Complete and Removable Partial Dentures

Treatment Outcomes in CD and RPD Patients

• This lecture will focus on treatment outcomes for patients with Complete Dentures (CD) and Removable Partial Dentures (RPD).
• The lecture will also cover two studies, including one conducted in the USA, regarding patient satisfaction with complete dentures

Factors Influencing Patient Satisfaction with Complete Dentures

• Numerous factors influence patient satisfaction with complete dentures and fall into three main categories: technique-related, patient-related, and dentist-related.

Technique-Related Factors

• Therapy Choice should take into account General Health, oral health and socioeconomic status.
• This includes whether to use CD, an implant, RBD, fixed partial dentures or implant retained dentures.
• Dentures can be fabricated by simplified techniques, where steps of CD construction are skipped, such as secondary impressions.
• The other method is comprehensive or conventional techniques.
• There is no significant difference between simplified and conventional techniques.
• There is no evidence that using two impressions improves denture quality or patient satisfaction with dentures.
• There is no difference if border molding techniques are used
• Retention is better using two impressions.
• A recent RCT shows balanced occlusion demonstrates higher patient satisfaction in comparison to lingualized and buccalized occlusion.
• Lingualized occlusion provided higher patient satisfaction rates relative to balanced occlusion in a six-month follow-up study.
• Currently, there is no evidence to support one occlusal scheme over another, dentists may consider many proposed occlusal schemes
• A randomized clinical trial found that patient satisfaction and self-perceived chewing ability were higher for dentures with lingualized or anatomic occlusal surfaces when compared to zero-degree (cuspless) teeth.
• Most denture patients seek esthetic improvement and have very high esthetic expectations.
• Regular maintenance and relining improve patient satisfaction in both complete denture and RPD therapy.
• The number of post-delivery appointments may influence patient satisfaction, and no association was found in a recent RPD wearer study.
• The number of post-delivery appointments correlates negatively with patient satisfaction rates
• Dentists should aim to make the best dentures possible, even with limited evidence on the impact of denture quality and fabrication processes.
• Less time-consuming techniques and less expensive materials can make complete dentures more accessible.

Patient-Related Factors

• Patient-related factors include age, gender, educational level, socioeconomic status, personality, psychological factors, previous denture experience, expectations before denture fabrication, and oral conditions.
• No association exists between age, complete dentures/RPD, and patient satisfaction.
• Women are typically more demanding about esthetics than men and are less satisfied with their dentures.
• There was no gender difference in implant-retained overdenture recipients
• Females had less satisfaction with conventional, complete dentures than males
• There is no significant difference between genders in patient satisfaction among both complete dentures and RPD patients.
• More educated patients in Brazil are typically more demanding and less satisfied with their dentures
• A Croatian study found a negative correlation between educational level and patient satisfaction.
• Turkish and Brazilian studies did not find these differences among educational level groups.
• The lower the socioeconomic status, the higher the denture satisfaction
• Neuroticism negatively impacts patient satisfaction with dentures.
• The lowest levels of denture satisfaction were achieved among Type A patients, who are anxious, ambitious, and rigidly organized.
• Psychological issues and emotional aspects related to tooth loss negatively correlate with denture satisfaction.
• Psychoeducation by specialists improves patient satisfaction.
• Patients with a positive experience with dentures adapt to new dentures at a higher rate.
• A patient's time of denture usage is associated with higher satisfaction rate
• Previous experiences with dentures correlate with patient satisfaction regarding new dentures
• Poor oral conditions can lead to dentures that are more difficult to wear, which reduces patient satisfaction.
• The most influential factor seems to be the mandibular ridge; the poorer the ridge, the lower the satisfaction.

Dentist-Related Factors

• Dentist-related factors include dentist experience, patients’ perception of the dentist, and communication issues.
• More skilled dentists will integrate patient expectations to give better understanding
• Patients' perceptions impacts if they trust the dentist and if directions are followed.
• Higher patient satisfaction ratings occur when dentists give more complete explanations.
• Patients and dentists have varied expectations for satisfaction.
• Establishing good communication with the patient is important.
• Denture limitations should be discussed to ensure success.
• Patients should be treated kindness and genuine consideration

RPD Clinical Performance Study

• Studies show that the The Effect Of Gender And Location (Maxilla Vs. Mandible) On The Clinical Performance Of Removable Partial Dentures (RPDs).
• A major obstacle to these treatment options is the financial consideration which may preclude some patients from receiving these treatments.
• Patient compliance for oral hygiene and routine maintenance should be completed before considering RPD
• RPDs are a justifiable option for partially edentulous patients if there are good success rates.
• 71.3% success rate for RPDs was found with circumferential clasp, and 76.6% for I-bar clasp after 5 years.
• Another study reported 74.7% success if failure was defined as the patient not wearing the original RPD.
• The usage for RPDs divided into categories
  • 85.7% success rate for 5-10 years -62.8% for 10-15 years -57.1% for over 15 years
• 43% of RPDs were reasonable with 46% made acceptable with modification RPD were also a reasonable tx option for partially edentulous patients based off data
• Demand from Males was to improve mastication while Females were linked to pain, hypersensitivity, and esthetics.
• No difference in gender was found in RPDs while men were less satisfied with mastication.
• Literature does not have evidence to show data correlating the RPDs performance between the maxilla and mandibular however failure rates were different. The mandibular RPDs had a higher failure rate of 33% as opposed to the maxillary RPDs at 12.7%
• Maxillary RPD found to have greater compliance for esthetic and comfort
• Maxillary RPDs had high success rate around 78% as opposed to mandibular RPD at 70.1% and 22 % was due to improper RPD causing impaction and discomfort in acceptance ratings
• Integrity of the prosthesis was a high factor for patients and design
• Males are still not able to adapt even though are within acceptable design
• Adaption for MD still has a high rating
• There was high significant in success rates between males and females Overall the data concluded that higher results in patients led to higher rated Therefore
• Patient factors are important along with patient factors from dr
• Treatment is important including patient consideration