Treatment of a partially edentulous patient with implant- retained removable partial denture prosthesis
CASE STORY
A 55-year-old male patient presents with a chief complaint of “I am not happy with the way my partial denture fits.” The patient has been wearing a removable partial denture in the maxilla for over 10 years. Given the design of the RPD, there was little retention on the patient’s left side. The patient wished to keep as many of his remaining natural teeth as possible.
Figures 1 and 2: Posttreatment maxilla with implant-retained removable partial denture.
Figure 3: Posttreatment smile.
Figures 4 and 5: Implant-retained removable partial
LEARNING GOALS AND OBJECTIVES
- Indications for implant-retained removable partial dentures (IRRPD)
- Design of IRRPD frameworks
- Supplemental RPD framework design elements in anticipation of future tooth loss
Medical History
- No significant findings
Dental History
- Multiple extractions due to caries and periodontal disease
- Fixed partial dentures and single-unit full coverage restorations
- Removable partial dentures in the maxilla and mandible
- Endodontic therapy of multiple teeth including maxillary right second premolar (4)
Medications and Allergies
- No medications
- No known drug allergies
Review of Systems
- Vital signs:
- Blood pressure: 120/80
- Heart rate: 74 beats/minute
- Respiration: 16 breaths/minute
Social History
- History of smoking one pack cigarettes per day for 10 years
- Discontinued smoking 25 years ago
Significant Soft Tissue Examination Findings
- No significant findings
Figure 6: Dental charting.
Significant Clinical Findings/Problem List
- Caries: Maxillary right 1st and 2nd molars and 2nd premolar (2, 3, 4)
- Ill-fitting maxillary removable partial denture
Diagnosis
- Caries
- Maxillary and mandibular partial edentulism
Clinical Decision- Making Determining Factors
- Removable partial dentures provide a sound and desirable treatment option for many prosthodontic patients. This can be for several reasons:
- Lack of suitable abutments for conventional fixed partial dentures
- Lack of suitable bone for implant therapy with fixed prostheses
- Financial constraints
- For these patients, a conventional removable partial denture (RPD) may be a comfortable, affordable, and desirable treatment option. In some clinical situations, however, the retention and function of a conventional RPD may be compromised due to lack of an adequate number of abutment teeth. This is the case for the patient being discussed here. Treatment alternatives for this patient include the following:
- Removal of the three remaining maxillary teeth and fabrication of a maxillary complete denture
- Fabrication of a conventional removable partial denture
- Fabrication of an implant-retained removable partial denture
- Because the patient has expressed the desire to maintain his remaining teeth yet have more retention with his RPD, option 3 was selected />
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