Gingival recession related to removable partial dentures in

older patients
P a u l S. W r i g h t , B D S , P h D , a a n d P a u l H. H e l l y e r , B D S , M S c b
The London Hospital Medical College Dental School, London, United Kingdom

One h u n d r e d forty-six patients, living in the c o m m u n i t y and attending a general

dental practice, w e r e e x a m i n e d on two occasions separated by 3 years to d e t e r m i n e
relationships a m o n g removable partial dentures, their design, and gingival recession.
This study confirmed the relationship b e t w e e n the presence of a partial denture and
an increase of gingival recession, but was unable to demonstrate any predictable
relationship to the lack of tooth support, the material used for the dentures, or
covering the gingival margins w i t h lingual plates. These design factors m a y be less
important than the m a i n t e n a n c e of good oral hygiene for the prevention of periodon-
tal disease in patients w e a r i n g removable ~artial dentures. (J PROSTHETDENT
1995;74:602-7.)

I n a study of the prevalence of root c a n e s in a
selected older population, living in the community a n d at-
t e n d i n g a g e n e r a l dental practice in Bexhill, E a s t Sussex,
d e n t u r e wearers revealed a g r e a t e r n u m b e r of exposed root
surfaces p e r person t h a n non-denture wearers. 1 This dif-
ference was significant when the n u m b e r of exposed root
surfaces was expressed as a percentage of the total num-
ber of roots (exposed and unexposed) per person. F u r t h e r
analysis of these d a t a d e m o n s t r a t e d a significant differ-
ence between tooth surfaces adjacent to the d e n t u r e and
other surfaces, with adjacent surfaces more likely to exhib-
it gingival recession. 2
The causes ofgingival recession a r e not well understood,
b u t are t h o u g h t to be associated with t r a u m a or the loss of
periodontal ligament a t t a c h m e n t , or both, and is most
common a t sites with i n h e r e n t l y thin gingiva. However,
the progressively thicker form of the investing tissues
more apically, coupled with the presence of underlying
crestal bone, m e a n s t h a t recession tends to be self-limiting
unless there is progressive periodontal ligament attach-
m e n t loss. 3 Consequently, progressive gingival recession
indicates progressive alveolar bone loss associated with
active periodontal disease.
A review of the l i t e r a t u r e t h a t describes periodontal re-
actions related to removable p a r t i a l dentures (RPDs) 4 re-
vealed t h a t earlier studies often d e m o n s t r a t e d extensive
periodontal injuries and l a t e r studies reported only mod-
e r a t e or practically no h a r m f u l periodontal effects. How-
ever, these studies were i n v a r i a b l y conducted with pa-
tients w e a r i n g well-designed RPDs a n d included tooth
support and well-motivated patients whose oral care pro-
cedures were r e g u l a r l y reinforced by frequent recall.
It is common practice in the United Kingdom to m a k e
RPDs with synthetic resin bases t h a t rely on mucosal sup-
port i n s t e a d of tooth support. According to the A n n u a l Re-
port of the Dental E s t i m a t e s Board for E n g l a n d and Wales
in 1987-1988, 5 missing teeth were replaced with synthetic
resin RPDs i n s t e a d of m e t a l RPDs in a ratio of 7:1. The
statistics do not show w h e t h e r the RPDs had tooth sup-
port: A mucosa-supported RPD is more likely to cause re-
sorption of the bone of the supporting residual ridge t h a n
an RPD t h a t h a s the benefit of tooth support. Such resorp-
tion is a s s u m e d to lead to loss of support for the RPD and
to cause gingival d a m a g e where the gingival margins are
covered by elements of the RPD, colloquially known as gum
"stripping," or gingival recession.
The aims of this study were to discover w h e t h e r p a t i e n t
and d e n t u r e characteristics influence the level of gingival
recession and to investigate w h e t h e r t h e r e is a difference
in t h e extent of gingival recession between individuals
w e a r i n g and not wearing dentures, in a given period of
time.

