The effect of removable partial dentures on periodontal health of abutment and non-abutment teeth

BACKGROUND: A removable partial denture (RPD) is a common treatment available for restoration of partially edentulous ridges. Longitudinal studies indicate that RPDs have been associated with increased gingivitis, periodontitis, and abutment mobility. METHODS: A total of 205 patients with RPDs participated in this study. There were 80 males and 125 females aged 38 to 89, with 123 maxillary and 138 mandibular RPDs. Patients were wearing existing RPDs for different periods ranging from 1 to 10 years. A two-part questionnaire was devised for this study. In the first part, patients answered questions on gender; age; smoking habits; denture age; denture wearing habits; mouth odor; and problems with food accumulating under the denture base, on the outside surface of the denture, and on the outside surface of remaining teeth after eating. The Kennedy classification, material, denture support, denture base shape, and number of teeth in contact, number of existing clasps, and occlusal rests were categorized. The quality of denture construction was also evaluated. In the second part of the questionnaire, baseline recordings of plaque (PI), gingival (GI), and calculus (CI) indexes were made, and Tarbet index (TI), as well as probing depth (PD), gingival recession (GR), and tooth mobility (TM) were measured, both on abutment and non-abutment teeth. RESULTS: Significant differences (P <0.01) were noted for PI, Cl, GI, PD, TM, and GR between abutment and non-abutment teeth, with abutment teeth showing more disease. CONCLUSIONS: RPD design plays an important role in the state of the periodontium. Appropriate design and good oral hygiene may decrease the appearance of periodontal disease.     

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.     

Direct resin-bonded, fibre-reinforced anterior bridges: A clinical report

Direct resin composite cantilever bridges were placed in patients to replace 26 single upper anterior teeth and one upper premolar. Twenty-four bridges were simple cantilevers, and three were fixed-fixed bridges. The bridges were constructed with hybrid resin composite placed around a resinimpregnated plasma-etched polyalkane fibre bundle bonded to the abutment tooth enamel by the acid-etch technique. Twenty-five bridges were assessed at 10±1 months. Two had fractured due to trauma, however, in both cases the pontic remained attached to the abutment tooth by the fibre bundle. This method of tooth replacement is viewed as a rapid, simple, cost-effective means of replacing anterior teeth in selected patients.     

The effect of three different periodontal pre-treatment procedures on the success of telescopic removable partial dentures

In this prospective study, 120 teeth consisting of maxillary and mandibular canines and premolars were divided into three groups each containing 40 teeth. The teeth were assigned randomly in quadrants to three different periodontal treatment protocols. The first group was treated with professional prophylaxis only. The second group received additional deep scaling. With the third group, additional surgical periodontal flap surgery and scaling was performed. Both papillary bleeding index (PBI) and probing depth (PD) were evaluated before, during and after treatment. During the subsequent prosthetic treatment phase all teeth were then used as telescope abutments supporting a removable prosthesis. The documentation of the attachment level (AL) was then used as a clinical parameter. One year after the incorporation of telescopic removable partial dentures (RPDs), PD, PBI and AL were again evaluated. The resulting periodontal parameters were compared between the different groups using the general linear model (GLM) repeated measures and the Kruskal-Wallis test for non-parametric variables. Differences within the three treatment groups were determined using the t-test, e.g. the Wilcoxon test for dependent variables (P < 0.05). A significant decrease in inflammatory indices (PBI) was found for all types of periodontal treatment (P < 0.03 for all groups). Additionally, the reduction in PD was significant for all of the three groups (P < 0.001 for all groups). The greatest reduction in PD was observed in the group in which a surgical approach was used. Evaluation of the attachment level after the incorporation of the telescopic RPDs showed that tooth position did not influence the periodontal prognosis and that the use of telescopic RPDs exerted no ascertainable negative influence on the periodontium of the abutment teeth.     

