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PRACTICE

conservative dentistry

Short and sticky options in


the treatment of the partially
dentate patient
N. J. A. Jepson,1 and P. F. Allen,2

As we move into the twenty-first century, patterns of dental


disease in adults are changing. Surveys of adult dental health In brief
● Not replacing missing teeth is
indicate that more people are keeping their teeth for longer in life.
acceptable in some patients.
In many cases, the ravages of dental disease and the cumulative ● Missing anterior teeth is a key factor
effect of a lifetime of restorative dentistry lead to gradual tooth influencing patients to seek
loss. For many of these patients, restoration of a complete replacement.
● Cantilevered, resin bonded bridges
dentition may not be feasible nor desirable. In recent years, perform well clinically.
functionally oriented treatment planning has become acceptable
in light of recent research findings. Using this approach, treatment
efforts and resources are directed principally at retaining the
teeth leads to a decrease in objectively
‘strategic’ part of the dentition in the long term, ie, the anterior
measured chewing efficiency, this does
and premolar teeth. This paper describes, with the aid of treated not appear to affect patients perceived
cases, a means of combining a shortened dental arch strategy chewing ability.7 Furthermore, descrip-
with resin bonded bridgework. With the aid of recent research in tive population studies indicate that
this area of clinical practice, some suggestions as to the use of the posterior tooth spaces are well tolerated
by patients, and most only seek some
technique are also described.
form of replacement when anterior
teeth are missing.8,9
Research findings such as these indicate
As recent surveys of adult dental health 20 teeth and not requiring a prosthesis has that while replacement of missing teeth
have shown, the retention of some nat- been described as a goal for oral health by may be possible, it may neither be neces-
ural teeth throughout life is now feasi- WHO.3 This indicates a shift away from sary nor desirable in all cases.
ble for most of the adult population.1 the traditional treatment philosophy of When a partially dentate patient pre-
However, levels of dental disease in the restoring a complete dentition in all cases. sents for treatment, possible treatment
current middle-aged cohorts in the UK In this paper, we describe applications of options are:
are significant. current restorative techniques, principally • Fixed prostheses
In a review of the most recent UK adult use of resin bonded cantilevered bridge- — tooth retained
dental health survey, Downer suggested work, in conjunction with a functionally — implant retained
that the burden of replacement of existing oriented treatment philosophy. • Removable partial denture
restorations in this age group will be con- — tooth retained
siderable.2 One of the many challenges for Is replacement of missing teeth — implant retained
the dental profession as we enter the essential? • Restoration/maintenance of a func-
twenty-first century will be how to plan In the past, it was considered essential tional (rather than complete) dentition
effective dental care for middle-aged and to replace all missing teeth, as failure to • Controlled progression to complete
elderly adults. do so would result in occlusal instability dentures.
Retention of a healthy, natural, func- and temporomandibular joint dysfunc- The decision on which of these options
tioning dentition comprising not less than tion.4 This assumption has been chal- to provide depends mainly on the follow-
lenged by a number of researchers who ing considerations:
1Senior Lecturer/Honorary Consultant, 2 Lecturer, reported that such consequences were • Patient motivation — how keen are
Department of Restorative Dentistry, The Dental not inevitable if all missing teeth were patients to replace missing teeth?
School, Framlington Place, Newcastle upon Tyne NE2 not replaced.5,6 Further reasons for • Periodontal status
4BW replacing missing teeth include • Willingness to undertake complex
REFEREED PAPER
Received 21.09.98; accepted 09.03.99 improvement of chewing function and treatment over multiple visits
© British Dental Journal 1999; 187: 646–652 cosmetic appearance. While loss of • Financial cost.

