ISSN:
Printed version: 1806-7727
Electronic version: 1984-5685
RSBO. 2011 Jan-Mar;8(1):88-92
Literature Review Article
Association between implants and removable
partial dentures: review of the literature
Marcos Aurélio Bomfim da Silva1
Rafael Leonardo Xediek Consani1
Guilherme José Pimentel Lopes de Oliveira2
José Ivo Limeira dos Reis2
Lucas Amaral Fontanari3
José Mauricio dos Santos Nunes Reis2
Corresponding author:
Marcos Aurélio Bomfim da Silva
836, Santo Antonio St. – Ponta Grossa
ZIP code 57014-680 – Maceió – AL
E-mail: [email protected]
1
2
3
Piracicaba School of Dentistry, State University of Campinas – Piracicaba – SP – Brazil.
Araraquara School of Dentistry, Sao Paulo State University – Araraquara – SP – Brazil.
School of Dentistry, Federal University of Alfenas – Alfenas – MG – Brazil.
Received for publication: February 22, 2010. Accepted for publication: April 5, 2010.
Keywords: partial
removable denture;
dental implant; dental
abutments.
Abstract
Introduction: Unilateral or bilateral distal-extension removable
partial dentures present complex biomechanics. The movements in
different directions, associated with the alveolar ridge shape and
soft tissue resilience can lead to damaging forces on the supporting
structures. The association between implants / removable partial
denture aims to provide better mechanical and biological properties
to the stomatognathic system. Objective: The aim of this paper
was to review the articles about the effect of implant support on
distal extension removable partial dentures. Literature review and
conclusion: Studies have shown that this combination provides
greater support, retention and stability to the prosthesis, thus limiting
their approach movement toward supporting tissues and providing
functional and psychological comfort to patients.
RSBO. 2011 Jan-Mar;8(1):88-92 89
Introduction
Literature review and discussion
Oral rehabilitation of subjects presenting very
large edentulous spaces by using removable partial
denture draws special attention by the dentist.
If treatment is not well planned and executed,
this type of therapeutic procedure can lead to
serial problems, such as: injuring of the support
periodontium of the abutment teeth, due to the
difference of resilience between the alveolar ridge
mucosa and its periodontal ligament [31], associated
with the lack of proper adaptation of the denture
bases to the support tissues.
The continue resorption of the residual alveolar
ridge damages the stability, support, and retention;
also, it alters the occlusal condition of distalextension removable partial denture. Moreover,
cases showing an edentulous maxilla rehabilitated
by a complete denture opposing a Kennedy class
I partially edentulous arch result in gradual
resorption of the alveolar bone under the denture’s
base, which promotes changes in the occlusal
planning, leading to anterior teeth overload. The
occlusal overload contributes to the additional
resorption of the ma xilla’s anterior area and
modifies the position of the remnant mandibular
teeth, characterizing the combination syndrome or
Kelly’s syndrome [14].
Due to the Implantodontology evolution, it is
possible to enhance the biomechanical behavior
of distal-extension removal partial dentures. The
presence of the osseointegrated implant, at the
posterior area, prevents bone resorption, helps in
the denture’s retention and stability increase, and
reduces the tension on the abutment teeth and the
number of extracoronal retainers, besides being
more comfort and safer for the patient [4, 15].
Previous investigations evaluating the behavior
of implants on the support structures, through
finite element analysis, have evidenced dental
implants advantages in reducing the tensions on
the residual ridge [8-32]. Although the benefits
of implant-supported partial dentures are clearly
proved in complete edentulous subjects, there is a
lack of studies on the association of implants and
removable partial dentures in partially edentulous
patients; clinical case reports are more prevalent
[15, 11-22].
Further researches are necessary for assessing
the advantages that this association would provided
to partially edentulous subjects. Therefore, the
literature review of laboratorial and clinical studies
may collaborate for the clarification of frequent
questions appearing during the diagnosis and
planning of this therapeutic approach.
A literature review was carried out using PubMed
database. The following terms was used: removable
partial dentures, implant, and support. The search
was performed in the articles published between
1972 and 2009. Ninety-seven reports were found,
and initially, no exclusion criteria were applied. After
the reading of the title and abstract, 26 articles
were selected, because they seemed to have a
greater correlation with this study. Besides PubMed
database, the references of the library collection
of the Araraquara School of Dentistry of the Sao
Paulo State University (Unesp) were used.
Unilateral or bilateral distal-extension removable
partial denture presents complex biomechanics. The
movements into different directions, associated with
the alveolar ridge shape and soft tissue resilience
can lead to damaging forces on the supporting
structures [2]. One alternative used since the 19th
century for favoring the biomechanics and improving
the prognosis of these therapeutic procedures has
been the removable dentures association with
posterior residual roots. In such cases, the residual
roots are maintained under the distal-extension
dentures, aiming to preserve the support structures
and the periodontal ligament, as well as, to increase
this denture’s retention and stability, the so-called
overdenture [18].
