Original article

Prevalence of removable partial dentures users treated at the Aracatuba Dental School UNESP
n-Antenucci, Eduardo P. Pellizzer, Daniel Augusto de Faria Almeida, Rosse M. Falco nchez, Paulo Renato J. Zuim and Fellippo R. Verri Daniela Mayumi I.K. Sa
Department of Dental Materials and Prosthodontics, Arac atuba Dental School, Sa atuba, SP, Brazil o Paulo State University-UNESP, Arac

doi: 10.1111/j.1741-2358.2012.00653.x Prevalence of removable partial dentures users treated at the Aracatuba Dental School UNESP Objectives: The aim of this study was to evaluate the frequency of removable partial dentures (RPD) at the Aracatuba Dental School. Methods: The study was conducted by analysing 412 clinical history of patients attended at the RPD clinics in the period from 2000 to 2007. Results: 412 charts were analysed: 148 (35.9%) men and 264 (64.1%) women. The mean age was 53.8 years (men) and 52.4 years (women). A total of 556 dentures were made; of these, 233 (41.90%) were maxillary and 323 (58.09%) were mandibular dentures. The most frequent Kennedy classication found was Class III (maxilla) and Class I (mandible). In the maxilla, 55% (126) of the major connectors were of the anteriorposterior palatal bar, while in the mandible, 64% (202) were the lingual bar. As regards the claps, 401 were circumferential and 318 were bar claps. Conclusion: The mean age of the patients was 52.9 years with higher prevalence of female patients; the most frequent Kennedys classication was Class I in mandible and Class III in maxilla; the most common major connector was anteriorposterior palatal bar for maxilla and lingual bar for mandible; the circumferential clasps were the most common retainer used in both jaws. Keywords: removable partial denture, Kennedy classication, denture construction. Accepted 23 October 2011

Introduction
Several options for rehabilitation of partially edentulous patients are available including conventional and implant-retained prostheses. However, some alternatives can be counter-indicated because of general and/or oral limitations (bone loss, medical treatment or extensive surgical protocols) as well as nancial condition1. The removable partial denture (RPD) is a treatment alternative widely indicated for rehabilitation of partially edentulous patients. Many authors suggested that the RPD is as a reliable, versatile and reversible treatment choice with low cost24. Oral rehabilitation with RPD restores oral and systemic health of patients and allows easy hygiene procedure in some cases. Biological, mechanical, aesthetic and physiological factors are related to the acceptance of the denture by the patient and professional; which is important for the treatment success5.
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On the other hand, the RPD is not well accepted by some patients and professionals6 because it may compromise function and aesthetics, as well as, increase risk to caries and periodontal disease. However, several factors such as accurate planning, patients instruction and motivation about oral hygiene and regular follow-ups may increase treatment longevity and success6,7. The prosthetic treatment for partially edentulous patients may be complicated due to the conditions of arches and edentulous spaces. Biomechanics, patients comfort, aesthetics and abutments conditions must be considered to avoid mechanical failures of the prosthetic framework or collapse of the remaining structures. The role of bromucosa as support for the RPD increases when the teeth in the residual ridge in mandibular free-end arches are lost. Considering that the biomechanical performance of bromucosa is different from teeth, the free-end RPDs may be harmful for periodontal tissues of

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abutment teeth because of the masticatory forces8, torque or horizontal forces that are applied9. Finally, an accurate evaluation of teeth condition, periodontal treatment, maintenance of oral hygiene and regular follow-ups after prostheses insertion are important to minimise the problems associated with RPD wearing, such as caries, periodontal disease and resorption of residual ridge9. Many researchers have evaluated the need of prosthetic treatment, indications of RPDs, patients satisfaction, effectiveness of rehabilitation, structures and designs of RPDs913. However, few studies5,10 associated the planning of RPD with age, gender, prevalence of design of the metallic framework, attachments type, classication of the edentulous spaces and its relation with age distribution. Epidemiological studies evaluate the past and try to predict future conditions, while investigative studies have demonstrated the relevance of clinical researches mainly for those conducted in universities because they can be associated with Science14. Thus, the aim of this study was to evaluate the incidence of wearing, fabrication and type of RPD in patients treated in the graduation clinic of Dental Prosthesis at the Aracatuba Dental School.

(version 3.4; Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA), collecting gender, age, arch, Kennedys classication, major connector, retention and number of follow-ups. After data collection, Epi Info software was used to tabulate data and generates the results.

