Mohamed Hania

 Introduction

 Oral & Dental Complications of RPDs

 Literature Review

 Discussion

 Conclusions
 Definition :-
Removable partial dentures (RPDs) are dental
prostheses that replace one or more missing teeth but
not all
They receive support and retention from underlying
tissues and from some, if not all, of the remaining
teeth
They can be removed by the patient from the oral
cavity
 Must have adequate support, retention, and
stability
 Used to restore function, occlusion, aesthetics and
phonetics
 RPDs are classified according to the material which
they are made
 The types of RPD include Acrylic resin and Chrome-
Cobalt
Chrome-Cobalt Acrylic
Advantages Disadvantages Advantages Disadvantages
Smaller design , less Cheaper than
Expensive Least comfortable
bulky chrome-cobalt
Difficulty in altering
Require more muscle
Good retention denture after made – Easy to make
control
cannot be relined
Better masticatory Tooth preparation Can alter denture Tend to break more
performance , needed design after made easily
Metal components Can be used for
More hygienic Least comfortable
may be visible immediate dentures
Fractured
Better conduction of Can be transitional
restorations will Less hygienic
temperature denture
effect fit of denture
More comfortable for More difficulty in Can be relined for
Less stable
patient making denture better fit
Zitzmann 2007
 The use of RPDs in Europe varies between 13% and 29.3%

Whealton 2007
 More teeth are retained in elderly population due changes in
attitudes and advancements in preventative dentistry
 In the Republic of Ireland the rate of edentulism of 65+ year
olds has decreased from 72% in 1968 to 40.9% in 2007

Age Groups Average number

Of Teeth Present In
2007
16 – 24 year olds 28.2
25 – 54 year olds 25.5
64 + year olds 14.3
 Decrease in the level of
Increasing elderly population
edentulism

Results in an increasing
number of partially edentulous
patients seeking RPDs

 Given the high percentage of RPD use, it is

important to note that the use of this prosthesis
is associated with several dental and oral
complications.
1. Deterioration in oral hygiene
2. Increased levels of plaque and gingivitis
3. Increased risk of caries in abutment and non-abutment teeth
4. Clinical attachment loss in abutment and non-abutment teeth
5. The risk of teeth overeruption in the opposing arch
6. Changes in oral microflora
7. Denture stomatitis
8. Traumatic ulceration
9. Denture granuloma

 These complications depend on the type of RPD used, the number

and position of missing teeth
 These complications are a result of poor design and/or
maintenance of RPD itself
Carlsson 1976
 Good oral hygiene is directly related to positive treatment outcomes

Chandler 1984
 No direct evidence between RPD wearing and oral and dental breakdown

Wagner 2000 et al:

 Most common complication – Poor Oral hygiene
 64% of dentures had poor hygiene
 Considerable difference between the levels of calculus on acrylic surfaces
and metal surfaces, 36% vs 14% respectively

De Souza 2009 – Cochrane Review

 Failed to identify the most effective method of maintaining denture
hygiene
 Author(S) , Year Design of Study
Carlsson, GE, 1976 13 year retrospective study
8- to 9-year retrospective
Chandler, JA, 1984
study
Retrospective study
Wagner B, 2000 10 years after provision of
RPDs
Cochrane review
De Souza, RF et al, 2009 Randomized controlled trials
(RCTs)
Sample Size Control Results
 Majority of patients need
treatment for caries,
periodontitis and other
58 patients No control prosthodontic treatment
 Good oral hygiene is directly
related to positive treatment
outcomes
 RPD wearing resulted in no
difference in the levels of caries,
probing depths, tooth mobility
and bone loss when compared
to non RPD wearers.
 RPDs caused increased levels of
38 patients Non-RPD 9wearers
gingival inflammation in areas
that were covered and in the
gingivae apical to clasp arms.
 No direct evidence between RPD
wearing and oral and dental
breakdown.
 Several abutment teeth
supporting an RPD had better
success rate
74 patients No control  Non – Clasp retained RPDs had a
higher failure rate (66.7%) than
Clasp Retained Partial Denture
(44.8%)
 Six RCTs could not be compared
N/A N/A due to wide range of variables
and different interventions.
Bergman et al 1977,1982
 RPDs that are carefully designed and accompanied with good oral hygiene and regular
follow ups, caused little deterioration in periodontal health
 Issues with occlusion, mastication, stability and clasp retention

Yusuf 1989
 The frequency and severity of the complications tended to increase with increasing age
of the RPDs

