Vermeulen Et Al 1996, Frameprotheses Overleving

6
Ten-year evaluation of removable partial dentures: Survival rates based on retreatment, not wearing and replacement A. H. B. M. Vermeulen, DDS, PhD,” H. M. A. M. Keltjens, DDS, PhD,” M. A. van% Hof, PhD,b and A. F. Kayser, DDS, PhD” Trikon, Institute for Dental Clinical Research, School of Dentistry, University of Nijmegen, Nijmegen, The N e t h e r la n d s From a group of 1480 patients, 1036 were treated with metal frame removable partial dentures (RPDs) at least 5 years before this analysis. Of those, 7 48 patients who wore 886 RPDs were followed up between 5 and 10 years; 288 patients dropped out. The 748 patients in the study groups were wearing 703 conventionally designed metal frame RPDs and 183 RPDs with attachments. When dropout patients and patients who remained in the study were com- pared, no differences were shown in the variables analyzed, which indicated that the dropouts did not bias the results. Survival rates of the RPDs were calculated by different failure criteria. Taking abutmen t retreatment as failure criterion, 40% of the conventional RPDs survived 5 years and more than 20% surviv ed 10 years. In RPDs with attachments crowning abutments seemed to retard abu tment retreatment. Fracture of the metal frame was found in 10% to 20% of the RPDs after 5 years and in 27% to 44% after 10 years. Extension base RPDs needed more adjustments of the denture base than did tooth-supported base RPDs. Taking replacement or not wearing the RPD as failure criteria, the survival rate was 75% after 5 years and 50% after 10 years (half-life time). The treatment approach in this study was characterized by a simple design of the RPD and regular surveillance of the patient in a recall system. (J &-osthet Dent 1996;76:267-72.) I n many countries a major part of the population has an i ncomple te but still functiona l dentition. A sub- stantial number of these edentulous portions of the den- tal arch are not prosthe tically restored,l and man y pa- tients are functioning with a shortened dental arch with- out any need for treatment.2 Nevertheless, restoring oral function and appearance is often necessary; there is a particularly higher percentage of replacem ents in higher economic gr0ups.l Treatment options to replace missing teeth are either fixed or removable appliances; each has its own indica- tion.3 The first reports about removable partial dentures (RPDs) indicated that these restorations could deterio- rate the health of remaining dentition and surrounding oral tissues.4,5 Few partial dentures survived for more than 5 to 6 years.6 Other studies demonstrated more fa - vorable results with respect to treatment with RPDs and suggested that the negative effects could be counteracted by a carefully planned prosthetic treatment and regular recall appo intmen ts that included patient instruction , retreatments of teeth, and prosthetic adjustments.7-g Studies of the follow-up of a large number of RPD s over an extended period are scarce. This article presents the results of a lo-year longitudinal stud y of patients (n “Assistant Professor , Department of Oral Function and Pros- thetic Dentistry. bAssociate Professor, Department of Statistical Consultation. cProfessor, Department of Oral Function and Prosthetic Den- tistry. SEPTEMBER 1996 = 748) treated with RPDs and includes ‘703 conventional metal frame RPDs and 183 RPDs with attachments. By extrapolat ing survival curves, the efficacy of the treat- ment and the need for retreatment could be determined. MATERIAL AND METHODS Participants The patients for this historic study were recruited from the clinic of the Dental School in Nijmegen, The Nether- lands. The total sam ple co nsisted of 1480 patients, 68% ofwhom were wome n. The mean age was 38 years (range 19 to 72 years). Fifty-five patients were treated with an acrylic resin RPD only and were excluded from the study. To ensure a reasonable follow-up time, only those pa- tients who started their treatme nt at least 5 years be- fore this analysis were selected, resulting in an exclu- sion of 389 patien ts. The remaining patients (n = 1036) were treated with a metal frame RPD that could be of a conventional design or provided with attachme nts. The RPDs were subdivided into extension base and tooth- supported base categories. All patients participated in a mainte nance program and returned for follow-up at g-mon th intervals. Patients who did not return for follow-up regularly (288) were considered “lost to follow-up,” and data of these patients were om itted when they did not return for at least 2 years. The data of the patients were collected by stu- dents and checked by staff mem bers. The data collection procedure was explained to the students. THE JOURNAL OF PROSTHETIC DENTIST RY 267