MATERIAL AND METHODS

Presented to The British Society for the Study of Prosthetic Den-
tistry Annual Conference, Cambridge, United Kingdom, 1993.
Supported by the South East Thames Regional Health Authority
(LORS Project 88/05).
aSenior Lecturer/Honorary Consultant, Department of Prosthetic
Dentistry.
bPrivate practice, East Sussex, United Kingdom.
Copyright 9 1995 by The Editorial Council of THE JOURNALOF
PROSTHETIC DENTISTRY.
0022-3913/95/$5.00 + 0. 10/1/67588
A total of 146 persons (49 men and 97 women), ranging
in age from 56 to 88 years (mean of 69.3 years), were ini-
tially examined. Subjects were selected consecutively from
p a t i e n t s a t t e n d i n g for routine dental examination at a
general dental practice. The only criteria for selection were
t h a t the subject had a m i n i m u m of 12 n a t u r a l teeth and
was a t least 55 years old.
This group was recalled 3 years l a t e r a n d 127 persons (39

602 THE JOURNAL OF P R O S T H E T I C D E N T I S T R Y VOLUME 74 NUMBER 6

W R I G H T A N D HELLYER
F i g . 1. Synthetic resin mucosa-supported m a x i l l a r y den-
ture.
F i g . 2. Synthetic resin mucosa-supported m a n d i b u l a r
denture.
m e n and 88 women), with a m e a n age of 67.9 years, were
examined again (19 failed to appear). Plaque was removed
a n d the teeth were dried before examination. Each root
surface (mesial, distal, buccal, and lingual) was recorded as
e i t h e r exposed, if the cementoenamel junction was clearly
visible above the gingival margin, or not visible. The max-
i m u m length of gingival recession on each palatal/lingual
surface was m e a s u r e d from the cementoenameljunction to
the gingiva, with a pocket m e a s u r i n g probe m a r k e d at
m i l l i m e t e r intervals. The presence or absence of a denture
in each j a w was recorded; the m a t e r i a l of the denture base
a n d the relationship of the prosthesis to each tooth surface
was noted. Surfaces of the teeth were classified as adjacent
to the d e n t u r e if either the d e n t u r e base or a clasp covered
t h a t surface. Photographs of all RPDs t a k e n out of the
m o u t h were used to identify elements in the denture
design t h a t provided support so t h a t each RPD could be
classified as mucosa-supported, tooth-supported, or hav-
D E C E M B E R 1995
THE J O U R N A L O F P R O S T H E T I C DENTISTRY
F i g . 3. Metal plate mucosa-supported m a x i l l a r y denture.
F i g . 4. Metal plate tooth- a n d mucosa-supported man-
d i b u l a r denture.
ing shared tooth and mucosa support (Figs. 1 through 5).
There were no specific criteria or controls over the fit and
design of t h e RPDs evaluated.
Multiple regression techniques were used to obtain ad-
j u s t e d e s t i m a t e s of the effects of different predictor vari-
ables on m e a n gingival recession (in millimeters) at the
second examination. Baseline m e a s u r e m e n t s at the initial
examination were always t a k e n into account.
RESULTS
A total of 146 persons were examined initially. Of these,
82 were w e a r i n g dentures, a n d 64 were not. A total of 111
RPDs were worn by 80 persons (54.8%). Maxillary com-
plete d e n t u r e s were worn by two persons (1.4%), who did
not w e a r m a n d i b u l a r dentures. Thirty-one individuals
(21.2%) wore RPDs in both jaws, and 39 individuals
(26.7%) wore only maxillary a n d 10 (6.8%) only mandibu-
lar RPDs. Lingual plate major connectors were used with
603
THE JOURNAL OF PROSTHETIC DENTISTRY WRIGHT AND HELLYER

