Open Journal of Stomatology, 2012, 2, 173-181 OJST

http://dx.doi.org/10.4236/ojst.2012.23032 Published Online September 2012 (http://www.SciRP.org/journal/ojst/)

Clinical performance of removable partial dentures:

A retrospective clinical study
Maged K. Etman1*, Darya Bikey2
1
Division of Prosthodontics, College of Dentistry, University of Saskatchewan, Saskatoon, Canada
2
Mount Sinai Hospital, University of Toronto, Toronto, Canada
Email: *maged.etman@usask.ca

Received 1 July 2012; revised 10 August 2012; accepted 21 August 2012

ABSTRACT 1. INTRODUCTION
Removable partial dentures (RPDs) (conventional and There is an increasing proportion of the elderly popula-
implant-supported) treatment is considered a viable tion that is retaining some natural teeth and this number
option to replace missing teeth as inexpensively as will continue to grow, at least in the short-term [1]. Al-
possible, but it has limitations. Objectives: This study though tooth loss will be reduced, prosthetic replacement
reports the effect of gender and location (maxilla vs. of missing teeth is unlikely to entirely disappear [2].
mandible) on the clinical performance of removable There will be an increase in unmet prosthodontics need
partial dentures (RPDs). Materials and Methods: A [3]. Several options are available for prosthetic rehabili-
total of 100 Patients who had RPDs delivered between tation such as conventional fixed and removable prost-
1990-1995 were evaluated. A 4-point scoring system hodontics and dental implant supported/retained pros-
was used to assess seventeen criteria. These criteria theses.
include acceptance, stability, support, retention, ad- Dental implants are becoming more common and are
aptation, occlusion, integrity, and design of the pros- rapidly becoming the standard of care in dentistry [4-9].
theses, rest and rest seat preparation, occlusal wear, It is important to realize that conventional fixed prosthe-
esthetics, phonetics, tissue condition, mobility of ses and dental implants have limitations [8-10]. A major
abutments, gingival and plaque indices. The data were obstacle to these treatment options is the financial con-
analyzed using Kruskal-Wallis and Mann-Whitney U sideration which may preclude some patients from re-
non-parametric statistical tests. Results: The results ceiving these treatments. For some patients needing to
showed that acceptance of RPDs was rated the lowest. replace missing teeth as inexpensively as possible, con-
Other reasons for failure were poor retention, lack of ventional and implant-supported removable partial pros-
integrity of the prostheses and inadequate adaptation. thetic treatment may be the most viable option. The data
Retention and design of major connectors attributed from the published reports suggest that the incorporation
to Mandibular RPD failure. Success rate of 75% was of dental implants into removable partial dentures could
observed in male compared with 67.2% for female. be an optional treatment plan for the partially edentulous
Maxillary RPDs showed a higher success rate (78%) patient to improve function and patient satisfaction [11-
compared with the mandibular (70.1%). No signifi- 13].
cant statistical difference in Alpha scores between fe- A careful assessment of patient compliance regarding
male and male patients and between maxillary and oral hygiene and routine maintenance should be com-
mandibular RPDs (p < 0.05). Conclusions: The clinical pleted before considering rehabilitation using RPDs [14].
performance of RPDs showed a higher success rate in The overall success rates of RPDs as reported in the lit-
male patients compared to female patients and the erature are at a respectable level. One study found a
maxillary RPDs showed a higher success rate com- 71.3% success rate for RPDs with a circumferential clasp
pared to mandibular. design and 76.6% success rate for RPDs with an I-bar
clasp design after 5 years of usage [15]. A different study,
Keywords: Clinical Performance; Removable Partial which defined failure as the patient not wearing the
Denture; Maxilla; Mandible; Gender original RPD, reported 74.7% of patients were still
wearing their RPDs [16]. The authors divided RPDs us-
age into 5 year intervals. They reported success rate of
*
Corresponding author. 85.7% for 5 - 10 years period, 62.8% for 10 - 15 years