Transcript of Vermeulen Et Al 1996, Frameprotheses Overleving

7/27/2019 Vermeulen Et Al 1996, Frameprotheses Overleving

http://slidepdf.com/reader/full/vermeulen-et-al-1996-frameprotheses-overleving 1/6

Ten-year evaluation of removable partial dentures: Survival

rates based on retreatment, not wearing and replacement

A. H. B. M. Vermeulen, DDS, PhD,” H. M. A. M. Kelt jens, DDS, PhD,”

M. A. van% Hof, PhD,b and A. F. Kayser, DDS, PhD”Trikon, Institute for Dental Clinical Research, School of Dentistry, University of

Ni jmegen, Ni jmegen, The Nether lands

From a group of 1480 patients, 1036 were treated with metal frame removable

partial dentures (RPDs) at least 5 years before this analysis. Of those, 7 48

patients who wore 886 RPDs were followed up between 5 and 10 years; 288

patients dropped out. The 748 patients in the study groups were wearing 703

conventionally designed metal frame RPDs and 183 RPDs with attachments.

When dropout patients and patients who remained in the study were com-

pared, no differences were shown in the variables analyzed, which indicated

that the dropouts did not bias the results. Survival rates of the RPDs were

calculated by different failure criteria. Taking abutmen t retreatment as

failure criterion, 40% of the conventional RPDs survived 5 years and more

than 20% survived 10 years. In RPDs with attachments crowning abutments

seemed to retard abu tment retreatment. Fracture of the metal frame was

found in 10% to 20% of the RPDs after 5 years and in 27% to 44% after 10 years.

Extension base RPDs needed more adjustments of the denture base than did

tooth-supported base RPDs. Taking replacement or not wearing the RPD as

failure criteria, the survival rate was 75% after 5 years and 50% after 10 years

(half-life time). The treatment approach in this study was characterized by asimple design of the RPD and regular surveillance of the patient in a recall

system. (J &-osthet Dent 1996;76:267-72.)

I n many countries a major part of the populat ion

has a n incomplete but stil l functiona l dentition. A sub-

stantial number of these edentulous port ions of the den-

tal arch are not prosthetically restored,l and many pa-

t ients are functioning with a shortened dental arch with-

out any need for treatment.2 Nevertheless, restoring oral

function and appearance is often necessary; there is a

particularly higher percentage of replacem ents in higher

economic gr0ups.l

Treatment options to replace missing teeth are ei ther

f ixed or removable appl iances; each has i ts own indica-

t ion.3 The f i rst reports about removable part ial dentures

(RPDs) indicated that these restorations could deter io-

rate the health of remaining dentition and surrounding

oral t issues.4,5 Few part ial dentures survived for more

than 5 to 6 years.6 Other studies demonstrated more fa-

vorable resul ts wi th respect to treatment with RPDs and

suggested that the negative effects could be counteracted

by a careful ly planned prosthetic treatment and regular

recal l appointments that included patient instruction,

retreatments of teeth, and prosthetic adjustments.7-g

Studies of the fol low-up of a large number of RPD s

over an extended per iod are scarce. This art ic le presents

the results of a lo-year longitudinal stud y of patients (n

“Assistant Professor, Department of Oral Function and Pros-

thetic Dentistry.

bAssociate Professor, Department of Statistical Consultation.

cProfessor, Department of Oral Function and Prosthetic Den-

tistry.

SEPTEMBER 1996

= 748) treated with RPD s and includes ‘703 conventional

metal f rame RPDs and 183 RPDs w i th at tachments . By

extrapolating survival curves, the eff icacy o f the treat-

ment and the need for retreatment could be determined.

