Implants in Conjunction With Removable Partial Dentures… et al 2007, implantaten en... · Implants in Conjunction With Removable Partial Dentures: ... satisfied with their removable

Implants in Conjunction With RemovablePartial Dentures: A Literature Review

Eitan Mijiritsky, DMD

Many authors have writtenabout the merits of implant-supported complete overden-

tures, which have been used clinicallywith high success rates for the fullyedentulous patients. The completeoverdenture has proven to be an im-provement over conventional com-plete prostheses with respect tochewing efficiency, patient comfort,and satisfaction.1–4 The context of in-creasing life spans and evidence fromvarious national dental health surveysin industrialized countries indicatethat the proportion of edentulous peo-ple will continue to decline and thatmore people will retain more teeth intoold age.5,6 Projections based on datafrom such surveys6,7 suggest a declinein tooth loss but an increased need formanagement of partial edentulism inpatients with compromised oral orgeneral health status. This trend ofage-related increased tooth retentionsuggests that partially edentulous co-horts will be older than before andprobably less disposed than youngerpeople to such treatment with exten-sive tooth or implant-supported fixedpartial dentures. Consequently, socio-economic factors and populationtrends suggest increased future treat-ment needs with different partial pros-theses.8 A well-constructed removablepartial denture can be an excellenttreatment alternative.9 –12 Yet, thesepatients deserve the best esthetic andfunctional results possible. In thesecases, a limited number of strategi-cally placed dental implants in con-

junction with the remaining naturalteeth can establish a favorable remov-able partial denture design by signifi-cantly reducing the effect of thereciprocal arm and improving the ful-crum line position. When an implantor a limited number of implants isused to support the removable partialdenture, additional retention isachieved, and the need for unestheticbuccal retentive arm clasps is avoidedat the esthetic zone.13–15

The aim of this article is to reviewthe literature regarding the use of im-plants with removable partial denturesin partially edentulous patients and toevaluate the evidence-based indica-tions for this clinical approach.

LITERATURE REVIEW

A MEDLINE/PubMed databasesearch was limited to peer-reviewedarticles published in English between1990 and 2006, focusing on the use ofimplants with removable partial den-tures and related features such as re-sidual ridge resorption, need anddemand for prosthodontic treatment,and cost-effectiveness of dental treat-

ment, all related to implants and re-movable partial prostheses. The digitalsearch was supplemented with ahand search to identify relevantpeer-reviewed English articles pub-lished in dental journals and textbookson removable partial dentures. Fewcase reports, 1 short-term retrospec-tive follow-up (1�4 years), and 1 lon-gitudinal clinical study (2�7 years)were identified.

CONSIDERATIONS FOR THEKENNEDY CLASS I ANDII SITUATIONS

Common complaints associatedwith the Kennedy class I (bilateral freeend) and II (unilateral free end) re-movable partial dentures situations arelack of stability, minimal retention,unesthetic retentive clasping, and dis-comfort upon loading.16

Kelly17 in 1972 described the com-bination syndrome as a common prob-lem associated with the mandibularbilateral partial denture distal extensionopposing a maxillary complete denture,which is characterized by downgrowthof the maxillary tuberosities, papillary

Private practice, Tel Aviv, Israel; Visiting Professor, DentalSchool, University of Chieti-Pescara, Chieti, Italy.

ISSN 1056-6163/07/01602-001Implant DentistryVolume 16 • Number 2Copyright © 2007 by Lippincott Williams & Wilkins

DOI: 10.1097/ID.0b013e3180500b2c

Although the benefits of implant-borne removable prostheses arereadily apparent for the fully eden-tulous patient and have been welldocumented, there is a paucity ofstudies concerning the combinationof implants with removable partialdentures in partially edentulous pa-tients. The aim of this article is toreview the literature regarding im-plants with removable partial den-tures and evaluate the evidence forthis clinical approach. A MEDLINE/PubMed search from 1990 to 2006,

focusing on the use of implants withremovable partial dentures and re-lated features, was supplementedwith a hand search to identify rele-vant peer-reviewed English articlespublished in dental journals andtextbooks on removable partialdentures. (Implant Dent 2007;16:1–●●●)Key Words: removable partial den-tures, dental implants, partiallyedentulous patients, cost-effective,treatment alternative