Kearn 2001
 Disproportionately more number of abutment teeth being lost compared to non-
abutment teeth (26.4% vs 14.2% respectively)
 Recommended Maintenance regime

Zlataric et al 2002
 Natural abutment teeth had the highest levels of plaque(PI) and gingivitis(GI) similar
levels to surveyed crowns on abutments
 Mobility(TM) of abutment teeth was grade one in 50% of cases.
 Non abutment performed better for levels of PI, GI and TM but had significantly more
gingival recession
 Recommended Maintenance regime
 Author, Year Design of Study Sample size Control Results

 RPDs did not result in the deterioration of the

periodontal status of the remaining teeth.
 Low number of new caries lesion was
Bergman , 1977 6-year retrospective study 28 patients No control observed.
 Deterioration was found of occlusion,
articulation, stability and clasp retention of
RPDs in the long term.
 RPDs did not result in the deterioration of the
periodontal status of the remaining teeth.
 Low increase in the number of decayed and
Bergman, 1982 10-year longitudinal study 27 patients No control
filled tooth surfaces was found.
 Deterioration of the RPD required corrective
prosthetic procedures.
 The wearing of RPDs resulted in higher levels
Plaque, Gingivitis compared to the controls.
Teeth in the opposing  Older dentures caused more plaque retention
Yusuf, Z, 1989 Retrospective study 18 patients arch not opposed to any and gingivitis.
prosthesis  Poor Hygiene while wearing dentures
resulted in a negative impact on the
periodontium.
 RPDs caused an increase in probing depths
and tooth mobility.
 The abutment teeth of the non-clasp retained
Retrospective study
Kern, M, 2001 74 patients No control RPDs suffered more deterioration than the
10 year study
abutment teeth of the clasp retained RPDs.
 Lack of maintenance regime may have
caused these complications.
 RPDs caused an increase in probing depths
and tooth mobility.
 There was substantial difference in the levels
Plaque, Gingivitis, Calculus, Tooth mobility,
Probing Depths and Gingival recession
Zlatarić, DK, 2002 Retrospective study 205 patients No control
between abutment and non-abutment teeth.
 Good design and oral hygiene are needed to
minimise the negative impact of RPD on the
periodontium.
Budtz-Jorgensen 1990
 Caries detected at six times the frequency in RPD
wearing than patients who were provided with
cantilever resin bonded bridges

Jepson (RCT) 2001

 RPD wearers had nearly five times more caries
lesions when compared to those with fixed
prostheses

Steele 1997 & Nevalainen 2004

 Increased susceptibility to root caries
 Author, Year Design of Study
Randomised control trial
Jepson, NJ, 2001
2 years
Budtz-jorgensen, 1990 A 5 year longitudinal study
Nevalainen, MJ, 2004 5 year follow-up study
Steele J.G 1997 Cross sectional study
Sample Size Control Results
 Bigger increase in the levels of
new and recurrent caries lesions
Cantilever resin bonded in patients wearing RPDs than
60 patients
bridges (RBBs) patients provided with cantilever
RBBs.
 Caries was 6 times more likely in
patients with RPD than patients
with FPD.
 Occlusion and function
Fixed partial denture opposing deteriorated in the RPD patients
53 patients
complete upper denture only.
 RPD patients needed more
follow-upprosthodontic
treatment than FPD patients.
 RPD patients had higher levels of
salivary microbes and higher
113 patients No control root caries incidence than those
with natural teeth.
 RPDs increased the risk of having
root caries.
Control is previous disease  RPDs use should precipitate
1228 patients
history additional steps to prevent root
caries.
Kiliardis 2000 & Craddock 2004
 Overeruption of molars with no opposing dentition
occurred in 82% to 83% of cases

