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J Bagh College Dentistry Vol. 17(3), 2005 Evaluation of fixed...

Evaluation of fixed partial denture in relation to gingival


recession and other factors

Faiza M. Abdul Ameer,B.D.S., M. Sc.
(1)

Zainab M. Abdul Ameer,B.D.S., M. Sc
(2)


ABSTRACT
Background: Gingival recession may be due to faulty dental treatment. The aim of this study was to investigate the
distribution of fixed partial dentures according to age, sex, location and type of material used in construction and discovers
the influence of fixed partial denture characteristics (quality, duration, number of abutments and pontics) on frequency of
gingival recession.
Materials and Methods: A total of 160 patients were selected from patients attending for dental examination at college of
dentistry, University of Baghdad. The subjects had cast or ceramic fixed partial denture or dentures for at least 3 years. The
distributions of restoration according to age, sex, location and type of material were investigated. Number of abutments and
pontics, quality and duration of restoration since worn in relation to gingival recession were evaluated.
Results: Females asked more for fixed partial dentures in younger age group than males, and in upper anterior region more
than other regions. The percentage of cast fixed partial denture was more than ceramic type. A higher percentage of
patients had gingival recession related to restoration with poor marginal integrity and longer period since worn. A high
significant difference was found between lengths of fixed partial denture and absence of gingival recession and low
significant differences between quality of restoration and presence of gingival recession.
Conclusion: The study concluded that fixed partial denture characteristics (quality, duration, number of abutments and
pontics) had significant and high significant effects on frequency of gingival recession.
Keywords: Gingiva, recession, fixed restoration, (J Bagh Coll Dentistry 2005; 17(3): 13-16)


INTRODUCTION
Inflamed gingivae can be caused by
accumulations of bacterial plaque on
restorations with poor marginal integrity
(1,2)
or
bulky contours with poor emergence profiles.
(3)
Conversely, patients with adequate plaque
control may have persistent gingival
inflammation secondary to violation of the
biologic width or hypersensitivity to
components of selected dental alloys.
(4,5)

The causes of gingival recession are not
well understood, but are thought to be
associated with trauma or the loss of
periodontal ligament attachment, or both, and
are most common at sites with inherently thin
gingiva. However, the progressively thicker
form of the investing tissues more apically,
coupled with the presence of underlying crestal
bone, means that recession tends to be self-
limiting unless there is progressive periodontal
ligament attachment loss.
(3,6)
Consequently,
progressive gingival recession indicates
progressive alveolar bone loss associated with
active periodontal disease.



(1) Lecturer, Department of Prosthodontics, College of
Dentistry, Baghdad University.
(2) Lecturer, Department of Conservative Dentistry, College of
Dentistry, Baghdad University.

The aim of this study was to investigate
the distribution of fixed partial dentures
according to age, sex, location and type of
material used in construction and discovers the
influence of fixed partial denture characteristics
(quality, duration, number of abutments and
pontics) on frequency of gingival recession.

Restorative Dentistry 13
J Bagh College Dentistry Vol. 17(3), 2005 Evaluation of fixed...
MATERIALS AND METHODS
A total of 160 persons (68 men and 92
women) ranging in age from 26 to 70 years
were examined. Subjects were selected
consecutively from patients attending for
dental examination at College of Dentistry
University of Baghdad. The only criteria for
selection were that the subject had cast or
ceramic fixed partial denture or dentures in his
oral cavity for at least 3 years. Plaque was
removed and the teeth dried before
examination. Each root surface (buccal \ labial
and palatal \ lingual) was recorded as either
exposed, if the cementoenamel junction was
clearly visible above the gingival margin, or
not visible. The maximum length of gingival
recession on each palatal \ lingual and buccal \
labial surface was measured from the
cementoenamel junction to the gingiva, with a
pocket measuring probe marked at millimeter
intervals. Location of restorations; anteriorly
or posteriorly and in upper or lower jaw,
number of abutments, number of pontics,
duration in years of wearing the prostheses,
type of material used in construction of
restoration and quality of restoration were
evaluated.
Means and standard deviations were
calculated for age groups. The t- test for
variance was calculated. The level of
significance set at P<0.005.

RESULTS
Table 1 shows the mean ages of the patient,
which were about 46.30 (14.53) for males
and 39.94 (14.10) for females. Table 2 shows
the distribution of fixed partial dentures
according to type of material and location; 142
(88.75%) patients wore cast fixed partial
dentures and 18 (11.25 %) patients worn
ceramic fixed partial dentures. A high
percentage of patients had cast fixed partial
dentures in the upper anterior regions, while a
much lower percentage had ceramic fixed
partial dentures in the same region.
The distribution of fixed partial dentures
according to the presence of gingival recession
and number of abutments and pontics, quality
and duration are shown in figure 1, figure 2
and figure 3 respectively.
The t-test showed significant and high
significant levels of differences for all test
groups at probability level <0.005.