IMPLANT DENTISTRY / VOLUME 16, NUMBER 2 2007 1

balt5/ziy-id/ziy-id/ziy00207/ziy2884-07z xppws S�1 4/2/07 16:32 Art: ID200132 Input-dms

<zdoi;10.1097/ID.0b013e3180500b2c> • <zjs;Clinical Science and Techniques> • <zjss;ClinicalScience and Techniques>

hyperplasia, resorption of the premax-illa, overeruption of the mandibularanterior teeth, and resorption of the pos-terior mandible.18 These signs may befound in 24% of the population wearinga maxillary complete denture opposinga bilateral distal extension partial den-ture.19 Kelly17 discussed various possi-bilities to avoid combination syndrome.He proposed using roots of anteriormandibular teeth to support an overden-ture. He also mentioned the option ofusing endodontic implants to preservequestionable roots for support in theposterior part of the mandible. Contro-versy exists regarding the potential de-velopment of combination syndromealso in those patients using an implant-supported overdenture with 2 anteriorimplants, since this type of restorationcan act as a bilateral distal extensionsituation.20–22 A posterior implant stopwould most likely eliminate the poten-tial for this to happen. An obvious ad-vantage of an implant with a removablepartial denture in this case is that theextension of the bases can be reduced,since the implant provides the same sta-bility as a terminal abutment would in aKennedy class III situation. The alteredcast impression, a standard technique formaximizing posterior support in theclass I situation, can be omitted aswell.23 One of the most challenging sit-uations to treat with a removable partialdenture is in certain cases classified asKennedy class II, when there are abut-ments only on 1 side of the arch.The long lever arm to the unilateraledentulous side results in an unstableremovable prosthesis, if treated conven-tionally. A strategically placed dentalimplant can establish an improved re-movable partial denture design by sig-nificantly reducing the effort arm andimproving the fulcrum line position.

Tissue-ward rotation during func-tion, around the fulcrum line createdbetween the abutment teeth closest tothe edentulous area, is prevented.13

Keltjens et al24 in 1993 and Haltermanet al25 in 1999 described a number ofclinical cases where 2 implants wereused to assist in the support of a man-dibular bilateral distal extension re-movable partial denture opposed by amaxillary complete denture. Each im-plant was placed in the first molararea, and on 1 occasion, only verticalsupport was derived from the implants

with no retentive elements, while onanother occasion, additional retentionwas provided by magnets, which wereattached in the distal extension denturebase over the implants. From a short-term experience, using implants, theauthors claim was to maintain the in-tegrity of the vertical dimension ofocclusion and prevent degenerativechanges that could have led to whatKelly17 described as the combinationsyndrome. Giffin26 in 1996 reported acase where a Kennedy class II man-dibular arch was restored using a com-bination of a single molar implant atthe edentulous alveolar crest with anextracoronal resilient attachment tosupport and retain a removable partialdenture. The patient claimed that theimplant-supported side of the pros-thesis felt more natural and waspreferred for mastication over the tooth-supported side.

Mitrani et al23 in 2003 described aretrospective study with a follow-up ofat least 1 year to a maximum 4 yearsof 10 partially edentulous patients un-satisfied with their removable partialdentures (Kennedy class I and II).They were treated with posterior os-seointegrated implants to providestability and/or retention of the remov-able prostheses, eliminating the needfor clasps when possible. The authorsperformed a follow-up clinical evalu-ation consisting of patient satisfaction,radiographic examination, and softtissue health. Results indicated consis-tent increased satisfaction in all pa-tients, minimal component wear, noradiographic evidence of excessivebone loss, and stable peri-implant softtissues. Kuzmanovic et al27 in 2004described a case where a Kennedyclass I mandibular arch was restoredusing a combination of bilateral singlemolar implants with ball attachmentsto support and retain a chromium-cobalt removable partial denture. Theauthors reported no complications af-ter 2 years.

