INTRODUCTION:

Removable partial dentures (RPDs) are considered a widely accepted means of replacing missing natural teeth thereby restoring function and aesthetics in partially edentulous patients.¹

Although other options are available, such as fixed prosthesis and implant-retained-over dentures, RPDs still play a major role in prosthetic rehabilitation owing to financial issues, patient compliance and residual height of edentulous ridges.^2,3. In South East Asian countries such as Sri Lanka, RPDs are still considered the main treatment modality for replacement of missing teeth. Since RPDs are at least partially supported/retained by remaining natural teeth, various studies have been carried out in order to assess their effects on periodontal health, especially plaque accumulation, gingival inflammation, mobility, pocket depth and bone loss.^4,5 Carlsson et al in their 4-year longitudinal study investigated abutment teeth associated with partial dentures, found an increased incidence of gingival inflammation, deepened gingival pockets, mobile abutment teeth, alveolar bone loss and dental caries compared to the base line.⁶ Although there are many studies available in the literature regarding the detrimental effects of RPDs on periodontal health and parameters^6,7,8-10. Therefore, the purpose of this study was to assess the periodontal parameters, plaque score, bleeding on probing, probing pocket depth, gingival recession and loss of attachment of teeth in contact with denture base of RPDs.

MATERIALS AND METHODS:

Patients from regular circulation at saveetha dental college and hospital for prosthetic dentistry having applied for new dentures have been examined and interviewed. The criteria of selection were that patients who wore temporary partial denture for at least 3months. Fourteen patients who had met these criteria were included in the present study.

The patients were divided into the following three groups.

4. Group -1 with maxillary RPD and mandibular natural teeth.

5. Group-2 with maxillary natural teeth and mandibular RPD.

6. Group-3 both maxilla and mandible with RPD.

Subjects' age, gender and periodontal complications were recorded.

Following periodontal complications were recorded

1. Plaque score

2. Bleeding on probing

3. Probing pocket depth

4. Loss of attachment

5. Furcation

6. Mobility.

In other study the patients chewing efficiency and speech after prosthesis was recorded and proved that the chewing efficiency is better after denture inserted. The periodontal health status of the patient was recorded before insertion and called for review after an average of 3 months and again the periodontal health status was recorded. The research was carried out under the guidance of the prosthodontic department of Saveetha dental college and hospital.

The plaque score was measured using (Greene and Vermillion Index), the probing pocket depth was recorded using perio probe with markings, the gingiva index was recorded using(Loe and Silness Index), loss of attachment was also recorded using perio probe but it was measured from CEJ to base of the pocket, the furcation was recorded using Naber's probe And mobility was recorded using(Millers Index)

RESULTS:

Among 22 patients who were selected for the study, 5people belong to first group, 6 people belongs to second group and 11 people belongs to third group of people.Periodontal health status including plaque score, periodontal pocket depth, gingival index, loss of attachment, furcation and mobility were recorded before temporary partial denture insertion. The patients were reviewed after 3-14 months after insertion of TPD. The periodontal health status was again reviewed after insertion. From the following study, it is been graphed the following data of group-1, 2 and 3. The graph is plotted based on the average value of all the indices.

Graph-1reveals the plaque score of all the three group of people and it is been found that the plaque score is high in first group of people both before and after prosthesis.

Graph-2 it reveals the periodontal pocket depth of all groups and it is been found that the PPD is high and compromised in third group of people both before and after prosthesis, it even reveals that PPD is increased for all the group people after insertion of denture.

Graph-3 shows the GI of all the group of peoples and it is been found that second group of people are compromised gingivally and shows the results of chronic gingivitis. It also shows that GI is increased after insertion.

Graph-4 is plotted to show LOA in different group of people and found LOA is excessively high in group-3 people.

Graph-5 and 6 shows the difference in mobility and furcation of tooth in an average of all the groups and it s found that group 1people has maximum of mobility and furcation involvement.

From the above plotted graph it is been shown that the group 3 people are more compromised periodontally when compared to other groups, as it has maximum of LOA, PPD. Next to group3, group1 people are compromised according to the mobility, furcation and PLS.

GRAPH:1 Plaque index score.

GRAPH:2 Periodontal pocket depth.