Based on the positive results observed for
treatments with overdenture and on the evolution
of osseointegrated implants, the association of
removable dentures with dental implants becomes
an alternative for partially edentulous patients
[6-10]. The procedure aims to provide a better
denture’s support, retention, and stability, limiting
its approximation movement towards the support
tissue, therefore decreasing the tension on soft
tissue and bone ridge. Also, there is a reduction of
the tension forces generated on the abutment teeth,
mainly in the rehabilitation of partially edentulous
arches presenting large spaces [23-25]. This occurs
due to the modification of the masticatory forces
transmission on alveolar ridge, transforming a
tooth-mucosa borne denture into a tooth-implant
borne denture [16].
Although osseointegrated implants and their
different types of attachments seem to provide the
reduction of the tensions on the abutment teeth
of distal-extension partial dentures, this is still
a literature’s controversial issue [17, 19]. Rocha
(2001) [27] and Verri et al. (2007) [32] assessed
the influence of the occlusion force, through finite
element analysis, and verified that there was no
reduction in the tension forces on the abutment teeth
after the procedures comprising the association of
distal-extension removable dentures with implants.
90 –
Silva et al.
Association between implants and removable partial dentures: review of the literature
These authors observed a reduction of the support
structure demanding, especially at the posterior half
of the residual bone ridge. It is worth noting that
these studies simulating the oral structures behavior
involve a very complex analysis, due to the features
of the elements composing the masticatory system.
Mostly, these studies assessed the employment of
the forces, intending to simulate the functional
and non-functional masticatory loads, such as
vertical (0º) and oblique (45º) forces, applying
both in mesiodistal and distomesial direction. The
forces, according to some authors [1, 20], show an
axial direction; the horizontal force are present in
almost 25% of the total forces generated during
mastication [30].
Despite of the literature controversies, it is
perceived that the implant’s positioning at molar, or
even bicuspid area improves the occlusal support of
distal-extension removable dentures, resulting in a
greater occlusal stability and functional comfort for
patients [15, 24]. However, it is necessary to evaluate the
long-term efficacy of implants’ installation associated
with removable partial dentures. Other aspect to be
respected is which type of attachment would be better
in the association with implants, aiming to favor the
removable denture’s retention, support, and stability.
Among these attachments, the O’ring type was the
most used for partial dentures with retainers or
transmucosal abutments and for implant-supported
prosthesis, without retention [5].
Mitrani et al. (2003) [24], during a 4-year
evaluation of 10 partially edentulous patients
(Kennedy class I and II) who were unsatisfied with
their distal-extension removable dentures, found a
significant increase in their satisfaction’s degree after
the association with dental implants. In order to
assess the patients’ satisfaction, the researchers used
physical, clinical, and complementary (radiographs)
examinations of the oral cavity’s tissues. Besides
the improving of satisfaction, they observed a
small weariness of the attachments and minimum
radiographic evidence of peri-implantar alveolar
ridge resorption. Kuzmanovic et al. (2004) [16]
also found positive results in subjects presenting
partially edentulous arches (Kennedy class I)
rehabilitated by removable dentures and bilateral
posterior implants. No complications were observed
during the follow-up period of two years.
Despite of the aforementioned information,
the association of osseointegrated implants with
removable partial dentures is lesser employed
than fixed partial prosthesis. Factors, such as
individual preference, treatment cost, cultural
differences, comfort, age, and accessibility to the
services should be considerate during this type of
rehabilitation procedure planning. This therapeutic
option type uses a limited number of implants,
reducing the total cost of the treatment, therefore
presenting a favorable risk-benefit ratio [3]. It is
highlighted that implants maintain the integrity
of the vertical occlusion dimension and prevent
a faster bone resorption, a very common pattern
in patients wearing distal-extension removable
dentures [13, 33].
Due to the elective character of the combined
t herapy w it h osseointegrated impla nts, it is
important to inform the patient about all its benefits
and limitations. Physiologic elements must be taking
into account. Bone availability and quality, as well
as patient’s general health, especially in users of
corticosteroids and biphosphonates, is very likely
to modify the results of implant therapy. Besides
that, the costs of the therapies associated with
osseointegrated implants should be discussed with
the patient, so that the patient is able to participate
in the decision on the treatment to be executed.
Conclusion
Based on the literature review and discussion
on the osseointegrated implants usage in association
with removable partial dentures, it can be concluded
that:
• there is a higher denture’s support, retention,
and stability in order to limit the denture’s
movement towards the support tissues and
provide patient’s functional and psychological
comfort;
• there is a reduction of the tension forces
generated on the abutment teeth, favoring the
maintenance of the supporting periodontium;
• further longitudinal studies should be carried
out, due to the lack of researches on this
therapeutic alternative.
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How to cite this article:
Silva MAB, Consani RLX, Oliveira GJPL, Reis JIL, Fontanari LA, Reis JMSN. Association
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between
implants and removable partial dentures: review of the literature. RSBO. 2011 Jan-Mar;8(1):88-92.