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period, and 57.1% for over 15 years period. Other re- evaluate the effect of gender and intra-oral location on
searchers evaluated RPDs with an average 2.5 years of the clinical performance of RPDs over a 15-year time
service and found 43% of RPDs to be acceptable and period in a university setting.
46% could be made acceptable with modifications, such
as a reline or adjustment [17]. As is evident in the litera- 2. MATERIALS AND METHODS
ture, success rates of RPDs are reasonable and they re-
Patient population for this retrospective study were se-
main a justifiable option for the treatment of partially
lected from the patient pool at a university setting fol-
edentulous patients [18].
lowing certain criteria. These criteria include: only class
Although a vast number of RPDs are fabricated, there
1 (philosophical) and 2 (exacting) patients according to
is a shortage of current research that attempts to study
Houses psychological classifications, patients who have
RPDs over an extended time period. Moreover, there is a
had at least one RPD delivered between 1990-1995, no
shortage of clinical studies closely investigating the ef- parafunctional habits, no known disabilities that may
fects of gender and location (maxilla vs. mandible) on have an effect on RPD maintenance, opposing natural
RPD success rates. An article published on gender dif- teeth, and a history of patient compliance to follow
ference regarding oral health found differences in chief post-delivery instructions with regular attendance for
complaints between elderly males and females [19]. maintenance. Ethics approval was obtained from the
Males appeared to demand that dentures improve their Biomedical Research Ethics Board. One hundred patients
mastication, whereas the concerns of females centered on who had their prostheses delivered between 1990-1995
problems related to pain, hypersensitivity and esthetics. were randomly selected using a random table created
The results from another study on RPDs revealed no sig- using a SPSS statistical program (SPSS 16.0.2, Chicago,
nificant difference in general satisfaction between males IL, USA). The demographic distribution of patients
and females, aside from men being less satisfied with the population and RPDs are represented in Table 1. Patients
mastication with lower RPDs [20]. A review of the lit- were enrolled and scheduled for a clinical examination.
erature also fails to produce evidence comparing the Patients were informed and a patient information sheet
success rates of maxillary and mandibular RPDs. One was given to each patient, also consent was obtained
study reported patient satisfaction to be equal between from each patient. In addition, medical and dental history
maxillary and mandibular RPDs, however, the authors was updated along with any other pertinent information.
found a significant difference in failure rates between Two calibrated assessors conducted all the examinations.
maxillary and mandibular RPDs [16]. In that study, the Radiographs were taken for all the RPD abutments, and
failure rate for mandibular RPDs was 33% compared to the radiographs were compared with previous radio-
12.7% for maxillary RPDs. Another study showed graphs. A four-point scoring system (Alpha, Bravo,
greater patient compliance with maxillary RPDs possibly Charlie, Delta was used (Table 2) to evaluate each of 17
due to esthetics and comfort [21]. Despite the fact that criteria. Each criterion was rated according to a prede-
RPD fabrication is not becoming an obsolete treatment termined definition (Table 3). Although the assessment
modality, there currently appears to be a decreasing fo- was subjective, having two calibrated assessors complete
cus on this subject area in the literature. It was expected all the examinations allowed consistency.
that gender and location of RPD would have no effect on Before beginning the examination, patients were asked
the success rate of the prosthesis. Expanding the knowl- about their satisfaction level with the prostheses. This is
edge about the long-term success rates of RPDs and the a very important criterion and does not always correlate
influences of gender and intra-oral location would be with the outcomes score from other criteria. Patients with
advantageous to both practitioners and patients alike. positive attitude towards their RPDs could function sat-
Consequently, the main objective of this study was to isfactorily even though their RPDs were poorly designed;

Table 1. Demographic distribution of study subjects. (KC: Kennedy Classification).

Demographic Distribution
Gender Location Age
Male Female Maxillary Mandibular Male N = 47 Female N = 53
0 - 20 0 0 - 20 0
47 53 50 67 21 - 40 13 21 - 40 12
KCI: 28 KCI: 26 KCI: 23 KCI: 31
41 - 60 18 41 - 60 20
KCII: 23 KCII: 20 KCII: 19 KCII: 24
KCIV: 9 KCIV: 11 KCIV: 8 KCIV: 12 61 - 80 10 61 - 80 13
81 - 100 6 81 - 100 8
Total Number of patients:100 Number of RPDs: 117 Average age 55 Average age 58

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 M. K. Etman, D. Bikey / Open Journal of Stomatology 2 (2012) 173-181 175

