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132 The Open Dentistry Journal, 2019, 9, 132-139

Open Access
Clinical Evaluation of Removable Partial Dentures on the Periodontal
Health of Abutment Teeth: A Retrospective Study

Linda J. Dula1,#,*, Enis F. Ahmedi1,2,#, Zana D. Lila-Krasniqi1,# and Kujtim Sh Shala1,#

1
Department of Prosthetic Dentistry, Faculty of Medicine, School of Dentistry, Prishtina, Kosovo; 2MedUni Graz,
Dental School, Graz, Austria

Abstract: The aim of this retrospective study was to evaluate the effect of removable partial dentures in periodontal
abutment teeth in relation to the type of denture support and design of RPD in a five-year worn period. Methods: A total
of 64 patients with removable partial dentures (RPDs), participated in this study. It were examined ninety-one RPDs.
There were seventy-five RPDs with clasp-retained and sixteenth were RPDs with attachments. There were 28 females and
36 males, aged between 40-64 years, 41 maxillary and 50 mandible RPDs. For each subjects the following data were col-
lected: denture design, denture support, and Kennedy classification. Abutment teeth were assessed for plaque index (PI),
calculus index (CI), blending on probing (BOP), probing depth (PD), gingival recession (GR), tooth mobility (TM). Level
of significance was set at p<0.05. Results: According to denture support of RPD, BOP, PD, PI, GR, CI and TM-index
showed no statistically significant difference. Based on the denture design of RPD’s, BOP, PD, PI, CI, and TM-index
proved no statistically significant difference. Except GR-index according to denture design confirmed statistically signifi-
cant difference in RPD with clasp p<0.01. The higher values of all periodontal parameter as BOP, PD, PI, CI and TM
were in patients with RPD’s with claps comparing with RPD’s with attachment. Conclusion: RPD’s with clasp increased
level of gingival inflammation in regions covered by the dentures and below the clasp arms in abutment teeth.
Keywords: Abutment teeth, periodontal health, removable partial denture (RPD).

INTRODUCTION
The main reason for the failure of RPD is the loss of
Removable partial denture therapy (RPD) is an adequate abutment teeth due to periodontal changes and caries [10].
form of treatment for patients with missing teeth. In these Longitudinal studies of RPDs manifested with gingivitis,
circumstances RPDs represent an acceptable and economical periodontitis and mobility of abutment teeth [11]. RPDs can
modality treatment for patients with partial edentulous [1]. increase the incidence of caries; damage the periodontium,
relatively large amounts of plaque and the amount of stress
McCracken proposes biomechanics principles for design
on natural teeth [12-17]. These changes occur due to poor
of RPD’s, which focuses on the distribution of forces in the
oral hygiene, increased plaque and calculus accumulation
supporting tissues by providing retention and stability of the
[18].
RPD [2]. Further, Marxkors paid attention that principles
design for RPD was controlling dental plaque for the preven- Therefore the control of dental plaque is important to ob-
tion of caries and periodontal disease, known as hygienic tain good denture prognosis and performance for a long pe-
design principles where the marginal gingival is free [3]. riod. Many studies have investigated the effect of regular
Epidemiological studies in animals and in humans have checkups on oral health and denture hygiene with carefully
shown that dental plaque is an essential factor in the ethol- planned prosthetic treatment. All periodontal parameters
ogy of periodontitis. If plaque control was established, gin- appeared with better results in patients who were going to
receive RPDs and they should be carefully motivated and
givitis and periodontitis can be satisfactorily treated [4]. The
instructed in order to prevent periodontal diseases [14, 19].
RPD in the mouth has the potential for increase plaque for-
mation on tooth, especially to abutment teeth, to which The aim of this retrospective study was to evaluate the
clasps or attachments are attached [5-8]. The RPD frame- effect of removable partial dentures in periodontal abutment
work designs contribute in increasing oral bacterial flora and teeth in relation to the type of denture support and design of
formation of dental plaque. Kennedy classification, denture RPD in a five-year worn period. The defined recordings of
base shape, denture construction and especially the number plaque index (PI), calculus index (CI), blending on probing
of position of the clasps and occlusal rests also influence (BOP), probing depth (PD), gingival recession (GR), tooth
periodontal deterioration [9]. mobility (TM) were measured on abutment teeth and ana-
lyzed due to design and denture support of RPDs.
*Address correspondence to this author at the Department of Prosthetic
Dentistry, Faculty of Medicine, School of Dentistry, Prishtina, Kosovo; MATERIALS AND METHODOLOGY
Tel: +381 38 512 525; Fax: +381 38 512 474;
E-mail: [email protected] The research has been accepted and approved by the In-
stitutional Ethic Committee (School of Dental Medicine,
#These authors contributed equally to this work