伴口呼吸及错牙合畸形慢性牙周炎牙周序列治疗观察

目的:探讨前牙区牙龈增生伴张口呼吸、错牙合畸形的慢性牙周炎患者接受牙周序列治疗的临床疗效。方法:选择2007年9月~2008年9月在大连市口腔医院牙周黏膜科就诊的前牙区牙龈增生伴张口呼吸、错牙合畸形的慢性牙周炎患者10例,进行牙周序列治疗(基础治疗、牙周手术治疗、正畸治疗和牙周支持治疗),历时5年以上。在治疗前、正畸治疗后1~3年采用Florida探针检查记录前牙区探诊深度(PD)、附着丧失(CAL)、牙齿松动度(TM)、探诊出血(BOP)等临床指标,并进行统计分析。在治疗前和正畸治疗后1～3年拍摄曲面断层片。结果:正畸治疗后1～3年前牙区PD、CAL均较治疗前有明显降低,BOP阳性位点较治疗前明显减少,差异均有统计学意义(P<0.01);TM较治疗前无明显变化,差异无统计学意义。治疗后3年较治疗后1年和2年,PD、CAL下降,BOP阳性位点减少,但差异均无统计学意义。结论:前牙区牙龈增生伴张口呼吸、错牙合畸形的慢性牙周炎患者进行历时5年以上牙周序列治疗,临床疗效良好且稳定     

Follow-up study of periodontal tissues around the abutment teeth in Konus telescope denture

The purpose of this study was to evaluate the periodontal tissues around the 47 abutment teeth in patients with advanced periodontitis for 5 years maintenance periods. The periodontal and prosthetic treatment were carried out and 16 Konus telescope dentures were applied for 11 patients. During 5 years maintenance therapy, periodontal conditions were observed once a year assessing probing depth, attachment level, tooth mobility index, gingival index, marginal alveolar bone height, width of periodontal ligament and loss of lamina dura. The results showed that increase of probing depth in 0.61 mm and attachment loss in 0.78 mm were observed for 5 years. A slight gingival inflammation occurred and tooth mobility increased in some extent. Enlargement of periodontal ligament space and loss of lamina dura in 40% of abutment teeth were observed for 5 years. There were six decayed teeth, six teeth, from which a intracoronal crown was removed, and two extracted teeth in 47 abutment teeth. In conclusion, the periodontal tissues around abutment teeth in Konus telescope denture changed slightly at one year after denture placement, after which, the periodontal tissues were well maintained.     

套筒冠式牙周夹板固定在重度牙周病治疗中的应用观察

目的临床观察重度牙周病患者经套筒冠式牙周夹板固定后临床治疗效果的影响。方法选择13例重度牙周炎患者,制作套筒冠式牙周夹板修复体19件,分别记录治疗前、治疗后3个月、6个月和12个月4个时段基牙的菌斑指数(PLI)、牙龈指数(GI)、牙龈出血指数(BOP)、探诊深度(PD)、牙齿松动度,并进行对照比较。结果经套筒冠式牙周夹板固定治疗后,牙齿松动度及牙周袋深度逐步变小,与治疗前相比有明显改善,差异有统计学意义(P<0.05),其他指标无明显差异(P>0.05)。结论牙周病患者经套筒冠式牙周夹板固定修复并结合牙周序列治疗,可提高牙周病治疗的成功率。     

Favorable periodontal regenerative outcomes from teeth with presurgical mobility: a retrospective study

