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Implant-supported removable partial denture treatment provides an esthetic and functional result that allows proper access for hygiene and maintenance. This article describes the treatment of a patient with a maxillary removable partial denture supported by 3 implants. The use of alignment-correction abutments enabled restoration of misaligned implants.
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STATEMENT OF PROBLEM: Major connectors of removable partial dentures must distribute forces bilaterally without damaging the supporting tissues. PURPOSE: This study investigated which design and cross-sectional shape of major connectors most favorably influence rigidity and flexibility. METHODS AND MATERIAL: Five designs for maxillary removable partial denture major connectors and 5 lingual bar major connectors of different cross-sectional forms were cast in chrome cobalt alloy on a master cast. Points M and P, which represented the position of the first premolar and second molar teeth, were positioned 20 mm apart on the casting. Vertical and horizontal forces were applied to each point while the opposite side was gripped in an Instron testing machine. A force-deflection curve was obtained for each loading point. Mean stiffness values were obtained for loading in compression and torsion. RESULTS: Values for torsional loading simulating vertical forces were lower when compared with values obtained for compression loading that simulated horizontal occlusal forces. Differences in stiffness were greater in mandibular major connectors loaded at M and P. The half pear-shaped cross section was the stiffest. CONCLUSIONS: In the maxillary arch, the most rigid major connector was the anteroposterior palatal bar combination placed on different horizontal and vertical planes. The most flexible was the U-shaped design. In the mandibular arch, the most important factor in achieving rigidity was the cross-sectional shape of the major connector. The half pear-shaped cross section proved to be the most rigid.
The prevalence of removable partial dentures in North America is not known. This study was designed to collect information about (1) the indications for, (2) the teeth to be replaced with, and (3) the type of major connectors used in removable partial dentures. Five commercial dental laboratories situated in different regions of North America were selected to give as wide as possible a view of the production of removable partial dentures. Each laboratory was asked to provide details of 300 consecutive removable partial dentures. Photographs (35 mm) of master casts and processed partial dentures were obtained for more than 1300 patients. The color slides were analyzed and the remaining teeth and types of dentures were recorded. The dentures were classified as follows: cast frame denture, acrylic resin denture with or without some wrought metal, and acrylic resin denture with some cast units. The major connectors were classified as one of seven alternatives in the maxillae, and as one of six alternatives in the mandible.
The purpose of a classification for removable partial dentures (RPDs) is to simplify identification and enhance its teaching. A classification also allows a longitudinal comparison of various classes of RPDs to determine whether the teaching of RPD design is consistent with the relative frequencies of RPD use. This study surveyed the types of removable partial dentures being fabricated in a regional dental laboratory and compared these findings with data from previous studies. Results indicate that mandibular RPDs are more common than maxillary RPDs and the class I mandibular RPD is the most common type of RPD for either dental arch. A palatal strap was the most frequently used maxillary major connector and a lingual bar was used three times more often than a lingual plate in the mandibular arch. Cast circumferential clasps were used twice as often as RPI clasp designs. The percentage of Kennedy class I RPDs was 40%, class II 33%, class III 18%, and class IV 9%. Comparisons with a previous study indicate the percentage of Kennedy class II has increased, whereas class I, class III and class IV RPDs have not changed significantly. Findings of the study indicate that the frequency of use of the various types of RPDs have changed in the past 30 years.
The success or failure of a removable partial denture is dependent on many factors. To achieve success, the practitioner must develop and sequence a sound treatment plan based on clinical and radiographic evidence. These findings must be carefully considered in prosthesis design and mouth preparation. Particular attention must be given to the proper placement of guiding planes and well-made rest seats and the use of surveyed crowns on abutment teeth. This article describes the rationale, importance, and clinical procedures for abutment preparation for removable partial dentures.
