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5410Journal of Applied Sciences Research, 8(11): 5410-5414, 2012ISSN 1819-544XThis is a refereed journal and all articles are professionally screened and reviewed

ORIGINAL ARTICLES

Corresponding Author: Dr. Islam Mubarak A. Moustafa, Removable Prosthodontic Department, Faculty of Oral andDental Medicine, Cairo University, EgyptE-mail: [email protected]

The Effect of Two Different Types of Direct Retainers in Mandibular Unilateral Distal

Extension Removable Partial Denture (Microbiological Study)

1Dr. Islam Mubarak A. Moustafa,

1Dr. Mohamed Sabry Badawey,

2Dr. Zeinab Abdul-Khalek

Ibrahim and 1Dr. Azza Farahat

1 Removable Prosthodontic Department, Faculty of Oral and Dental Medicine, Cairo University, Egypt2 Medical Microbiology and Immunology Department, Faculty of Medicine, Cairo University, Egypt

ABSTRACT

Objective: The purpose of the present study was to evaluate the microbiological effect of different types ofdirect retainers in mandibular unilateral distal extension partial dentures. Materials & Methods: fourteen

patients were selected, divided into two groups. The first group received attachment retained removable partialdenture (RPD). However, the second group received clasp RPD. The gingival fluid samples were collected fromthe highest scored site around the abutment teeth. Before RPD insertion, two weeks, four weeks and eight weeks

after RPD insertion. Results: Study group (attachment retained RPD group) showed statistically significanthigher values of microbial count than the control group (Clasp retained RPD group). Conclusions: Attachmentretained RPD induced higher bacterial count than clasp retained RPD.

Key words: Unilateral distal extension, extra-coronal attachment, RPD, micro biological.

Introduction

The restoration of unilateral distal extension partially edentulous cases has always been a challenge to prosthodontists. The main problem lies in choosing a restoration that provides adequate support, retention andstability without jeopardizing the health and the integrity of the remaining oral structures (Innim et al , 2001)

Clasp retained removable partial denture remains the most commonly used restoration despite the many problems associated with its use. However, it is has been associated with increased gingivitis, periodontitis andabutment mobility. Those complications may be attributed to plaque accumulation in the absence of satisfactory

oral hygiene measures (Vanzeveren et al , 2003).Osseointegrated implants may be considered a successful treatment modality for unilateral distal extension partially edentulous cases. Implant supported prostheses provide superior biomechanical qualities. However,certain conditions might contra-indicate their use (Palmer et al , 2002)

Extra-coronal attachments may be utilized successfully in unilateral distal extension cases providing goodesthetics and retention. Moreover, favorable stress distribution to the abutment teeth is also an advantage (Berg& Caputo, 1992).The complicated design of the extra-coronal attachments may require specific oral hygienemeasures and motivation of the patient.

It is important to choose the restoration that does not jeopardize the health of the remaining structures. Atthe same time, this restoration must be well tolerated by the patient.

Materials and Methods

Fourteen partially edentulous patients were selected from the Out-patient Clinic, Faculty of Oral & Dental

medicine, Cairo University.Patients were randomly divided into two groups each included seven patients.Group-A: Received attachment retained RPD. However, Group-B: Received clasp retained RPD.

For Group-A: Construction of attachment retained RPD:

A rubber base impression was made using putty impression material in the patient's custom tray. The first and the second premolars on the edentulous side were prepared to receive two porcelain

veneered crowns. Wash impression was made in light body rubber base over the putty impression. Metallic crowns-attachment assembly was trial -inserted intra-orally.

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Results:

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10-5414, 2012

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5413 J. Appl. Sci. Res., 8(11): 5410-5414, 2012

Comparison between mean percentage (%) increases in bacterial counts (log 10 values of CFU) of the two

groups:

The percentage increase in bacterial counts of the two groups was calculated according to the followingformula:

Bacterial counts (after) – Bacterial counts (before) x 100

Bacterial counts (before)The % increase in bacterial counts of study group (attachment retained RPD) showed statistically

significantly higher value than control group (Clap retained RPD) from the denture insertion to 4 weeks andfrom the denture insertion to 8 weeks.

The % increase in streptococci counts of study group showed statistically significantly higher value thancontrol group from the denture insertion to 8 weeks.

Discussion:

The significant increase in mean bacterial counts (CFU) throughout the follow-up period may be due to thecomplicated design of the attachment retained RPD which may complicate the oral hygiene maintenance andconsequently increasing the mean bacterial counts in agree with Budtz-Jorgensen et al ., 1998

The percentage increase in the bacterial counts of the attachment RPD group showed higher values than the

clasp RPD group throughout the follow-up period. Those results may be due to preparation of the abutmentssub-gingivally to create the finish lines of the crowns.This may change the micro flora of the gingival crevice. The inability of a patient to pass dental floss

through inter-proximal spaces of the splinted crowns may lead to inadequate oral hygiene and higher bacterialcount when compared to that reported in the clasp RPD group. These findings agree with Stewart et al ., 2003.