Table 2. 4-point scoring system used to assess each criterion. movement observed was recorded. Support for the pros-
Scoring Scale Description
thesis was evaluated by applying bilateral vertical pres-
A = Alpha Excellent, RPD clinically ideal
sure apically and determining the resistance to displace-
ment towards the tissues. Retention was assessed by de-
Clinically acceptable, RPD with changes
B = Bravo
that are clinically acceptable termining the force required to vertically displace and
C = Charlie RPD with changes that require intervention
remove the RPD away from the alveolar ridge. The as-
sessors would remove the RPD using both hands by ap-
D = Delta Unacceptable, replacement necessary
plying bilateral force directed coronally along the path of
insertion of the prosthesis. The adaptation of RPD com-
Table 3. 17 criteria for evaluation of RPDs.
ponents, such as major connectors, minor connectors,
Criteria Definition direct and indirect retainers, and the denture base were
Patients acceptance
Patient satisfaction level with RPD
determined visually and by an explorer and probing in-
of prosthesis strument. In order to assess occlusion, each patient was
Movement of RPD on alveolar ridge asked to repeat jaw movements several times. Centric
Stability when vertical pressure applied and eccentric movements of each subject were examined
unilaterally
by marking contacts with articulating paper. Occlusion
The resistance to displacement
Support towards the tissues when applying
was considered clinically acceptable when the RPD was
vertical pressure stable and a free gliding movement (2 - 3 mm) without
Vertical resistance of RPD when cuspal interference during these actions was observed
Retention [22,23]. Integrity of the prostheses was evaluated visu-
applying force to remove denture
Adaptation of clasp assembly, major/ ally for any structural defects. Evaluation of rests and
Adaptation
minor connectors, and denture base rest seats, major and minor connectors design and abut-
Presence of adequate number of ment teeth were carried out according to standard proto-
Occlusion contacts with an even distribution col [24]. Any design characteristics, such as inappropri-
in centric occlusion
ate position of rest seats, inadequate preparation of rest
Integrity of prosthesis Integrity of prosthesis structure seats, inappropriate minor and major connector design
Rests and rest seats Design of rests and rest seats selection were recorded.
Major connector design Design of major connector Occlusal wear of acrylic teeth of RPDs was evaluated
Minor connector design Design of minor connector visually and was compared to wear of the patients natu-
Occlusal wear Wear of teeth on occlusal surface ral dentition. The aesthetics of RPDs replacing anterior
Evaluation of esthetics (shade, teeth was assessed according to the shade, morphology,
Esthetics morphology, position, size, position, size of the anterior teeth, and proper lip support
and clasp visibility) as well as inspecting visibility of the for clasp. Phonetics
Assessment of speech problems by with RPDs was evaluated, but was more critical in Ken-
Phonetics asking patient to say words with nedy Class IV arches. The patient was asked to repeat
letters p, b, f, v, and s
words that emphasized the letters p, b, f, v, and
Abnormal color and swelling on
Tissue evaluation
denture bearing surface
s and any irregular sounds or difficulties with these
words were recorded. The abutment teeth and the at-
Mobility evaluation Detecting tooth mobility of abutments
tached mucosa (quality and quantity) were evaluated.
Clinical severity of gingival
Gingival index
inflammation Tissue evaluation was based on determining the quality
and quantity of the attached mucosa, which are indicative
Plaque index Level of plaque accumulation
of supporting structures of the denture-bearing surface.
Also, the presence of inflammation, ulceration, or any
whereas patients who have poor attitude toward their
other denture-related pathology on the denture bearing
RPDs may not be satisfied even with excellent or ac-
area was recorded. Tooth mobility was evaluation by
ceptable RPDs. Thus, although the other criteria are im-
manual inspection of abutment and non-abutment teeth.
portant, patient acceptance is an absolutely critical.
The data were analyzed using Kruskal-Wallis and Mann-
Stability of the prosthesis was determined by the
Whitney U non-parametric statistical tests using a SPSS
amount of movement observed when moderate unilateral
statistical program.
apically directed pressure was applied on the occlusal
surface of the RPD. This movement was recorded in mil-
3. RESULTS
limetres. Likewise, with Kennedy Class IV RPDs, mod-
erate apically directed pressure was applied to the incisal Success rates of the RPDs were based on calculating the
surface of the replacement teeth of the RPD and any percentage of Alpha, Bravo and Charlie scores from the

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176 M. K. Etman, D. Bikey / Open Journal of Stomatology 2 (2012) 173-181