BACKGROUND: The relevance of tooth mobility on periodontal healing is still controversial. The purpose of the present study was to evaluate the effect of presurgical tooth mobility on periodontal regenerative outcomes. METHODS: The data in this study were derived from three randomized clinical trials which evaluated regenerative procedures. Sixty-four patients with one intraosseous periodontal defect each received one of the following treatments: guided tissue regeneration (GTR) using expanded polytetrafluoroethylene (ePTFE), GTR using a bioabsorbable membrane with or without demineralized freeze-dried bone allograft (DFDBA), or enamel matrix derivative with or without DFDBA. Probing depth (PD), clinical attachment level (CAL), recession (REC), and tooth mobility (TM) were recorded at baseline and 1 year after treatment by a calibrated examiner. The post-surgical follow-up and maintenance periods were designed to optimize plaque control. The teeth were grouped according to their baseline Miller index TM score. The grouping yielded 36 teeth with minimal mobility, score 0; 13 teeth with score 1; and 15 with score 2. The mean changes in PD, CAL and REC from baseline to 1 year were calculated for each group. One-way analysis of variance (ANOVA) was performed to assess differences between the tooth mobility groups considering changes in PD, CAL, and REC at 1 year. RESULTS: The mean PD reduction from baseline to 1 year for teeth with TM score 0 was 3.67 mm; for TM score 1, 2.81 mm; and for score 2, 3.73 mm. The corresponding values for the gain in CAL were 2.73, 1.96, and 2.36 mm, respectively. According to ANOVA, the probing depth reductions and clinical attachment level gains found in each group were not statistically different, P= 0.218 and P= 0.252, respectively. CONCLUSION: Within the limitations of this analysis, it can be concluded that interproximal, intraosseous defects of teeth with limited presurgical tooth mobility; i.e., teeth with Miller's Class 1 and 2 mobility, will respond favorably to regenerative therapy.     

Longitudinal clinical evaluation of undercut areas and rest seats of abutment teeth in removable partial denture treatment

Purpose: Adequate preparation of abutment teeth for removable partial denture (RPD) rest seats allows appropriate masticatory force transmission, retention, and stability of supporting structures. It follows that careful preparation will be important for the longevity of the rehabilitation. The present study aimed to clinically evaluate rest seats and undercut areas of abutment teeth in RPD wearers after 2 years of use. Materials and Methods: A total of 193 occlusal, incisal, and cingulum rest seats were evaluated in terms of shape, rest adaptation, wear, caries, fractures, and surface type (enamel, composite resin, or amalgam). Two hundred and fourteen undercut areas were evaluated in terms of surface type (enamel or restoration) and integrity. This study was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte, resolution 196/1996, protocol number 11/05. Results: Intact preparations accounted for 92.2% of the total. Application of the Pearson test (p= 0.289) found no statistically significant differences among the materials on which the rest seats were prepared. For the undercut areas, 20.7% of those obtained on restorative material were nonintact. In addition, Fisher's exact test showed a statistically significant difference (p= 0.001) in surface type; enamel surfaces were shown to be 14 times more stable than restored surfaces. Conclusions: The results of this study suggest that rest seats are stable, regardless of the material on which they are prepared. Retentive areas were shown to be more stable when they were located in enamel.     

游离端义齿修复中太极扣附着体对基牙牙周的影响

目的研究单侧后牙游离缺失修复中太极扣附着体对基牙牙周健康的影响。方法选择肯氏Ⅱ类缺损患者20例,采用太极扣附着体修复。纵向观察修复前、修复后2周、修复后6个月第一、二、三基牙的牙周指数及牙槽骨吸收情况,并进行统计学分析。结果太极扣附着体修复后牙游离缺失后2周和修复后6个月内,义齿稳定,固位良好。第一、二、三基牙牙龈指数、菌斑指数、探诊深度在治疗前、修复后2周之间的差异,以及治疗前、修复后6个月之间的差异均无统计学意义;基牙X线根尖片未见根尖病变,未见明显牙周膜增宽、牙槽骨吸收或高度降低;修复前基牙的松动度在进行联冠修复后有所降低。结论太极扣附着体应用于游离端义齿修复对基牙牙周健康未见不利影响。     

Dual Path: A Concept to Improve the Esthetic Replacement of Missing Anterior Teeth with a Removable Partial Denture

The dual path of insertion concept for removable partial denture (RPD) design may be used in esthetically demanding situations. When compared to conventional RPDs, the main advantage of this design is the minimal use of clasps. This clinical report describes the treatment of a patient with an anterior maxillary edentulous area using a dual path RPD. The diagnostic cast was surveyed to ensure the adequacy of the undercuts on the mesial surfaces of the anterior abutments, where rigid minor connectors were placed. Inverted V‐shaped canine cingulum rest seats were prepared to provide resistance to tooth movement during function. The dual path RPD concept allows excellent esthetic results, minimizes tooth preparation, and reduces the tendency toward plaque accumulation in a Kennedy class IV partially edentulous arch.     