1874-2106/15 2019 Bentham Open

Clinical Evaluation of Removable Partial Dentures The Open Dentistry Journal, 2015, Volume 9 133
University of Prishtina) and a written consent was obtained
Data Analysis
from each subject.
A total of 64 patients with RPD made by different clini- Statistical analysis was made using Statistical Package
cians at the Prosthodontics Department at University Den- for Social Science (SPSS) 19 for Windows (SPSS Inc., Chi-
tistry Clinical Center, in Prishtina, Kosova, were contacted cago, Illinoiss, USA) and MS Excel (Microsoft Office, Win-
by phone and they have been invited to participate in this dows 2007, USA). Statistical parameters were calculated
study. The patients were chosen by consecutive form, from from the structure index, arithmetic average and standard
the prosthetic delivery files of the department. They were deviation. Testing parametric data was done with T-test and
wearing existing RPDs for different periods, from one to five the non-parametric data with the Fisher exact test, X 2-
test,
years after placement. Mann-Whitney test and Kruskal Wallis test. Difference in
p<0.05 were considered significant.
The measurements were done by a single examiner to re-
duce interobserver error, and each measure was taken for
RESULTS
three times and the average of three values was obtained to
minimize the intraobserver error. For each subject the fol- Study Population and Dentures Characteristics
lowing data were collected:
The 64 patients with removable partial dentures partici-
 Denture design for each individual patient was based on pated in this study. There were 28 females and 36 males,
the state of the remaining teeth and the status of their oral aged between 40-64 years (Table 1). It was examined ninety-
health. There were the RPD’s with clasp-retained with one RPD and each prosthesis was considered statistically
extracoronal direct and indirect retainers and the RPD’s independent case. There were seventy-five RPD with clasp-
with attachment retained. The framework casts were retained and sixteenth were RPD with attachments. The ex-
made by cobalt-chrome-molbiden alloys (Co-Cr-Mo). amined RPD were 41 maxillary arch and 50 from mandibles
 The classification for partially edentulous was made by arch. The most frequent was RPD with linear 47.8% and
Kennedy 1925, denoted Class I through Class IV [20]. triangular 22.8% denture support, and least common RPD
with quadrangular 6.5% and one point 4.3% denture support
 According to Steffel 1962 denture support of the RPDs
was classified point, linear, triangular, quadrangular de- (Table 2). More than half of partially edentulous was Ken-
sign. Linear support was divided into diametric, diagonal nedy I and I with modification, 11% class II, IIA 13.2% and
and transversal [21]. 4.4% IIB, Class III and IV have a small percentage (Table
3).
Abutment teeth used as direct or indirect retainer for the
RPD, periodontal examination was conducted and the fol- Clinical Periodontal Parameters
lowing variables were determined: plaque index (Sil-
ness/Löe), calculus index (Green-Vermilion), bleeding on According to denture support of RPD’s, BOP-index (Ta-
probing (BOP), probing depth (PD), gingival recession (GR) ble 4), PD-index (Table 5), PI-index (Table 6), GR-index
and tooth mobility (TM). (Table 7), CI- index (Table 8) and TM-index (Table 9),
 Plaque index (PI) according to Silness/Löe Index 1964 showed no statistically significant difference. Therefore, the
[22]. values of all periodontal parameter as BOP, PD, PI, CI, GR
and TM were high between dental support of RPD, but no
 Calculus index (CI), according to Green-Vermilion Index significant difference between them, because of the small
1964 [23]. number of patients with quadrangular and one point denture
 Bleeding on probing (BOP) according to Ainamo & Bay support of RPD.
1975 [24]. Based on the denture design of RPD’s, BOP-index (Table
 Probing pocket depth (PD) was measured from the crest 10), PD-index (Table 11), PI-index (Table 12), CI-index
of the gingival margin to a probable pocket depth using a (Table 13), and TM index (Table 14) proved no statistically
Williams Probe and read to the nearest millimetres (mm). significant difference. Except GR-index according to denture
Measurements were made in the forth surfaces in abut- design confirmed statistically significant difference in RPD
ment teeth: mesial, oral, distal and vestibular sur- with clasp p<0.01 (Table 15). However the values of all
faces. Scores ranging from 0-3 represented the highest periodontal parameter as BOP, PD, PI, CI and TM were
PD observed: 0-normal probe depth of 2 mm or less; 1 - higher in patients with RPD’s framework with claps retained
probe depth of about 2mm, but not greater than 3 mm; 2- compared with RPD’s with attachment. Because of the small
probe depth greater than 3 mm but less than 5mm and 3- number of patients with RPD’s with attachment the differ-
probe depth greater than 5 mm or more [25]. ence has not been significant and the results must be judged
 Gingival recession (GR) was measured in abutment teeth carefully.
according to its presens or absence of it [26].
DISCUSSION
 Tooth mobility (TM) was recorded according to Miller
1985 from 0-3: 0-no mobility, 1-mobility smaller than 1 A retrospective study has some disadvantages since the
mm in the horizontal direction, 2-mobility more than 1 feature of its data is based on the feature of the clinical avail-
mm in the horizontal direction, 3-mobility in the apical able records. After denture placement, every patient was
vertical direction [27]. advised to attend a follow-up appointment at least one in six
months; nevertheless, not all patients followed this advice.
Table 1. Comparison of gender and age.