raw data. All the data were comprised of the evaluations prehensive examination. Figure 4 portrays the other cri-
of the calibrated assessors except patient acceptance. teria with the highest Delta scores in females, they in-
Patient acceptance involved the patients input in relation clude: retention, adaptation, integrity of prosthesis, rests
to other criteria, such as stability, retention, esthetics, etc. and rest seats, and major connector design. Statistical
Only the prostheses that had Delta ratings were consid- analysis showed no significant difference in Alpha scores
ered failures. An overall 70.5% success rate was ob- between female and male patients.
served for the RPDs over 15-year period. In general, The maxillary RPDs showed a higher success rate of
failure of RPDs was mainly due to patient acceptance, 78% compared with 70.1% in mandibular RPDs. Similarly,
poor retention, integrity of the prostheses and adaptation the patient acceptance criteria was rated the lowest for
(Figures 1 and 2). both maxillary and mandibular RPDs. 22% of acceptance
A 75% success rate was observed in male patients ratings of maxillary RPDs were given Delta scores mainly
compared with 67.2% for female patients and for both due to improper adaptation of the RPD as patient was
genders patient acceptance of RPDs was rated the lowest complaining from discomfort and food impaction. The
among all the criteria. In male patients 23% of accep- other criteria with high Delta scores among maxillary
tance ratings were given Delta scores, mainly because RPDs were integrity of the prosthesis and major connector
these patients either found they were not able to adapt to design (Figure 5). On the other hand, mandibular RPDs
wearing the RPD(s) or found they functioned sufficiently had 25% of their acceptance ratings given Delta scores as
without the prosthesis. As seen in Figure 3, the other a result of patients not being able to adapt to wearing the
criteria with the highest Delta scores in male patients RPD, even though these RPDs were generally assessed as
were adaptation and occlusion. In female patients 25% of acceptable or excellent. The other criteria with high Delta
acceptance ratings were given Delta scores, which in scores among mandibular RPDs were adaptation and re-
most cases was due to their perception of undesirable tention (Figure 6). Statistical analysis showed no signifi-
esthetics and poor retention, even though these criteria cant statistical difference in Alpha scores between maxil-
were assessed as acceptable to excellent during the com- lary and mandibular RPDs (p < 0.05).

(a) (b) (c)

Figure 1. (a) Mandibular RPD demonstrating poor adaptation of direct retainer clasp; (b) Mandibular RPD with fractured rest and
severe occlusal wear; (c) Mandibular RPD with poor adaptation of lingual plate major connector.

(a) (b)

Figure 2. (a) Maxillary RPD with impingement on tissues leading to gingival recession; (b) Maxillary
RPD with severe occlusal wear.

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 M. K. Etman, D. Bikey / Open Journal of Stomatology 2 (2012) 173-181 177

Figure 3. Male evaluation scores for the 17 criteria assessed.

Figure 4. Female evaluation scores for the 17 criteria assessed.

Figure 5. Maxillary evaluation scores for the 17 criteria assessed.

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178 M. K. Etman, D. Bikey / Open Journal of Stomatology 2 (2012) 173-181

Figure 6. Mandibular evaluation scores for the 17 criteria assessed.

4. DISCUSSION evaluated the prostheses and patients were only asked for
their level of satisfaction (i.e. acceptance) with their
There is a shortage of clinical performance studies on
RPD(s). As reported by some clinicians, patients and
RPDs that further investigate the influence of factors
such as gender and intra-oral location. The purpose of dentists evaluate the success of RPD treatment differ-
this research was to report on the effect of gender and ently [25]. Patients look upon success in terms of per-
intra-oral location on the clinical performance of RPDs. sonal satisfaction, which differs from dentists who assess
These findings in turn may have ramifications on the denture success in terms of specific technical and clinical
manner in which dentists evaluate treatment of partially standards. Our results agree with this finding and draw
edentulous patients with RPDs. attention to disparities in gender. Among male patients
It must be noted that the evaluation of the criteria for examined it was observed that the chief concern raised
this study contains a degree of subjectivity because of the was regarding their ability to chew with the prosthesis,
somewhat subjective nature of clinical evaluations of despite the fact that there were other serious shortcom-
dental prostheses. Utilizing two Calibrated Assessors ings with the prosthesis that affected the success rates. In
however, allowed for maintaining a high level of consis- female patients there was a lower acceptance of RPDs
tency in the clinical evaluations. The nature of the study due to the perception of poor retention and undesirable
performed, a retrospective clinical study, must also be esthetics, in spite of these criteria being evaluated as ac-
taken into consideration when interpreting the findings. ceptable or excellent in most cases. Several studies have
Retrospective studies are one approach used to surmise reported the level of satisfaction or the acceptance of
survival rates and the longevity of different restorative RPDs to have a multi-causal or multi-dimensional char-
treatments. Unlike prospective studies that may have the acter [26-31]. The present study confirms this finding,
same operator(s) complete both the treatment and the but it also highlights that each gender may have more
follow-up evaluations, the evaluator(s) in a retrospective particular, fundamental issues that influence acceptance
study evaluate the treatment completed by a different and thereby influence overall success.
operator or operators. Nonetheless, retrospective studies The failure scores in acceptance for male and female
provide a valuable means to evaluate restorative treat- patients and maxillary and mandibular RPD patients was
ments and illustrate the possible basis for their success a major determinant in the resulting RPD success rates in
and failure. Criteria for patients selection were used to this study. The findings indicate that males may have a
eliminate or to reduce factors that may affect the results slightly greater adaptability to a removable prosthesis
of this study. than females and this may be linked to the overall
Success rates of the RPDs were calculated based on slightly greater acceptance in males. It has been de-
the percentage of Alpha, Bravo, and Charlie scores. The scribed that a slightly higher percentage of women re-
overall success rate of RPDs delivered by undergraduates ported having issues with their mandibular RPDs, but a
between 1990 and 1995 with average 17 years in func- significant relationship between gender and patient sat-
tion was comparable with other RPD success rates in isfaction with new RPDs was not encountered [32].
published studies [15-17]. In this study the Assessors Conversely, studies on complete denture patients have