646 BRITISH DENTAL JOURNAL, VOLUME 187, NO. 12, DECEMBER 25 1999
PRACTICE
conservative dentistry

Table 1 Criteria for application of SDA

• Caries and periodontal disease confined mainly to molar teeth

• Good long-term prognosis for the anterior and premolar teeth

• Limited finances available for restorative care

Problems with removable and fixed conclusion is that patients are unlikely to The shortened dental arch concept
options for replacing missing teeth wear a partial denture in the absence of (SDA)
self-perceived need. A further explana- It would appear that economic resources
Removable partial dentures tion may be that patients consider wear- from public funds for dental care are
When many teeth are missing, the use of ing a removable partial denture as less decreasing.23 Effective use of the funds
removable partial dentures is a com- acceptable than not replacing missing available to promote dental health would
monly used treatment option. Bergman teeth, and compliance may be greater if a seem, therefore, of paramount impor-
et al.,10 have shown that such prostheses more sophisticated option (eg an implant tance. Recent figures from the Dental
are not likely to contribute to dental dis- supported prosthesis) were offered. Practice Board for England and Wales
ease if well maintained. However, work- indicate that it costs around 52 million
ers such as Berg11 and Drake and Beck12 Fixed bridgework pounds every year to fund the provision
suggest that partial denture wearers are Restoration of short edentulous spans of partial dentures.24 In light of the high
often not meticulous in the care of their often lends itself to the use of fixed bridge- level of non-compliance with partial den-
dentures, and, therefore, experience work. Until recently, in the molar and pre- ture wearing, whether this constitutes
increased levels of caries and periodontal molar regions of the mouth, this involved effective use of public funds is a matter of
disease. These studies show that abut- full or partial crown preparations on one debate. Workers such as Yule,25 and
ment teeth for partial dentures are partic- or both teeth adjacent to the tooth space, Drummond et al.26 have indicated that
ularly prone to periodontal attachment followed by placement of a conventional new treatment strategies are required to
loss and root caries. The study by Drake bridge. While this technique has been meet the demands of the future elderly
and Beck of a large independently living widely used, problems have been reported and to account for economic considera-
population also indicated that levels of with loss of vitality of abutments and tions in treatment planning.
dental disease were correlated with den- mechanical failure of the bridge.17,18 The shortened dental arch concept
ture fit. They reported that poorly main- More recently, resin bonded designs have (SDA) described by Kayser27 is a frame-
tained ill-fitting dentures contributed to been employed with some success.19,20 In work for limiting treatment goals to meet
disease prevalence. either case, problems arise when restora- patient aspirations. The conceptual
Strict adherence to the principles of tion of longer spans (eg > two teeth) is underpinning for this strategy is that
denture design during construction is not attempted. Flexure of metal castings in treatment efforts and resources are
always evident, and this also is a compo- conventional bridgework increases with directed at the anterior and premolar
nent of the iatrogenic problems associ- length of span, which may lead to failure teeth, which are considered essential for
ated with partial dentures.13 A well of the bridge and/or abutments. Failure chewing function and appearance. The
known example of this is the use of ‘gum rates of resin bonded bridges also increase treatment aim is to achieve an acceptable,
strippers’, ie poorly supported acrylic par- with the number of teeth replaced.19 though sub-optimal, level of oral func-
tial dentures which strip the gingival tis- Furthermore, patient motivation is tion. Absent molar teeth are only replaced
sues as they sink under occlusal load. important, as failure to maintain a satis- if their absence gives rise to problems.
A further factor to consider is the factory level of oral hygiene is likely to Kayser and co-workers28 describe the
apparent discrepancy between normative lead to caries or periodontal disease ‘problem oriented approach’ as a means
and subjective need. To elaborate, many affecting abutment teeth. of applying the shortened dental arch
studies have indicated that there is often strategy. Basically, this involves making an
an apparent discrepancy between profes- Implant supported prostheses inventory of patient perceived problems,
sionally assessed (ie normative) need and The option of restoring a fixed bridge or and directing treatment at solving these
patient demand (ie subjective need) for removable denture on endosseous problems. Criteria described by Kayser
dental care.14,15 Tooth loss is often implants is becoming more frequently for application of SDA are shown in Table
accepted and tolerated by many adults, used in the UK.21,22 However, data on 1, with contra-indications to SDA shown
even when access to dental care is not a long-term survival rates of implant ther- in Table 2.
problem.9 This was further shown by Jep- apy in the posterior mandible and maxilla In a longitudinal study of oral function
son et al.16 who, in a survey of patient is limited. In addition, the procedure to in shortened dental arches, Witter et al.
acceptance of partial dentures, found that place implants in the posterior maxilla or 5,29 concluded that: SDA can provide suf-
40% of a 300 patient sample did not wear mandible can be complex, because of lack ficient occlusal stability; SDA provides
their partial dentures. Consonant with of bone, or proximity of the inferior dental satisfactory comfort and appearance;
descriptive population studies,8 they nerve to the proposed implant site. Finally, and, chewing and comfort were not sig-
found that absence of an anterior tooth implant procedures are expensive and may nificantly enhanced by the provision of
was a major influencing factor in patient be beyond the financial resources of indi- removable partial dentures. While further
acceptance of a partial denture. The vidual patients or care providers. work is required to investigate the