m e a n n u m b e r of tooth surfaces covered by a lingual plate

t h a n m a x i l l a r y tooth-supported RPDs (p < 0.02).
M a x i l l a r y resin RPDs h a d a significantly g r e a t e r m e a n
n u m b e r of teeth adjacent to the denture a n d a significantly
g r e a t e r m e a n n u m b e r of tooth surfaces covered by a lingual
plate t h a n maxillary m e t a l RPDs (p < 0.05 a n d p < 0.01,
respectively) (Table III).
F o r mucosa-supported and resin RPDs the n u m b e r of
tooth surfaces covered by a lingual plate was almost the
s a m e as t h e n u m b e r of t e e t h adjacent to the d e n t u r e in both
the maxilla and the mandible. Conversely, for tooth-
supported and m e t a l RPDs the n u m b e r of tooth surfaces
covered by a lingual plate was less t h a n the n u m b e r of
teeth adjacent to the denture.
F i g . 5. Metal b a r tooth-supported m a x i l l a r y denture. D a t a on gingival recession is available for all denture
wearers (82) at the initial examination a n d for 64 (78.0%)
d e n t u r e w e a r e r s at the second examination. In relation to
subjects without dentures, d a t a on gingival recession were
T a b l e I. T y p e s of removable p a r t i a l d e n t u r e available on both occasions for 57 (89.1%) subjects.
Support
Only the lingual or p a l a t a l tooth surfaces a n d gingiva
Denture base were investigated because these are the surfaces t h a t are
material Arch Number Mucosa Tooth Both covered with lingual plates. The m e a n gingival recession
of those w e a r i n g dentures was 0.63 m m a n d 1.19 m m on
Synthetic resin Max 52 52
initial a n d second examinations. I n those not wearing
Mand 34 34
Metal plate Max 15 9 4 2 dentures, the m e a n gingival recession was 0.42 m m and
Mand 2 2 0.55 mm.
Metal bar Max 3 1 2
DISCUSSION
Mand 5 1 1 3
Totals f Max 70 61 5 4 I n the first analysis, only individuals with RPDs were
/ Mand
All
41
111
35
96
1
6
5
9
considered, because the objective was to assess the effect
of RPDs with lingual plate-covered gingiva. Therefore, 64
Max, maxillary; Mand, mandibular. individuals with no RPDs a n d two individuals with com-
plete m a x i l l a r y dentures were excluded. Table IV presents
the results of a multiple regression model t h a t was fitted
to predict the extent of gingival recession a t the second ob-
m a n d i b u l a r and/or m a x i l l a r y RPDs in 65 (81.3%) persons. servation from age, gender, presence of maxillary, man-
The m a j o r i t y of RPDs (86, or 77.5%) were m a d e of syn- dibular, or both m a x i l l a r y a n d m a n d i b u l a r RPDs, m a t e r i a l
thetic resin only a n d 25 (22.5%) with cobalt-chromium of construction, type of support (tooth or mucosa), and
bases a n d resin saddles (metal). All resin RPDs were mu- n u m b e r of tooth surfaces associated with a lingual plate,
cosa-supported. Only m e t a l RPDs were either mucosa- t a k i n g into account the gingival recession at the time of the
supported, tooth-supported, or both (Table I). D a t a on initial examination. The t i m e t h a t elapsed since the initial
d e n t u r e support were available for all persons at the first e x a m i n a t i o n was not included in the model because this
examination, b u t only 68 persons (85%) who wore RPDs was the s a m e for all individuals (3 years).
were also available a t the second examination: 55 (68.8%) Because gingival recession is irreversible, the extent of
with mucosal supported RPDs, nine (11.3%) with tooth- gingival recession at the initial examination was signifi-
supported RPDs, a n d four (5%) w i t h both mucosal- and cantly related with the extent of gingival recession at the
tooth-supported RPDs. second examination. None of the other factors examined in
The m e a n n u m b e r of teeth adjacent to the denture was the multiple regression model h a d a n y predictable effect on
not significantly different between mucosa-supported and the extent of gingival recession for lingual plate-covered
tooth-supported RPDs (Table II). However, lingual plates tooth a n d gingival surfaces.
covering tooth surfaces are likely to be more d a m a g i n g be- A multiple regression model was likewise developed to
cause of the associated coverage of the gingival margin. compare individuals with dentures (whether in j u s t one
Therefore, if the tooth surfaces contacted by clasps were j a w or in both) with the group of persons who did not wear
excluded from the comparison, m a x i l l a r y mucosa-sup- a n y dentures, with respect to the extent of gingival reces-
ported RPDs were found to h a v e a significantly g r e a t e r sion at t h e second examination. This comparison was done

604 VOLUME 74 NUMBER6

WRIGHT AND HELLYER THE JOURNAL OF PROSTHETIC DENTISTRY

Table II. Mean n u m b e r of all te e t h adjacent to d e n t u r e and of lingual/palatal tooth surfaces covered by lingual plate in
persons wear i n g RPDs
Tooth surfaces c o v e r e d
Teeth adjacent to d e n t u r e b y l i n g u a l plate

n MAX SD n MAND SD n MAX SD n MAND SD

Mucosa-supported 61 5.70 2.05 35 7.03 2.02 61 5.70* 2.05 35 6.86 2.32

Tooth-supported 9 4.89 1.17 6 5.67 3.78 9 3.33* 2.40 6 3.83 4.54

*p < 0.02.

