folate liar ane) Knowledge Assessment of Designing of Removable Partial Dentures Hina Zafar Raja, Maryam Mumtaz, Mahvish Wahad Khan ABSTRACT. Objectives: To assess the knowledge of designing removable partial dentures amongst graduates of last five years and to assess the assoviation of experience with knowledge of designing removable partial dentures. Study Design & Setting: A questonnaite based survey conducted in thee dental colleges ofLabore, Subjects & Methods: Graduates ofthe last 5 years were categorized in two groups according to their ages. They were asked to design a removable partial denture fora given Kennedy's clas and knowledge about the design was assessed through questions, The experience of respondents was compared with their knowledge. Results: Inthe age group of 2-25 years, epproximately 1% subjects scored > 50%, whereas inthe age group of 26-31 yea approximately 59% ofthe subjects scored"S0%, 14% of general dental practitioners had fabricated only SRPDS. p value was $0.01 Conclusion: Awareness about the designing of RPDs was unsatisfactory. Experience of designing RPDs had a positive eorelation with knowledge, Keywords: Removable partial denture, Design, Patients, Knowledge, Dental students, Prosthodontics, Assessment. INTRODUCTION Inadequate planning of a removable partial denture might become the most costly way to extract a tooth “The designing of a removable partial denture is a crucial step in overall treatment plan of a partially dentate patient. Itcan affect the success and failure of the prosthesis. Therefore the importance of having adequate knowledge cannot be emphasized enough. It is the requirement of dental students to show competency in independent designing of a removable prosthesis.’ But unfortunately, this is an area of prosthodontics that seems to be the most neglected in modem dentistry. Generally, the dentists delegate the designing part of the process to the technicians who do not have the required clinical information to design a removable partial denture accurately.’ The proportion of practice time dentists are giving to RPD services is very small (<30%).’ The dentist is responsible for biomechanical planning’ and preservation of the remaining natural tissues. Although in modern dentistry, there isa paradigm shift in utilization of fixed prosthesis but removable partial dentures do have an irreplaceable positio At the undergraduate level, students are relying on the teaching staff to design the dentures forthem. "This leads to a lack of practical application of theoretical knowledge. This also hinders the students in acquiring proper experience in this area of prosthodontics, However a few recent studies show that fresh dental Correspondence: Dr. Hina Zafar Raja Associate Professor Department of Prosthodontics “Institute of Dentistry CMH Lahore Medical College Lahore Email: hinazafarraja@ygmail.com graduates are more adept in designing RPDs as compared to those who have more general dental experien ‘The aim of this study is to assess the awareness about the knowledge of removable partial denture designing amongst graduates of last five years and to find the association of experience with that knowledge. MATERIALS AND METHODS The study was a descriptive study conducted at three dental colleges of Lahore over a petiod of one month, The calculated sample size was 150. Random sampling technique was used. We included dentists who graduated in the last five years, house surgeons and demonstrators, Dentists who graduated earlier than the last five years, post graduate students and specialists were excluded fromthe study. DATA COLLECTION A questionnaire was devised relating to questions about the designing of removable partial dentures. It was distributed amongst various dental colleges of Lahore, by using a random sampling method. The subjects involved in this survey consisted of those dental practitioners who had graduated in the last five years and were practicing as either demonstrators or house surgeons. The confidentiality of all the subjects regarding their personal and professional information was assured. A total of 150 survey questionnaires were collected. The participants were asked to fill out questions regarding the number of RPDs they had designed during their practice to gain information about their experience. Five questions were asked about the designing of Journal of CMH Lahore Medical College, Pakistan 2018; Vol2(01):29-32 )Kaowledge Assessment of Designing of Removable Paral Dentures removable partial dentures regarding the components e.g. major and minor connectors, rests and clasp assemblies to be used in specific partially edentulous states. Each question was given a score based on the information given in the evidence based literature. After the completion of the questionnaire, a cumulative score was calculated for each participant. They were also asked to design and draw a removable partial denture for a clinical scenario of a maxillary Kennedy's class IT modification I. This clinical scenario was selected because of its prevalence in the dental clinics in this, region. The following components of RPD design were evaluated in the designs given by the subjects." ‘Outlining the saddle areas Rests Direct Retainers Major connector Minor connector . Indirect Retention ‘The design given by the participants was also scored according to the guidelines present in evidence based literature. GROUPS ‘The subjects who participated were divided into two groups according to age. The first group comprised of individuals who were from ages 21-25 years, The second _2toup comprised of individuals of ages 26-31 