Matsuda 2014
 Overeruption can occur in 38.1% of cases in patients
provided with RPDs, 57.1% in unopposed teeth, and
4.1% in teeth opposed by natural dentition
 This may be due to wearing of the artificial teeth
and/or the displacement of denture by residual ridge
resorption
 Which can be minimized by having regular relining
and/or replacement of artificial teeth i.e. maintenance
regimes
John MT 2004
 Provision of fixed partial dentures, RPDs, and
complete dentures
 He found there was an improvement in quality of
life in all patients
 The provision of fixed partial dentures resulted in
the greatest improvement in the patient’s quality
of life
Aleem 2009 & Jepson 1995
 Observed that just replacing RPDs will have a
positive effect on patient’s quality of life
 Patient acceptance and satisfaction with RPDs was
still poor
Baxter 1984 & Krall 1998
 Found that there was either little or no relationship
between fully dentate patients and patients with
RPDs on nutrition
 Factors such as financial and socioeconomic status
were more likely to be a significant factor on
nutrition
Shinkai 2001
 RPDs had poorer masticatory performance,
compared with fully dentate patients
 Nutritional intake did not differ
Nordlund 2009
 Streptococcus Mutans and Lactobacilli are the microorganisms
responsible for the caries process
Beighton 1990 & Tanka 2009
 They are found in higher levels in patients wearing RPDs
than in patients with fixed prostheses & natural dentition
 Candida Albican was detected to be three times higher in
RPD wearers
Mihalow 1998
 Levels of Strep Mutans increased within 4-6 months of RPD
wearing
Preshaw 2011
 Periodontal disease-causing pathogens were found to be in
insignificant levels in RPD wearing patients compared to
non-RPD wearing patients
 Sample Control Results
Author, Year Design of Study
Size
 Missing teeth and the presence of RPDs are predictors of
nutrition.
Prospective 1,231  Preventative measures and Replacement of missing
Krall 1998 No control teeth help people maintain a healthy diet and reduce risk
observational study patients
of diet related chronic disease.

 Masticatory factors are not indicative of diet quality

Shinkai, RS, 2001 Cross-sectional study 731 patients No control across all socio-demographic groups.

 18% of molars did not overerupt.

 Less than 2mm of overeruption in molars occurred in
58% of cases.
 24% of molars showed signs of moderate to severe
Retrospective study of
Kiliardis 2005 53 patients No control overeruption.
10 years
 Molars are less likely to overerupt in older age of
patients when their antagonist is lost.
 Maxillary molars are more likely to rotate.
 Mandibular molars are more likely to tip.
 RPD increase Lactobacillus numbers and more
cariogenic than FPD.
Tanaka, J, 2009 Longitudinal 3-year. 22 patients No control
 RPD may cause increased risk of caries when compared
to FPD.
 Overeruption was observed in 38.1% of teeth opposed
by RPDs.
Control is unrestored  Overeruption was observed in 4.1% of teeth opposed by
Matsuda, 2014. Retrospective study 33 patients
opposing dentition natural teeth.
 Overeruption was observed 57.1% of teeth that were
unopposed.
Definition :-
Denture stomatitis is defined as an inflammation
of the denture bearing mucosa caused by
microbial plaque composed of bacteria and/or
candida species
 Candida involvement in 90% of cases

 It is caused by night-time denture wearing and

poor denture hygiene
 It affects older dentures more
 Traumatic ulcers which are a break in the
lining of epithelium caused by mechanical
injury to the mucosa by RPDs

 Chronic irritation by a denture can result in a

condition called denture granuloma
 benign hyperplasia of fibrous connective tissue
and is most commonly found in the sulci where
the denture is overextended
 It is clear from the research of the literature that
well-designed, randomised controlled studies with
large sample size is lacking
 It is difficult to extrapolate valuable conclusions
regarding RPD complications, as the baselines of
the patient’s oral health have not been established
and poor level of evidence in the literature
 It can be reasonable to assume that some oral and
dental complications can be a result of certain risk
factors (poor oral hygiene and diet, untreated
periodontal disease etc) of patients remaining
following prosthodontic treatment
 RPDs alone is not a major risk factor
 Nonetheless complications of RPDs are extensive and real.
 The design of the RPD is very critical in maintaining periodontal health
and a need for a maintenance regime
Kratochvil, 1963
 In distal extensions RPDs – RPI system
Kapur (RCT) 1994
 I Bars vs Occlusally approaching clasps
McHenry 1992
 Lingual bars causes significantly less gingival inflammation than lingual
plates
Zlataric 2002
 RPDs should be located as far away from the gingival margin as possible
to prevent gingival trauma and inflammation.

Every effort should be made to retain posterior teeth for the distal extensions
The options of implant supported dentures or the use of attachments should
be explored
 The oral and dental complications of RPDs are
extensive and can be severe but that should NOT
preclude them as a treatment modality

 The complications that are widely known can be

minimised if not eliminated with careful design,
beginning at mounted study cast stage and a regular
maintenance regime following delivery of prosthesis

 RPDs are still an effective treatment modality , have a

major role in replacing missing teeth which can restore
function, occlusion, aesthetics and phonetics
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