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Case Study
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Aesthetic Considerations for the Treatment of Partially Edentulous Patients with Removable Dentures

Learning Objectives:

This podcast discusses various treatment options utilizing removable partial dentures for anterior and posterior restorations. Upon completion of this podcast, the listener should:

  • Have an awareness of various framework and clasp concepts
  • Be able to discuss rotational path design and the minimal extension of denture bases
  • Understand the function of auxiliary attachments and retentive bars

Treatment with removable partial dentures (RPDs) is an affordable solution for anterior or posterior tooth loss. In determining a proper treatment solution, it is important for the clinician to consider the patient's aesthetic expectations, socioeconomic situation, and the prognosis for the prosthesis and remaining dentition. This article presents guidelines to optimize the aesthetic result of this treatment and considers framework and clasp concepts; rotational path design; minimal extension of the denture bases; auxiliary attachments or retentive bars; and implants for retention and support of RPDs.

An RPD may also be indicated in Class III, IV, or V situations when the edentulous space is too large for a fixed prosthesis or when alveolar bone loss is so important that it is necessary to replace the missing bone with a resin flange to support the middle third of the face. The principle disadvantages of RPDs are the risk of caries and periodontal disease adjacent to the abutment teeth and resorption of the residual ridge. In addition, the wear of RPDs may be associated with complaints regarding the appearance of the dentition as elements of the denture framework or the acrylic resin becomes visible. In general, the aesthetics and function of fixed partial dentures (FPDs) are superior to that of RPDs. In numerous instances, however, treatment with RPDs may be the only feasible solution due to financial restrictions, biological considerations (eg, residual ridge resorption), or doubtful prognosis of potential abutment teeth for an FPD. Various clinicians have previously considered principles of framework design in order to improve the comfort of patients wearing RPDs. In this article, several concepts for treatment with RPDs that could improve the aesthetic result of treatment will be outlined.

Lost anterior or posterior teeth can be inexpensively and predictably restored with RPDs. This presentation has described the various framework and retentive concepts that enable the restorative team to provide functional, aesthetic care to contemporary dental patients. These designs may also involve implant therapy, although such treatment must anticipate future restorative criteria. Removable partial dentures allow the attending clinician to simultaneously address patients' aesthetic and socioeconomic concerns while ensuing functional success.

 

*Professor, Division of Gerodontology and Removable Prosthodontics, University of Geneva, School of Dentistry, Geneva, Switzerland.

 

Related Reading:
  1. Zarb GA, MacKay HF. The partially edentulous patient. I. The biologic price of prosthodontic intervention. Aust Dent J 1980;25(2):63-68.          
  2. Tuominen R, Ranta K, Paunio I. Wearing of removable partial dentures in relation to periodontal pockets. J Oral Rehab 1989;16(2):119-126.       
  3. Wright PS, Hellyer PH, Beighton D, et al. Relationship of removable partial denture use to root caries in an older population. Int J Prosthodont 1992;5(1):39-46.           
  4. Witter DJ, van Elteren P, KŠyser AF, van Rossum MJ. The effect of removable partial dentures on the oral function in shortened dental arches. J Oral Rehabil 1989;16(1):27-33.
  5. Cowan RD, Gilbert JA, Elledge DA, McGlynn FD. Patient use of removable partial dentures: Two- and four-year telephone interviews. J Prosthet Dent 1991;65(5):668-670.          
  6. Budtz-J¿rgensen E, Isidor F. Cantilever bridges or removable partial dentures in geriatric patients: A two-year study. J Oral Rehab 1987;14(3):239-249.          
  7. Budtz-J¿rgensen E, Bochet G. Alternate framework designs for removable partial dentures. J Prosthet Dent 1998;80(1):58-66.      
  8. Crum RJ, Loiselle RJ. Oral perception and proprioception: A review of the literature and its significance to prosthodontics. J Prosthet Dent 1972;28(2):215-230.           
  9. Crum RJ, Rooney GE Jr. Alveolar bone loss in overdentures: A 5-year study. J Prosthet Dent 1978;40(6):610-613.  
  10. Budtz-J¿rgensen E, Bochet G. The concept of the partial removable denture. Schweiz Monatsschr Zahnmed 1995;105(4):506-514.
  11. Krol AJ, Finzen FC. Rotational path removable partial dentures: Part 2. Replacement of anterior teeth. Int J Prosthodont 1988;1(2):135-142.        
  12. Bissada NF, Ibrahim SI, Barsoum WM. Gingival response to various types of removable partial dentures. J Periodontol 1974;45(9):651-659.       
  13. Wright PS, Hellyer PH. Gingival recession related to removable partial dentures in older patients. J Prosthet Dent 1995;74(6):602-607.     
  14. Glantz PO, Nilner K, Jendresen MD, Sundberg H. Quality of fixed prosthodontics after 15 years. Acta Odontol Scand 1993;51(4):247-252. 
  15. Quirynen M, Naert I, van Steenberghe D, et al. Periodontal aspects of osseointegrated fixtures supporting a partial bridge. An up to 6-year retrospective study. J Clin Periodontol 1992;19:118-126. 
 
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