BRITISH DENTAL JOURNAL, VOLUME 187, NO. 12, DECEMBER 25 1999 647
PRACTICE
conservative dentistry

Fig. 1 Conventional,
cantilever bridge
and quality of luting cements available
replacing 4 using 3 as when the technique was first described.
the abutment However, Simon et al. found that use of
preparation features such as grooves
decreased the rate of debonds, and rec-
long-term prognosis for dentitions man- bridges to extend mandibular shortened ommended that such features should be
aged by SDA, it would appear that this dental arches in an elderly population over used routinely.35 This finding was simi-
pragmatic approach has much to com- a 5-year period. They concluded that the lar to that reported by de Kanter et al.36
mend it. Using this approach, treatment is performance of these prostheses was far who recently described the findings of a
functionally rather than mechanically more satisfactory than the control group 5-year multi-practice clinical trial of
orientated. Patients’ aspirations are fully provided with removable partial dentures. posterior resin bonded bridges. Their
incorporated into the treatment strategy, Significantly, the prevalence of caries in main findings were that proximal
and finances are targeted at preserving the the bridge group was dramatically less grooves in abutment teeth increased sur-
components of the dentition essential to than the partial denture control group. vival rates, and that the choice of cemen-
the patient. Recently, the technique of resin bonded tation material appeared to have no
Case selection is critical when consider- bridgework has been described, and influence on chances of failure. They also
ing the SDA approach. The patient must preparation guidelines have been reported higher retention rates for max-
be sufficiently motivated to maintain the reported.31 Initially proposed as a fixed- illary bridges than those placed in the
remaining dentition, as loss of teeth may fixed design, the technique involved mini- mandible. They suggested that this was
compromise function and appearance. mal preparation of anterior or posterior because of shorter crown height,
Furthermore, as indicated earlier, the abutment teeth. increased occlusal loads and greater
clinician must be confident that the Key considerations in providing resin tooth isolation problems in the
remaining natural dentition has a good bonded bridges are shown in Table 3. mandible. Kilpatrick and Wassell37 pro-
long-term prognosis. Despite the advantages of this tech- posed partial occlusal coverage of abut-
nique compared with conventional fixed ment teeth with the bridge, as well as
Applications of the SDA concept and removable prostheses, resin bonded enhancing the rigidity of the framework
One of the goals of prosthodontic rehabil- bridges are not widely used in the general to minimise these problems.
itation is to minimise the ‘biological price’ dental services in the UK.24 This may be Evidence has been presented which
associated with tooth replacement. For influenced by the initially low survival suggests that a cantilevered design of resin
some carefully selected patients, restora- rates reported for this technique, especially bonded bridgework performs at least as
tion of tooth spaces essential for appear- for posterior resin bonded bridges.32,33 In effectively as fixed-fixed designs. Hussey
ance and chewing rather than complete a review of failure rates of single tooth and Linden38 assessed, prospectively, the
restoration may be particularly indicated. restorations, Priest34 described a number performance of cantilevered resin-
In this respect, alternatives to using of factors which may account for this, bonded bridges provided in a hospital
removable partial dentures to replace including the very minimal preparation environment. They concluded that can-
absent teeth, or to extend shortened tilevered resin bonded bridges performed
dental arches include: well, with a low incidence of caries. An
• Cantilevered, conventional bridgework important caveat in their commendation
• Cantilevered, resin bonded bridgework Table 2 Contra-indications to SDA of this treatment modality was that care-
• Implant supported crowns/bridges. ful moisture control and handling of the
This cantilever bridge design involves cementation materials was critical to the
attaching a prosthesis to a single abutment outcome. They also reported higher suc-
tooth, as illustrated using a conventional • Marked dento-alveolar malrelationship cess rates in replacement of missing pre-
bridge in fig. 1, thus accepting a reduced, • Parafunction molar and lateral incisor teeth than
but functionally acceptable, occlusal table. central incisors and canine teeth.
The advantages in this design include less • Pre-existing TMD Application of this technique in con-
tissue coverage and ease of access for oral • Advanced pathological toothwear
junction with a shortened dental arch
hygiene procedures. strategy has a number of potential advan-
Possible designs of cantilevered bridge- • Advanced periodontal disease tages, namely:
work include conventional crown retained • The minimal preparation of teeth
• The patient is under the age of 40 years
pontics, and resin-retained pontics. involved decreases the ‘biological
Budtz-Jorgenson and Isidor30 described price’
the use of conventional cantilevered fixed • The technique is cost effective in terms