Results
The records of 1058 patients treated from 2000 to 2007 were evaluated. Among all records, 412 were in accordance with the inclusion criteria and were selected to this study. The demographic and clinical characteristics of the patients are shown in Table 1. Among the 412 records, 148 (35.9%) were from men and 264 (64.1%) were from women (Table 1). A total of
Table 1 Demographic and clinical characteristics of the sample. Frequency Sex Female Male Total Age (years) 2030 3140 4150 5160 6170 >70 Total Dental arch with removable Maxilla Mandible Bimaxilar Total patients Total de Prostheses Kennedy classication Maxillary Class I Class II Class III Class IV Mandibular Class I Class II Class III Class IV Total 264 148 412 Percentage 64.1 35.9 100.0

Materials and methods

The rules and orientations established by the Research Ethics Committee of the Aracatuba Dental School UNESP (Process FOA 2008-01979), were followed in this study. The research was conducted through the analysis of the records of the patients treated in the clinics of Removable Partial Denture at the Aracatuba Dental School UNESP from 2000 to 2007, totalising 1058 records. The dentures were fabricated by undergraduate students in Dentistry using the principles and methods of fabrication of RPD of the Department of Dental Materials and Prosthodontics approved by the institution. The metallic frameworks and the resin bases were fabricated by laboratories accredited by the Department of Prosthodontics that followed the methods previously mentioned. The records were selected by four examiners through the analysis of data about clinical records, radiographies and specic data about RPD. The inclusion criteria were the presence of planning of the denture framework and records lled accurately including all information about the treatment. The records that did not present such information were excluded from the study as well as the records of patients that gave up the treatment. After selection of the records, data were tabulated and stored in the Epi Info 2000 software

03 46 124 146 70 23 412 partial dentures 233 323 144 412 556

00.70 11.20 30.10 35.40 17.00 05.60 100.00 56.5 78.4 34.95 100.0

44 60 121 9

7.91 10.79 21.76 1.62

143 87 89 3 556

25.72 15.65 16.01 0.54 100.0

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556 prostheses were fabricated including 233 maxillary dentures and 323 mandibular dentures. In 35% of the patients, both maxillary and mandibular dentures were fabricated. The mean age of the patients was 52.9 years, ranging from 28 to 95 years. The mean age for woman was 52.4 years, while the mean age for man was 53.8 years. The patients distribution according to age is shown in Table 1. Considering the arches classication, Kennedy Class III predominated for maxillary dentures while Class I was prevalent for mandibular dentures. When these data were associated with age (Table 2), it was observed more maxillary Class III for the age range from 41 to 50 years and more mandibular Class I for the age range from 51 to 60 years. The retention used in the RPDs is indicated in Table 3. Both arches presented 401 circumferential clasps (55%) and 318 bar clasps (43%). Other types of direct retainer were observed with no signicant percentage. The major connectors and their distribution are shown in Table 4. Maxilla presented 126 anterior posterior palatal bars (55%), while lingual bar was used in 202 mandibular RPDs (64%). Table 5 demonstrates the number of follow-ups conducted after prosthesis insertion. A minimum of
Table 2 Kennedy classication ages. 2030 Maxillary Class I Class II Class III Class IV Mandible Class I Class II Class III Class IV 0 0 2 0 3140 2 6 17 1 4150 11 18 47 2 5160 21 21 40 3 6170 7 13 11 3 >70 3 5 5 0

Table 4 Major connectors. Maxillary connectors Frequency Percentage

Anterior suspense bar 5 2.18 U-shaped palatal strap 9 3.93 Anteroposterior palatal bar 126 55.02 Palatal strap 34 14.85 Palatal plate 55 24.02 Total 229 100 Mandible connectors Frequency Percentage Dental bar Lingual bar Lingual plate Total 8 202 103 313 2.56 64.54 32.90 100

Table 5 Frequency of control. Numbers of controls 0 1 2 3 4 5 6 7 8 9 10 Total Frequency 53 106 128 102 19 2 0 0 1 0 1 412 Percentage 12.8 25.7 31 24.7 5 0.4 0 0 0.2 0 0.2 100

2 follow-ups was observed in most of the cases (31%).