Table III. Mean n u m b e r of all t e e th adjacent to denture and of lingual/palatal tooth surfaces covered by lingual plate in
persons w e a r i n g RPDs
Tooth surfaces c o v e r e d
Teeth adjacent to d e n t u r e by lingual plate

n MAX SD n MAND SD n MAX SD n MAND SD

Synthetic resin 52 5.85* 2.02 34 7.06 2.04 52 5.85t 2.02 34 7.03 2.11
Metal 18 4.89* 1.68 7 5.71 3.45 18 4.11t 2.35 7 3.43 4.28

*p < 0.05.
tp < 0.01.

Table IV. Predictors of gingival recession in persons w ear i n g RPDs in one or both arches for a fixed period of time
Predictors R e g r e s s i o n coefficient t-Statistic p-Value 95% CI

Initial gingival recession 0.95 19.343 <0.0005 0.85 to 1.05

Age 0.004 0.44 0.66 -0.01 to 0.02
Gender (female) -0.11 -0.94 0.35 -0.34 to 0.12
No. of teeth associated with a lingual plate -0.007 -0.38 0.71 -0.05 to 0.03
Maxillary dentures -0.28 -1.67 0.10 -0.63 to 0.06
Maxillary and mandibular dentures 0.03 0.12 0.90 -0.41 to 0.46
Metal dentures -0.04 -0.19 0.85 -0.49 to 0.41
Resin dentures and metal dentures -0.22 -0.90 0.37 -0.70 to 0.27
Tooth-supported dentures -0.27 -0.97 0.34 -0.82 to 0.29
Tooth-supported and mucosa-supported dentures -0.20 -0.73 0.47 -0.75 to 0.35

N 64; CI, confidence interval.

by adjusting for some potential confounders such as age
and gender and for the m e a n gingival recession at the ini-
tial examination.
Mean gingival recession on all lingual/palatal surfaces
was used for both d e n t u r e w e a r e r s and non-denture
wearers, and for those individuals w e a r in g dentures, only
t e e t h covered by a lingual plate were counted. Tables V
and VI present the results of these analyses. The pres-
ence of dentures is statistically significant in the first
instance, but not when lingual plate-covered tooth and
gingival surfaces only are used to derive m e a n gingival
recession in individuals w e a r i n g dentures. Whereas
before, the presence of dentures seemed to contribute
to increased gingival recession (coefficient 0.32), now the
data show a "protective effect" of dentures (coefficient
-0.08). However, as indicated by the confidence intervals,
the d a t a are also compatible with an average increase of
0.06 m m in gingival recession because of the presence of a
denture.
In both examples the m e a n gingival recession at the ini-
tial examination is statistically significant, although the
effect of gingival recession on the initial examination
seems to be greater in the first calculations (1.41 m m in-
crease in gingival recession on the second examination for
each unit of"original" m e a n gingival recession versus 1.00
mm).
All other variables were found to be nonsignificant.
Nonetheless, the data suggest t h a t the extent of gingival
recession decreases for women compared with men of the
same age, with the same denture status and the same level
of recession on the initial examination. Gingival recession
also appears to increase gradually with age.

