INTRODUCTION:

Removable partial dentures are most commonly and adequately used treatment of choice for patient with missing teeth. It is widely used, as it is economical and acceptable modality of treatment^[1]. Many investigators have studied the effect of removable partial denture on gingival health and have reported that there is significant increase in gingival index, loss of attachment, gingival recession which have been increased even after sufficient amount of gingival relief has been given^[2]. Factors such as rests, contour, connector, extension of denture influence and results in mobility of abutment teeth^[3].

Placement of removable partial dentures in oral cavity seems to influence the already existing ecological situation by deposition of plaque on both abutment teeth as well as non-abutment teeth^[4]. A simple design of removable partial denture will reduce the accumulation of food debris and plaque on teeth and gingival margins. With properly planned prosthetic treatment and adequate maintenance of the oral and denture hygiene, little or no damage will be caused to the remaining teeth and their periodontal support.

Removable partial denture may increase the incidence of caries, damage to periodontium and increases the amount of stress on the natural teeth. The control of dental plaque is important to be obtained for good prognosis and performance for a long period. If there is good alveolar support of abutment teeth, if plaque control is established and if the prosthetics are checked regularly, forces are transmitted to the abutment teeth do not seem to induce periodontal breakdown^[5].

Effect of removable partial denture on gingival health was reported by many investigators. Orr et al^[2] conducted a study to assess the gingival health of patients after the insertion of acrylic resin base plate, the study showed an increase in gingival index after 21 days, the reason for this increase occurred rapidly and irrespective of the degree of the gingival relief, and the results was in correlation with Hobkirk and Strahan^[6] who concluded that partial dentures should provide minimal coverage. The pocket depth was also affected by the placement of RPD since many studies reported an increase in the probing pocket depth following the use of these prosthesis^[6].

Fenner et al^[3] and Browning et al^[7] reported in their study that there is an undesirable effect on the distal extension of a removable partial denture due to increase in the mobility of abutment teeth. Many studies have been conducted to assess the effect of regular check-ups on periodontal health, and some of the studies insisted on periodic recall^[8]. A study was conducted by Bergman et al^[5] where they compared two groups of patients with partial dentures that differ from each other on the basis of periodic recall and concluded that patients who had regular follow up visits had better prognosis.

Temporary removable partial dentures can exert considerable amount of destructive forces due to lack of occlusal rests.As a result of this the abutments may not be adequately supported, and this can affect the periodontal health of the primary abutments. Hence this study was initiated with the aim to assess the effect of removable partial denture on periodontium of abutment teeth in comparison with non -abutment teeth.

METHODOLOGY:

Patients who have been wearing removable partial denture reported to Saveetha Dental College, aged 32 -72 years for review were included in the study.

INCLUSION CRITERIA:

1) Patients wearing temporary partial dentures for more than 2 years.

2) Both the genders.

3) Willingness to participate the study.

EXCLUSION CRITERIA:

1) Patients wearing over dentures.

2) Patients wearing fixed removable prosthesis.

3) Patients wearing removable prosthesis for maxillofacial defects.

EVALUVATION OF OUTCOME MEASURES:

Twenty patients were finally selected for the study based on inclusion and exclusion criteria and informed consent were obtained from them. The patients selected for the study were then subjected to athorough intra oral examination. The primary abutments supporting the temporary partial dentures with retainers were assessed for periodontal status by estimating loss of attachment (LOA) and gingival recession. Loss of attachment (LOA) and gingival recessionwas measured using Williams probe and read to nearest millimetres (mm) at four areas (mesiobuccal, distobuccal, mesiolingual, distolingual) for each tooth.Teeth used as primary abutments supporting retainers for removable partial denture were used as experimental groups and the abutments adjacent to this were taken as control group.The examination was done by single operator and obtained data were tabulated and statistically analysed.

RESULT:

The mean value of loss of attachment of abutment teeth was found to be 1.98+0.28mm and non-abutment tooth was 1.58+0.34 mm and statistically significant difference was observed between the primary and control abutments (T value=5.55, P value<0.001) (Table 1), while the mean value of gingival recession of abutment teeth and non-abutment teeth was found to be 1.69+0.47 mm and 1.16+0.24 mm respectively and statistically significant difference was observed between the primary and control abutments (T value=4.67, P value < 0.001) (Table2).

TABLE 1:

LOSS OF ATTACHMENT BETWEEN PRIMARY AND CONTROL GROUPS

Mean

Standard Deviation

T value

P value

Primary abutment with retainer

1.98

0.28

5.55

0.001

Secondary abutment without retainer

1.58

0.34

TABLE :2

GINGIVAL RECESSION BETWEEN PRIMARY AND CONTROL GROUPS

Mean

Standard Deviation

T value

P value

Primary abutment with retainer

1.69

0.47

4.67

0.001

Secondary abutment without retainer

1.16

0.24

DISCUSSION:

From the study results, it is significant that there is high risk of development of gingivitis, periodontitis in patients wearing removable partial denture. In the clinical study, loss of attachment of gingiva is used because it is more representative measurement of periodontal ligament destruction than clinical pocket depth.