RESIDUAL RIDGERESORPTION RELATED TOIMPLANTS AND REMOVABLEPROSTHESES–GENERAL ASPECTS

There are clear indications and lit-tle doubt that removable dentures are

an important causative factor in thebone resorption process. This is sup-ported by studies showing significantdifferences in residual alveolar bonebetween edentulous subjects wearing,or not wearing, removable den-tures.28,29 Subjects not wearing den-tures had more remaining bone. Ingroups of patients who had been wear-ing complete mandibular dentures fordifferent lengths of time, the continu-ous bone resorption stopped in the ar-eas distal to the mental foramina afterthe patients had been provided withimplant-supported prostheses placedanterior to the foramina.30 Animalstudies have shown that continuouspressure from an experimental denturecaused bone resorption when exceed-ing a threshold value and that theresorbed bone was not reshaped whenpressure was discontinued.31–33

Kordatzis et al34 in 2003 comparedthe posterior mandibular residual ridgeresorption in patients with conventionaldentures and implant overdentures. Theresults were that the estimated averagereduction in posterior mandibular resid-ual ridge height was 1.63 mm in 5 yearsfor conventional denture groups and0.69 mm for implant overdenture groups(i.e., almost 1 mm less). The authorsconcluded that depending on biome-chanical factors, bone areas adjacent tothe implants might be more favored.One should expect that reduced resorp-tion rates with implant-supported over-dentures could be attributed to the lessunfavorable loading of bone adjacent tothe implants and the protection of theresidual posterior ridge from excessiveloading, which is inversely proportionalto the distance from the implant. Thecurrent author et al13 in 2005 reportedthat a limited number of strategicallyplaced dental implants in conjunctionwith the remaining natural teeth can es-tablish a favorable removable partialdenture design by significantly reducingthe reciprocal arm and improving thefulcrum line position. This prevents ro-tation toward the tissue during function,and repeated relining of the denture torestore posterior support is prevented. Inthese large edentulous areas, bone ispreserved as a result of the remodelingstimulus around osseointegratedimplants.35–38

2 IMPLANTS IN CONJUNCTION WITH REMOVABLE PARTIAL DENTURES


IMPLANT-SUPPORTED FIXED

PARTIAL DENTURES AS

ABUTMENTS FOR REMOVABLE

PARTIAL DENTURES

Jang et al39 in 1998 described aclinical case report to investigate howa single implant-supported porcelain-fused-to-metal crown in the mandibu-lar right cuspid area can function as anabutment to support a removable par-tial denture in conjunction with theremaining mandibular teeth: right firstincisive to left canine. From a short-term experience, the authors report nobone loss around the implant, orcrown or abutment loosening.

LONG-TERM STUDIES ON

IMPLANTS WITH REMOVABLE

PARTIAL DENTURES

The current author et al13 in 2005published the first longitudinal studyin English that was aimed to determinewhether the use of a limited number ofimplants, with no rigid connection be-tween implants and teeth and as few aspossible prosthetic element require-ment, is a viable solution for improv-ing unfavorable removable partialdentures design and esthetics. Fifteenpartially edentulous patients with anunfavorable number and distributionof abutment teeth were treated, eachwith a limited number of implants (to-tal of 33 implants), from 1997 to 2004,resulting in an improved removablepartial denture design.

Throughout the study follow-up(2�7 years), the implant survival ratewas 100%, and prosthetic complica-tions were minor. All patients reportedsuperior satisfaction with the partialdentures and good chewing efficiency.The results indicate that this clinicalapproach is a viable and cost-effectivetreatment option. Van Zeghbroeck(personal communication) in 2000 re-ported a 5-year follow-up of 21 casestreated with implant ooth-supportedremovable partial dentures. The sur-vival of implants, teeth, and function-ing prosthesis was 100%. No decay ormobility was found, and the survivalrate of the prosthetic componentswas 74%.