DISCUSSION
The results of this study showed clearly, that
females asked more for fixed partial dentures in
the younger age group than males. This finding
is in agreement with the results of Albino et al
(7)
and Luan et al.
(8)
A high percentage of patients had cast and
ceramic fixed partial denture in the upper
anterior region compared with upper and lower
posterior region. This is because maxillary
central incisors are the most frequently involved
teeth by trauma in early age,
(9)
and need to be
replaced by fixed restoration as soon as they are
lost due to their aesthetic importance.
(10)

In the lower anterior region only one case
was reported with cast fixed partial denture. This
is because lower anterior teeth had smaller size
than upper anterior or upper and lower posterior
teeth and if sufficient tooth structure is not
removed, technicians cannot fabricate
restorations with optimal contours and esthetics,
therefore bulky and over contoured restorations
may result.
(11)

This study showed that patients with cast
fixed partial dentures were more than those with
ceramic fixed partial denture. This is probably
related to the financial factor.
(12)

A high percentage of patients with fixed
partial dentures had 2 abutments and 1 pontic
(36.87%) while a lower percentage was recorded
with patients having 2 abutments and 3 pontics
fixed partial dentures (6.87%). This result may
be due to the fact that a high percentage of
patients had lost one tooth in young age needing
to be replaced by fixed restoration later on.
(13)

A statistical significant difference was found
between length of fixed partial dentures and
presence of gingival recession. A high
significant difference was found between lengths
of fixed partial denture and absence of gingival
recession.
It has been found that high percentage of
patients with gingival recession had fixed partial
dentures with poor marginal integrity. This is
because bacterial plaque retained on relatively
rough restoration surfaces and on the exposed
dental cement between the tooth and the
restoration is difficult for the patient and dentist
to remove, and is responsible for the
inflammatory changes seen in the periodondium
adjacent to sub gingival restoration margins.

(1,2,14)

It has been found that a low significant
difference was noticed between quality of
restoration and presence of gingival recession,
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J Bagh College Dentistry Vol. 17(3), 2005 Evaluation of fixed...
and significant difference between quality of
restoration and absence of gingival recession.
In studying the distribution of fixed partial
denture in relation to duration of restorations
worn, it was found that most patients presented
with gingival recession after 6 years. This
might be related to the fact that gingival
recession appears to increase gradually with
age.
(15)
In the first group after 3-5 years
duration, high percentage of patients had
gingival recession; this might be due to the fact
that Iraqi population during the past years
suffered from poor security circumstances which
lead to neglect and improper oral hygiene. Oral
hygiene and gingival inflammation had strongest
relationship with gingival recession than other
factors.
(16)
Also the quality of restoration
regarding the materials, laboratory and clinical
work recently is not as good as the oldest fixed
partial dentures.
A significant difference between duration of
restorations and presence or absence of gingival
recession was also found.

Table 1: Mean age of patients with fixed partial dentures.
Sex Number Mean age SD
Males 68 46.30 14.53
Females 92 39.94 14.10

Table 2: The Distribution of fixed partial dentures according to type of material and location
(numbers and percentages).
Material Anterior
upper
Anterior
lower
Posterior
upper
Posterior
lower
Total
Cast 67 (41.87) 1
(o.62%)
25
(15.62%)
49
(30.62%)
142
(88.75%)
Ceramic 12
(7.50%)
0
(0%)
2 (1.25%) 4 (2.50%) 18 (11.25)
Total 79
(49.37%)
1
(0.62%)
27
(16.87%)
53 (33.12) 160
(100%)

gingival recession.
absence of gingival
recession.
1A 1P 2A 1P 2A 2P 2A 3P 3A 2P
0
5
10
15
20
25
30
35
40
45
50

Figure 1: The distribution of fixed partial dentures according to numbers of abutments and
pontics and presence of gingival recession.A: abutments, P: pontics



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J Bagh College Dentistry Vol. 17(3), 2005 Evaluation of fixed...
gingival recession.
absence of gingival
recession.
Poor marginal integrity BULKY GOOD
0
10
20
30
40
50
60

Figure 2: The distribution of fixed partial dentures according to quality of fixed partial dentures
and presence of gingival recession.
gingival recession.
absence of gingival
recession.
3-5 years
6-10 years
11-15 years
16 and over
0
5
10
15
20
25
30
35
40
45
50

Figure 3: The distribution of fixed partial dentures according to duration and presence of
gingival recession.

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