IMPLANT SUPPORTED PARTIAL DENTURES

Introduction
 As might be expected, extension base removable partial dentures represent the most
challenging situations in removable partial denture therapy.
 Common complaints among patients wearing extension base partial dentures include lack of
stability, inadequate retention, aesthetically objectionable clasp display, and discomfort upon
occlusal loading.
 The most important problem with them is the potential for movement under function. The
impact that such movement will have on related oral sensory and oral functional
expectations of patients is potentially critical to understand.
 Strategic placement of dental implants can minimize or eliminate all of these difficulties.
 A variety of attachments can be used with common implant systems. These attachments
provide excellent retention and stability. Attachments also can allow practitioners to minimize
or eliminate conventional clasping within the aesthetic zone.
 Such treatments can result in improved comfort and function and can significantly impact
patient confidence and satisfaction.
 Extension base removable partial dentures that are converted to implant-assisted removable
partial dentures are not significantly reliant upon support from the residual ridges. As a result,
soft tissue coverage may be minimized, and the increased stability from support of the
implants may help prevent the occurrence of combination syndrome.
 Placement of implants in mandibular posterior locations may combat the effects of
combination syndrome by stabilizing the mandibular posterior occlusal surfaces .This results
in a more stable occlusal plane and a more equitable distribution/ of forces to the opposing
maxillary denture. Equitable distribution of forces is maintained, and the likelihood of
combination syndrome is minimized.
 The role of oral hygiene should be considered. Hygiene for implant-supported removable
partial dentures is simpler than hygiene for implant-supported fixed restorations. This may be
particularly important in patients with impaired dexterity and those with histories of
inadequate oral hygiene.
 When extensive hard and soft tissue defects exist, implant-supported removable prostheses
provide distinct advantages. It is often difficult to restore significant soft tissue or alveolar
ridge defects with fixed restorations. Attempts to do so may result in contours that complicate
oral hygiene, increase the likelihood of food entrapment, or compromise esthetics and
phonetics. By choosing a removable option, acrylic resin denture base materials may be used
to optimize facial support and permit improved oral hygiene.
 Removable restorations also provide greater latitude in implant placement than their fixed
counterparts. Implant positioning difficulties are more easily accommodated with removable
restorations because implant abutments are located within the confines of the denture bases.
This eliminates many of the problems associated with the emergence of screw access
channels when attempting to provide fixed, screw-retained implant restorations.
 When the crown height space exceeds 15 mm, implant-assisted removable prostheses may be
indicated. This permits placement of the rigid implant components well beneath the occlusal
plane The resultant lever arms are shorter and, therefore, less detrimental
Advantages of an implant-assisted removable partial denture compared to a conventional
removable partial denture
• Improved stability
• Increased retention
• Improved esthetics
• Increased patient comfort
• Enhanced patient satisfaction
• Improved patient confidence
• Decreased need for relines
• Reduced risk of combination syndrome
Advantages of an implant-assisted removable partial denture compared to an implant-assisted
fixed partial denture
• More economical
–Fewer implants required
–Less need for augmentation
• More potential implant sites because shorter implants are possible
• Simplified hygiene
• Improved cross-arch stabilization
• Improved ability to restore large defects
• Potential improvement in esthetics
• Diminished cantilever forces
• Reduced likelihood of damage related to nocturnal bruxism since appliance can be removed