Numerous methods for replacing missing removable partial denture abutments have been introduced, however, most of them are time consuming and require several visits to complete the procedure. Since magnetic attachments can provide support and bracing as well as retention for overdenture abutments, the remaining tooth root structure can be used to support the coping with the keeper. Through the use of composite resin and adhesive material, improved retention of the keeper to the root may be achieved, along with improved esthetics. This article describes a method for replacing the missing abutment of a removable partial denture with a magnetic attachment, and a composite resin coping with a keeper.
Esthetics is often compromised in patients who wear removable partial dentures with metal clasps placed on anterior teeth. Clinical procedures are presented for a new design of a removable partial denture that improves esthetics and function through a new dental attachment. The extracoronal resilient attachment system offers vertical resiliency and universal stress relief for use where a resilient prosthesis is indicated. The removable partial denture retained by these attachments provides esthetics, vertical resiliency, and easy replacement of worn attachments.
In this study, the adaptation of patients to removable partial dentures was evaluated related to articulation of Turkish phonemes. Articulation of /t,d.n,l,r/, /g,k/, /b,p,m/ and /s,z,ş,v,f,y,j,h,c/ phonemes were evaluated by three speech pathologists, on records taken from 15 patients before the insertion of a removable partial denture, just after insertion, and one week later. The test consisted of evaluation of phoneme articulation of independent syllables in terms of distortion, omission, substitution, mass effect, hypernasality and hyponasality. Data were evaluated with Cochrane Q. McNemar and Kruskal-Wallis tests. The results showed that for some phonemes, problems in articulation occurred after the insertion of a removable partial denture while for others a significant amelioration was observed after the insertion of a removable partial denture. In general, problems in articulation of evaluated phonemes were resolved after one week of use.
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 1/2 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.
Limited interarch space causes maintenance problems with removable partial dentures. The problem of abrasion and breakage of acrylic resin teeth, the concomitant supraeruption of opposing natural teeth, and possible decrease of vertical dimension of occlusion can be prevented or minimized with cast-gold occlusals. Use of metal occlusals has been advocated on newly constructed removable partial dentures, but not on existing prostheses with severely worn or broken denture teeth. This article describes a repair procedure for a removable partial denture where minimal interarch distance resulted in wear and breakage of denture teeth. A thin, abraded denture tooth that had been repaired numerous times was prepared and covered with a cast gold restoration. The problem of abrasion and breakage of the acrylic resin tooth was solved and the service life of the prosthesis was extended.
OBJECTIVE: To study the method for preparing removable partial denture using Saddle-Lock hidden-clasp and evaluate its clinical effect. METHOD: Casting process was adopted for the preparation of the clasp, which was fixed at the points on the mesial and distal surfaces of the abutment tooth. The clinical records of 305 patients treated with such removable partial dentures were reviewed. RESULTS: Within a follow-up period of 6 years, 295 of the 305 patients retained good abutment condition and were satisfied with the denture that was capable of easy wearing and removing. CONCLUSIONS: Removable partial denture made by Saddle-lock hidden-clasp exhibits good performance in fixation and stability. As an innovation of traditional design of partial denture clasp, it is simple to prepare and well received by the patients with good clinical effect.
The prosthetic treatment of a structurally compromised abutment tooth supporting a removable partial denture may present a variety of restorative modalities. Ideally, a surveyed crown is made for the individual tooth, which is later followed by a new removable partial denture fit to the contours of the crown. Frequently, however, the removable partial denture is clinically acceptable, and remaking the prosthesis is not indicated. In these cases, the crown can be made to fit the existing removable partial denture. Fabricating crowns to fit existing removable partial dentures can be accomplished using a direct method, an indirect method, or combinations of these techniques. Direct techniques traditionally use acrylic resin and inlay wax intraorally to develop a custom pattern that captures the contours of the clasp assembly. Indirect techniques use a pick-up impression to allow the crown pattern to be waxed against the denture framework on a cast in the laboratory. Combination methods use either a direct-indirect or indirect-direct approach. The direct-indirect method develops the preliminary resin pattern directly on the tooth and finalizes the contours in wax on a master cast. The indirect-direct technique initiates a crown pattern on a die and completes it either intraorally or on the die after the intraoral refinements. This article reviews the literature for methods of fabricating surveyed crowns under existing removable partial dentures. Additionally, two cases are presented that illustrate an indirect and combination direct-indirect technique for making the restorations.