Gender
Total
Age group
F M
(year)
N % N % N %

<40 1 3.6 - - 1 1.6

40-64 19 67.9 18 50.0 37 57.8

65+ 8 28.6 18 50.0 26 40.6

N 28 100.0 36 100.0 64 100.0

Total
% 43.8 - 56.3 - 100.0 -

Mean ± SD 57.2 ± 10.3 64.5 ± 7.7 61.4 ± 9.6

Rank 34 – 75 46 – 79 34 – 79

Table 2. RPD Denture support according Steffel and distribution of denture arch (n=91).

N %

Support
Quadrangular 6 6.5

Triangular 21 22.8
Linear 44 47.8

Over one point 4 4.3

Total RPD with clasp 75 81.5

RPD with attachments 16 17.4

Arch

Maxilla 41 44.6

Mandible 50 55.4

Table 3. Distribution of kennedy classification.

Total
Kennedy Classification
N %
I 34 37.4
IA 11 12.1

IB 3 3.3
II 10 11.0

II A 12 13.2

II B 4 4.4

IIIA 1 1.1
III B 1 1.1

IV 3 3.3

IV A 2 2.2
Subtotal 10 11.0

Total 91 100.0
Table 4. Bleeding on probing (BOP) index according to denture support.

BOP Index
Total
Denture support Yes No P-value

N % N % N %

Quadrangular 3 50.0 3 50.0 6 100.0

Triangular 11 52.4 10 47.6 21 100.0

X2=0.127
Linear 22 50.0 22 50.0 44 100.0
P=0.998
One point 3 75.0 1 25.0 4 100.0

Attachments 9 56.3 7 43.8 16 100.0

Total 48 52.7 43 47.3 91 100.0

Table 5. Periodontal probing depth (PD) according to denture support.

Periodontal probing depth

Total
Denture support P-value

0 =<2mm 1 =2-3mm 2 =3-4.9mm 3 =5+mm

N % N % N % N % N %

Quadrangular 2 33.3 2 33.3 2 33.3 - - 6 100.0

Triangular 10 47.6 9 42.9 2 9.5 - - 21 100.0

KW=6.06
Linear 21 47.7 13 29.5 9 20.5 1 2.3 44 100.0
P=0.194
One point - - 2 50.0 2 50.0 - - 4 100.0

Attachments 8 50.0 5 31.3 3 18.8 - - 16 100.0

Total 8 50.0 5 31.3 3 18.8 1 6.3 91 100.0

Table 6. Plaque Index (PI) based on Silness and Löe according to denture support.

Silness /Löe Index

Total
Denture support 0 1 2 3 P-value

N % N % N % N % N %

Quadrangular - - 3 50.0 3 50.0 - - 6 100.0

Triangular 5 23.8 16 76.2 - - - - 21 100.0

Linear 12 27.3 24 54.5 6 13.6 2 4.5 44 100.0 KW=7.39

P=0.116
One point - - 3 75.0 1 25.0 - - 4 100.0

Attachments 8 50.0 8 50.0 - - - - 16 100.0

Total 25 27.5 54 59.3 10 11.0 2 2.2 91 100.0

Table 7. Gingival recession (GR) index according to denture support.