树脂夹板固定牙周病松动前牙疗效的综合评价

目的：采用多项客观指标与主观指标相结合的方法,综合评价尼龙丝加强树脂夹板固定牙周炎松动前牙的临床疗效。方法：16例重度牙周病病例牙周基础治疗后,制作16例尼龙丝加强树脂夹板,固定II°～III°松动的牙周病前牙：分别于术后3月、6月观察牙周指数、咬[牙合]力、x线根尖片和患者主观满意度。结果：患牙的PD、CAL值在术后3月、6月均显著下降（P〈0.01）,基牙的PD、CAL值在术后3月显著下降（P〈O．01）,夹板完成后咬合力显著增强（P〈O．01）：主观满意度评分显示疗效肯定（P〈O．01）：全部病例牙槽骨无继续吸收,其中11例患者骨量有一定程度增加。结论：综合分析评价表明,尼龙丝加强树脂夹板固定牙周病松动前牙,可获得较满意的临床疗效和较高的患者接受度。     

Periodontal response to cantilevered and fixed-fixed resin bonded bridges

The periodontal response to two types of resin bonded bridges was investigated. Cantilever or fixed-fixed resin bonded bridges which had been in service for at least two years were reviewed. Periodontal indices (plaque index, gingival index, bleeding index and pocket depth) were recorded for each bridge abutment and for matched contralateral teeth. There was no difference in the periodontal condition of the abutment teeth between cantilever and fixed-fixed resin bonded bridges, after they had been in service for at least two years. There was evidence of greater plaque accumulation and higher gingivitis levels affecting abutment teeth for both types of bridges compared with control teeth.     

正畸牵引联合冠延长术后桩冠修复外伤前牙的临床效果评价

目的：观察正畸牵引与冠延长术后桩冠修复前牙龈下根折的治疗效果。方法：选择60颗断端位于龈下3mm以上的外伤前牙进行正畸牵引至平龈后行冠延长术,分别记录术前、桩冠修复前、修复后3个月、6个月及12个月的牙周探诊深度（PD）、龈沟出血指数（SBI）、牙齿松动度（TM）,观察临床效果。结果：所有病例术前、修复前、修复后3个月、6个月及12个月的PD、SBI、TM值均有显著改善,差异有统计学意义,TM在修复前明显增加,但随时间延长逐渐稳定。结论：正畸牵引与冠延长术、桩冠修复外伤前牙断端位于龈下3mm以上的患牙,取得较好的临床效果。     

Periodontal reactions related to removable partial dentures: a literature review

In several clinical studies on RPDs, great attention was paid to the occurrence of reactions in periodontal tissues. Some early studies reported extensive periodontal breakdown, often a short time after insertion of a prosthesis. Other studies reported moderate or practically no harmful periodontal changes. In articles on causes of periodontal breakdown related to RPDs, the three main factors discussed were (1) plaque and oral hygiene, (2) coverage of the marginal gingivae by parts of an RPD, and (3) occlusal forces that are transmitted to the remaining teeth and their periodontal tissues by the prosthesis. Longitudinal studies have shown that it is possible for patients provided with RPDs to maintain good plaque control. If plaque control is established, and if the prostheses are regularly checked and indicated procedures performed, the forces transmitted to abutment teeth do not seem to induce periodontal breakdown. However, the scientific documentation about the effects of RPDs in patients with extremely reduced periodontium is scanty.     

