Attachment-Retained Unilateral Partial Denture versus Tooth Implant-Supported Prosthesis in Mandibular Distal Extension Cases: A Randomized Controlled Trial

Objective: To evaluate patients’ satisfaction, biting force measurement, and radiographic evaluation of abutment teeth of tooth implant-supported fixed partial denture, unilateral attachment, and conventional partial denture in mandibular distal extension cases. Materials and Methods: Twenty-four participants were selected according to the following criteria: participants with unilateral mandibular distal extension with last standing second premolar abutment; participants having abutments with sufficient occluso-gingival height and good periodontal condition. Participants were divided into the following three equal groups: participants of the implant group received fixed tooth implant-supported fixed partial dentures, attachment group participants received unilateral attachment removable partial dentures, and conventional group participants received conventional removable partial dentures. The evaluation included patient satisfaction using “OHIP14” questionnaires, biting force measurement, and radiographic evaluation of terminal abutments using the ANOVA test. Results: Participants of the implant group were mainly satisfied with their prosthesis than the attachment group, which is higher than the conventional. Regarding biting force measurement, there is a statistically significant difference (p < 0.05) between all groups, including the implant group and attachment group, as well as between attachment and conventional group (p < 0.05). The conventional group showed statistically significant (p < 0.05) highest mean bone loss, while there was no statistically significant difference between implant and attachment groups; both showed statistically significantly lower mean amounts of bone loss. Conclusion: The tooth implant-supported fixed prosthesis could be considered a superior line of treatment for managing distal extension cases. Unilateral attachment, which is considered an excellent alternative in the case of implant placement, is not recommended.

Treatment outcomes of implant-assisted removable partial denture with distal extension based on the Kennedy classification and attachment type: a systematic review

Background Implant-assisted removable partial dentures (IARPDs) have recently become popular, but little information is available on the treatment outcomes based on the Kennedy classification and attachment types. Objective The objective of this review was to evaluate the treatment outcomes of IARPD delivered for distal extension edentulous areas based on the differences in the Kennedy classification and attachment type. Materials and methods English-language clinical studies on IARPD published between January 1980 and February 2020 were collected from MEDLINE (via PubMed), the Cochrane Library (via the Cochrane Central Register of Controlled Trials), Scopus online database, and manual searching. Two reviewers selected the articles based on pre-determined inclusion and exclusion criteria, followed by data extraction and analysis. Results Eighty-one studies were selected after evaluating the titles and abstracts of 2410 papers. Nineteen studies were finally included after the perusal of the full text. Fourteen studies focused on Class I, 4 studies investigated both Class I and II, and only 1 study was conducted on Kennedy’s class II. Eight types of attachments were reported. The ball attachment was the most frequently used attachment, which was employed in 8 of the included studies. The implant survival rate ranged from 91 to 100%. The reported marginal bone loss ranged from 0.3 mm to 2.30 mm. The patient satisfaction was higher with IARPD than with conventional RPDs or that before treatment. The results of prosthetic complications were heterogeneous and inconclusive. Conclusion IARPD exhibited favorable clinical outcomes when used as a replacement for distal extension edentulous areas. The comparison between the clinical outcomes of Kennedy’s class I and II was inconclusive owing to the lack of studies focusing on Kennedy Class II alone. The stud attachment was the most commonly used type in IARPDs. Overall, the different attachment systems did not influence the implant survival rate and patient satisfaction. Further high-quality studies are needed to investigate the attachment systems used in IARPD.

Clinical effectiveness of implant support for distal extension removable partial dentures: functional evaluation using occlusal force measurement and masticatory efficiency

Background Implant-supported removable partial dentures (ISRPD) are supported at the free-end region with implant retainers. As implant retainers prevent denture settlement and facilitate denture retention, this is intended to improve masticatory performance in comparison with that of conventional removable dentures. In the present study, we evaluated the effect of implant retainers at the free-end region of removable dentures on occlusal force and masticatory efficiency using a pressure-sensitive sheet, and measured glucose concentration in saliva after mastication with gummy candy. Methods In the present study, the occlusal force and masticatory efficiency of 13 subjects were measured in the following three conditions: without dentures (Condition 1), wearing dentures but not supported by implants (Condition 2), and wearing dentures supported by implants (ISRPD) (Condition 3). All data were statistically compared. Results Regarding the occlusal force, Condition 3 showed significantly higher scores than the other conditions; however, there were no significant differences between Conditions 1 and 2. Regarding the masticatory efficiency, Condition 3 showed significantly higher scores than Condition 2. Conclusions With ISRPD, the occlusal force and masticatory efficiency were increased in comparison with those with conventional removable dentures.