SALVAGING FAILED FIXEDIMPLANT THERAPY

McAndrew40 in 2002 reported acase where 4 implants were placed inthe maxilla of a partially edentulouspatient with a treatment plan of animplant-supported fixed partial den-ture. Three of the implants failed toosseointegrate and were removed. Aswing-lock removable partial denturewas fabricated, and an O-ring attach-ment was used on the implant toprovide additional retention for theprostheses. The author reported that15 months later, the prostheses wasentirely satisfactory to the patient, andthe remaining teeth and implant werein sound condition. The current authorand Karas41 in 2004 described theprosthodontic rehabilitation of a par-tially edentulous patient using a re-movable partial denture involvingteeth and implants as an alternative tounsuccessful fixed implant therapy.Since the patient declined any addi-tional dental implant therapy, thistreatment option solved a difficultclinical problem derived from the fail-ure of 2 strategic implants, and pro-vided the patient with an esthetic andfunctional prosthesis.

Asvanund and Morgano42 in 2004described a treatment approach for apartially edentulous patient where afixed metal-ceramic restoration was notpractical due to unfavorably positionedimplants and deficient contour of thealveolar ridge at the anterior maxillaryzone. The definitive treatment plan in-cluded an implant-supported milled-barpartial overdenture. Jivraj and Chee43 in2005 described a clinical case that pre-sented with multiple episodes of screwloosening of an implant-supported res-toration replacing the maxillary left in-cisor, secondary to developing reducedposterior support that could not be rees-tablished with fixed implant-supportedrestorations due to the patient’s financialconstrains. The patient had already ad-justed to a maxillary removable partialdenture. A healing abutment was placedon the implant to permit a positivemetal-to-metal contact with the internalsurface of the framework providing sup-port to the prostheses. The authors’opinion was that this method was theleast invasive and most economical ap-proach for this patient to address the

issue of repeated screw loosening.Uludag and Celik44 in 2006 described acase with poorly positioned dental im-plants. The patient declined a secondreparative surgery and the associatedcost. For this situation, considering theinterarch space and maxillomandibularrelationship, a removable partial dentureappeared to be more appropriate. Theuse of angulated abutments enabled res-toration of misaligned implants with amaxillary removable partial denturesupported by 3 implants.

CONNECTING TEETH ANDIMPLANTS TO SUPPORTIMPLANTS WITH REMOVABLEPARTIAL DENTURES

Jackson45 in 1990 reported a casewhere the patient had 1 remainingtooth, the lower right first premolar,and 2 implants were placed in themandibular cuspid sites. An 8-unitporcelain-fused-to-metal bridge wasdesigned to telescope over cement-inimplant heads and the natural abut-ment. Magnetic keepers were cantile-vered, extracoronally, off the distalabutments, and a removable partialdenture with a hollow receptacle wasthen fabricated.

Ganz46 in 1991 placed 2 implantson the patient’s maxillary right areaand splinted them to the remaining 3teeth (left lateral incisive to first pre-molar) with a bar attachment. Thisserved as a substructure to retain aremovable partial denture that, in theauthor’s opinion, would fulfill thefunctional and esthetic requirementsof the patient without jeopardizing theprognosis of the remaining 3 naturalteeth. Amet47 in 1993 reported a casewhere a patient had in the mandibulararch only the cuspids and first bicus-pids retained, with 3 implants placedin the symphysis region. Cast postswere prepared for the 4 remainingteeth, and an implant-connecting barunited all the implants and teeth, usingO-ring retention to retain a completedenture.

In these case reports, the disad-vantages were the complexity of thedesign and added features that in-creased the treatment time and cost.The design involved a rigid prostheticconnection of natural teeth and dental


AQ: 1


implants. There is a differential resil-iency between an implant and naturaltooth because of the osseointegrationof the implants and lack of peri-implant soft tissue attachment such asthe periodontal membrane in naturalteeth. Considering the differential re-siliency, since implants and teeth wererigidly connected by the substructure,the load to the prostheses will be bornemainly by the implants in normalfunction, risking the intrusion of nat-ural teeth as described in differentreports.48–51

