Rotational path removable partial denture (RPD): conservative esthetic treatment option for the edentulous mandibular anterior region: a case report

It can be esthetically and financially daunting for patients to lose teeth in an anterior region of the mouth. For these patients, traditional treatment options presented in the past have included fixed partial denture, implants, and conventional removable partial denture (RPD). For patients faced with financial, anatomical, and/or esthetic limitations, the edentulous region can be restored successfully with a rotational path RPD. Rotational path RPD designs have often been overlooked by the dental profession due to its complex concepts involving the prosthetic design and sensitive laboratory techniques. With better understanding of the concepts and design, the dental clinician can deliver the highest esthetic outcome in compromised areas in which other treatment options may often face limitations. This paper reviews the method used to esthetically design and plan a posterior-anterior rotational path RPD in an edentulous mandibular anterior region for a patient missing the mandibular incisors. CLINICAL SIGNIFICANCE: Due to inadequate understanding of the mechanics of rotational path RPDs, many clinicians have not adapted the application of this advantageous prosthesis. When correctly designed and fabricated, the rotational path RPD provides improved esthetics, cleanliness, and retention for patients who may not be suitable candidates for implants or fixed partial dentures in tooth-supported edentulous regions.     

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.     

Maxillary Rehabilitation Using Fixed and Removable Partial Dentures with Attachments: A Clinical Report

Despite requiring dental crown preparation and possible root canal treatment, besides the difficulty of clinical and laboratory repairs, and financial burden, the association between fixed (FPD) and removable partial dentures (RPD) by means of attachments is an important alternative for oral rehabilitation, particularly when the use of dental implants and FPDs is limited or not indicated. Among the advantages of attachment‐retained RPDs are the improvements in esthetics and biomechanics, as well as correction of the buccal arrangement of anterior teeth in Kennedy Class III partially edentulous arches. This article describes the treatment sequence and technique for the use of attachments in therapy combining FPD/RPD.     

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.     

Should we extract teeth to avoid tooth–implant combinations?

Summary  The controversy over combining teeth and implants for support of fixed partial dentures still remains after almost three decades of debate. The aim of this review was to evaluate what support that could be found in the literature for extracting teeth in favour of implants, and to elucidate whether tooth–implant prostheses were inferior to solely implant supported constructions in terms of survival and complications. The methods for gathering relevant information entailed electronic searches on PubMed using relevant key words, as well as complementary manual searches in the retrieved publications. The results showed that there was no support for extracting teeth in favour of placing implants. On the contrary, the healthy tooth had a survival that was life-long, which is yet to be shown for the dental implant. Also the use of teeth as abutments in combination with dental implants for support of fixed dental prostheses could be endorsed in certain situations with solid albeit limited scientific support. In a wider sense, such prostheses could be used as a reliable therapy in all regions of the jaws. However the status of the abutment teeth in terms of periodontal support, pulpal status and risk for carious lesions and biomechanical complications should always be considered in relation to the long-term prognosis of the prosthesis. The conclusion was that teeth should not be extracted in favour of placing dental implants without a specific indication, and that tooth–implant supported prostheses should be considered as a viable prosthetic option.     

Radicular Stud Attachment: An Alternative to Improved Retention and Esthetics

With the increasing demand and popularity of dental implants, the use of removable partial dentures in replacing missing teeth has become less popular. One of the obvious limitations of RPD is the unsightly view of metal used for the retentive clasp and the difficulty in obtaining a good fit. This case report describes the use of a radicular stud attachment as an alternative method to obtain improved retention and esthetics.     