Classification of Implant Assisted Removable Partial Dentures

Modification to the original Kennedy designation is done. The letter I added to the original Kennedy
designation would communicate the change from the conventional tooth-tissue–borne situation to one
that is now tooth-implant–borne.
Tooth numbers that correspond to implant locations in combination with the traditional Kennedy
classification can be used effectively to describe the mechanical result of implant placement.
Clinical applications
The number of implants needed for retention and support of a removable partial denture is based on
many factors. Considerations include-
a. the extent and distribution of edentulous spaces,
b. the need for auxiliary support, and
c. the desire for additional retention
 Most Class 1-I and 2-I removable partial dentures can be adequately restored using one
implant per side.
 In Class 3 applications, implants may be used to minimize or eliminate extracoronal clasp
assemblies. Therefore, Class 3-I situations generally require one or more implants per
edentulous space.
 As might be expected, longer edentulous spans generally require greater numbers of implants,
while shorter spans may reduce the numeric requirements.
 Class 4-I removable partial dentures should have at least one implant placed on each side of
the midline to provide bilateral support and/or retention.
 Implants supporting distal extension bases should be placed as far posteriorly as practical to
improve prosthesis support.
 If only one implant is planned for a distal extension base, placing it beneath the most posterior
replacement tooth will result in an extension base that is supported at both ends, as in a
supported beam.
 Placing the implant more anteriorly could result in potentially detrimental cantilever forces on
the implant or attachment components.
 According to Keltjens et al, it is reasonable to expect that implants supporting a removable
partial denture can be shorter and narrower than implants supporting fixed restorations.
 Appropriate buccolingual and mesiodistal placement should result in axial loading of
implants.
 Placement also should allow attachments to be contained within proposed denture base
contours.
 Diagnostic tooth arrangements and positional matrices permit improved analyses of implant,
abutment, and attachment locations relative to prosthesis contours.
 The proposed path of insertion and removal should be carefully planned and should be used to
direct surgical placement of the implants. In rare instances, attachments may have to be
changed to accommodate final implant positions.
Framework design

 Principles consistent with conventional RPD-

A. broad stress distribution,
B. cross-arch stabilization, and
C. major connector rigidity.
 The use of parallel guiding planes on multiple abutments is helpful in limiting the path of
insertion and removal for a prosthesis.
 The necessity to incorporate clasp assemblies designed for conventional tooth-tissue–
supported extension base removable partial dentures (eg, distal restT-clasp, combination
clasp, I-bar, RPI) may not apply.
 The need for indirect retention also may be minimized if displacement of denture bases away
from the supporting tissues can be decreased or eliminated using implant-borne retentive
components.
 Frameworks should be designed to accommodate the chosen implant abutments and
attachments.
 Metal bases are often recommended for well-healed ridges where additional resorption is
unlikely and for instances in which restorative space is limited.
Attachment selection and connection

 There are several attachment system options available for conventional removable partial
dentures. These are-
a. intracoronal,
b. extracoronal,
c. stud type, and
d. bar type
 All are applicable to implant-assisted removable partial denture therapy, depending on the
location and extent of the edentulous areas and the number of implants used.
 The most widely used attachments are the stud type. Stud attachments include O-rings,
magnets, and other matrix-patrix assemblies. These attachments may be further subdivided
into rigid and resilient categories
 Their advantages include
i. relatively low cost,
ii. ease of fabrication and repair, and
 iii. access for patient hygiene
 In cases where restorative space for attachments is limited, implant-retained abutment crowns
may be beneficial
 When resilient configuration of attachment is used, the occlusal forces are transmitted to the
supporting edentulous ridge as well as the implant
 It is generally considered advantageous to select the lowest profiles abutments that are
consistent with posthealing soft tissue thickness.
 Excessively tall abutments may encroach on available interarch restorative space, minimizing
the space available to connect retentive elements and weakening the acrylic resin component.
Occlusal considerations

 Regardless of whether an implant restoration is fixed or removable, occlusal contacts should

be designed to exert vertical forces in the long axes of the corresponding implants.
 Minimize harmful nonaxial forces
 Protecting the remaining teeth and implants
 Mutually protected articulation should be provided whenever possible.
 When a patient presents with a group function occlusal scheme, possibly due to attrition or
missing natural canines, bilateral balance may be indicated.
 Whatever scheme is chosen, disoccluding forces should be placed solely on natural dentition
when possible or shared between natural dentition and the implant-supported prosthesis if
necessary.
 If an implant-assisted prosthesis must bear the forces of disocclusion, the use of resilient
attachments and a bar assembly to join multiple implants should be considered.
Maintenance

 Regular recall appointments should be established to assess –

 function,
 stability,
 occlusion, and
 esthetics.
 Attachment assemblies should be evaluated for proper retention and integrity within the
acrylic resin bases.
 Abutments should be retightened to proper torque specifications.
 The patient’s occlusion should be meticulously examined for prosthetic tooth wear
 The denture-bearing tissues should be examined to ensure the tissues are healthy.
 The health of the periimplant gingival tissues should be verified.
 Most importantly, the effectiveness of oral hygiene should be evaluated and proper technique
reinforced as needed.