The effect of partial denture connectors on gingival health
Sandra Orr\ Gerard J. Linden^ and Hubert N. Newman' ^Department of Restorative Dentistry, Queen s University ot Belfast, UK: ^insiitute of Dental Surgery, University of London, UK
Orr S. Linden GJ and Newman HN: The effect of partial demure connectors on gingival health. J Clin Periodontol 1992; 19: 589-594. Abstract. The effect on the gingiva of a variety of relationships of a removable partial denture connector to the gingival margin was investigated in 10 subjects. Acrylic resin baseplates were designed incorporating a variety of relationships of the connector to the gingival margin. The appliances were worn for a 12 hour period daily, for 21 days. At baseline and at days 7, 21 and 49. plaque index, gingival index and probing pocket depth measurements were recorded, and subgingival plaque samples were examined using darkfield microscopy. No increase in plaque accumulation was detected in any area at any time interval. There was a significant increase in gingival index at day 21 in areas where the appliance covered the gingival margin. Small increases in probing pocket depth were recorded at day 21. there being no difference between any of the test areas. Baseline values were re-established by day 49, No significant differences were detected in the percentage of motile organisms or spirochaetes counted in the subgingival plaque samples collected from any area. It was concluded that deterioration in gingiva] health occurred rapidly following the insertion of a removable appliance, and that coverage of the gingiva] margin, irrespective of the degree of gingival relief, had a detrimental effect.
El Ghamrawy (1976), Addy and Bates (1979) and Stipho et al. (1978) found removable partial dentures were associated with increased plaque accumulation, not only on tooth surfaces in direct contact with the denture but also on teeth in the opposing arch, and in some cases, even on buccal surfaces of teeth. Several studies have shown increased or continuous periodontal breakdown in patients fitted with partial dentures (Carlsson et ai, 1965, Derry & Bertram 1970. Rissin et al. 1979), It is possible to reduce the effect of removable partial dentures on the periodontium. Bergman et al. (1982) and Chandler & Brudvik (1984) demonstrated only minor periodontal effects in patients recalled regularly for supportive treatment, including professional oral hygiene. Taken together these studies suggest that the insertion of a partial denture constitutes a risk factor for periodontal health. One particular problem may be the relationship of the denture connector to the gingival margin, Bissada et al. (1974) concluded that if tooth approximation was necessary, the gingiva! margin should be relieved, i.e. there should be a space underneath the denture base, whereas Hobkirk and Strahan (1979) concluded
that the appliance should be very closely applied to the gingival margin. The aim of this study was to investigate the effect on the gingiva of a variety of relationships of a removable partial denture connector to the gingival margin. In addition darkfield microscopy was used to examine associated microbiological changes, in an attempt to identify whether a disease-associated flora became established in the period shortly following the insertion of a removable partial denture. Material and Methods 10 healthy adult volunteers were selected from Dental Surgery Assistants working at the Eastman Dental Hospital. London. Each subject had an intact maxillary arch, adequately restored dentition and displayed no occlusal abnormalities. The purpose and design of the study were explained clearly to each subject and voluntary informed consent obtained. None had previously worn a removable appliance, nor had they any medical condition which contra-indicated their inclusion in the study, Ali subjects were right-handed. The upper first premolars and first molars were selected as test teeth, and in
Key words: partfal dentures: plaque: gingivat infiammation. Accepted for publication 6 August 1991
each subject the upper second premolars were present so that the test teeth were not contiguous. Two mandibular teeth were chosen as controls. In each subject the mean gingival index was
Sandra Orr\ Gerard J. Linden^ and Hubert N. Newman' ^Department of Restorative Dentistry, Queen s University ot Belfast, UK: ^insiitute of Dental Surgery, University of London, UK
Orr S. Linden GJ and Newman HN: The effect of partial demure connectors on gingival health. J Clin Periodontol 1992; 19: 589-594. Abstract. The effect on the gingiva of a variety of relationships of a removable partial denture connector to the gingival margin was investigated in 10 subjects. Acrylic resin baseplates were designed incorporating a variety of relationships of the connector to the gingival margin. The appliances were worn for a 12 hour period daily, for 21 days. At baseline and at days 7, 21 and 49. plaque index, gingival index and probing pocket depth measurements were recorded, and subgingival plaque samples were examined using darkfield microscopy. No increase in plaque accumulation was detected in any area at any time interval. There was a significant increase in gingival index at day 21 in areas where the appliance covered the gingival margin. Small increases in probing pocket depth were recorded at day 21. there being no difference between any of the test areas. Baseline values were re-established by day 49, No significant differences were detected in the percentage of motile organisms or spirochaetes counted in the subgingival plaque samples collected from any area. It was concluded that deterioration in gingiva] health occurred rapidly following the insertion of a removable appliance, and that coverage of the gingiva] margin, irrespective of the degree of gingival relief, had a detrimental effect.
El Ghamrawy (1976), Addy and Bates (1979) and Stipho et al. (1978) found removable partial dentures were associated with increased plaque accumulation, not only on tooth surfaces in direct contact with the denture but also on teeth in the opposing arch, and in some cases, even on buccal surfaces of teeth. Several studies have shown increased or continuous periodontal breakdown in patients fitted with partial dentures (Carlsson et ai, 1965, Derry & Bertram 1970. Rissin et al. 1979), It is possible to reduce the effect of removable partial dentures on the periodontium. Bergman et al. (1982) and Chandler & Brudvik (1984) demonstrated only minor periodontal effects in patients recalled regularly for supportive treatment, including professional oral hygiene. Taken together these studies suggest that the insertion of a partial denture constitutes a risk factor for periodontal health. One particular problem may be the relationship of the denture connector to the gingival margin, Bissada et al. (1974) concluded that if tooth approximation was necessary, the gingiva! margin should be relieved, i.e. there should be a space underneath the denture base, whereas Hobkirk and Strahan (1979) concluded
that the appliance should be very closely applied to the gingival margin. The aim of this study was to investigate the effect on the gingiva of a variety of relationships of a removable partial denture connector to the gingival margin. In addition darkfield microscopy was used to examine associated microbiological changes, in an attempt to identify whether a disease-associated flora became established in the period shortly following the insertion of a removable partial denture. Material and Methods 10 healthy adult volunteers were selected from Dental Surgery Assistants working at the Eastman Dental Hospital. London. Each subject had an intact maxillary arch, adequately restored dentition and displayed no occlusal abnormalities. The purpose and design of the study were explained clearly to each subject and voluntary informed consent obtained. None had previously worn a removable appliance, nor had they any medical condition which contra-indicated their inclusion in the study, Ali subjects were right-handed. The upper first premolars and first molars were selected as test teeth, and in
Key words: partfal dentures: plaque: gingivat infiammation. Accepted for publication 6 August 1991
each subject the upper second premolars were present so that the test teeth were not contiguous. Two mandibular teeth were chosen as controls. In each subject the mean gingival index was