GRAPH:3 Gingival Index.

GRAPH:4 Loss of attachment

GRAPH:5 Mobility

GRAPH:6 Furcation.

DISCUSSION:

Although there are numerous studies in the literature 11-16 regarding the relationship between RPDs and periodontal health, Therefore, such a study would also facilitate one aspect of the cost effectiveness of education and oral health care provided.

Among 22 patients who were selected the 5 patients were under group-1, 6 people belongs to group-2 and 11 people belongs to group -3. As mentioned above Group-1with maxillary RPD and mandibular natural teeth.Group-2 with maxillary natural teeth and mandibular RPD and. Group-3 both maxilla and mandible with RPD. Categorization of teeth in contact and not in contact with RPDs is considered to be an established method to study possible effects of denture wearing on oral health.17 Various studies have investigated the factors that might be related to occurrence of plaque, calculus accumulation and gingival inflammation, changes in PPD, tooth mobility and GR on abutment and non abutment teeth in patients wearing RPDs11, 18

Studies by Bergman, Bates and Addy, McHenry and Johannsen et al, and Brill and Tryde et al have shown that partial dentures in the mouth increase plaque formation11, 19, 20, 21 particularly, as shown by Ghamrawy, on tooth surfaces in contact with the partial dentures.22The results of this study also confirmed this by demonstrating significant increases in plaque score on teeth in contact with denture bases 3 months and 6 months post denture wearing. Bissada et al (1974) concluded that gingival areas covered by parts of RPDs without relief demonstrated the most adverse periodontal reactions both clinically and his to logically, whereas the uncovered areas were the least affected.23 The most severe gingival changes were seen in areas where an acrylic resin denture base covered the gingival margins. Based on the data in the present study, the authors propose that a distance of 5 to 6 mm be maintained from the gingival margins for all RPD components. Findings from the present study support those from a 1994 study by Yusof and Isa, who reported a significant increase in plaque index, gingival index and LOA of teeth in contact with acrylic resin denture base of RPDs when compared without insertion of denture.

Bissada, Ibrahim et al, Brill, Tryde et al and Stipho, Murphy et al have shown that coverage of marginal gingival tissues with RPDs enhances gingival inflammation around abutment teeth. 23, 21,24This finding is confirmed by the present study as it demonstrated an increase in BOP after insertion of TPD. In this study it is proved that BOP is increased in group-2 people who is wearing lower TPD. In a 10 year retrospective study Kern and Wagner reported an increase in probing depth and tooth mobility in RPD wearers.22 Yeung et al in a clinical study with cobalt-chromium RPDs found that there were significant (p<0.001) increases in probing depths around teeth in contact with RPDs.14Tawse-Smith, Rivillas et al compared the short term clinical effects of an experimental acrylic removable appliance. Their study revealed that the side of the arch in contact with acrylic resin base showed significantly higher gingival index scores and probing depth measurements during the 21 days of the study when contrasted with the side of the arch relieved from the acrylic resin bases.25 After the test prosthesis was discontinued, the PPD measurements returned to baseline levels or better on both sides. The authors concluded that there were potential irritant effects of various denture base designs on gingival tissues.

The results of this study are compatible with the above studies that reported increased findings regarding PPD, GR and LOA in teeth in contact with RPDs. In addition to above results of author we have even conclude that group-3 are more periodontally compromised. Multiple authors have suggested simpler designs, less tissue coverage and frequent recalls for all patients. A number of clinical studies have concluded that proper plaque control in RPD wearers depend on strict recall and optimal personal oral hygiene.26, 27, 28 It is suggested that a denture base kept well relieved from the gingival margin with regular denture and periodontal maintenance will improve periodontal health in RPD wearers.

CONCLUSION:

Removable acrylic resin partial dentures tend to adversely affect periodontal parameters when teeth are in contact with resin base. This effect is increased with longer duration of RPD wear. Therefore, it is recommended to keep the dentures well relieved from the gingival margin wherever possible. Now a days even fixed prosthesis is advised to maintain good oral and periodontal hygiene.

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Received on 19.07.2017 Modified on 30.08.2017

Research J. Pharm. and Tech 2017; 10(12): 4339-4342.

DOI: 10.5958/0974-360X.2017.00795.8