Discussion
According to the results of the present study, there was a difference of 28.2% between the genders, with more female patients (64.1%). Although some studies demonstrated similar trend5,12,1518, the fact was not discussed. Some authors evaluated the frequency, distribution and localisation of xed prostheses and observed that 68.3% of the xed dentures were fabricated for women19. According to Carvalho et al.20, female patients are predominant in dental ofces because of the importance of aesthetics and available time as a result of different work schedule. Considering that women visit professionals more frequently, they are more susceptible to exodontia and rehabilitation procedures than men, which is in agreement with the results of the present study. According to

0 1 0 0

4 11 7 1

31 12 16 2

32 26 20 0

16 8 6 0

6 2 0 0

Table 3 Retainers. Clasps Circumferential clasps Bar clasps Others Total Frequency 401 318 11 730 Percentage 54.93 43.56 1.51 100

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Martins et al.21, men avoid dental and medical examinations because of culture and economic situation. The population census of 2000 showed that there were 96.93 men for each 100 women in Brazil, which means that there were 2 647 140 more women than men. The previous census revealed similar situation as a result of different mortality rate with higher mean lifetime for women than men. In the last two decades, the proportion of men has decreased slightly from 98.7 in 1980 to 97.5 in 1991 and 96.9 in 200022. Table 1 reveals a mean age of 52.9 for the patients that were treated in the clinic, which is similar to the data found by Budtz-Jrgensen and Isidor17 and Vanzeveren et al.12 In the present study, the mean age of the male patients was slightly higher than for the female patients; as it was also demonstrated by Vanzeren et al.,11 Carlsson et al.,23 Schwalm et al.24 and Benson and Spolsky25. A bibliographic research revealed that there is no standard for stratication by age, which inuences comparison between data5,10,12. In the present study, the patients distribution according to age demonstrated higher number of patients between 51 and 60 years. Cosme et al.5 applied the same stratication by age and found higher prevalence of patients wearing dentures with more than 60 years (2% higher than the age range between 51 and 60 years). The sample (n = 50) of Cosme et al.s5 study was smaller than in the present study (n = 412). In 2007, Zitzmann et al.26 conducted a literature review about prevalence of dentures in Europeans and concluded that most of the patients wearing RPD were older and presented poor socialeconomic situation and low educational level. In this study, there were more mandibular dentures (323) than maxillary (233). In addition, mandibular Class I was more prevalent mainly in patients between 40 and 60 years, which is in agreement with previous studies4,5,12,16,19,25,2729. The prevalence of mandibular RPDs is related to the pattern of teeth loss and related problems27,29. Considering the patients that already wear RPD, unfavourable situations as alterations in oral microbiota and increase in plaque retention on abutment teeth may increase the risk to gingivitis, periodontitis and caries28; which changes the distribution of edentulous spaces. Although maxilla presented prevalence of Kennedy Class III mainly in the patients between 41 and 50 years, several researches found different Kennedys classication12,15,27, with higher frequency for Classes I, II and III. Considering the

major connectors, anteriorposterior palatal bar was more prevalent in maxilla as lingual bar was in mandible. Similar results were described by Sadig and Idowu10 while Vanzeveren et al.11 found more anteriorposterior palatal bar or U-shaped bar in maxilla. However, this type of major connector would be mechanically decient because of its deformation during handling and uncomfortable for the patients for covering the palatine ridges. The circumferential clasp was the most common retainer followed by the bar clasps, as it was also demonstrated by Becker et al.30; Lechner and Thomas31; Sadig and Idowu10. Similar results were found in other study showing more circumferential clasps in maxilla and RPA or RPI in mandible10. Most patients needed up to three follow-ups after RPD insertion. About 12.8% of the patients did not attend to the follow-ups, which means that no additional adjusts were required as the treatment was conducted in a Dentistry School clinic. Less than 6% of the patients needed more than three follow-ups, indicating that when the dentures are fabricated according to controlled criteria, the posterior adjusts are less complicated. The RPD provides not only denitive rehabilitation but also social restoration even when used provisionally during complex treatments with implant-supported xed prostheses. Some implantsupported treatments require longer period of osseointegration, which may be solved by wearing RPDs.

Conclusion
1. The mean age of the patients was 52.9 years with higher prevalence of female patients; 2.The most frequent Kennedys classication was Class I in mandible and Class III in maxilla; 3. The most common major connector was anteriorposterior palatal bar for maxilla and lingual bar for mandible; 4. The circumferential clasps were the most common retainer used in both jaws.

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Correspondence to: Bonifa cio 1193 Prof Eduardo P. Pellizzer, Rua Jose Vila Mendonc a, Arac atuba, Sa o Paulo 16015-050, Brazil. Tel./Fax: (18) 3636 3297/3636 3245 E-mail: ed.pl@uol.com.br

2012 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2012; 29: 140144