WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

COPYRIGHT © 2001 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM

Treatment Outcomes with Removable Partial Dentures: A Comparison Between Patient and Prosthodontist Assessments

Dubravka Knezovic ’ Zlataric ’ , DDS, MSDa ˇ Asja Celebic ’ , DDS, MSD, PhDb

Purpose: This article presents the results from a survey of patients’ degree of satisfaction with their removable partial dentures (RPD) and the comparison between patient and prosthodontist assessments. Materials and Methods: A total of 165 experienced RPD wearers filled in a questionnaire and graded their RPDs depending on their level of satisfaction. A scale ranging from 1 to 5 was used to assess general satisfaction with RPDs and to assess their esthetics, retention, and hygiene. A specialist in prosthodontics assessed the same prostheses using the same scale, not knowing the patient’s opinion. Results: The patients’ assessments were high, and more than half of them graded their dentures as excellent. On average, all variables were assessed higher by the patients than by the prosthodontist (P < .001). For the patients who gave the worst grades to their dentures, the grades were lower than the prosthodontist’s (P < .001), while the satisfied patients graded their dentures much better than did the prosthodontist (P < .001). Conclusion: On average, patient assessment of the treatment outcomes with RPDs was less critical than prosthodontist assessment. However, the few dissatisfied patients assessed their dentures worse than did the prosthodontist. Int J Prosthodont 2001;14:423–426.

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he majority of patients are satisfied with their removable partial dentures (RPD).1 However, even if RPDs are constructed according to all accepted criteria, some patients will still be dissatisfied. Satisfaction with RPDs seems to have a multicausal character.2 In addition to the factors directly related to the functioning of dentures, patient-related factors influence the final result. Satisfaction with RPDs relates in some patients primarily to comfort and the ability to masticate,3 but esthetics and retention also seem to be important.4 Besides the clinician’s skill and the quality of dentures, the following factors related to the patient are very important to final satisfaction with RPDs: personality, attitude toward the dentures, prior RPD experience, and motivation for wearing a denture.5,6 The
a Junior

Researcher, Department of Prosthodontics, School of Dental Medicine, University of Zagreb, Croatia. b Associate Professor, Department of Prosthodontics, School of Dental Medicine, University of Zagreb, Croatia. Reprint requests: Dr Dubravka Knezovic ’ Zlataric ’, Department of Prosthodontics, School of Dental Medicine, University of Zagreb, Gundulic ’ eva 5, 10000 Zagreb, Croatia. Fax: + 38514802159. e-mail: dkz@email.hinet.hr

patient’s expectations of the dentures are related to satisfaction, which makes later adjustment to the dentures easier, regardless of the oral conditions.7 The most common reasons for patient dissatisfaction with RPDs have already been studied.8,9 They are the condition, number, and alignment of the abutment teeth; the gingival, periodontal, and mucosal tissue health; the type of the construction and denture support; and the material and denture base shape (the type of the major connectors). According to the results of recent studies, the most frequent areas of dissatisfaction are fit (34%), eating-chewing (30%), natural tooth problems (26%), mouth cleanliness (20%), speech (18%), appearance (18%), denture cleanliness (15%), and odor (13%).5,6 The success of RPD treatment, however, is often judged differently by clinicians and patients.10 Prosthodontists consider their dentures to be successful if they meet certain technical standards,11 whereas patients evaluate them from the viewpoint of their personal satisfaction.12 Knowledge about patient satisfaction with the treatment outcomes of their RPDs would be helpful to both clinicians and patients as they decide on prosthodontic treatment. The purpose of the present