Social and functional impact of reduced posterior dental units in older adults

The number of teeth needed to maintain adequate dental function in older adults is unknown. The purpose of this study was to examine the relationship between oral function and the number of opposing pairs of posterior teeth. We identified 338 subjects with complete anterior dentitions from an interview and examination survey of Ontario adults aged 50 and over; 261 had no partial denture and 77 had removable partial dentures (RPD). Oral function was measured using questions assessing chewing ability, mandibular function and socio-psychological impact.
Subjects with no partial dentures were further allocated to five groups, based on their dental status: complete dental arch ( n = 69); 5–7 functional units-pairs of opposing posterior teeth ( n = 109); 3 or 4 functional units ( n = 48) and 0–2 functional units ( n = 35). Oral function problems increased with decreasing functional units being markedly more prevalent among the groups with 0–2 functional units. 34% of subjects in the 0–2 group reported one or more problems with chewing ability compared to 6–17% in the other groups (χ² P = 0.001 d.f. = 3).
The 77 subjects who wore removable partial dentures, reported social and dental function at levels comparable to those with no dentures.
From these results, there appears to be little socio-functional need to replace lost posterior teeth with a partial denture until the person has fewer than, 3 posterior functional units. The low number of partial denture wearers limited our ability to detect a lasting benefit from RPD treatment.     

Fixed Rehabilitation of an ACP PDI Class III Patient

This clinical report documents the treatment of a 63-year-old Caucasian female Prosthodontic Diagnostic Index Class III patient using dental implants and a fixed prosthetic reconstruction. The treatment involved the fabrication of single crowns and fixed partial dentures retained by natural teeth in the maxillary arch. The posterior segments of the mandibular arch were rehabilitated with fixed partial dentures retained by endosseous implants.     

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.     

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.     

Immediate implant loading: a case report

The therapeutic goal of implant dentistry is not merely tooth replacement but total oral rehabilitation. Considering dental implants as a treatment option can provide patients with positive, long-term results. Implants have developed into a viable alternative to conventional prosthetic reconstruction of edentulous areas. They provide excellent support for fixed or fixed detachable appliances, which increases function compared with conventional complete dentures. Implant dentistry has gone through many phases over the years. Modern technology and design allows us to predictably place our dental implants in immediate extraction sites and often load the implants at the time of placement. Single tooth-by-tooth reconstruction provides easy access for the patient to floss and clean the areas compared with the relative difficulty in maintenance when crowns are splinted. This case study demonstrates full maxillary and partial mandibular reconstruction using dental implants. The implants were surgically placed immediately after extractions and loaded using a stable roundhouse composite temporary bridge. Following osseointegration, the implants were permanently restored with individual crowns.     

Fabrication of a removable partial denture combining conventional and digital techniques

This article describes a combined conventional and digital workflow for fabricating removable partial dentures (RPDs). After scanning the dental cast and RPD framework assembly, artificial teeth and denture base regions were designed using computer-aided design software. The artificial teeth and denture base assembly was milled as a single structure by using a wax disk and then placed on the RPD framework. The artificial teeth were additionally milled from a polymethyl methacrylate disk. Conventional procedures were followed for denture investment until the wax elimination procedure, after which the assembly was replaced with the artificial teeth in the cope of the flasks, and the denture resin material was injected to process the RPD. This technique enabled the RPD to be fabricated in the same form as the design state.     

Implant-retained partial overdenture with resilient attachments.

Management of partially edentulous patients can still be a prosthodontic challenge. Replacing the missing teeth with conventional removable partial dentures (RPDs) is the traditional method for the treatment of partial edentulism; however, there are many potential disadvantages associated with traditional RPDs. With the advent of osseointegrated dental implants, possibilities of prosthetic reconstruction for partial edentulism are endless. This article discusses the implant-retained partial overdenture (IRPOD) with resilient attachments as a predictable and cost-effective treatment for partially edentulous patients.     

Removable partial denture design and its effect on remaining teeth, based on Hungarian national survey

