Consequences of Partial Denture Use

• A partial denture = a (removable) prosthesis which replaces some or all of the missing dento-alveolar complex in an arch where some natural teeth remain. You can get removable partial dentures or fixed partial dentures.
• If a partial denture is to be provided, it should be underpinned by appropriate consent (give all risks, pros and cons). Disease should be stabilised to an extent which is appropriate for each patient. All partial dentures should be designed and the design should be simple. Provision for maintenance and aftercare should be planned and provided too.
• Patient acceptance of a space:

  • Aesthetics unaffected
  • Function unaffected
  • Patient unlikely to seek help - phobic
  • Cost/perceived cost
  • Professional attitude/advice
• Patient concerned about a space:

  • Aesthetics
  • Function
  • Worried well - worried about the right things (ie concerned about health/function/aesthetics)
  • Psychological impact
  • Objective/subjective differences
• The effects of tooth loss and replacement:

  • Tooth loss
  • Even a single tooth will result in some functional limitation
  • A partial denture may result in functional limitation
  • Functional limitation
  • Perceived limitation
  • Effect of limitation
  • Remediation of limitation
  • Perceived effect of remediation
• Why fill a space:

  • Speech
  • Aesthetics
  • Masticatory efficiency - the more teeth you lose, the more it will affect how you eat
  • Gastric upsets
  • Weight loss
  • Limitation in the range of food eaten
  • Nutrition
  • Occluding pairs > teeth lost
• A stable occlusion = a reproducible and functional ICP

  • Stable:
  • Maintained contacts, no parafunction, no symptoms, loss of stability is not inevitable
  • Unstable:
  • Maybe initially asymptomatic, tilting, drifting, over-eruption (dento-alveolar compensation), maybe manifest after many years
• Consequences of partial dentures:

  • Balance between health gain and health loss
  • Stabilisation vs destabilisation
  • Health benefit - psychological
  • Nutritional
  • Functional
  • Patient motivation
  • No perceived advantage - not adequate motivation
  • Psychological impact
• Potential problems with removable partial dentures - iatrogenic damage:

  • Risk factor for disease processes
  • Tooth modification and loss of tooth tissue
  • Abrasion
  • Mucosal trauma
  • Allergic reaction
  • Psychological damage
• Potential problems with removable partial dentures - disease:

  • Plaque retention
  • Caries
  • Periodontal disease
  • Mucosal disease
• Prepare the patient for the denture:

  • Is a denture necessary or desirable?
  • Motivation - OHI, diet, scaling
  • Eliminate pockets >3mm or accept non-bleeding pockets
  • Manage active caries
  • Extract teeth of poor prognosis - unless they have a justified place within the treatment plan
  • Restorations - extra-coronal
• Removable partial dentures increase plaque retention, caries risk, periodontal disease markers, and mobility in abutment teeth. But they do not cause these effects.
• Caries and partial dentures:

  • Findings
  • Abutment teeth are more likely to have caries and periodontal disease than other teeth
  • Removable partial dentures in elderly pts -> strong association with root caries
  • Risk 4x greater than non-removable partial dentures
  • Root caries/perio disease more frequent if removable partial denture is technically and clinically suboptimal
  • Conclusions
  • Highly motivated and capable patients can offset these risks
  • Dentists should ensure they educate and enable patients to achieve these levels
  • Complacency is the enemy of success - maintenance