutment teeth, 85.2% had no significant change in mobility, 11.5% showed a substantial decrease in mobility, and 3.3% showed a considerable increase in mobility.The patients were able to successfully wear the swinglock removable partial denture without clinically significant changes in the supporting structures of the abutment teeth.This report is part of an ongoing study to determine the efficacy of swinglock removable partial dentures.     

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.     

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。     

Veterans Administration Cooperative Dental Implant Study--comparisons between fixed partial dentures supported by blade-vent implants and removable partial dentures. Part IV: Comparisons of patient satisfaction between two treatment modalities.

This study compares treatment assessments made by two groups of patients with Kennedy class I or class II mandibular edentulous conditions, who received either a removable partial denture (RPD) (N = 115) or one or two fixed partial dentures (FPDs), each supported distally by a blade implant (N = 113). Two questionnaires were administered, one at 16 weeks after the implant or RPD insertion and at the 6-month interval and the other at 18, 36, and 60 months. Marked functional improvements were perceived by a large majority of patients in both groups after the insertion of prosthesis. At 6 months, a higher percent of patients with RPDs than those with FPDs found it easy to clean their RPDs and experienced chewing discomfort, restriction of food choices, feeling of insecurity with their RPDs, and difficulty with their pronunciation. The exclusion of assessments by 25 RPD patients, whose treatment was judged to be a failure functionally, made the mean differences between the two treatments statistically significant (p less than 0.05) only for ease of cleaning in favor of the RPD and fewer restrictions of food choices in favor of the FPD group. At 60 months, significant differences between the percents of patients with the most favorable responses occurred for perceptions of eating enjoyment, food particles seldom getting under the removable partial denture, and improvement in social life in favor of the FPD treatment and for the ease of cleaning the removable partial denture in favor of the RPD treatment. The results seem to support superiority of the FPD in terms of patient satisfaction, but not enough to favor this type of prosthesis over the RPD without consideration of other pertinent factors.     

Oral health-related quality of life in patients treated by implant-supported fixed dentures and removable partial dentures

Objectives: This study investigated the association between denture status [implant‐supported fixed dentures (IDs) and removable partial dentures (RPDs)] and oral health‐related quality of life (OHRQoL). Materials and methods: Consecutive patients with IDs and RPDs were recruited from the Prosthodontics Departments at Showa University and Tokyo Medical and Dental University. The Japanese version of the Oral Health Impact Profile (OHIP‐J‐49) was administered to each subject. For each OHIP‐J‐49 question, the subjects were asked to indicate the frequency with which they had experienced a dental problem during the last month. Responses were recorded on a 5 point Likert rating scale, with 0 being never and 4, very often. Summary scores were calculated and regression analyses conducted to investigate the association between denture status and OHIP‐J‐49 summary score. Results: In total 79 ID subjects (mean age±SD of 51.7±12.4 years, 44.3% men) and 109 RPD subjects (mean age of 66.5±8.6 years, 30% men) participated after giving informed consent. The regression analysis between the type of treatment and the OHIP‐J‐49 summary score revealed a significant association with a coefficient of 17.0 (Confidence interval, CI: 10.9–23.1). When age and duration of denture usage, which had significant associations with OHIP‐J‐49, were included in this model, the regression coefficient remained virtually unchanged at 17.4 (CI: 9.75–25.0), thus indicating little potential confounding by them. Conclusions: OHRQoL in patients with implant‐supported fixed dentures is generally less impaired than it is in those patients with RPDs. To cite this article :
Furuyama C, Takaba M, Inukai M, Mulligan R, Igarashi Y, Baba K. Oral health‐related quality of life in patients treated by implant‐supported fixed dentures and removable partial dentures.
Clin. Oral Impl. Res. 23 , 2012; 958–962
doi: 10.1111/j.1600‐0501.2011.02247.x     

Comparison of mandibular bone density and radiomorphometric indices in wearers of complete or removable partial dentures