648 BRITISH DENTAL JOURNAL, VOLUME 187, NO. 12, DECEMBER 25 1999
PRACTICE
conservative dentistry

Table 3 Key considerations in providing resin bonded bridgework

Case selection

• Is there sufficient tooth structure for bonding?

• Is the occlusion favourable?


19 Hussey D L, Pagni C, Linden G J. Performance
Preparation and cementation of 400 adhesive bridges fitted in a restorative
dentistry department. J Dent 1991; 19:
• Cingulum grooves 221-225.
20 Verzijden C W, Creugers N H, Van’t Hof M A.
• Occlusal rest seats A meta-analysis of two different trials on resin-
bonded bridges. J Dent 1994; 22: 29-32.
• Maximal, supra-gingival coverage of non-visible aspects of abutment teeth 21 Allen P F, McMillan A S, Smith D G.
Complications and maintenance requirements
• Good moisture control during bridge cementation of implant-supported prostheses provided in a
UK dental hospital. Br Dent J 1997; 182:
• Strict adherence to manufacturer’s instructions when handling cements 298-302.
22 Chan M F, Johnston C, Howell R A, Cawood
J I. Prosthetic management of the atrophic
mandible using endosseous implants and
of time to complete and provide the 5 Witter D J, De Haan A F J, Käyser A F, Van overdentures: a six year review. Br Dent J 1995;
Rossum G M J M. A 6-year follow-up study of 179: 329-337.
bridge, and maintenance costs are low 23 Pilot T. Economic perspectives on diagnosis
oral function in shortened dental arches. Part I:
• Debond will cause the bridge to fall out, occlusal stability. J Oral Rehabil 1994; 21: and treatment planning in periodontology. J
eliminating the risk of partial debond 113-125. Clin Perio 1986; 13: 889-893.
and the risk of caries associated with the 6 Pullinger A G, Seligman D A, Gorbein J A. A 24 GDS analysis of treatments (1994). Dental
multiple logistic regression analysis of the risk Practice Board for England and Wales.
fixed-fixed designs. 25 Yule B F. Need and decision making in
and relative odds of temporomandibular
Using implant supported crowns or disorders as a function of common occlusal dentistry — an economic perspective. Int Dent
bridges are an alternative to using resin features. J Dent Res 1993; 72: 968-979. J 1984; 34: 219-223.
7 Boretti G, Bickel M, Geering A H. A review of 26 Drummond J, Newton J P, Yemm R. Dentistry
bonded bridgework to extend shortened for the elderly: a review and assessment for the
masticatory ability and efficiency. J Prosthet
dental arches. In view of the complex Dent 1995; 74: 400-403. future. J Dent 1988; 16: 47-54.
nature of this form of treatment, it should 8 Steele J G. The dental status, needs and demands 27 Käyser A F. Shortened dental arches and oral
not be considered as the first option. of the elderly in three communities. PhD Thesis, function. J Oral Rehabilitation 1981; 8:
University of Newcastle upon Tyne, 1994. 457-462.
However, in situations where potential 9 Liedberg B, Norlen P, Owall B. Teeth, tooth 28 Käyser A F, Battistuzzi P F, Snoek P E, Plasmans
abutment teeth are unsuitable for con- spaces and prosthetic appliances in elderly men P J, Spanauf A.J. The implementation of a
ventional and resin bonded cantilevered in Malmo, Sweden. Comm Dent Oral Epidemiol problem oriented treatment plan. Aust Dent J
bridgework, implant therapy may be the 1991; 19:164-168. 1988; 33: 18-22.
10 Bergman B, Hugoson A, Olsson C. Caries, 29 Witter D J, De Haan A F J, Käyser A F, Van
treatment of choice. periodontal and prosthetic findings in patients Rossum G M J M. A 6-year follow-up study of
When a shortened dental arch strategy with removable partial dentures: a ten year oral function in shortened dental arches. Part