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 M. K. Etman, D. Bikey / Open Journal of Stomatology 2 (2012) 173-181 179

shown women to be more likely to have problems ac- RRR is worse in the mandible [37]. One such study
commodating to new dentures [33,34]. It appears women found a noticeable reduction of the mandibular alveolar
may be more likely to have problems adapting to their ridge and only a slight reduction of the maxillary alveo-
new RPD(s), resulting in lower acceptance of their pros- lar ridge during subsequent years of denture wear [38].
thesis. The results of this study suggest that there is in- These same authors found the relationship between the
deed a difference in the level of acceptance of RPDs be- mandibular and maxillary reduction to gradually increase
tween males and females, females having an overall lower to about 4:1 at the seven-year stage. It is important to
acceptance, resulting in a lower success rate of RPDs in note that the current authors did not include an evalua-
females. tion of RRR in the maxilla and mandible as part of its
There was a noticeable difference in the evaluation criteria, but identifies it as one of the critical factors in-
scores for occlusion between male and female patients; fluencing differences in the success rates between RPDs
male patients having more failure scores. This finding is in the maxilla and mandible. In addition to RRR patterns
likely because males generate higher masticatory forces in the mandible, it has been reported that women have a
compared to females [35], thereby resulting in excessive unique pattern of bone resorption: they have a greater
wear and poor occlusion. Another relevant finding be- tendency to develop a knife-edge type of mandibular
tween males and females was in the design criteria scores; residual ridge due to continuous resorption activity that
RPDs in females had greater failure scores for design. is pronounced at the labial and lingual surfaces of the
This result could be explained by the nature of the de- residual mandibular alveolar ridge [39]. According to
sires and expectations of female patients. Female patients another study females make up the majority of referrals
would appear to have higher esthetic demands and con- for prosthodontic specialist advice [40]. Moreover, man-
cerns than males. Therefore, females may opt for im- dibular RPDs have been reported to be associated with
proving esthetics at the risk of compromising the design retention, stability and relining problems, possibly due to
of the prosthesis, whereas males may not be as con- factors such as the muscles in the tongue and floor of the
cerned about the appearance of a component(s) of the mouth displacing the prosthesis and the decreased sur-
prosthesis, as long as the function of the prosthesis is ac- face area of a mandibular RPD [41]. It would therefore
ceptable. appear that there are major obstacles in fabricating a
The slight difference found in stability, support and mandibular RPD in female patients with a favorable
retention between the genders might be due to the dif- outcome, a finding reinforced by the results of this study.
ference in changes in tissue support area. Gender did not Having discussed that RRR appears to affect retention
bear any effect on the integrity of RPDs, despite greater and adaptation, among other things, no explanation could
masticatory forces in males, nor did it have an influence be given as to why the findings suggest that RRR did not
on esthetics and phonetics. Also, no explanation could be have profound effect on RPD stability and support for
given for the difference in rests and rest seats scores be- the study period of this report. Location was not found to
tween the genders. This may also be related to changes in have an influence on design, esthetics, and phonetics
soft and hard tissues and abutment movement. A slight scores. Also, a slight difference in oral hygiene ratings
difference was also noticed in the level of oral hygiene between the two locations was found in this study.
between males and females. Outside of the dentists control are the many patient
Acceptance of the prostheses was found to be some- factors that affect RPD treatment outcomes, including:
what higher with maxillary RPDs. This could be due to level of alveolar ridge resorption, quality and quantity of
the presence of anterior replaced teeth in the maxillary denture bearing oral mucosa, muscles, quality and quan-
RPDs; patients may be more likely to be satisfied with tity of saliva, age of the patient and psychological factors,
their maxillary RPD especially when it involves the es- previous denture experience, condition and position of
thetic zone. It has also been reported that there is a dif- other teeth in the mouth, diet, hygiene, systemic diseases,
ference in the frequency of untreated spaces in the max- and others [32,42,43]. However, the influence of gender
illa and mandible, with a greater propensity for prosthetic and location are focused on and the results demonstrate
treatment of spaces in the maxilla, likely due to esthetic some interesting notions. Also of significance are the
reasons [36]. Our results indicate that the presence of potential mismatched perceptions and expectations of the
anterior replacement teeth in maxillary RPDs could in- patient and dentist and a patients pre-treatment expecta-
crease the acceptance of the prosthesis. tions and attitude toward treatment strongly affects out-
Lower success rates and higher failure scores in adap- comes in dentistry [44-46]. Bearing this in mind and re-
tation and retention with mandibular RPDs could be due gardless of the gender or location of prosthesis, it is the
to residual ridge resorption (RRR) in the mandible. Nu- authors suggestion that through adequate patient evalua-
merous researchers have studied RRR in the maxilla and tion and education there could be more realistic patient
mandible and there seems to be a general consensus that expectations and a resulting improvement in the accep-