MATERIAL AND METHODS

Participants

The patients for this histor ic study were recruited from

the cl inic of the Dental School in Ni jmegen, The Nether-

lands. The total sam ple co nsisted of 1480 patients, 68%

ofwhom were wome n. The mean age was 38 years (range

19 to 72 years). Fi fty- f ive patients were treated with an

acryl ic resin RPD only and were excluded from the study.

To ensure a reasonable fol low-up t ime, only those pa-

t ients who star ted their treatme nt at least 5 years be-

fore this analysis were selected, resul ting in an exclu-

sion of 389 patients. The remaining patients (n = 1036)

were treated with a metal frame RPD that could be of a

conventional design or provided with attachme nts. The

RPD s were subdivided into extension base and tooth-

supported base categor ies.All patients participated in a mainte nance program

and returned for follow-up at g-mon th intervals. Patients

who did not return for follow-up regularly (288) were

considered “ lost to fol low-up,” and data of these patients

were om itted when they did not return for at least 2

years. The data of the patients were col lected by stu-

dents and checked by staff mem bers. The data col lection

procedure was explained to the students.

THE JOURNAL OF PROSTHETIC DENTIST RY 26 7

7/27/2019 Vermeulen Et Al 1996, Frameprotheses Overleving

http://slidepdf.com/reader/full/vermeulen-et-al-1996-frameprotheses-overleving 2/6

THE JOURNAL OF PROSTHETIC DENTISTRY VERMEULE N ET AL

Table I. Survival (% + SD) after 5 and 10 years for conventional RPD s (n = 703) according to di fferent fai lure reasons

(read from survival curves)

Maxilla Mandib le

Failure reason Extension base Tooth-supported base Extension base Tooth-supported base

Initial No. 78

Abutme nt retreatment (yr)

5 38 + 6

10 23 IL 8

Adjustmen t denture base (yr)

5 60 + 6

10 40 + 9

RPD fracture (yr)

5 84 + 5

10 65 f 9

168 338 119

41+ 4 38 f 3 38 zt 5

22 + 5 26 f 4 16 + 5

82 + 3 65 ZL 3 75 f 4

55 + 6 41 f 4 55 f 7

89 f 3 86 + 2 82 + 4

73 f 5 72 + 4 56 + 7

Table II . Survival (% + SD) after 5 and 10 years for RPD s with attachme nts (n = 183) divided into di fferent fai lure

reasons (read from survival curves)

Max i l la Mandib le

Failure reason Extension base Tooth-supported base Extension base Tooth-supported base

Original No. 21 20 83 59

Abutme nt retreatment (yr)

5 76 + 10 75 + 11 68 zi 6 592 7

10 48 ir 17 41+ 18 45 * 9 30 + 10

Adjustmen t denture base (yr)

5 72+11 83+ 9 29 + 5 89+ 4

10 36 + 17 66 f 17 10 + 5 65 k 10

RPD fracture (yr)

5 84 + 9 88+ 8 80 f 5 842 5

10 - 59 f 18 64 + 8 63 zk 10

Criteria of evaluation

At the star t of the study the distribution of the re-

maining denti t ion and the dental heal th was scored with

the fol lowing standard method s:

ment of fai lure. This treatment could be a new restora-

t ion or extraction. For si tuations that required extrac-

t ion, i t could be necessary to adapt the RPD to the new

environment.

1. caries determina tion with a mirror, explorer, and ra-

diographs,

2. pocket measuremen t with a pocket probe (Wil l iams,

Hu Fr iedy, Chicago) lO

3. determination of tooth mobi l ity wi th a 4-point scale,i i

an d

Corrections of the RPD i tsel f could have occurred dur-

ing the evaluation per iod. This retreatment consisted of

repairing, relining, rebasing, or recons truction of the

R PD .

4. measureme nt of the alveolar bone height on radio-graphs.

The f i rst retreatment caused b y fracture of the appl i-

ance or resorption of the alveolar ridge resulting in ad-

justment of the denture base marked the mom ent of fai l-ure.