Sorensen, 1989and Goodacare, 1990, added that the sub-gingival margins of the crowns may greatlyincrease the frequency of periodontal diseases. Moreover, the surface roughness, the marginal fit and the crowncontour may mediate plaque accumulation and influence gingival health. Other studies have indicated moresevere gingival tissue reactions when the gingiva is covered with dentures; whereas, an open space design ofminor connectors may be less conducive to increases in plaque accumulation, gingival inflammation, and

pocket depth (Chandler et al ., 1984, and Nada et al ., 1987).The clasp retained RPD group showed significant increase in mean Streptococci counts and percentage

increase in streptococci counts from the denture insertion to 8 weeks than those of the attachment group whichmay be due to more inflammatory conditions accompanying the attachment retained RPD than the clasp retainedRPD. Those findings agreed with Beighton et al , 1991 who reported that wearing RPDs predisposing one tohigh salivary levels of mutants streptococci.

The results revealed that there was no statistically significant difference between the mean probing depthsin the two studied groups along the study period which may be due to the short follow-up period.

Some clinical studies showed that on providing regular recall system with control, re-instruction and re-motivation, the removable partial dentures might not cause any damage of the periodontium (Kapur et al ., 1994;Bergman et al ., 1996; WoÈ stmann, 1997).

Conclusions: Within the limitations of the present study, the following conclusions that:

The attachment retained RPD causes increase in the bacterial count and streptococci microorganism morethan the clasp retained RPD. The attachment retained RPD needs more precise and meticulous oral hygiene measures and frequent recallvisits to obtain the predicted efficacy than clasp RPD.

References

Beighton, D., P.H. Hellyer, E. Lynch, M.R. Heath, 1991. Salivary levels of mutans streptococci, lactobacilli,yeasts, and root caries prevalence in non-institutionalized elderly dental patients. Community Dent OralEpidemiol., 19: 302-7.

Berg, T and A.A. Caputo, 1992. Comparison of load transfer by maxillary distal extension removable partialdentures with a spring-loaded plunger attachment and I-bar retainer. J Prosthet Dent., 68: 492-499.

Bergman, B., A.Ê. Ericson and M. Molin, 1996. Long-term clinical results after treatment with conical crown-retained dentures. International Journal of Prosthodontics, 9: 533.

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5414 J. Appl. Sci. Res., 8(11): 5410-5414, 2012

Budtz-Jørgensen Eand Isidor, F., 1990. A 5-year longitudinal study of cantilevered fixed partial denturescompared with removable partial dentures in a geriatric population. J Prosthet Dent., 64: 42-7.

Chandler, J.A. and J.S. Brudvik, 1984. Clinical evaluation of patients eight to nine years after placement ofremovable partial dentures. J Prosthet Dent., 51: 736-43.

Goodacre, C.J., 1990. Gingival esthetics. J Prosthet Dent., 64: 1-12.Innim Park, Miho Eto, Noriyuki Wakabayashi, Masayuki Hideshima and Takashi Ohyama, 2001. Dynamic

retentive force of a mandibular unilateral removable partial denture framework with a back-action clasp. J

Med Dent Sci., 48: 105-111.Kapur, K.K., R. Deupree, R.J. Dent and A.L. Hasse, 1994. A randomized clinical trial of two basic removable partial denture designs. Part I: Comparisons of five-year success rates and periodontal health. Journal ofProsthetic Dentistry, 72: 268.

Nada, M., S. Gharrphy and M.S. Badawy, 1987. A two year longitudinal study on the effect of removable partialdenture design on the health of the remaining teeth. Egypt Dent J 33: 85-95.

Palmer, R.M., B.J. Smith, L.C. Howe and P.J. Palmer, 2002. Implants in Clinical Dentistry, 1st edn. London:Martin Dunitz Ltd.

Sorensen, J.A., 1989. A rationale for comparison of plaque-retaining properties of crown systems. J ProsthetDent., 62: 264-269.

Steward, K.L., R.D. Phoenix, D.R. Cagna and C.F. Defreest, 2003. Stewart’s clinical removable partial prosthodontics. 3rd ed. Chicago: Quintessence., p: 1-18.

Vanzeveren, C., W. D’Hoore, P. Bercy, G. Leloup, 2003. Treatment with removable partial dentures: alongitudinal study. PartII. J Oral Rehabil., 30(5): 459–469.

WoÈ stmann B., 1997. Tragedauer von klammerverankerten EinstuÈ ckguûprothesen im uÈ berwachtenGebrauch. Deutsche ZahnaÈ rztliche Zeitschrift, 52: 100.

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