Conditions which may influence the choice of partial or complete denture service

Abstract

A goodly number of varying conditions comprise the factors to be evaluated in making the frequent choice between partial and complete denture service. Since many situations are border line in character, there are honest differences of opinion to be expected. It is urged that in making such analyses, that the best interests of the patient be considered, not on a basis of immediacy, but rather on what will be of most benefit for him throughout his expected life span. In view of the greatly increased life expectancy of the present age, this altered viewpoint in prosthodontics is urgently needed. This division of dentistry has geriatric problems of great importance. The probable length of service to be had from the remaining teeth must be estimated in terms of the cost of their reconditioning and maintenance. Caries susceptibility, and the attitude of the patient toward dental caries control, as well as his economic status, must be considered in this evaluation. If the condition of the remaining teeth has been further impaired by the cervical loss of supporting alveolar bone, another economic complication has been added. Because of the unfavorable leverage which follows such bone loss, the greatly increased work-load on the reduced surface of the supporting alveolar walls is such that tissue tolerance will be exceeded unless splinting of adjacent teeth is accomplished. The value of this procedure is well established, but the fact remains that it entails arduous and time-consuming effort, and, therefore, for many it will present financial difficulty. Let us face the facts. Regardless of the need, or the patient's great desire for a partial denture service, and not withstanding every consideration which an overly generous prosthodontist can make, there will be those cases in which a good partial denture program is economically impossible. However, when this obstacle does not exist, it is urged that every effort be made to provide a partial denture service of greater longevity. The marvelous advancement made in recent years in endodontics and periodontics is certain to result in an increasing number of partially endentulous mouths. Teeth which were routinely lost yesteryear are being saved today. Still more will be salvaged tomorrow. The vigorous attempt to indoctrinate a physiologic approach to the rendering of partial denture service has brought about a marked improvement in partial denture design and fabrication. Under favorable conditions, the partial denture need not be a “stop-gap” service, nor need it be a “stepping stone” to the complete denture. Certainly, some partial denture treatment will fail. It is inevitable that some patients will decline physically. But this group of failures should not include those partial dentures which were from the beginning intended only to be temporary. The author urges that these appliances be called “treatment” dentures. They are to be used only where conditions contraindicate the attempt to retain the remaining teeth. The patient should be impressed with the facts that the “treatment” denture is of great value but that it is to be temporary. An increased effort toward the conditioning of the edentulous ridge structure should be made before the residual ridge is used to support a prosthesis, whether partial or complete. This is going to be the next great step forward in prosthodontics. It will be a further step toward achieving DeVan's ideal, “the preservation of that which remains, rather than meticulous replacement of that which is missing.”