The construction of crowns for teeth that will serve as abutment teeth for removable partial dentures is an important and technically demanding procedure. The preparation of the tooth itself must include provision for the components and path of placement of the removable partial denture and at the same time conform to all the parameters associated with proper tooth preparation. Some of the factors unique to surveyed crowns that must be considered include the position of the tooth in relation to the proposed occlusal plane with the removable partial denture, the type of facial and lingual tooth contours desired for the direct retainer, the size and suitability of existing restorations, and the proposed path of placement and removal of the removable partial denture relative to the orientation of the abutment tooth as well as to other adjacent teeth if the abutment also is to be used as a fixed partial denture retainer. The design requirements for the removable partial denture must be determined before treatment is initiated, to account for all of these factors.
Fifty-three patients were recalled for clinical examination to determine oral changes which occurred during the time that they wore swinglock removable partial dentures. Pertinent findings were as follows: 1. The swinglock removable partial denture should be considered as a treatment alternative for patients with unfavorable periodontal support and for patients missing key abutments. 2. Patients who have worn swinglock removable partial dentures for periods of 13 to 75 months did not demonstrate a continued periodontal breakdown, even when there was unfavorable periodontal support. 3. The swinglock removable partial denture may aid in reducing tooth mobility when the patient can maintain good levels of oral hygiene to control inflammation and the dentist can provide a proper occlusion. 4. As evidenced by responses to a satisfaction questionnaire, patient acceptance of the swinglock design was good. 5. The high prevalence of patients reporting for recall examination with one or more decayed teeth (22.4%) and removable partial dentures requiring relines (28.3%) emphasizes the need for proper recall of patients. 6. The swinglock removable partial denture will function satisfactorily if the dentist follows basic principles of removable partial denture construction and if the patient maintains a good level of oral hygiene and returns for regular recall visits.
PURPOSE: The purpose of this report was to evaluate indications for the use of removable partial dentures based on a comprehensive literature review. MATERIALS AND METHODS: Using a model similar to a Delphi process, the literature relating to the indications and contraindications for the prescription of removable partial dentures was discussed by seven experienced educators in a 2.5-day workshop. RESULTS: Evidence for indications and contraindications for the prescription of removable partial dentures is not clearly stated in the literature; however, some basic principles are defined. There appears to be a trend in favor of the use of the shortened dental arch concept or implant-supported restorations instead of conventional removable partial dentures, given the evidence that the long-term use of removable dentures is associated with increased risks of caries and periodontitis and low patient acceptance. The presence of sound abutment teeth appears to encourage the use of removable partial dentures, as the fixed partial denture alternative requires sacrifice of healthy hard tissues. When economic factors influence the decision-making process, removable partial dentures are often chosen. CONCLUSION: While evidence-based indications and contraindications for prescribing removable partial dentures are still lacking, major underlying principles for clinical decision making are identified.
It is commonly assumed that a distal extension partial removable dentures rotates around the supporting rests when the saddle is occlusally loaded and that this rotation may expose the abutment teeth to a distal torque believed to be potentially harmful to their periodontal tissues. Attempts are therefore often made to counteract this effect through the denture construction. However, a review of relevant literature does not appear to substantiate an unqualified acceptance of the above mentioned assumptions, nor of the beneficial effect of special denture constructions designed to reduce the abutment loading. On the other hand, well controlled longitudinal studies seem to indicate that a favourable periodontal prognosis may be expected in such cases provided the following conditions are satisfied: Periodontal problems should be treated and an adequate oral hygiene established prior to the insertion of the denture; The periodontal health and oral hygiene should be maintained through regular recalls. During these recalls possible prosthodontic defects should be diagnosed and necessary measures implemented.
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