DECEMBER 1995 605

THE JOURNAL OF PROSTHETIC DENTISTRY WRIGHT AND HELLYER

T a b l e V. Comparison of RPD a n d non-RPD users: m e a n The design of the RPDs worn by subjects in this study
gingival recession on all teeth p r e s e n t used in both m a y be r e p r e s e n t a t i v e of RPD designs commonly used in
groups general dental practice in the United Kingdom, although
Regression t- p- t h e r e was a greater proportion of m e t a l RPDs in the sam-
Predictors coefficient Statistic Value 95% C I ple of this study t h a n reported in Dental E s t i m a t e Board
statistics, 5 which do not report the proportion of RPDs t h a t
Initial gingival 1.41 16.73 <0.0005 1.24 to 1.57
have the benefit of tooth support. In this study, only 13.5%
recession
Presence of 0.32 4.27 <0.0005 0.17 to 0.47 of the RPDs were p a r t i a l l y or wholly tooth-supported. The
denture RPDs were constructed by different practitioners at differ-
Age 0.003 0.44 0.66 -0.009 to 0.01 ent times and in different practices, a n d approximately
Gender -0.13 -1.67 0.10 -0.29 to 0.03 h a l f were over 5 y e a r s old. The oral a n d d e n t u r e hygiene
m e a s u r e s recommended to these p a t i e n t s were not spe-
N 122; CI, confidence interval.
cially modified or monitored for the study.
I t is not possible to identify the reasons for the choice of
m e t a l bases for some of the p a t i e n t s examined in this
T a b l e VI. Comparison of RPD a n d non-RPD users: study. Of interest, over h a l f of the m a x i l l a r y metal RPDs
m e a n gingival recession on tooth surfaces covered by did not have tooth support b u t tooth s u p p o r t was present
lingual plates used in dentures group
in all b u t one of the m a n d i b u l a r m e t a l RPDs. Tooth sup-
Regression t- p- port is considered beneficial in p a r t i a l d e n t u r e design, b u t
Predictors coefficient Statistic Value 95% CI
this s t u d y failed to show any significant effect of the
Initial gingival 1.00 27.34 <0.0005 0.93 to 1.08 presence or absence of tooth support on the extent of
recession gingival recession over t h e 3 years of t h e study. None of
Presence of -0.08 -1.14 0.26 -0.21 to 0.06 the factors examined in the multiple regression model
denture were able to predict t h e effect of d e n t u r e s on gingival
Age 0.007 1.44 0.15 -0.003 to 0.02 recession for lingual p l a t e - c o v e r e d t e e t h and gingivae. It
Gender -0.08 -1.21 0.23 -0.22 to 0.05 was thought t h a t the time since an individual began wear-
N 121; CI, confidence interval. ing a denture might be an i m p o r t a n t predictor or con-
founder; however t h a t information was not available. The
choice of denture base m a t e r i a l and factors in design for
individual patients m a y have been influenced by percep-
SUMMARY tions of periodontal s t a t u s and prognosis. This is unknown,
Most previous studies of periodontal reactions r e l a t e d to b u t could have influenced the results in comparing syn-
RPDs concentrated on the effects of plaque and oral thetic resin with m e t a l bases or tooth s u p p o r t with mucosa
hygiene, coverage of the m a r g i n a l gingivae by p a r t s of the support.
RPD, a n d occlusal forces t r a n s m i t t e d to the r e m a i n i n g Gingival recession is not sufficient to indicate the peri-
t e e t h a n d t h e i r periodontal tissues by the prosthesis. 4 0 n l y odontal status. Periodontal pocket d e p t h and a t t a c h m e n t
one s t u d y specifically investigated the possibility t h a t the loss together with other disease indices would be useful.
use of tooth support was associated with periodontal indi- A t t a c h m e n t loss and pocket depth can be confused by de-
ces 6 a n d a significant relationship was not evident. Con- velopment of gingival h y p e r p l a s i a and false pocketing in
versely, t h e coverage of gingival m a r g i n s by the d e n t u r e periodontal tissues covered by a n RPD. In a recent study
base h a s indicated a relationship with more severe patho- of m a i n l y mucosa-supported RPDs, t h e s e factors were
logic changes even in the presence of tooth support for the strongly and significantly associated with the occurrence
prosthesis. 7 This is considered the result of increased ac- of periodontal pockets.ll The significant association of the
cumulation of plaque, s a change in the quality of the presence of an RPD with more extensive gingival recession
plaque, a n d the restriction of s a l i v a r y flow 9 in this study. on all lingual/palatal surfaces at the second examination in
Previous studies reported t h a t synthetic resin bases elicit this s t u d y seems to confirm a relationship between the
g r e a t e r gingival i n f l a m m a t i o n t h a n metal bases, 6, 7,10 presence of an RPD a n d periodontal disease. Another
even though this was also associated with night time w e a r s t u d y also d e m o n s t r a t e d t h a t w e a r i n g a n RPD was signif-
in one study. 6 The s t r e n g t h of a m e t a l base clearly allows icantly related to gingival recession a n d loss of attachment,
a more hygienic design with less gingival m a r g i n coverage, although details of t h e design of the RPDs were not given.12
as was d e m o n s t r a t e d in this study. However, this s t u d y Conversely, a small s t u d y of 14 r e g u l a r dental patients
failed to show a significantly different effect on the extent who mostly wore mucosa-supported RPDs concluded t h a t
of gingival recession w h e r e the gingiva were covered by ei- t h e y were no more likely to have poorer periodontal h e a l t h
t h e r a synthetic resin or a m e t a l RPD. t h a n comparable non-denture wearers, la