Gingival Recession
Total
Denture support Yes No P-value
N % N % N %
Quadrangular 6 100.0 - - 6 100.0
Triangular 16 76.2 5 23.8 21 100.0
X2 = 8.5
Linear 34 77.3 10 22.7 44 100.0 P=0.07

One point 4 100.0 - - 4 100.0

Attachments 6 37.5 10 62.5 16 100.0
Total 66 72.5 25 27.5 91 100.0

Table 8. Calculus Index (CI) based on Green-Vermilion according to denture support.

Green Vermilion Index

Total
Denture support 0 1 2 P-value
N % N % N % N %
Quadrangular 3 50.0 3 50.0 - - 6 100.0
Triangular 15 71.4 6 28.6 - - 21 100.0
KW = 5.37
Linear 34 77.3 8 18.2 2 4.5 44 100.0 *P=0.051

One point 4 100.0 - - - 4 100.0

Attachments 14 87.5 2 12.5 - - 16 100.0
Total 70 76.9 19 20.9 2 2.2 91 100.0

Table 9. Teeth mobility (TM) index according to denture support.

Teeth Mobility
Total
Denture support P-value
0 1 2 3 4
N % N % N % N % N % N %
Quadrangular 3 50.0 3 50.0 - - - - - - 6 100.0
Triangular 13 61.9 7 33.3 1 4.8 - - - - 21 100.0
KW=8.94
Linear 23 52.3 12 27.3 4 9.1 2 4.5 3 6.8 44 100.0 P=0.062

One point - - 3 75.0 1 25.0 - - - - 4 100.0

Attachments 13 81.3 3 - - - - - - - 16 100.0
Total 52 57.1 28 30.8 6 6.6 2 2.2 3 3.3 91 100.0

Table 10. Bleeding on probing (BOP) index according to RPD design.

BOP Index
Total
RPD design Yes No P-value
N % N % N %
Clasps 39 52.0 36 48.0 75 100.0 X2=0.002
Attachments 9 56.3 7 43.8 16 100.0 P=0.963

Total 48 52.7 43 47.3 91 100.0

Table 11. Periodontal probing depth (PD) according to RPD design.

Periodontal probing depth

Total P-value
RPD design
0 =<2mm 1 =2-3mm 2 =3-4.9mm 3=5+mm
N % N % N % N % N %
Clasps 33 44.0 26 34.7 15 20.0 1 1.3 75 100.0 U’=13.0
Attachments 8 50.0 5 31.3 3 18.8 - - 16 100.0 P=0.200

Total 41 45.1 31 34.1 18 19.8 1 1.1 91 100.0

Table 12. Plaque Index (PI) based on Silness and Löe according to RPD design.

Sillnes / Löe Index

Total P-value
RPD design 0 1 2 3
N % N % N % N % N %
Clasps 17 68.0 46 85.2 10 100.0 2 100.0 75 82.4 U’=14.0
Attachments 8 32.0 8 14.8 - - - - 16 17.6 P=0.114

Total 25 100.0 54 100.0 10 100.0 2 100.0 91 100.0

Table 13. Calculus Index (CI) based on Green-Vermilion according to RPD design.

Green Vermilion Index

Total
RPD design 0 1 2 P-value
N % N % N % N %
Clasps 56 74.7 17 22.7 2 2.7 75 100.0
P=0.344
Attachments 14 87.5 2 12.5 - - 16 100.0
Total 70 76.9 20 22.0 2 2.2 91 100.0

Table 14. Teeth mobility (TM) index according to RPD design.

Teeth Mobility
Total
RPD design P-value
0 1 2 3 4
N % N % N % N % N % N %
Clasps 39 52.0 25 33.3 6 8.0 2 2.7 3 4.0 75 100.0 U’=32.0
Attachments 13 81.3 3 18.8 - - - - - - 16 100.0 *P=0.058

Total 52 57.1 28 30.8 6 6.6 2 2.2 3 3.3 91 100.0

Table 15. Gingival recession (GR) index according to RPD design.