year. DATA ANALYSIS For data analysis, SPSS version 23.0 was used, Descriptive analysis was done and Chi square test was used. The p value came out to be $ 0.01 which is statistically non-significant, RESULTS Age Group 21-25 Years: ‘Approximately 79% of the subjects within the age group of 21-25 years answered 50% and more of the questions correctly Age Group 26-31 Years Figure I shows that approximately 60% of the subj within the age group of 26-31 years answered 50% and more of the questions correctly. Figure 2 showed that a greater percentage was able to correctly answer the questions and gain a higher score in the group of the more recent graduates i.e. the ones falling in the 21-25 age group. Whereas the older graduates falling in the age group of 26-30 were able to get lower scores comparatively. DISCUSSION According to the findings obtained, majority of the subjects did not have satisfactory knowledge about the designing of removable cast partial dentures. There are ‘multiple reasons for that, the most significant being the negligence of practicing this area of prosthodontics in the under-graduation years.’ According to a study conducted, in schools in 201 due to the specific quota system that is prevalent in schools over the world, only a few numbers ‘of patients are allocated to students and out of those, there is no clinical requirement allocated for designing and fabricating removable cast partial dentures.’ For those very few cases where students do provide the patient with a cast partial denture, the designing is done by the teaching faculty rather than the students themselves. This, problem needs to be addressed since unless the teaching ‘of both the practical and theoretical aspects of removable partial denture designing is not made a focus of attention in the undergraduate level, a solid foundation of the students in this area of prosthodonties cannot be established. Another important factoris that due to the shift of modem dentistry towards fixed restorations, dentists are now dedicating lesser time to removable cast partial ‘he roup: 261 yore lesa Figure 1 | ff | fl Figure 2: Journal of CMH Lahore Medical College, Pakistan 2018; Vol2(0 29-32 0‘ina Zafar Raja, Maryara Muntaz, Mabvish Webad Khas dentures.“* More and more time is being delegated to providing implant-oriented prosthesis to the patients. This could be because of multiple reasons. Firstly, due to the more aware and educated patient quotient presenting to the dental clinies nowadays, there is an increased demand for better and more long-lasting treatment modalities. Patients want the service that is the most modern and technologically advanced, Also the economical factor cannot be ignored. Majority of practitioners tend to shift towards the provision of prostheses that are more financially rewarding to them. Therefore less and less time is spent in provision of prostheses like RPDs because they are less modern and financially less rewarding. According to the studies available, this problem is more prevalent in the developing countries like Pakistan as compared to developed countries. This finding is corroborated by a local study that was conducted which studied the knowledge and practices of dentists in designing clasps in removable cast partial dentures.“ In this study, it was found that the majority of dentists in the developing countries are dedicating lesser time to removable cast partial dentures and thus have inadequate knowledge and facilities required for this discipline.* In comparison, in developed countries, dentists dedicate a suitable amount of time for designing RPDs and thus have the required knowledge and technical facilities. Another important finding in this study was that the more recent graduates have more knowledge about the designing as compared to those dentists who have been practicing for some years.” This presents a dilemma in today's advancing world of dentistry in which as the practicing dentist gains more experience, the link with the literature and evidence based research seems to be ‘growing weaker. The importance of keeping in touch with the theoretical and research side of field alongside the practical aspect cannot be emphasized enough but unfortunately seems to be missing. This finding is also corroborated by a local study which found that house surgeons due to their fresh knowledge and more involvement in the design and fabrication of RPDs have ‘more knowledge followed by general dentists and lastly the specialist dentists." CONCLUSION Recent graduates do not have sufficient knowledge about the designing of removable cast partial dentures. There is need forallocatinga specific number of cast RPDsto be designed and fabricated for under-graduates independently to enhance their learning inthis field. ‘Also, more the experience with designing RPDs more is, the knowledge acquired. Since fresh graduates have been found to have more knowledge in this field as compared to older graduates, there is a need to introduce courses, and dental programs for practicing dentists that refreshes, their skills regarding cast RPDs and also reinforces the importance of this treatment modality to the dentists, In general, there should be measures for practitioners to keep in touch with the modem literature and theoretical side of the treatment modalities so that their knowledge doesnotbecome obsolete. REFERENCES 1. Pereira JR, Pamato S, Afonso D, Freitas T. Assessment of the structural components of removable partial dentures. Journal of Research in Dentistry. 2015 Jun 11;2(6):467-73, 2. Clark R, Radford DR, Jusze7yk A. 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