is employed, regular check-up visits and longitudinal study. J Prosthet Dent 1982; 48: II: craniomandibular dysfunction and oral
506-514. comfort. J Oral Rehabil 1994; 21: 353-366.
periodontal maintenance is required to 11 Berg E. Periodontal problems associated with 30 Budtz-Jorgenson E, Isidor F. A 5-year
ensure long-term survival of the remain- the use of distal extension removable partial longitudinal study of cantilevered fixed partial
ing dentition. The importance of ade- dentures — a matter of construction? J Oral dentures compared with removable partial
quate plaque control should also be Rehabil 1985; 12: 369-379. dentures in a geriatric population. J Prosthet
12 Drake C W, Beck J D. The oral status of elderly Dent 1990; 64: 42-47.
emphasised to the patient. removable partial denture wearers. J Oral 31 Barrack G. Recent advances in etched cast
In the following pages, a series of cases Rehabil 1993; 20: 53-60. restorations. J Prosthet Dent 1984; 52: 619-626.
are presented (Cases 1 to 3) to illustrate 13 Basker R M, Harrison A, Davenport J C, 32 Marinello C P, Kerschbaum T H, Pfeiffer P,
Marshall J L. Partial denture design in general Reppel P D. Success rate experience after
the use of resin bonded bridgework in dental practice — 10 years on. Br Dent J 1988; rebonding and renewal of resin-bonded fixed
shortened dental arches. In each of these 165: 245-249. partial dentures. J Prosthet Dent 1990; 63: 8-11.
cases, patients either had unfavourable 14 Diu S, Gelbier S. Oral health screening of 33 Chang H-K, Zidan O, Lee I K, Gomez-Martin
experiences with partial dentures, or elderly people attending a community care O. Resin-bonded fixed partial dentures: A recall
centre. Comm Dent Oral Epidemiol 1989; 17: study. J Prosthet Dent 1991; 65: 778-781.
refused to wear such a prosthesis. 212-215. 34 Priest G F. Failure rates of restorations for
15 Wilson G N, Salway D J, McLaughlin E A. The single tooth replacement. Int J Prosthodont
1 Todd J E, Lader D. Adult dental health, UK dental needs and demands of an elderly 1996; 9: 38-45.
1988. Office of Population Censuses and population living in care in South Cumbria. 35 Simon J F, Gartrell R G, Grogono A. Improved
Surveys. London: HMSO, 1990. Comm Dent Health 1987; 4: 395-405. retention of acid-etched fixed partial dentures:
2 Downer M C. The improving dental health of 16 Jepson N J A, Thomason J M, Steele J G. The a longitudinal study. J Prosthet Dent 1992; 68:
United Kingdom adults and prospects for the influence of denture design on patient 611-615.
future. Br Dent J 1991; 170: 154-158. acceptance of partial dentures. Br Dent J 1995; 36 de Kanter R J A M, Creugers N H J, Verzidjen C
3 World Health Organisation. A review of 178: 296-300. W G J M, Van’t Hof M A. A five-year multi-
current recommendations for the organisation 17 Glantz P-O, Nilner K, Jendresen M D, practice clinical study on posterior resin-
and administration of community oral health Sundberg, H. Quality of fixed prosthodontics bonded bridges. J Dent Res 1998; 77: 609-614.
services in Northern and Western Europe. after 15 years. Acta Odontol Scand 1993; 51: 37 Kilpatrick N. M., Wassell R. W. The use of
Copenhagen: WHO regional office for 247-252. cantilevered, adhesively retained bridges with
Europe, 1982. 18 Saunders W P, Saunders E M. Prevalence of enhanced rigidity. Br Dent J 1994; 176: 13-16.
4 Agerberg G, Carlsson G E. Functional disorders periradicular periodontitis associated with 38 Hussey D L, Linden G J. The clinical
of the masticatory system II. Acta Odonto crowned teeth in an adult Scottish population. performance of cantilevered resin-bonded
Scand 1973; 31: 337-347. Br Dent J 1998; 185: 137-140. bridgework. J Dent 1996; 24: 251-256.