Removable partial dentures (RPD) are used to restore Class 2A, 2B, 2A/1, and Class 3 type partially edentulous arches. Calibrated dentists of the Department of Prosthodontics performed oral health survey first in 1985-1989 and a second survey in 2003-2004. The oral surveys were carried out at the lung cancer screening stations, after obtaining formal consent of those individuals who were originally referred to perform x-ray lung screening examination. Subjects were interviewed and clinically examined under artificial lighting conditions. In the "second" survey data collected on 765 RPDs were analysed. Examined aspects of RPD design were: the protection of the marginal periodontium, extension of major connectors, base plate materials, tooth and tissue support. The level of restoration related damage on the remaining teeth was estimated according to whether remaining teeth were used for retention or for support; had any other type of denture-contact or remaining teeth were free from contact with denture. Approximately 50% of dentures showed dento-mucosal or muco-dental support; metal base was present in 45-48% of dentures; 47% of major connectors were designed with reduced extension; freedom of gingival margin was assured in 43-45% of the dentures. 26.10% of reference teeth; 19.11% of the remaining teeth used for support; 31.53% of the teeth used for retention; 28.07% of the teeth free from contact with denture and 38.00% of those remaining teeth with any other type of denture contact showed a sign of damage. Findings of the authors' survey show a considerable improvement in all aspects of RPD design--but still further progression is required. Those principles of RPD design taught in dental schools can only gradually influence the routine daily dental practice. Assessment of remaining teeth damages confirm the standards we outlined for RPD design with the main priorities of dental support and the protection of the gingival margin.     

Retrospective evaluation of complete-arch fixed partial dentures connecting teeth and implant abutments in patients with normal and reduced periodontal support

STATEMENT OF PROBLEM: The clinical outcome of complete-arch fixed prostheses supported by implants and natural tooth abutments in patients with normal or reduced periodontal support has been reported by few studies, with controversial results. PURPOSE: The purpose of this study was to report on the implant success rate, prosthetic complications, and the occurrence of tooth intrusion, when complete-arch fixed prostheses, supported by a combination of implants and teeth, were fabricated for patients with normal and reduced periodontal support. MATERIAL AND METHODS: Nineteen patients with residual teeth that served as abutments were consecutively treated with combined tooth- and implant-supported complete-arch fixed prostheses and were retrospectively evaluated after a period varying from 24 to 94 months. Nine patients showed reduced periodontal support as a result of periodontal disease and treatment (RPS group), and 10 patients had normal periodontal support of the abutment teeth (more than 2/3 of periodontal support [NPS group]). Ninety implants and 72 tooth abutments were used to support 19 fixed partial dentures. Screw- and cement-retained metal-ceramic and metal-resin prostheses were fabricated with rigid and nonrigid connectors. Implant survival and success rates, occurrence of caries and tooth intrusion, and prosthetic complications were recorded. The number of teeth, implants, prosthetic units, fixed partial dentures, and nonrigid connectors were compared with a t test to assess differences between the 2 groups, while data for the occurrence of intrusions and prosthetic complications were compared with the Fisher exact test (alpha=.05). RESULTS: One of the 90 implants was lost (99% survival rate) over 24 to 94 months, while 3 implants showed more than 2 mm of crestal bone loss (96% success rate) over the same period. No caries were detected, but 5.6% (4/72) of the abutment teeth exhibited intrusion. Intrusion of abutment teeth was noted in 3 patients who had normal periodontal support (13% of teeth in NPS group) of the abutment teeth and was associated with nonrigid connectors. No intrusion of teeth was noted in the patients exhibiting reduced periodontal support regardless of the type of connector or when a rigid connector was used for either group. The number of intruded teeth was significantly greater in patients with intact periodontal support (P=.03). CONCLUSIONS: Complete-arch fixed prosthesis supported by implant and tooth abutments may be associated with intrusion of teeth with intact periodontal support when nonrigid connectors are used to join the implant- and tooth-supported sections of the prostheses. However, fixed partial dentures supported by implants and teeth with reduced periodontal support were not associated with tooth intrusion, regardless of the type of connectors used.     

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.     

Implant‐Retained Removable Partial Dentures: An 8‐Year Retrospective Study

Purpose: To evaluate the long‐term outcomes of removable partial dentures (RPDs) retained (but not supported) by dental implants. Materials and Methods: We retrospectively evaluated 32 consecutive patients who received implant‐retained RPDs. Each patient received one to four endosseus implants; the sample included a total of 64 implants. Follow‐up was conducted for a minimum of 8 years, during which satisfaction, implant survival, and prosthetic success were evaluated. Results: Patient satisfaction systematically increased. The implant success rate was 93.75%, and 100% of the prostheses were successful. Conclusion: Implant‐retained RPDs are a reliable intermediate solution that can reduce biological and economic costs while maintaining implant treatment benefits and the ease of RPD procedures.     