In previous study conducted by Dubravka on effect of removable partialdentures on periodontalhealth of abutment and non-abutment teethshowed a significant difference(P <0.01) were noted for plaque (PI), gingival index (GI), calculus index (CI) and Tarbet index (TI), probing depth (PD), gingival recession (GR), and tooth mobility (TM)between abutment and non-abutment teeth, with abutment teeth showing more disease^[9].The influence of removable partial dentures (RPD) on the periodontal health of abutment and non-abutment teeth was evaluatedin a study conducted by Linda J. Dulabased on periodontal parameters such as plaque index (PLI), calculus index (CI), bleeding on probing (BOP), probing depth (PD) (mm) and tooth mobility (TM) index. These measurements were taken immediately before insertion the RPD, then one and 3 months after insertion of RPD.The results showed a significant difference between abutment and non-abutment teeth after 3 months with regard to the bleeding on probing(BOP) (1.53 ± 0.50 and 1.76 ± 0.43 respectively), probing depth(PD) (0.28 ± 0.45 and 0.12 ± 0.33 respectively) and plaque index(PLI) (1.20 ± 0.46 and 0.75 ± 0.64 respectively)^[10].According toAmaral BA, plaque index values significantly increased after 1-year of RPD's wearing in abutment teeth, comparing with non-abutment teeth. From the initial assessment to 1-year of wearing RPD it was found that probing depth and gingival index were increased^[11].

According to Samir et al., in their study assessed the periodontal status of abutment and non-abutment teeth in 36 patients wearing RPD for at least 3 years and concluded that direct abutments teeth are more periodontal affected than non-abutments teeth.Further, according to Bergman et al., it was concluded that there were no periodontal changes in patients wearing the RPD's after a 10 year^[12].Education, awareness and motivation during the construction of removable partial denture were not assessed in our study. Due to this fact, it is important to stress the importance of awareness, level of education, level of motivation in similar condition.In another study conducted by Akaltan F and Kapur K, assessment of education, motivation and awareness of the patients wearing RPD's was done. There was minor difference in periodontal changes in initial stage,which was important for diagnosis and planning of treatment.The results concluded that well planned prosthetic treatment, with an appropriate designs and good oral hygiene can reduce changes that may affect in periodontal disease of abutment teeth^[13,14].

Regarding the reaction of periodontium to removable partial denture several studies has reported a variation between extensive to moderate periodontal changes after construction of removable partial dentures^[15,16,17]. But the studies conducted by Plontick IJand Glickman I have shown that wearing removable partial denture is threat to periodontal tissues and lead to increased mobility of abutment teeth ^[18,19].If the prosthesis is regularly checked and indicated procedure is performed, the forces transmitted to teeth do not seem to induce periodontal breakdown.

Removable partial denture should be constructed with adequate abutment support, good periodontal health and with proper occlusion. In removable partial denture number of abutment teeth used is also major factor which influences the periodontal status ^[20].Occlusal rest in partial dentures transmits or directs the forces along the vertical axis of the teeth. It is constructed in such a way that it is seated on spoon shaped preparation in the abutment teeth with floor inclined so that deepest point is towards the vertical axis of the teeth^[21].

Removable partial dentures comes in direct contact with soft tissue in the oral cavity. This direct contact of the denture with oral cavity can sometimes transmits the occlusal load to adjacent soft tissues like buccal mucosa and gingiva may lead to ulcers and injury of the soft tissue. This injury can be minimised with proper designing of the denture and also the denture wearing habits of the patients. The type of clasp have a greater influence on the amount of denture displacement.

The main reason for failure of removable partial denture is loss of abutment teeth due to periodontal changes and caries. When temporary partial dentures not subsequently replaced with cast partial dentures, the primary abutments are subjected to severe occlusal stress, this stress will be translated into the supporting tissues and will manifest as periodontal detoriation characterised by gingival recession, loss of attachment and eventual bone loss.

This failure can be prevented by proper planning of removable partial dentures,patients education, oral hygiene maintenance, maintenance of removable partial denture and routine dental followups.

CONCLUSION:

The patients receiving removable partial denture should be carefully motivated,educated and instructed to prevent periodontal diseases. With carefully designed prosthetic treatment and adequate maintenance of oral hygiene, little or no damage will be caused to remaining teeth and their periodontal support. Periodic recall for review of dentures helps to avoid compromises in oral health.

REFERENCE:

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2 Orr S, Liden GJ, NewmanHN. The effect of removable partial denture connectors on gingival health. J Clinic Periodontal 1969:7:15-21

3 Fenner W, Gerber A, Muhlemann HR. Tooth mobility changes during treatment with partial prosthesis. J Prosthet Dent 1986;55(3):347-351.Qudah SA, Nassrawin N. Effect of removable partial denture on periodontal health. JRMS. 2004 Dec;11(2):17-9.

4 GHAMRAWY E. Quantitative changes in dental plaque formation related to removable partial dentures. Journal of Oral Rehabilitation. 1976 Apr 1;3(2):115-20.

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Received on 02.02.2018 Modified on 27.02.2018

Research J. Pharm. and Tech 2018; 11(6): 2587-2590.

DOI: 10.5958/0974-360X.2018.00478.X