The denti t ions were categor ized according to the

Kennedy Classi f ication. I2 Dur ing the recal l v isits the

changes tha t occurred to the teeth, the restorations, and

the RPD s were recorded. Moreover, al l retreatment of

the RPD s and treatments of the abutment teeth were

recorded. To study the survival rates of RPD s, three rea-

sons for fai lure were dist inguished: (1) treatment of the

abutment teeth, (2) corrections of the RPD , and (3) re-

placement of or not wear ing the RPD. For the survival

analysis on the basis of abutment treatment, the f i rst

treatment of one of the abutment teeth marked the mo-

For these failure reaso ns, 5- and lo-year survival rates

were read from the Kaplan-Meier survival curves (Tables

I and II) .

Som e of the earlier mentione d failure reasons 1 and 2

resul ted in restorative treatment of the abutment teeth

or corrections of the RPD s. However, these RP Ds were

functioning again after the adjustments had been per-

formed without any problems. Therefore Kaplan-Meier

survival curves were calculated, reflecting the percent-

age of RPD s that were replaced completely or not worn

anymore (Fig. 1). In si tuations that require replacement

26 8 VOLUME 76 NUMBER 3

7/27/2019 Vermeulen Et Al 1996, Frameprotheses Overleving

http://slidepdf.com/reader/full/vermeulen-et-al-1996-frameprotheses-overleving 3/6

VERMEULEN ET AL THE JOURNAL OF PROSTHETIC DENTIST RY

CONVENTIONAL RPD’s

mandible

---j-- extension base - -@- -II=338

tooth-supportedn=119

10 0 -~--__

00

60

50

base

3. -‘-L-i- I0 12 3 4 5 6 7 a 0 lo

YEARS

RPD’s w ith ATTACHM ENTS RPD’s w i th ATTACHMENTS

mandible maxilla

L0 - L----L ___..-l _-___-'J.---L-.. J0 12 3 4 5 6 7 6 9 10

YEARS

CONVENTIONAL RPDs

maxilla

+ extension basen=78

loo r--T--

-9 - tooth-sup ported basen=168

L i40 ..L----L--I---L.-L--I L---l----0 12 3 4 5 6 7 6 9 10

YEARS

+ extension basen=21

100 "

so -

60 -

- -o- - tooth-supp orted basen=ZCt

30

2n -

,o -L---L-A-1-1 _---- ;-,y

0 12 3 d 5 0 IO

YEARS

Fig. 1. Survival curves o f RPD s on basis of replacement and not wear ing RPD .

or not wear ing the RPD , only the fai lure reason wa s

scored. Other fai lure reasons could occur simultaneously.

RESULTS

Dropout

Dropout

Because 288 patients dropped out and might bias the

resul ts of the study, the study group and the dropout

group were compared on the basis of seven var iables:

age, sex, number and type of remaining teeth, num ber

of abutment teeth, type of prosthesis, dental visi ts, andtreatment satisfaction.

First, a questionnaire was mailed to all dropout pa-

t ients. Those who did not respond were cal led by tele-

phone and requested to answer the questionnaire.

The dropouts and study group were matched with re-

spect to the mom ent of intake in the study, age, sex, and

type of prosthesis received. It was only possible to per-

form this for the dropouts between 25 and 65 years old.

Final ly, 593 patients of the study group and 248 drop-

outs remained in the dropout analysis.

A three-way analysis of var iance (dropout, sex, and

age) was appl ied to the seven mentioned var iables.

Of the 288 dropout patients, 149 (53%) responded to

the questionn aire, 129 (45%) did not respond , and 10

(3%) had died. Table II I summ arizes the reasons for the

dropout. The mos t important reason for not returning

for the recall ap pointments was “no t ime”; “moving out

of the region” was another frequent reason. An indica-

t ion for the dental awareness of the dropout group wa sthe fact that 80% of the responding dropouts were sti ll

visiting a den tist regularly.

