Long-term analysis of telescopic crown retained removable partial dentures: Survival and need for maintenance
Introduction
Despite the indisputable success of preventive treatment and prophylaxis in recent years, the need for prosthetic treatment due to tooth loss will continue to increase in relation to the age of the patient. The rate of edentulism among the elderly is, however, continually decreasing and it is anticipated that in 2010 75-year-old patients will still likely to have more than 16 residual teeth on average.1
Apart from implant treatment or even leaving the partially dentate status, a conventional removable partial denture (RPD) is a viable treatment option in these cases. Functional denture stability, good retention, oral comfort and satisfactory aesthetics are important factors for a successful treatment with RPDs.[2], [3], [4], [5] In addition, oral hygiene should be easy to perform and the distribution of the functional loads should be optimized among the abutment teeth and the alveolar ridge.[2], [4], [5] Taking these requirements into consideration, a RPD retained by telescopic crowns (TRPD) on the residual dentition is an alternative treatment option to a conventional clasp retained RPD.[5], [6], [7], [8]
A TRPD has a positive impact on preserving the abutment teeth.8 The principles of tooth preservation are based on a rigid connection between the abutment teeth and the TRPD with mainly axial loading, which reduces any existing mobility.9 In general, two different retention principles are used for TRPDs: parallel-sided inner and outer crowns or conical shaped inner and outer crowns. In the latter group, the degree of taper is kept within a well-defined range of inclination.10
The supposed advantages of a TRPD[6], [7], [9], [10], [11] may, however, be offset by the disadvantages of high treatment costs and treatment requirements within the denture's functional period.10 Loss of cementation and fractures of the artificial teeth are the most common problems in TRPDs.12 As TRPDs are rigidly connected to the abutment teeth, there is an increased risk for tooth fracture.13 Technically, the treatment and laboratory procedures are highly complex,14 which in turn results in higher costs for the patient.
Currently little information is available regarding the long-term survival of TRPDs and their maintenance need.12 The aim of this retrospective longitudinal study was therefore to determine the long-term survival of TRPDs, taking into consideration possible influencing factors as well as treatment needs within the functional period.
Section snippets
Study population
This study investigated patients who received a TRPD between 1995 and 2004 in the Department of Prosthodontics, Justus-Liebig-University Giessen, Germany. Implant-borne dentures and cases with no assessable data available after fitting the denture (n = 90) were excluded. Overall 463 patients (male/female: 224/239; mean age 58.8 ± 11.2 years; range: 21–84 years) with a total of 554 TRPDs retained on 1758 abutment teeth (Table 1) could be evaluated. Table 2 provides an overview of the number of
Conformity of patients in the study and dropouts
None of the parameters tested for conformity showed a significant difference between the study-patients and the dropout-patients (Table 5).
Survival probability of TRPDs and abutment teeth
During the observation period a total of 26 (=4.7%) out of the 554 TRPDs required replacement. In 15 cases the new restoration involved a new TRPD whereas in 11 cases the TRPD had to be replaced by a full denture due to tooth loss. 66 of the 1758 abutment teeth (3.8%) were extracted. The survival probability after 5 years was calculated as 95.1% for the
Study design
This study aimed to evaluate the survival probability and maintenance needs of TRPDs using a retrospective longitudinal study design. Though retrospective studies have natural shortcomings as they have to rely on the data available, they are nevertheless helpful as long as data of higher evidence (e.g. RCTs) are missing. This is especially valid for the topic we investigated.
A general problem of longitudinal studies is their inevitable dropout as it may affect the results if the dropout is not
Conclusions
Within the limits of this retrospective study it can be concluded that the number of attachments and thorough aftercare have a considerable impact on the long-term success of TRPDs. Though loss of cementation and defects of the facings were significant in number and may cause considerable follow-up costs, they did not endanger the further functioning of the TRPDs in any way.
Acknowledgements
We would like to thank Dr. Manfred Hollenhorst of the Department for Documentation, Justus-Liebig-University Computer Centre, Giessen, for his assistance with the statistical analysis.
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