Why Partial Dentures Fail

Abstract

Volumes of information regarding the removable partial denture are accessible to all who are interested, and yet this dental restoration continues to be the least understood, most abused restoration in today's society. The stigma of the “removable bridge” is as prevalent today as it was 30 years ago. Why? If one becomes truly dedicated to discovering the answers, it soon becomes a matter of accepted fact that with our present and prevailing modus operandi most removable partial dentures could be considered in the category of positive failures. While there are a multitude of technical and mechanical problems inherent in every restoration of this type, these are mere minutiae as compared to our basic philosophy related to this phase of prosthodontics. Let us consider that: 1. The average student, who is destined to become the average dentist, generally receives a very scanty background in partial denture construction in the School of Dentistry, for the course usually is taught by an individual whose interest is in complete dentures and who, in addition, is reluctantly compelled to teach removable partial dentures. 2. The removable partial denture is the most demoralizing and challenging dental restoration placed into an oral environment; yet the average restoration is designed and fabricated by a dental laboratory technician who has no background of understanding of the biologic environment with which this restoration must coexist, where it must function, and which it must complement. 3. Little or no mouth preparation is contemplated or accomplished, for this restoration is to be designed by a franchised dental technician committed to the proposition that monetary gains can be realized for both the dentist and the laboratories with a minimum of time spent by the dentist, while still producing an appliance that will result in minimum complaint by the patient. 4. While it is a well known and accepted fact that whenever a fixed partial denture could be constructed, generally a removable partial denture should not be considered, it seems economically unfeasible truly to put this statement into practice. Therefore, far, far too many removable restorations are constructed when they are contraindicated. One “spot survey” conducted showed that 56 per cent of all work requests were for partial dentures and only 7.2 per cent for fixed bridgework. A poorly designed removable partial denture, constructed and planned for by a second party as a result of a shoddy oral examination and diagnosis, with a resultant inappropriate treatment plan, and with little or no mouth preparation must be doomed for failure. 5. Patients’ attitudes regarding the restoration are that it is an expensive treatment type of oral appliance that requires a minimal involvement on their part in maintenance, if in fact it can be worn at all.