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180 M. K. Etman, D. Bikey / Open Journal of Stomatology 2 (2012) 173-181

tance of their prosthesis. Hence, there could be a reduc- Prosthodontic problems and limitations associated with
tion in the failures of this nature resulting in more pre- osseointegration. Journal of Prosthetic Dentistry, 79, 74-
78. doi:10.1016/S0022-3913(98)70197-0
dictable prosthetic restorations.
[8] Eckert, S.E., Parein, A., Myshin, H.L., et al. (1997) Vali-
5. CONCLUSION dation of dental implant systems through a review of lit-
erature supplied by system manufacturers. Journal of
The clinical performance of the RPDs showed higher Prosthetic Dentistry, 77, 271-279.
success rates in male patients compared to female pa- doi:10.1016/S0022-3913(97)70184-7
tients. Also, the maxillary RPDs showed higher success [9] Scully, C., Hobkirk, J. and Dios, P.D. (2007) Dental en-
rates compared to mandibular RPDs. A critical determi- dosseous implants in the medically compromised patient.
Journal of Oral Rehabilitation, 34, 590-599.
nant affecting success rates and the difference in success
doi:10.1111/j.1365-2842.2007.01755.x
rates was the acceptance (or level of patient satisfaction).
[10] Salinas, T.J., Block, M.S. and Sadan, A. (2004) Fixed
Therefore, it would seem that patient factors would be as
partial denture or single-tooth implant restoration? Statis-
important, if not more influential, as factors controlled tical considerations for sequencing and treatment. Journal
by the practitioner. Practitioners must identify and keep of Oral and Maxillofacial Surgery, 62, 2-16.
in mind all the factors that affect RPD treatment out- doi:10.1016/j.joms.2004.06.001
comes. Despite the gender of the patient or the intra-oral [11] Grossmann, Y., Nissan, J. and Levin, L. (2009) Clinical
location of the prosthesis, the importance of proper effectiveness of implant-supported removable partial den-
treatment planning and proper patient education is em- turesA review of the literature and retrospective case
phasized as an essential role of the practitioner. Patients evaluation. Journal of Oral and Maxillofacial Surgery, 67,
1941-1946. doi:10.1016/j.joms.2009.04.081
must be educated and made aware of the limitations and
shortcomings of RPDs to ensure realistic expectations. If [12] Kuzmanovic, D.V., Payne, A.G.T. and Purton, D.G. (2004)
Distal implants to modify the Kennedy classification of a
patient expectations and attitudes are realistic, then ac-
removable partial denture: A clinical report. Journal of
ceptance of the new prosthesis could be improved, po- Prosthetic Dentistry, 92, 8-11.
tentially resulting in higher success rates. doi:10.1016/j.prosdent.2004.04.010
[13] Uludag, B. and Celik, G. (2006) Fabrication of a maxil-
6. ACKNOWLEDGEMENTS lary implant-supported removable partial denture: A clini-
cal report. Journal of Prosthetic Dentistry, 95, 19-21.
We would like to thank our patients who volunteered to take part in this
doi:10.1016/j.prosdent.2005.10.021
study. This study was funded by the University of Saskatchewan.
[14] Mojon, P., Rentsch, A. and Budtz-Jorgensen, E. (1995)
Relationship between prosthodontic status, caries, and pe-
riodontal disease in a geriatric population. International
REFERENCES Journal of Prosthodontics, 8, 564-571.
[1] Weintraub, J.A, and Burt, B.A. (1985) Oral health status [15] Kapur, K.K., Deupree R., Dent R.J., et al. (1994) A ran-
in the United States: Tooth loss and edentulism. Journal domized clinical trial of two basic removable partial den-
of Dental Education, 49, 368-378. ture designs. Part I: Comparisons of five-year success
[2] Douglass, C.W., Shih, A. and Ostry, L. (2002) Will there rates and periodontal health. Journal of Prosthetic Den-
be a need for complete dentures in the United States in tistry, 72, 268-282 doi:10.1016/0022-3913(94)90340-9
2020? Journal of Prosthetic Dentistry, 87, 5-8. [16] Vanzeveren, C., DHoore, W., Bercy, P., et al. (2003)
doi:10.1067/mpr.2002.121203 Treatment with removable partial dentures: A longitudi-
[3] Douglass, C.W. and Watson, A.J. (2002) Future needs for nal study. Part I. Journal of Oral Rehabilitation, 30, 447-
fixed and removable partial dentures in the United States. 458. doi:10.1046/j.1365-2842.2003.01106.x
Journal of Prosthetic Dentistry, 87, 9-14. [17] Frank, R.P., Brudvik, J.S., Leroux, B., et al. (2000) Rela-
doi:10.1067/mpr.2002.121204 tionship between the standards of removable partial den-
[4] Henry, P.J. (2000) Tooth loss and implant replacement. ture construction, clinical acceptability, and patient satis-
Australian Dental Journal, 45, 150-172. faction. Journal of Prosthetic Dentistry, 83, 521-527.
doi:10.1111/j.1834-7819.2000.tb00552.x doi:10.1016/S0022-3913(00)70008-4
[5] Feine, J.S., Carlsson, G.E., Awad, M.A, et al. (2002) The [18] Wostmann, B., Budtz-Jrgensen, E., Jepson N., et al. (2005)
McGill consensus statement on overdentures. Interna- Indications for removable partial dentures: A literature
tional Journal of Prosthodontics, 15, 413-414. review. International Journal of Prosthodontics, 18, 139-
[6] Walton, J.N, Glick, N. and Macentee, M.I. (2009) A ran- 145.
domized clinical trial comparing patient satisfaction and [19] Shah, N. (2003) Gender issues and oral health in elderly
prosthetic outcomes with mandibular overdentures re- Indians. International Dental Journal, 53, 475-484.
tained by one or two implants. International Journal of doi:10.1002/j.1875-595X.2003.tb00890.x
Prosthodontics, 22, 331-339. [20] Zlatari, D.K., elebi, A., Valenti-Peruzovi, M., et al.
[7] Walton, J.N, Glick, N., Macentee, M.I. et al. (1998) (2003) A survey of treatment outcomes with removable