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14 Aside from psychologic factors. COPYRIGHT © 2001 BY QUINTESSENCE PUBLISHING CO. (The most frequent was Kennedy Class I and tooth-retained dentures. influence of the surrounding muscles on the denture flanges. The RPDs were of different Kennedy classifications and denture support modes. P < . P < . 5 = excellent). 3 = satisfactory on average. The distribution of the grades was different from the normal distribution (one-sample KolmogorovSmirnov test. WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. three different specialists in prosthodontics separately evaluated 10 different RPDs. also by using the scale from 1 to 5 and without any idea about the patients’ assessments. presence of chronic diseases. The highest percentage of the patients’ best scores (grade 5) was assigned to the esthetics of the maxillary and mandibular RPDs (80% and 76%. other factors that depend upon the patient are quality of the denture-supporting area. but not as much as the patients’ grades. There were 59 men and 105 women aged between 38 and 87 years. More than half of the patients assessed all variables describing their satisfaction with the RPDs as the best (grade 5). A questionnaire divided into two parts was devised for the purposes of the study. the patients graded the RPDs depending on the level of their satisfaction. and none of the patients were hardly satisfied with their maxillary RPDs. diet. The median for the prosthodontist’s evaluation of the RPDs was lower.15–18 The International Journal of Prosthodontics 424 Volume 14. respectively). and for the retention it was 3. Croatia took part in this study. esthetics. The percentage of hardly satisfied patients was 2% for the mandibular RPDs.72 to .Patient and Prosthodontist Assessments of RPDs ˇ elebic Knezovic ’ Zlataric ’ /C ’ study was to determine the degree of patient satisfaction with their RPDs and to compare patient and prosthodontist assessments of treatment outcome. Prior to the assessment. and it was completed by both the patients and the prosthodontist independently. 2001 . condition of the other teeth in the mouth.001). The patients first graded their dentures in general. at least one of the anterior teeth had been replaced. The patients were chosen at random from the files of the department. 4 = very satisfactory. and hygiene of their dentures (their opinion on how clean they thought they kept their RPDs). that could have an influence on patients’ satisfaction with their RPDs. Discussion There are many factors dependent on the patient. while 57% of the RPDs were given grade 4. patient’s age and ability to get used to the denture. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM Materials and Methods A total of 165 patients with RPDs made by different clinicians at the Department of Removable Prosthodontics.89 for the different parameters assessed). for the same reasons of objectivity. and a Kappa test revealed sufficient consistency between them (from . According to this study. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.001).001 were considered significant. The distribution of prosthodontist grades was also skewed toward the highest scores. the percentage of completely dissatisfied (grade 1) patients was 2% for the mandibular and 1% for the maxillary RPDs. using a scale from 1 to 5. but it was decided that only one of them should evaluate all patients. School of Dental Medicine. The patients had been wearing the existing RPDs for different periods ranging from 1 to 10 years. The prosthodontist listed 30% of the RPDs in the best category. The examined patients had 113 maxillary and 130 mandibular RPDs. Number 5. position of the patient’s teeth in the mouth. The 1 to 5 scale is a common grading scale in the Croatian educational system (1 = unsatisfactory. relation between the horizontal and vertical dimensions of occlusion. quality of the oral mucosa. esthetics. To ensure an objective assessment. In 48% of the dentures. and the median value was 5 for all assessments. The parameter with the highest percentage of the lowest scores (grade 1) was the patients’ general satisfaction with their mandibular RPDs (2%).001). A descriptive statistical analysis (SPSS 10. a trained prosthodontist evaluated the dentures. The distribution of patient and prosthodontist general assessments for the maxillary and mandibular RPDs is shown in Fig 1. not to the patients’ names. The prosthodontist assessing the dentures independently was referring only to those identifying numbers. Results The great majority of the patients were very satisfied with the treatment outcome. and hygiene it was 4. In the first part of the questionnaire. The distribution of patient grades in this study was completely skewed toward the highest scores. hygiene habits. the patients were attributed an identifying number when responding to the questionnaire (on paper). at 81%). In the second part of the questionnaire. The homogeneity of the population was tested using the one-sample KolmogorovSmirnov test. University of Zagreb. state of the abutments.0 for Windows) was made. 2 = hardly satisfactory. Differences in P values that were < . The difference between patient and the prosthodontist assessments was tested by the Wilcoxon test. Patient assessments were higher than those of the prosthodontist for all variables (P < . and quality of the removable appliance. viscosity of saliva. INC. as well as on the clinician. for the general assessment.13. and then they gave separate grades on the retention. which was significantly lower than the patients’ listing (74%.

when compared to the most satisfied patients. implant-supported dentures.19 For that reason.ˇ elebic Knezovic ’ Zlataric ’ /C ’ Patient and Prosthodontist Assessments of RPDs WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. it was decided that patients with anterior teeth replaced in the RPDs should not be treated separately in the present study. he or she graded the RPD as the best. expectations.20–30 Although it is not completely justified to compare patient acceptance of complete dentures and RPDs. According to the results of this study. Generally. Number 5. and fixed partial dentures. etc. we can suppose that the clinician’s assessment is more objective. Almost the same results appeared in a study comparing the esthetic outcome of implantsupported single-tooth replacement assessed by patients and prosthodontists. compared with the least satisfied patients. mandibular RPD Prosthodontist assessment. attitude toward the RPD. COPYRIGHT © 2001 BY QUINTESSENCE PUBLISHING CO. overdentures. Although it was reported elsewhere that the presence of anterior teeth in an RPD could influence patients’ degree of satisfaction. When the patient was satisfied. the majority of the patients (more than 60%) gave the highest grade to their dentures (Fig 1). maxillary RPD Patient assessment. the prosthodontist graded the RPD with higher grades.28 there are fewer dissatisfied patients with RPDs. mandibular RPD 70 60 50 40 30 20 10 0 Percentage 80 1 2 3 Grade 4 5 Fig 1 Patients’ and prosthodontist’s general assessment of RPDs. RPDs. Considering the 54% of the patients completely satisfied with the complete dentures. such as psychologic factors. in which the percentage of dissatisfied patients varied between 20% and 35%. Conclusion The results reflecting patient satisfaction with the treatment outcomes of their RPDs could be helpful to Volume 14. ie. 7% completely dissatisfied.6 this was not true in our previous study. or even partially edentulous patients’ better sense of chewing force because of the mechanoreceptors in the periodontal ligament of the remaining teeth. The results of this study considering patient satisfaction are even better than the results from some other studies dealing with complete dentures.27. we would like to underline that patients’ general satisfaction with their RPDs registered in this study was better than patients’ general satisfaction with their complete dentures in the Croatian adult population. as it relies on technical denture standards and clinical demands in the mouth. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM Patient assessment. a phenomenon that held true for the worst grades. Better satisfaction with the RPDs in comparison to the complete dentures could be ascribed to the clasps and other retentive elements. INC. probably without any margin of criticism. 2001 425 The International Journal of Prosthodontics .29 The opinion of the RPD treatment outcomes was significantly different between the patients and the assessing prosthodontist.3. the prosthodontist evaluated the RPD with lower grades. indirect and direct retainers used in the construction of partial dentures to improve retention and stability. and 11% hardly satisfied. maxillary RPD Prosthodontist assessment. The appreciation of esthetics was rated higher by patients than prosthodontists. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. it is clear that the distribution curve showing the patient assessments depending on the level of satisfaction with their RPDs is skewed toward the highest score area. These facts point out that most patients are completely satisfied with their therapy outcomes. play a role in the final result of the therapy.30 These facts point out that subjective patient factors.

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