BRITISH DENTAL JOURNAL, VOLUME 187, NO. 12, DECEMBER 25 1999 649
PRACTICE
conservative dentistry

Case 1
This 66-year-old female was referred to
the Newcastle Dental Hospital for an
opinion regarding replacement of her
existing P/ cobalt chromium based den-
ture. She had not experienced any dis-
comfort or retention problems with the
denture, which had been constructed 18
months prior to her attendance at NDH. Fig. 2 Anterior view
Her principal complaint was that she of Patient 1 with
upper partial denture
‘was always conscious of the denture’ replacing 2 456 in
and that it ‘never felt part of me’. She felt place
compelled to wear the denture, as her
upper right lateral incisor was missing.
In fact, she admitted that she only wore
the denture on occasions where she was
likely to come into contact with other
people.
On examination, teeth present were
43 1 123
4321 1234567
Oral hygiene was fair, and no mobility
of remaining teeth was noted. She had a
class III malocclusion, with a tendency
to overclosure. The P/ denture replacing
7652 4567 (fig. 2) was well retained, and Fig. 3 Anterior view of
patient 1 showing
fit was adequate. It was possible to make
resin-bonded bridges
minor improvements to the denture, replacing 2 4 and 4
but it was felt that this would not address
her presenting complaint. Further dis-
cussion with the patient indicated that if
the space left by the upper right lateral
incisor could be restored, she could hap-
pily manage without restoration of the Fig. 4 Occlusal view of
upper, cantilever resin
posterior tooth spaces. Consequently, a bonded bridges
cantilevered, resin bonded bridge was placed for Patient 1.
provided using the upper right first pre- For both abutments,
molar abutment. To provide more stable wide coverage of the
retaining ‘wings’
occusal contacts, cantilevered resin maximises the
bonded bridges were also provided in bonding area. Note
the upper left and lower right premolar the reinforced design
of the premolar
regions (figs 3, 4). A course of oral
retainer that results
hygiene instruction and simple scaling from the use of
procedures was also undertaken. The positive occlusal
patient was very pleased with the cos- support mesially and
distally
metic end result, and reports no chew-
ing difficulties. Her only ‘problem’ is tht
she has not yet gotten out of the habit of
reaching to her handbag for her denture
when planning to go out!