ESTHETIC AND FUNCTIONALCONSIDERATIONS WITHIMPLANTS WITH REMOVABLEPARTIAL DENTURES

Budtz-Jorgensen et al14 in 2000stated that the rationale for this treat-ment is to place a limited number ofimplants capable of sustaining an en-tirely implant and tooth-supported re-movable partial denture without visibleretentive elements. The authors’ opinionis that the treatment with tooth andimplant-supported removable partialdentures might have particular relevancein instances where the interarch space istoo limited for aesthetically and techni-cally acceptable metal-ceramic fixedpartial dentures. de Carvalho et al15 in2001 described a maxillary partiallyedentulous case where an implant-retained removable partial denture with-out retentive clasps was used. Thisapproach required: (1) fewer patient vis-its and laboratory procedures, (2) the useof a minimal number of implants, (3)lower financial obligations, and (4) nosinus elevation surgery. The authorsconcluded that the detachable partialprosthesis over implants allows easieroral hygiene by the patient, and providessuperior esthetics and phonetics in casesinvolving advanced ridge resorption.Chee52 in 2005 presented a case of apartially edentulous patient with a his-tory of trauma to the maxilla, with aconsecutive avulsion of 4 maxillaryteeth, with a significant ridge loss. Thepatient presented with a removable par-tial denture and was satisfied with theesthetics of the restoration, but not withits stability. He elected to have animplant-supported partial overdenture torestore the missing teeth and tissue in-

stead of undergoing multiple surgeriesto restore the missing alveolar ridge tis-sue. The arch form and dentition wasrestored with the partial overdenture,and the patient was satisfied with thestability and esthetics of the restoration.The authors’ opinion was that the addedadvantage of this implant-supportedoverdenture was to obtain support fromthe implants and have minimal toothand tissue coverage.

NEED AND DEMAND FOR

PROSTHODONTIC TREATMENT

The concepts of need and demandare central in studies on dentistry.Need has been defined as “the quantityof dental health care which expertopinion judges ought to be consumedover a relevant time period, in order toremain or become as dentally healthyas is permitted by existing knowl-edge.”53 However, such a definitiongives little attention to the individual’spersonal comfort and quality of life.Need, however defined, does not al-ways lead to demand for treatment,54

depending on factors such as individ-ual preferences, cost, cultural differ-ences, psychosocial considerations,comfort, age, and accessibility of ser-vices. In most industrialized countries,the demand for prosthodontic treat-ment is influenced more by estheticdemands rather than by a few missingteeth in the posterior regions.55,56

Therefore, so-called sociodental fac-tors, social and cultural background,socioeconomic aspects, oral comfort,and appearance should be includedand evaluated when dealing withneed and demand for prosthodontictreatment. The professional attitudetoward need must be that there is notrue objective or subjective need.Need is established only in communi-cation with mutual respect betweenthe professional and the patient.57 Thispoint has to be taken into consider-ation when evaluating the treatmentapproach of implants with removablepartial dentures compared to othermore expensive and complex treat-ment options, since it can satisfy inmany cases the patient’s needs andtreatment outcome expectations.

ECONOMIC EVALUATION OFIMPLANTS WITH REMOVABLEPARTIAL DENTURES:COST-EFFECTIVENESS

Because of the elective characterof implant therapy, it is necessary toinform the patient thoroughly so thathe or she is able to participate in thedecision about adequate treatment.Thus, implant treatment options andalternative therapies should be dis-cussed, advantages and disadvantagesexplained, and benefits expected fromthe different treatment options clari-fied. As the patients have to pay forthe treatment, their financial meansmust also be considered, and the deci-sive factor may be the relationship be-tween costs and benefits.58 To describethis relation and facilitate a compari-son of different treatment modalities, acomplete economic evaluation, suchas the cost-effectiveness analysis, isrequired.59,60 In implant therapy, treat-ment costs gradually increase with thenumber of implants placed and dependon the materials used.61,62 It is impor-tant that patients receive value fortheir proposed treatment. Think ofvalue in the form of the followingequation63:

Value �Results � Process Quality

Cost of Care to Patient

Value will be created in the eyesof the patient only if the patient’s sat-isfaction with treatment outcomes andthe way care is delivered are greaterthan the cost he or she will incur toreceive that care. A greater number ofpatients turn down treatment becausethey do not understand the value itrepresents.64 Unless the patient hassome means for a more limited treat-ment option, the financial barrier canbe an absolute impediment to case ac-ceptance. The current author et al13 in2005 reported that the analysis of thecosts of implants with removable par-tial dentures compared with implant-supported fixed partial denturesshowed that patients save more than50% on treatment costs when implantswith removable partial dentures areused. The longer the multiunit implant-supported fixed partial denture required,the more money saved with the pro-posed implants with the removable par-



tial denture approach. Costs becomeeven more relevant when bone augmen-tation procedures are required in con-junction with implant placement.

PROSTHODONTICS FOR THEMANY, NOT JUST FORTHE FEW

Evidence of oral health quality im-provement is more obvious, particularlysince the advent of osseointegration.However, partial and complete edentu-lism is still experienced by millions ofpeople even in some of the most ad-vanced economies in the world. Theemerging popularity of the 2-implant-supported overdenture appears to be animportant initiative, but it may remainrestricted to the very few high-per-capita-income countries. Prosthodontics offersan extraordinary range of treatment pos-sibilities for oral rehabilitation. How-ever, its reliance on the high technologylimits it to relatively few people. Toprovide treatment for the many, cost-effective conventional treatment is re-quired but with adequate quality control.Owen65 introduced the philosophy of“appropriatech”: using appropriate tech-nology (both methods and materials) toprovide cost-effective treatment withoutsacrificing biofunctional and prosth-odontic principles. In his opinion, itought to be possible to set out, for eachprocedure, a minimum acceptable pro-tocol that will conform to generally ac-cepted prosthodontic principles, and willassist patients in regaining chewingfunction and esthetic rehabilitation, andthereby significantly improve their qual-ity of life. Minimum acceptable proto-cols could also be reconciled withevidence-based clinical practice guide-lines that could be adapted for socioeco-nomic circumstances.

The clinical modality of implantswith removable partial dentures couldeasily adapt to the “appropriatech”philosophy by providing a cost-effective treatment without sacrificingbiofunctional and prosthodontic prin-ciples, and in this way, an improvedrestoration is becoming available forthe many and not just for the few.

DISCUSSION

Dental treatment of partially eden-tulous patients is becoming more im-

portant because people are savingmore teeth, and the fully edentulouspopulation diminishes.5–8

Almost all partially edentulouspatients desire the benefits of implantrestorations; but, unfortunately, manyof them cannot or will not meet thecriteria to have fixed implant-supported restorations because ofanatomical, medical, financial, or per-sonal reasons. In situations when fi-nancial, systemic, or local conditionspreclude the use of a fixed partial den-ture, a well-constructed removablepartial denture can be a valid treatmentalternative.9–12 However, a significantproportion of prescribed removablepartial dentures are not used.8 In thiscontext, it must be clearly recognizedthat practical problems with remov-able partial dentures (lack of stabilityand retention, unesthetic retentiveclasping, and discomfort upon load-ing) are common and may be thereason why so many patients stopwearing their removable partial den-tures. Yet, these patients deserve thebest esthetic and functional resultspossible. In these cases, a limitednumber of strategically placed dentalimplants in conjunction with the re-maining natural teeth can establish afavorable removable partial denturedesign by significantly reducing theeffect of a reciprocal arm and improv-ing the fulcrum line position. Whenan implant or a limited number ofimplants are used to support the re-movable partial denture, additional re-tention is achieved, and the need forunesthetic buccal retentive arm claspsis avoided at the esthetic zone.13,16

Other advantages of implants withremovable partial dentures are that theexisting natural dentition is retained, ex-tensive surgery is avoided, hard and softtissues are easily “replaced” by the den-ture’s flanges, the extent and length ofthe treatment are reduced, hygiene ac-cess is facilitated, failed implant-supported fixed partial dentures casesare salvaged, flexibility is achieved inlong-term care and future changes in theremaining dentition are easily restored,patient’s satisfaction increases, and thepatient’s financial limitations are ad-dressed.13–16,23–27,39 – 47,52 These factorswill often favor the use of implants withremovable partial dentures and should

be considered when contemplating re-storative treatment options.