The patient’s judgment with respect to the resul t and

the procedures of the treatment was included in the ques-

t ionnaire. Of the dropouts, 88% were satisf ied with the

resul t and 96% with the procedure of the treatment. For

5% of the patients dissatisfaction was the pr imary rea-

son for dropout (Table II I) . Seven percent of the drop-

outs did not wear the RP D in the maxi lla and 13% in the

mandible. In this aspect no di fference was found com -

pared to patients remaining in the study group.

The dropout groups and study groups were evaluated

SEPTEMBER 1936 26 9

7/27/2019 Vermeulen Et Al 1996, Frameprotheses Overleving

http://slidepdf.com/reader/full/vermeulen-et-al-1996-frameprotheses-overleving 4/6

THE JOURNAL OF PROSTHETIC DENTISTRY VERMEULEN ET AL

Table III. Overview of reasons for dropout (a = 149)

Reason for dropout

No t ime

Moved

Prefer another dentist

Noncompl iance

Recal l procedure unknown

Dissatisf ied with treatment

No reason

%

34

29

12

10

5

5

5

with respect to classi f ication and type of prosthesis (Table

IV). Analysis of the classi f ication showed that for the

mand ible the nonresponding dropout group contained

significan tly more patien ts with a natural dentition (p =

0.04). Moreover, for the maxi l la signi f icantly more pa-

t ients were included in the study group who were classi-

f ied as Kennedy I and II (JI = 0.04) (Table IV). Analysis

of the type of prosthesis demonstrated that in al l drop-

out groups more patients with a complete denture were

included (p = 0.03) (Table IV). As shown in Table V, the

clinical variables for the different groups w ere similar

and did not reveal a significant difference betwee n

groups.

The dropout analysis showed that no ser ious activi ty

occurred as a resul t of dropout.

Survival rates of RPDs

In total , 886 RPD s worn by 748 patients were ana-

lyzed: 703 conventional metal frame RPD s (Table I) and

183 with attachme nts (Table II) . The distribution per

jaw and the di fferentiat ion into extension base and tooth-

supported base is also given. Mos t of the RPD s were in-

serted in the mandible; especial ly conventional exten-

sion-base RPD s consti tuted the larger part of the total

number of RPDs.

The number and survival percentages of the RPD s

after 5 and 10 years are shown in Tables I and II. By

use of the f i rst retreatment of one of the abutment teeth

as the criterion for failure, approx imately 40% of the

conventional RPD s survived 5 years and over 20% sur-

vived 10 years (Table I) . Between mandible and max-

i lla or extension-base and tooth-supported base RPD s,

only sl ight di fferences were noticed. For RPD s with at-tachme nts “abutment retreatment” resul ted in 59% to

76% survival after 5 years and 30% to 48% after 10

years.

Treatments related to adjustments of the denture base,

such as rel ining, rebasing, or reconstruction, were combined

as one cause of fai lure. A higher percentage of extension-

base RPD s needed an adjustment ofthe denture base within

a shorter t ime than did tooth-supported base RPD s. This

phenomenon was found especial ly in extension-base RPD s

with attachmen ts in the mandible (Table II) .

Another factor of fai lure was fracture of the RPD . The

percentage of extension-base RPD s with attachme nts in

the maxi l la after 10 years is not presented because of

the low number at r isk at that m ome nt. The percentage

of RPD s that presented no fracture within 5 years was

80% to 90%; after 10 years the percentages of RPD s with

no fracture var ied between 56% and 73%.

The di fferences within the groups of conventionalRPD s and within the groups of RPD s with attachm ents

were limited. Figure 1 il lustrates the Kaplan-Meier sur-

vival curves over 10 years for the di fferent RPD s. These

curves demonstrated that after 10 years about 50% of

al l RPDs were sti l l functioning.

Extension-base conventional RPD s tended to show

lower survival percentages than did tooth-supported base

RPD s. For RPD s with attachm ents in the mandible the

survival curves of the extension-base RPD s were less

favorable than those with tooth-supported bases. The

reason “no t wearing” accou nted for 5% of the failures in

RPD s with attachm ents, whereas in conventional RPD s

these percentages were 8% for the mandible and 4% for

the maxi l la.