Veterans Administration Cooperative Dental Implant Study--comparisons between fixed partial dentures supported by blade-vent implants and removable partial dentures. Part II: Comparisons of success rates and periodontal health between two treatment modalities

Five Veterans Administration centers have participated in a study to determine whether fixed partial dentures (FPDs) supported by blade implants offer an acceptable substitute for mandibular unilateral or bilateral distal-base extension removable partial dentures (RPDs). The study design and methodology have been described in Part I. A total of 232 patients received comprehensive dental care including RPDs for 118 patients and FPDs for 114. Prespecified criteria determined treatment failures. During the 60-month period, treatment failures occurred in 19 FPD patients and 30 RPD patients. Ten FPD failures occurred before and nine after the FPD insertion. Five RPD failures were caused by abutment tooth loss and 25 for not using the RPD while eating. Life table analysis showed 5-year success rates of 84.2% for the FPD and 74% for the RPD. The 17.9% higher FPD success rate in Kennedy class II patients was both statistically and clinically significant. Excluding the 10 early failures, the 5-year FPD success rate was 91.5%. Of the 170 attempted implants, 26 failed, including 12 before the FPD fabrication. Radiographic assessments by a panel of three judges showed no bone deterioration during baseline to 60 months in 29.6%, slight in 25.4%, moderate in 15.9%, marked in 27%, and severe deterioration in 2.1% of the implant posts.     

Veterans administration cooperative dental impant study—Comparisons between fixed partial dentures supported by blade-vent implants and removable partial dentures. Part II: Comparison of success rates and periodontal health between two treatment modalities

Five Veterans Administration centers have participated in a study to determine whether fixed partial dentures (FPDs) supported by blade implants offer an acceptable substitute for mandibular unilateral or bilateral distal-base extension removable partial dentures (RPDs). The study design and methodology have been described in Part I. A total of 232 patients received comprehensive dental care including RPDs for 118 patients and FPDs for 114. Prespecified criteria determined treatment failures. During the 60-month period, treatment failures occurred in 19 FPD patients and 30 RPD patients. Ten FPD failures occurred before and nine after the FPD insertion. Five RPD failures were caused by abutment tooth loss and 25 for not using the RPD while eating. Life table analysis showed 5-year success rates of 84.2% for the FPD and 74% for the RPD. The 17.9% higher FPD success rate in Kennedy class II patients was both statistically and clinically significant. Excluding the 10 early failures, the 5-year FPD success rate war 91.5%. Of the 170 attempted implants, 26 failed, including 12 before the FPD fabrication. Radiographic assessments by a panel of three judges showed no bone deterioration during baseline to 60 months in 29.6%, slight in 25.4%, moderate in 15.9>, marked in 27%, and severe deterioration in 2.1% of the implant posts.     

Periodontal considerations in removable partial denture treatment: a review of the literature

PURPOSE: A critical review of the literature on the periodontal considerations in removable partial denture (RPD) treatment is presented. MATERIALS AND METHODS: A MEDLINE search was conducted for studies pertaining to the effects of RPDs on the periodontal tissues during the various phases of prosthetic treatment. The review included both in vivo and in vitro studies. RESULTS: The use of RPDs leads to detrimental qualitative and quantitative changes in plaque. There seems to be a lack of information regarding the effects of RPDs on the status of periodontally compromised abutments. A number of studies, mainly in vitro, have failed to agree on the ideal RPD design. Clinical trials have shown that if basic principles of RPD design are followed (rigid major connectors, simple design, proper base adaptation), periodontal health of the remaining dentition can be maintained. CONCLUSION: Removable partial dentures do not cause any adverse periodontal reactions, provided that preprosthetic periodontal health has been established and maintained with meticulous oral hygiene. Frequent hygiene recalls and prosthetic maintenance are essential tools to achieve a good long-term prognosis. More prospective clinical trials are needed on the effect of RPDs on the condition of periodontally involved abutment teeth.