Microbiological risk for periodontitis of abutment teeth in patients with removable partial dentures

Summary  Tannerella forsythia , Porphyromonas gingivalis and Treponema denticola are identified as the red complex which exists in high proportions in periodontally diseased patients. The aim of this study was to assess the microbiological risk for periodontitis of abutment teeth in subjects wearing removable partial dentures (RPDs) by measuring the red complex using BANA-ZymeTM test. Thirty-eight subjects (mean age: 62·2 years) with Kennedy Class II partially edentulous arch participated in this study. The red complex and clinical parameters, such as plaque index, gingival index, probing depth and tooth mobility were recorded at abutment teeth in contact with the direct retainer of unilaterally designed RPDs and the corresponding non-abutment teeth on the opposite side. Mean scores for the red complex, plaque index, gingival index and tooth mobility of the abutment teeth were significantly greater than those of the non-abutment teeth ( P  < 0·01). No significant mean difference in pocket depth was found between the abutment and non-abutment teeth. Logistic regression analysis revealed that abutment teeth, high scores of plaque index and a maintenance interval longer than 6 months were significant predictors for positive red complex scores ( P  < 0·05). These results suggest that the microbiological risk for periodontitis of abutment teeth is greater than that for non-abutment teeth in RPD wearers.     

The use of composite resin in removable prosthodontics

Economic, esthetic, and concerns of tooth preservation are important when considering bonded composite resin for the partially edentulous patient's prosthetic rehabilitation. This article has described the clinical success of the use of bonded composite resin in removable prosthodontics. Composite resin may be used in daily clinical practice for the restoration of abutment teeth in contour, vertical support, and re-establishment of a patient's vertical dimension.     

The Use of Ceramic Orthodontic Brackets as Rest Seats for Removable Partial Dentures

Ceramic orthodontic brackets were developed for the purpose of esthetics and increased tooth-to-bracket strength. An alternative method of preparing a rest seat on the lingual surface of lower canine teeth without violating the entemel integrity is offered. Ceramic orthodontic brackets were bonded to the lingual surfaces of mandibular canines and shaped into rest seats using diamond burs. Because the rest seats are not cut into the tooth structure, sensitivity and potential caries complications are avoided. The bracket is adhered to the tooth surface with a dimethacrylate bonding material. The brackets are bonded with either a no-mix or a two-part adhesive system. The strength of this bond will easily support the forces of a partial denture framework. The advantage over metal acid–etched retained rests is that this method avoids a time-consuming laboratory step. The greatest advantage over the use of composite resins that are shaped into rest seats is the much higher bond strength. After ceramic brackets were bonded to the lingual surfaces of mandibular canines and shaped into rest seats, an impression was obtained for the fabrication of a conventional partial denture framework.     

Supportive periodontal therapy for high‐ and low‐risk patients

Aim: The validity of the risk assessment in predicting tooth loss due to periodontitis or disease progression was explored. Methods: Systemic factors, smoking status, bleeding on probing (BoP) percentage, number of residual pockets (probing pocket depth ≥6 mm), tooth loss, and alveolar bone loss in relation to age were the variables of the risk assessment. Based on an improving or deteriorating risk assessment in 2005 compared with 1999, 89 patients were divided into either a high‐ or low‐risk group. Findings were compared with the 2008 outcome. Results: Using BoP ≤ 20% as the cut‐off, the relationship between BoP and interleukin‐1 genotype status was neither significant in 2005 nor in 2008. Neither the high‐ nor low‐risk group was predictive for tooth loss. Patients displayed similar proportions of probing pocket depths ≥6 mm in 2005 and in 2008. Linear stepwise regression analysis demonstrated that only the number of supportive periodontal therapy visits explained the number of teeth lost due to periodontitis (P < 0.01). Conclusions: The categorization of patients into high‐ and low‐risk groups, according to the periodontal risk assessment model applied within a supportive periodontal therapy period of 3 years, had limitations in predicting future tooth loss.