DISCUSSION

This longitudinal study was conducted on 748 patients

with 886 RPD s examined dur ing a 5- to lo-year span.

In the ear lier studies car ies activi ty was reported to be

This research was not a controlled clinical trial and there-

high in patients with RPDs .4J3 This study does not support

fore some aspects should be interpreted careful ly. In

part icular , when cast restorations were needed on abut-

these negative effects. The resul ts of this study are in agree-

men ts, the choice between a conventional ly designed

RPD with only crowned abutmen ts or an RPD with at-

tachme nts was part ial ly dependent on the interest and

ment with those o f Bergman et a1.,7 who did not f ind a

exper ience of the staff membe r and the student. Another

phenomenon observed was also the high retreatment

marked increase in car ies caused by wear ing RPD s. In the

need of extension-base RPD s with attachm ents, leading

to a decrease of these restorations in later groups. For

current study and the study of Bergman et al . patients were

these reasons, i t is not appropr iate to compare the re-

kept under survei llance in an active recal l system , which

sul ts of RPD s with and without attachm ents.

was probably responsible for the low caries increase . A re-cent study by Drake and BeckI demonstrated the impor-

tance of patient educa tion, good oral self-care, and regular

professional recall for people who wear RPDs.

In 40% and 20% of the jaws with conventional RPD s

no restorative retreatment of any of the abutment teeth

was performed after 5 and 10 years, respectively.

Bergman et a1.7 reported 44% of the abutment teeth in

need of restorative treatment after 10 years. These per-

centages give the impression that in this study the re-

sul ts were more unfavorable. I t should be considered,

however, that the f i rst restorative treatment of one of

the abutment teeth w as taken as a cr i ter ion for fai Iure

27 0 VOLUME 76 NUMBER 3

7/27/2019 Vermeulen Et Al 1996, Frameprotheses Overleving

http://slidepdf.com/reader/full/vermeulen-et-al-1996-frameprotheses-overleving 5/6

VEFlMEULEN ET AL THE JOURNAL OF PROSTHETIC DENTIST RY

Table IV. Distribution of stud y group (n = 593) and dropout group (n = 248) according to classification and type of

prosthe sis in max illa and mandible (in percenta ges)

Max i l la Mandib le

Study

group

Dropout group Study Dropout group

group

R N-R R N-R

Edentulous area

Complete

Kennedy I and II

Kennedy III

Kennedy IV

Natural dentition

Type of prosthesis

Complete denture

Free-end

Non free-end

No denture

28 32 25 -

36 26 26 62

28 32 32 31

3 5 7 3

5 5 10 4

28 37 35 1 8 16

19 13 10 54 54 40

28 28 27 24 18 22

25 22 27 20 18 22

69 51

27 36

1 0

3 13

I?, Respond ing dropout group; N-R, nonresponding dropout group.

Table V. Cl inical var iables of study and dropout groups (mean values)

Study group

(n = 593)

Dropout group

SD, total group

N-R

R (n = 139) (n = 109)

Total No. of teeth 16.5 16.1

No. of sound teeth 6.2 6.3

No. of abutment teeth 4.6 4.6

Bone height” 92.5 91.0

Mobility 0.17 0.12

R, Responding dropout group; N-R, nonresponding dropout group.

“Bone height expressed as a percentage of the maximum height of two thirds root length.

17.9 4.5

7.2 3.0

4.2 1.0

94.3 8

0.21 0.10

and that most RPD s had several abutm ents, leading to

a higher fai lure r isk per RPD . Moreover, many abut-

me nts were fi l led with plastic fi l l ing mate rials and only

one third were crown ed, which resulted in a large por-

t ion of abutment teeth at r isk for retreatment.

