A Clinical Overview of Removable Prostheses: 5. Diagnosis and Treatment of RPD Problems
J. FRASER MCCORD, NICK J.A. GREY, RAYMOND B.WINSTANLEY AND ANTHONY JOHNSON
Abstract: This, the fifth and final article in the series, addresses the diagnoses and
treatment of problems which may arise followingprovision of removable partial dentures (RPDs). These include difficulties seating the denture, pain and discomfort, looseness and functional problems. Dent Update 2003; 30: 88–97
Clinical Relevance: Satisfactory diagnoses of problems is central to the provision
of successful RPDs.
roblems related to RPDs may be associated with errors in diagnosis and treatment planning, including inadequate mouthpreparation. Other errors relate to mechanical deficiencies, such as inappropriate denture design or poor choice of component materials. There may also be problems in relation to physical and psychological aspects of the patient, and these may contribute either directly or indirectly to a patient’s inability to accept RPDs. None of these problems is new.1 In this article, a review of the commonproblems associated with RPD treatment is presented. In the interests of clarity,
J. Fraser McCord, BDS, DDS, FDS, DRD RCS (Edin.), FDS RCS(Eng.), CBiol, MIBiol, Professor and Head of Unit of Prosthodontics, University Dental Hospital of Manchester, Nick J.A. Grey, BDS, MDSc, PhD, FDS, DRD, MRD RCS(Edin.), Consultant/Honorary Senior Lecturer in Restorative Dentistry, Edinburgh Dental Institute,Raymond B.Winstanley,BDS,MDS,FDS RCS (Edin.), Senior Lecturer/Honorary Consultant in Restorative Dentistry, Charles Clifford Dental School, Sheffield, and Anthony Johnson, MMedSci, PhD, Lecturer in Dental Technology, Charles Clifford Dental School, Sheffield.
each problem is identified and the cause, diagnosis, treatment and means of avoidance discussed. Despite advances in materials, pluscareful treatment planning and improved technological and clinical expertise, there is little doubt that many patients experience difficulties in wearing RPDs. Many of these problems are biological/ biomechanical in nature and relate to faulty or inappropriate diagnosis or treatment planning. Other problems, however, have their origin in technical deficiencies associated with inappropriateprosthesis design and/or selection of component materials. Less quantifiable are those problems of a psychological nature which, unless catered for, may lead to patient rejection of otherwise acceptable prostheses. Previous authors2,3,4 have stressed that denture treatment should not normally be undertaken unless the mouth is in a healthy state, possible exceptions being immediate dentures or the provisionof transitional dentures in the short-term management of elderly, partially dentate patients. Failure to observe this maxim will inevitably result in problems at
insertion and post-insertion of RPDs. Similarly, the importance of proficient impression techniques and appropriate denture design should not be underemphasized as deficiencies in those aspects of RPD prescription may contribute toproblems. The purpose of this paper is to review problems associated with RPD wearing, which may be immediate, short-term or long-term. These problems relate, potentially, to a multitude of factors. In the interest of simplicity, these factors may be grouped, collectively, as follows: difficulty seating the RPD; pain/discomfort; looseness; functional problems; appearance; miscellaneous/general, e.g.intolerance and personality factors. In order that appropriate treatment can be dispensed, an accurate diagnosis of the cause(s) of each complaint must be made before remedial treatment may be effected. For each of the categories of complaints listed above, therefore, a list of causes will be presented, followed by diagnosis and suggested treatment options with hints on avoiding the problems....