650 BRITISH DENTAL JOURNAL, VOLUME 187, NO. 12, DECEMBER 25 1999
PRACTICE
conservative dentistry

Case 2
This 80-year-old lady attended for
review following routine conservation
and provision of an upper partial
cobalt-chromium denture 2 years pre-
viously. Although she had no com-
plaints about the fit or retention of the Fig. 5 Patient 2:
denture, she reported only wearing Occlusal view of the
it because it replaced the missing well-designed upper
partial denture
upper left lateral incisor, and tended replacing 654 2
to restrict its use to social occasions. teeth
She avoided its use for eating when-
ever possible as it interfered with taste
and felt bulky.
On examination
7 321 1 3456
6 54321 12345
were present. All teeth were sound
and their periodontal condition
healthy. The design, fit and occlu-
sion of the partial upper denture was
very satisfactory and, apart from the
replacement of the lost gingivally
approaching clasp at 3 , improvement
or modification was not possible or Fig. 6 Anterior view
advised (fig. 5). During subsequent of Patient 2 showing
discussion, it became apparent that the resin-bonded
bridge replacing 2
the patient’s only concern was the
missing 2 and that she was not unduly
concerned by the missing 654 teeth.
Accordingly, 2 was replaced using a
resin bonded bridge cantilevered from
1 to avoid a tight occlusal contact
between upper and lower canines
(figs. 6,7). The patient was very satis-
fied with the appearance of the bridge,
and reported no difficulties chewing
despite the missing upper posterior
teeth.
Fig. 7 Patient 2:
Occlusal view of
cantilevered resin
bonded bridge
replacing 2 using
1 as the abutment.
Missing 654 teeth
have not been
restored

BRITISH DENTAL JOURNAL, VOLUME 187, NO. 12, DECEMBER 25 1999 651
PRACTICE
conservative dentistry

Case 3
This 72-year-old gentleman attended
the Prosthodontics Department for
replacement of 10-year-old complete
upper and lower partial dentures fol-
lowing the successful completion of a
course of periodontal treatment.
Though an experienced denture wearer Fig. 8 Anterior view of
Patient 3 showing the
who found these and previous C/P 10-year-old lower
dentures generally satisfactory, he was partial denture replacing
somewhat ambivalent towards the 7654 2567 teeth and
need for a /P denture which he wore complete upper denture
largely because he been advised to do
so. He did report occasional discom-
fort from this and previous lower par-
tial dentures.
On examination only 321 1 34 teeth
remained. All teeth were sound and
periodontally stable. C/P dentures Fig. 9 Anterior view of
were poorly adapted and unstable and Patient 3 to show
required replacement (fig. 8). Follow- cantilevered, resin
ing discussion with the patient, he was bonded bridges
replacing 4 25. The
provided with cantilever resin bonded complete upper denture
bridges to restore the lower arch as a has been replaced along
part of a clinical trial investigating the with the construction of
the resin bonded bridges.
efficacy of these restorations as com-
Note the even occlusal
pared to partial dentures in the contacts in the anterior
restoration of patients with severely and premolar region
shortened lower dental arches. The
three bridges used to replace 4 2 5
teeth were cantilevered from 3 34
teeth respectively and have now been
Fig. 10 Lower occlusal
in place for 2 years (figs. 9,10). The mirror view of Patient 3
patient is very satisfied with the result showing the three
and reports an improved comfort and cantilevered, resin
chewing function. Lack of other lower bonded bridges
replacing 4 25. The
posterior teeth has, to date, not design of all retainers
affected the stability of function of the ensures the maximum
complete upper denture. bonding area, wrap
round and support. Use
of lingual cuspal
coverage at 4 further
improves support and
strength of the retainer.
Compare this to the
design of the retainer at
4 where the functional
palatal cusp prevents
full coverage

652 BRITISH DENTAL JOURNAL, VOLUME 187, NO. 12, DECEMBER 25 1999