RPD s with attachments included a var ied col lection

of designs. M ost extension-base RPD s were provided with

Dolder bars and bal l or Dalbo a ttachme nts, whereas in the

non-free end ones primarily Dolder bars were used.15-17 The

survival curves, wi th the f i rst restorative treatment of an

abutment tooth as a cr i ter ion for fai lure, indicated that

cast crowns gave a retardation of decay as reported in ear-

l ier studies.8J3 The resul ts seemed to be comparable with

those of other studies18Jg when the values in this study are

reduced to two abutments per jaw.

As may be expected, extension-base RPD s, especial ly

in the mand ible, needed a higher percentage of adjust-

ments of the denture base. This can be explained by the

progression of the resorption in the edentulous parts of

the jaw, which was probably intensif ied by the pressure

of the free-end denture base. Bergman et al7 also re-

ported a great number of denture base adjustments af-

SEPTEMBER 1096 27 1

ter 10 years in a population that ha d a large nu mber of

extension-base RPDs.

Many of the extension-base RPD s were provided with

bal l attachm ents, which m ay be responsible for the un-

favorable resul ts of the RPD s with attachments. Dur ing

the f i rst years of the study the bal l attachme nts were

not provided with occlusal rests, resul ting in excessive

pressure on the alveolar bone and as a consequence a

high resorption rate, responsible for the high numb er of

adjustments needed. This problem could be prevented i fthe bal l attachme nts were suppl ied with vert ical occlusal

stops.=

Fracture of the RPD w as found in 17% after 5 years,

increasing to 35% after 10 years. A study of Korber et

a1.20 showed a repair percentage of 40% after 5 years, of

which 15% was exclusively caused by fracture of metal-

l ic parts. Spiekermanr?l reported a clasp fracture per-

centage of 19% after 4 .5 years. In fact, the fracture per-

centages of RPD s can be considered low consider ing the

high number of casting defects and inaccuracies men-

tioned in several studies.22,23

When replacement and not wear ing of the RPD were

7/27/2019 Vermeulen Et Al 1996, Frameprotheses Overleving

http://slidepdf.com/reader/full/vermeulen-et-al-1996-frameprotheses-overleving 6/6

THE JOURNAL OF PROSTHETIC DENTIST RY VERMEULEN ET AL

combined as a cr i ter ion for fai lure, about 50% of the RPDs

survived 10 years. This f inding is in contrast wi th the

resul ts of Wetherel l and Smales,‘ j who reported that only

few prostheses lasted for more than 5 to 6 years.

Wetherel l and Smale@ and Roberts5 reported a large

number of RPD s that were not worn. Because of a prob-lem-oriented approach used in this stud y, a higher per-

centage of RPD s were worn by the patientsz4 The re-

sul ts of this study are confi rmed by Cowan et a1.,25 who

reported a high number of patien ts wearing their RPD

several years after insertion without apparent problems.

CONCLUSIONS

Within the l imits of this study i t was concluded that

the survival rate for conventional metal frame RPD s, on

the basis of replacement and not wear ing, is approxi-

mately 75% after 5 years and 50% after 10 years ( the so-

cal led hal f l ifet ime). The negative effect of an RPD on

the remaining teeth can be kept to a minimum .

With a simple RPD design and a regular survei llance

of the patient in a recall system with an individual ly

adjusted interval, the resul ts of RPD treatment wi l l en-

sure predictability.

REFERENCES

1. Battis tuzzi P, Kayser AF, Kanters N. Partial edentulism, prosthetic

treatment and oral function in a Dutch popula tion. J Oral Reha bil

1987;14:549-55.

2. Witter DJ, Elteren van P, Kayser AF. Signs and symptoms of man-

dibular dysfunction in shortened dental arches. J Oral Reha bil

1988;15:413-20.

3. Zarb GA, Bergman B, Clayton JA, MacKay HF. Prosthodontic treat-

ment for partially edentulous patients. 8th ed. St. Louis: Mosby, 1980.

4. Carlsson GE, Hedegard B, Koivumaa KK. Studies in partial dental

prosthesis, IV: f inal results of a 4-year longitu dinal investigation of

dentoging ivally supported pa rtial dentures, Acta Odontol Stand

1965;23:443-72.