606 VOLUME 74 NUMBER 6

WRIGHT AND HELLYER THE JOURNALOF PROSTHETIC DENTISTRY

C O N C L U S I O N S A N D CLINICAL 4. Bergman B. Periodontal reactions related to removable partial den-

SIGNIFICANCE
Removable partial dentures have been demonstrated to
be associated with an increased prevalence of gingival re-
cession~ This study confirmed the association of RPDs with
more extensive gingival recession, but was unable to show
any predictable consequence of the lack of tooth support,
of the material of denture construction, or of covering the
gingival margins with lingual plates. These design factors
may be less important than the maintenance of good oral
hygiene for the prevention of periodontal disease in pa-
tients wearing dentures. Further studies on the effects of
mucosa-supported synthetic resin removable partial den-
tures are strongly indicated because this type of denture is
often provided in general dental practice in the United
Kingdom.
REFERENCES
1. Hellyer PH, Beighton D, Heath MR, Lynch EJ. Root caries in older
people attending a general dental practice in East Sussex. Br Dent J
1990;169:201-6.
2. Wright PS, Hellyer PH, Beighton D, Heath R, Lynch E. Relationship
of removable partial denture use to root caries in an older population.
Int J Prosthodont 1992;5:39-46.
3. Kieser JB. Periodontics: a practical approach. London, United King-
dom: Wright, 1990.
tures: a literature review. J PROSTHETDENT 1987;58:454-8.
5. Dental Estimates Board for England and Wales. Annual report 1987-
88. Treatments, prosthetic. East Sussex: ABR Lithgow, 1988.
6. Wilding RJ, Reddy J. Periodontal disease in partial denture wearers--a
biolog/cal index. J Oral Rehabil 1987;14:111-24.
7. Bissada NF, Ibrahim SI, Barsoum WM. Gingival response to various
types of removable partial dentures. J Periodontol 1974;45:651-9.
8. Stipho HD, Murphy WM, Adams D. Effect of oral prostheses on plaque
accumulation. Br Dent J 1978;145:47-50.
9. McHenry KR, Johansson OE, Christersson LA. The effect of removable
partial denture framework design on gingival inflammation: a clinical
model. J PaOSTm~TDENT 1992;68:799-803.
10. Markkanen H, Lappalainen R, Honkala E, Tuominen R. Periodontal
conditions with removable complete and partial dentures in the adult
population aged 30 years and over. J Oral Rehabil 1987;14:355-60.
11. Tuominen R, Ranta K, Paunio I. Wearing ofremovable partial dentures
in relation to periodontal pockets. J Oral Rehabil 1989;16:119-26.
12. Drake CW, Beck JD. The oral status of elderly removable partial den-
ture wearers. J Oral Rehabil 1993;20:53-60.
13. Mullally BH, Linden GJ. Periodontal status of regular dental attend-
ers with and without removable partial dentures. Eur J Prosthodont
Rest Dent 1994;2:161-3.
Reprint requests to:
DR. P. S. WRIGHT
DEPARTMENTOF PROSTHETICDENTISTRY
THE LONDON HOSPITAL MEDICAL COLLEGE
DENTAL SCHOOL
TURNER ST.
LONDON
E1 2AD
UNITED KINGDOM

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