Copyright 2012 SciRes. OPEN ACCESS

 M. K. Etman, D. Bikey / Open Journal of Stomatology 2 (2012) 173-181 181

partial dentures. Journal of Oral Rehabilitation, 30, 847- Patient factors in appreciation of complete dentures. The
854. doi:10.1046/j.1365-2842.2003.01039.x Journal of Prosthetic Dentistry, 17, 322-328.
[21] Jepson, N.J., Thomason. J.M. and Steele, J.G. (1995) The doi:10.1016/0022-3913(67)90002-9
influence of denture design on patient acceptance of par- [35] Youssef, R.E., Throckmorton, G.S., Ellis, E., et al. (1997)
tial dentures. British Dental Journal, 178, 296-300. Comparison of habitual masticatory patterns in men and
doi:10.1038/sj.bdj.4808742 women using a custom computer program. Journal of
[22] Jeffreys, F.E. and Platner, R.L. (1960) Occlusion in re- Prosthetic Dentistry, 78, 179-186.
movable partial dentures. The Journal of Prosthetic Den- doi:10.1016/S0022-3913(97)70123-9
tistry, 10, 912-920. doi:10.1016/0022-3913(60)90125-6 [36] Battistuzzi, P., Kayser, A. and Kanters, N. (1987)) Partial
[23] Colman, A.J. (1967) Occlusal requirements for remov- edentulism, prosthetic treatment and oral function in a
able partial dentures. The Journal of Prosthetic Dentistry, Dutch population. Journal of Oral Rehabilitation, 14, 549-
17, 155-162. doi:10.1016/0022-3913(67)90030-3 555. doi:10.1111/j.1365-2842.1987.tb00751.x
[24] Carr, A.B. and Brown, D.T. (2011) Principles of remov- [37] Klemetti. E. (1996) A review of residual ridge resorption
able partial denture design. In: McCrackens Removable and bone density. Journal of Prosthetic Dentistry, 75,
Partial Prosthodontics, 12th Edition. Elsevier Mosby, St. 512-514. doi:10.1016/S0022-3913(96)90455-2
Louis, 115-129. [38] Tallgren, A. (1972) The continuing reduction of the re-
doi:10.1016/B978-0-323-06990-8.00010-5 sidual alveolar ridges in complete denture wearers: A
[25] Wakabayashi, N., Yatabe, M.A.M., Sato, M., et al. (1998) mixed-longitudinal study covering 25 years. The Journal
The influence of some demographic and clinical variables of Prosthetic Dentistry, 27, 120-132.
on psychosomatic traits of patients requesting replace- doi:10.1016/0022-3913(72)90188-6
ment removable partial dentures. Journal of Oral Reha- [39] Nishimura, I., Hosokawa, R. and Atwood, D.A. (1992)
bilitation, 25, 507-512. The knife-edge tendency in mandibular residual ridges in
doi:10.1046/j.1365-2842.1998.00264.x women. The Journal of Prosthetic Dentistry, 67, 820-826.
[26] Van Waas, M.A.J. (1990) The influence of psychologic doi:10.1016/0022-3913(92)90592-X
factors on patient satisfaction with complete dentures. [40] Yemm, R. (1985) Analysis of patients referred over a
Journal of Prosthetic Dentistry, 63, 545-548. period of five years to a teaching hospital consultant ser-