5. Roberts BW. A survey of chrome-cobalt partial dentures. N Z Dent J

1978;74:203-9.

6. Wetherell JD, Smales RJ. Partial denture failures: a long term clini-

cal survey. J Dent 1980;8:333-40.

7. Bergman B, Hugoson A, Olsson C. Caries, periodonta l and prosthetic

findings in patients with removable partial dentures: a ten-year lon-

gitudin al study. J Prosthet Dent 1982;48:506-14.

8. Schwalm CA, Smith DE, Erickson JD. A c linical study of patients 1

to 2 years after placement of removable partial dentures. J Prosthet

Dent 1977;38:380-91.

9. Rissin L, Feldman RS, Kapur KK, Chauncey HH. Six-year report of

the periodonta l health of f ixed and removable partial denture abut-

ment teeth. J Prosthet Dent 1985 ;54:461-7.

10. Rateitschak KH, Reng gli HH, Muhle mann HR. Parodon tologie. 2nd

ed. Stuttgart: Thieme, 1978.

11. Caranza FA. Glickman’s c linical periodontology. 5th ed. Philad elphia :

WB Saunders Co, 1979.

12. Appleg ate OC. Essentials of removable partial denture prosthesis.3rd ed. Phi ladelphia: Saunders, 1965.

13. Henrich H, Kerschbaum T. Frequency of caries-related sequelae in

the unsupervised use of a removable partial denture [ in German].

Dtsch Zahnarztl Z 1980;35:926-30 .

14. Drake CW, Beck JD. The oral status of elderly removable partial

denture wearers. J Oral Reha bil 1993;20:53-60.

15. Preiskel HW. Precis ion attachments in dentistry. 3rd ed. St. Louis:

Mosby, 1979.

16. Dolder EJ, Durrer GT. The bar-joint denture. Chicago: Quintessence.

1978.

1 7. Owall B. Precis ion attachment-retained removable partial de ntures,

Part 2: long-term study of ball attachments. Int J Prosthodont

1995;8:21-8.

1 8. Luzi C. Die steg-geschiebe-prothese: Nachuntersuchungen nach

15ingerer Tragzeit. SSO 1974;84:261-90 .

1 9. Lofberg PG, Ericson G, Eliasson S. A c linical and radiographic evalu-

ation of removable partial dentures retained by attachments to al-veolar bars. J Prosthet Dent 1 982;47:126-32.

20. Korber E, Lehma nn K, Pangid is C. Control studies on periodontal

and periodontal-gin gival retention of partial prosthesis [ in German].

Dtsch Zahnarztl Z 1975;30:77-84.

21. Spiekermann H. Follow-up studies on mode l cast prostheses after 4

years’ wear [ in German]. Dtsch Zahnarztl Z 1975;30:689-9 1.

22. Eerikainen E, Rantanen T. Inaccuracies and defects in frameworks

for removable partial dentures. J Oral Reha bil 1986;13:347-53 .

23. Ben-Ur Z, Patae l H, Cardash HS, Baharav H. The fracture of cobalt-

chromium alloy removable partial dentures. Q uintessence Int

1986;17:797-801.

24. Kayser A F, Witter DJ, Spana uf AJ. Overtreatment with removable

partial dentures in shortened dental arches. Aust Dent J 1987;32:178-

82 .

25. Cowan RD, Gilbert JA, Elled ge DA, McGlynn FD. Patient use of re-

movable partial dentures: two- and four-year telephon e interv iews.

J Prosthet Dent 199 1;65:668-70.

Reprint requests to:

DR. H. M . KELTJENS

UNIVER SITY OF NIJMEGEN

SCHOOL OF DENTISTRY

PHILIPS VAN LEY~ENLAAN 25

6525 EX NIJMEGEN

THE NETHERLANDS

Copyr ight0 1996 by The Editorial Counci l of The Journal of

Prosthetic Dentistry.

0022-391 3/96/$5.00 + 0. 10/l/74422

27 2 VOLUME 76 NUMBER 3