Objectives To examine bone mineral density (BMD) and linear radiomorphometric parameters of the mandible in elderly patients with different types of dentures. Methods Patients had mandibular complete dentures (CDs) or Kennedy Class I removable partial dentures (RPDs) in the mandible; all patients had CDs in the maxilla. The age and sex distributions of patients with CDs and of those with RPDs were not significantly different. Three parameters were measured in dental panoramic radiographs (DPRs) from a total of 136 patients: thicknesses of the mandibular cortex below the mental foramen, the antegonion, and the gonion. Mandibular BMD was measured densitometrically using DPRs and a copper step wedge. All BMD values were expressed relative to the step wedge thickness. Results There was a significant difference between patients with CDs and those with RPDs for all the radiomorphometric indices measured (P < 0.001); specifically, radiomorphometric indices were higher in RPD wearers. Mandibular BMD values in RPD wearers were higher than those of patients with CDs, and BMD was significantly higher under the saddle in RPD wearers (P < 0.05). Conclusions These results support the hypothesis that occlusal forces that are transmitted directly to the mucosa beneath mucosa-borne dentures may cause overloading, which may cause bone resorption; by contrast, under tooth and mucosa-borne dentures, occlusal forces are transmitted not only to mucosa but also to the periodontal ligament of the abutment teeth, thereby reducing the transmission of force to the mucosa, which prevents overload. Greater chewing forces might thus be achieved with tooth and mucosa-borne dentures, which may stimulate bone growth at the mandibular cortex.     

Clinical evaluation of patients eight to nine years after placement of removable partial dentures

Removable partial dentures, constructed following principles outlined in this study, provided reasonable service for an 8- to 9-year period for patients who were wearing them. The oral hygiene of the patients was less than ideal. Few teeth were lost by patients in the study. There were no significant differences in caries incidence, changes in sulcus depths, tooth mobility, or alveolar bone loss between patients who were wearing their dentures and those who were not. There were increased levels of gingival inflammation seen in regions covered by the removable partial dentures and in gingivae apical to clasp arms. Other than these findings, there seemed to be no direct evidence that the removable partial dentures were causing dental or periodontal breakdown.     

Prospective 3-year study of cross-arch fixed partial dentures in patients with advanced periodontal disease.

STATEMENT OF PROBLEM: Several choices exist for the treatment of advanced periodontal disease. One is a combined periodontal and prosthetic treatment that includes cross-arch fixed partial dentures (FPDs). However, the outcomes of such therapy have been reported mainly from studies in Scandinavian countries. PURPOSE: The aims of this study were: (1) to longitudinally evaluate, after periodontal and prosthodontic treatment that included cross-arch FPDs, treatment outcomes in Korean patients who suffered from severe periodontitis; and (2) to evaluate the patients' treatment assessments and the FPDs after 3 years. MATERIAL AND METHODS: This survey included 39 Korean patients provided with 50 FPDs. Clinical and radiographic examinations were performed at the time of delivery of the FPDs and at the 3-year follow-up examinations. The prostheses were divided into 3 groups according to design (end abutments, unilateral cantilever, and bilateral cantilevers) and the amount of supporting tissues at the time of insertion. On average, only 26% of the total original periodontal tissue remained at the time of insertion. The FPDs consisted of 11 to 14 units, with a mean of 5 to 7 abutments in the 3 groups. The mean periodontal ligament area of the abutments was 79% of the total ligament area of the replaced teeth. RESULTS: At the 3-year follow-up examination, the FPDs were stable in all patients, who in general displayed good oral hygiene and had healthy periodontal conditions. The change in periodontal ligament area over the 3-year observation period was negligible (1 mm(2) per dental unit) and showed no statistically significant difference in relation to FPD design. Most patients were satisfied with the function of their FPDs with respect to mastication, phonetics, hygiene, esthetics, and chewing comfort. A few patients stated that they were careful with the FPDs and avoided certain foods (for example, raw peanuts and grilled squid) because they felt insecure with the cantilever segments. Most patients reported that they would choose the same treatment again. CONCLUSION: Patients with advanced periodontal disease demonstrated successful outcomes over a 3-year period and reported satisfaction with combined periodontal and restorative treatment that included cross-arch FPDs.     

Opinions and wearing habits among patients new to removable partial dentures. An interview study

Thirty-five patients treated at the Department of Prosthetic Dentistry, University of Ume?, who had received removable partial dentures (RPD) during the period July 1st 1981 to December 31st 1982, were interviewed regarding the use and experiences of their dentures. None of the patients had previously used an RPD. The treatment had been carried out by dentists and dental students. At the time of the interview, 1-2 1/2 years after receiving the prosthesis, 34 subjects (97%) declared that they used their RPDs during various parts of the day.