doi:10.1016/0022-3913(90)90073-L vice in dental prosthetics. British Dental Journal, 159, 304-
[27] Van Waas, M.A.J. (1990) Determinants of dissatisfaction 306. doi:10.1038/sj.bdj.4805715
with dentures: A multiple regression analysis. Journal of [41] Hummel, S.K., Wilson, M.A., Marker, V.A., et al. (2002)
Prosthetic Dentistry, 64, 569-572. Quality of removable partial dentures worn by the adult
doi:10.1016/0022-3913(90)90130-5 US population. Journal of Prosthetic Dentistry, 88, 37-43.
[28] Van Waas, M.A.J. (1990) The influence of clinical vari- [42] Cowan, R.D., Gilbert, J.A., Elledge, D.A., et al. (1991)
ables on patients satisfaction with complete dentures. Patient use of removable partial dentures: Two- and
Journal of Prosthetic Dentistry, 63, 307-310. four-year telephone interviews. The Journal of Prosthetic
doi:10.1016/0022-3913(90)90202-N Dentistry, 65, 668-670.
[29] Carr-Hill, R.A. (1992) The measurement of patient satis- doi:10.1016/0022-3913(91)90204-A
faction. Journal of Public Health Medicine, 14, 236-249. [43] Petridis, H. and Hempton, T.J. (2001) Periodontal con-
[30] Hakestam, U., Sderfelt, B., Rydn, O., et al. (1997) Di- siderations in removable partial denture treatment: A re-
mensions of satisfaction among prosthodontic patients. view of the literature. International Journal of Prostho-
European Journal of Prosthodontics Restorative Dentistry, dontics, 14, 164-172.
5, 111-117. [44] Albino, J.E., Tedesco, L.A. and Conny, D.J. (1984) Pa-
[31] Watson, C.L., Reeve, P.E., Barnes, E., et al. (1986) The tient perceptions of dental-facial esthetics: Shared con-
role of personality in the management of partial dentures. cerns in orthodontics and prosthodontics. The Journal of
Journal of Oral Rehabilitation, 13, 83-91. Prosthetic Dentistry, 52, 9-13.
doi:10.1111/j.1365-2842.1986.tb01558.x doi:10.1016/0022-3913(84)90172-0
[32] Wong, M.M.L., Ettinger, R. and Barsby, M.J. (1995) An [45] Weinstein, M., Schuchman, J., Lieberman, J., et al. (1988)
evaluation of removable partial dentures: A retrospective Age and denture experience as determinants in patient
study. Iowa Dental Journal, 81, 13-16. denture satisfaction. The Journal of Prosthetic Dentistry,
59, 327-329. doi:10.1016/0022-3913(88)90184-9
[33] Langer, A., Michman. J. and Seifert, I. (1961) Factors
influencing satisfaction with complete dentures in geriatric [46] Diehl, R.L., Foerster, U., Sposetti, V.J., et al. (1996) Fac-
patients. The Journal of Prosthetic Dentistry, 11, 1019- tors associated with successful denture therapy. Journal
1031. doi:10.1016/0022-3913(61)90038-5 of Prosthodontics, 5, 84-90.
doi:10.1111/j.1532-849X.1996.tb00279.x
[34] Carlsson, G.E., Otterland, A. and Wennstrm, A. (1967)

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