Evaluation of Chewing Time for Wearers of Distal Extension Removable Partial Dentures

Background: The restoration of mastication is an element of the therapeutic success of the removable prosthesis. The aim of this study was to evaluate the chewing time of subjects wearing a metallic removable partial denture (MRPD) restoring a distal extension edentulism. Materials and methods: This is a descriptive pilot study carried out after a review of patient records. Subjects were asked to chew test foods, carrots and peanuts. Chewing was to continue until they perceived that the bowl was fit to be swallowed. All sequences were videotaped and data on the duration of the chewing sequence of the test foods was recorded on an Excel® spreadsheet. Data analysis was performed using SPSS® version 23 software with a 5% risk of error. Results: Out of a sample of 17 MRPD wearers, 12 subjects had a toothless Kennedy class I and 5 subjects had a Kennedy class II edentulism condition with 9 females (53%) and 8 males (47%). Subjects between 46 and 65 years of age were in the majority with a percentage of 59%. After chewing the sampled bowls, Kennedy class I edentulous subjects had an average chewing time of 93.24 seconds ± 31.93 for peanuts and 109.18 seconds ± 53.35 for cores. The respective averages of the class II edentulism subjects were 127.53 seconds ± 62.84 and 128.95 seconds ± 73.35 for peanuts and carrots respectively. Conclusion: This study reveals that peanut chewing is easier and the subjects with MPD restoring a class I edentulism performed less time than those with class II edentulism, a fact related to the presence of changes in class II edentulism. Statistically, no significant correlation was found between carrots or peanuts chewing and type of distal extension MRPD wearers.

Distal extension of palatal rugae as a limitation for donor soft tissue grafts in a Jordanian population: A cross-sectional study

Background The purpose of the cross sectional study was to investigate the distal extension of the rugae area in a Jordanian (Middle Eastern) population, as an anatomical limitation influencing the surgical decision of harvesting a palatal soft tissue graft. Factors that may influence or predict the extension were also assessed. Methods Sixty periodontally healthy participants (29 males and 31 females) were included. Maxillary alginate impressions were made and casts were poured. The measurements were highlighted from the origin of the rugae (near mid palatine raphe) to the terminal end with a sharp graphite pencil on the cast and a magnification lens was used for identification. The most posterior extension of the rugae were marked on the casts and determined by a standardized periodontal probe. The normal approximation test for binomial distribution was used to determine the proportion of the subjects with rugael extensions beyond the mesial end of the upper second premolar and fisher’s exact test for the purpose of analysis of the association of this extension with other factors. Results In almost half (41.7%) of the sample, the rugae extended distal to the upper second premolar, 23.3% extended to the mid-palatal of the upper second premolar, and 11.7% extended to the mesial of the upper second premolar. The implication is that 90.0% of the rugae reached the upper second premolar and 78.3% extended beyond its mesial aspect. The normal approximation test performed with 95% CI with the "rugael extension proximal to the mesial end of the upper 2nd premolar" considered to be the "success" category revealed that the proportion of the subjects with rugael extensions proximal to the mesial end of the upper second premolar was significantly lower than the proportion beyond the mesial end of the upper second premolar (95% CI of 11.2–32.0%, p = .00001). There was no significant difference between gender, smoking status, gingival phenotype and palatal shape with the posterior extension of palatal rugae. Conclusions Palatal rugae in a sample of a Jordanian population extends beyond the mesial aspect of the upper second premolar which may cause a substantial limitation for graft harvesting from the palate. The hard palate of Jordanian patients may not be a reliable source of soft tissue grafts required for aesthetic mucogingival surgery. No significant association existed between the most posterior extent of palatal rugae and gender, gingival phenotype or palatal shape. Other possible sources should be explored.