Gingival Recession
Total
RPD design Yes No P-value
N % N % N %
Clasps 60 80.0 15 20.0 75 100.0 X2=9.91
Attachments 6 37.5 10 62.5 16 100.0 *P=0.0016

Total 66 72.5 25 27.5 91 100.0

 Depending on the type of denture support and designs of
[35]. Some clinical studies have shown that after the regular
RPDs with clasp ore with attachment during our study we
examinations, re-instructions and the patient’s re-motivation
founded minor differences that occur on the periodontal
oral hygiene maintenance, RPDs will not cause changes in
abutment teeth. Therefore, the values of all periodontal pa-
periodontal abutment teeth [36, 37].
rameter as BOP, PD, PI, CI, GR, TM were higher between
dental support of RPD, there were no significant difference The need for partially edentulous care will be increasing.
between them, because of the small number of patients with Patient use of RPDs has been high in the past and is expected
quadrangular and one point denture support of RPD. to continue in the future. Some patients who are given the
choice between an implant-supported prosthesis and a re-
According to authors, an ideal design for RPD was
movable partial denture are not able to pursue implant care.
minimal stress in abutment teeth and alveolar ridges, so cor-
This contributes to higher use of removable partial dentures
rect design of the RPD does not cause any damage to the
[38].
abutment teeth depending of the type of retention [28-30].
The literature suggests that clasp retained design produce
CONCLUSION
less torque on abutment teeth than attachment designs [31,
32]. Addy M, Bates JF., concluded that the denture design RPD with clasp increased levels of gingival inflammation
should be as simple as possible; covering only the essential in regions covered by the dentures and below the clasp arms
hard and soft tissues and a higher level of oral hygiene is in abutment teeth. With carefully planned prosthetic treat-
needed for RPD patients [11]. ment, with suitable design and adequate maintenance of the
Depending on the design of RPD although no significant oral and denture hygiene we can prevent the periodontal dis-
differences was found in BOP, PD, PI, CI, TM index in eases of abutment teeth. Aspect of the design of RPD in-
abutment teeth; however the values of all periodontal pa- cludes not only static-dynamic but also biological principle
rameter as BOP, PD, PI, CI, TM were higher in patients with for the patients, affecting longevity and success of treatment.
RPD’s framework with claps retained compared with RPD’s Regular recall of appointments plays an important role in
with attachment. Except GR-index according to denture de- preventing changes of abutment tooth.
sign p<0.01 confirmed statistically significant difference in
RPD with clasp. This is because bacterial plaque retained in LIST OF ABBREVIATIONS
regions covered by the dentures and below to clasp arms in RPD = Removable partial dentures
abutment teeth and the most patients presented with gingival
recession after 4-5 years. This finding is in agreement with PI = Plaque index
the results of authors Wright PS, Hellyer PH., to the fact that CI = Calculus index
gingival recession appears to increase gradually with age
[33]. Because of the small number of patients with RPD with BOP = Bleeding on probing
attachment the difference has not been significant and the PD = Probing depth
results must be judged carefully. Therefore the existing re-
sults are inconclusive and sometimes contradictory. GR = Gingival recession
TM = Tooth mobility
Most of the studies have compared the periodontal pa-
rameter of abutment and non - abutment teeth that differ
from our research. Significant differences (p <0.01) were CONFLICT OF INTEREST
noted for PI, CI, GI, PD, TM, and GR between abutment and The authors confirm that this article content has no con-
non-abutment teeth, with abutment teeth showing more dis- flict of interest.
ease, for different periods ranging from 1 to 10 years [8].
Yeung et al. analyzed a total of 87 patients 5-6 years after ACKNOWLEDGEMENTS
placement cobalt–chromium RPD’s wearers and concluded
there was a high prevalence of gingivitis, plaque, and gingi- LD collected all the data from the patients, participated in
val recession, especially in dento-gingival surfaces in close the writing of the manuscript and in the statistical analysis.
proximity (within 3 mm) to the dentures [15]. Furthermore, EA and ZLK were principal investigators and participated in
according to the author do Amaral BA., plaque index values all phases of the manuscript and advised how to conduct the
significantly increased after one year of RPD’s wearing in statistical analysis. KSH has been supervisor of the project.
abutment teeth, comparing with non-abutment teeth. It was All authors read and approved the final manuscript and par-
also confirmed that PD and GI mean values increased from ticipated in the bibliography review.
the initial assessment to 1 year of RPD’s [34]. The authors acknowledge all the patients of the Univer-
A further limitation of this study could be explained due sity Dentistry Clinical Center, Pristina, Kosova that have
to short period of this study, unlike the other studies they facilitated in this study.
examined the teeth 5 to 10 years after wearing the RPDs.
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Received: December 20, 2018 Revised: February 21, 2019 Accepted: March 03, 2019
© Dula et al.; Licensee Bentham Open.

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