CONCLUSIONS

A MEDLINE/PubMed databasesearch was limited to peer-reviewedarticles published in English between1990 and 2006, focusing on the use ofdental implants with natural teeth inremovable partial denture design. Fewcase reports, 1 short-term follow-up(1�4 years), and 1 longitudinal clini-cal study (2�7 years) were identified.On the basis of this review of theliterature, it may be concluded that theuse of a limited number of implants toimprove unfavorable removable par-tial denture design and esthetics is aviable solution for partially edentulouspatients. Further research with con-trolled prospective clinical trials isneeded.

Disclosure

Not applicable.

REFERENCES

1. Mericske-Stern R. Treatment out-comes with implant-supported over-dentures: Clinical considerations. J ProsthetDent. 1998;79:66-73.

2. Burns DR, Unger JW, Elswick RK.Prospective clinical evaluation of mandibularimplant overdentures: Part I–Retention, sta-bility, and tissue response. J Prosthet Dent.1995;73:354-363.

3. Cune MS, dePutter C, HoogstratenJ. Treatment outcome with implant-retained overdentures: Part I–Clinical find-ings and predictability of subjectivetreatment outcome. J Prosthet Dent.1994;72:144-151.

4. Cune MS, dePutter C, HoogstratenJ. Treatment outcome with implant-retained overdentures: Part II–Patient sat-isfaction and predictability of subjectivetreatment outcome. J Prosthet Dent.1994;72:152-158.

5. Kelly M, Steele J, Nuttal N. AdultDental Health Survey–Oral Health in theUnited Kingdom 1998. London, UK: Na-tional Statistics Public Inquiry Service;2000.

6. I�G Gesundheitsforschung. Be-darfsermittlung fur Protetische LeistungenBis Zum Jahr 2020. Munich, Germany:I�G Gesundheitsforschung; 2001.

7. Douglass CW, Watson AJ. Futureneeds for fixed and removable partial den-tures in the United States. J Prosthet Dent.2002;87:9-14.

8. Wostmann B, Budtz-Jorgensen E,Jepson N, et al. Indications for removable



partial dentures: A literature review. IntJ Prosthodont. 2005;18:139-145.

9. Kapur KK. Veterans Administrationcooperative dental implant study–Comparison between fixed partial den-tures supported by blade-vent implantsand removable partial dentures. Part III:Comparison between two treatment mo-dalities. J Prosthet Dent. 1991;62:272-283.

10. Kapur KK. Veterans Administrationcooperative dental implant study–Comparison between fixed partial den-tures supported by blade-vent implantsand removable partial dentures. Part IV:Comparison of patient satisfaction be-tween two treatment modalities. J ProsthetDent. 1991;66:517-530.

11. Bergman B, Hugoson A, OlssonC-O. A 25-year longitudinal study of pa-tients treated with removable partial den-tures. J Oral Rehabil. 1995;22:595-599.

12. Rissin L, Feldman RS, Kapur KK, etal. Six-year report of the periodontal healthof fixed and removable partial dentureabutment teeth. J Prosthet Dent. 1985;54:461-467.

13. Mijiritsky E, Ormianer Z, Klinger A,et al. Use of dental implants to improveunfavorable removable partial denture de-sign. Compend Contin Educ Dent. 2005;26:744-746.

14. Budtz-Jorgensen E, Bochet G,Grundman M, et al. Aesthetic consider-ations for the treatment of partially edentu-lous patients with removable dentures.Pract Periodontics Aesthet Dent. 2000;12:765-772.

15. de Carvalho WR, Barboza EP,Caula AL. Implant-retained removableprosthesis with ball attachments in partiallyedentulous maxilla. Implant Dent. 2001;10:280-284.

16. Brudvik JS. In: Advanced Remov-able Partial Dentures. Chicago, IL:Quintessence; 1999:153-159.

17. Kelly E. Changes caused by amandibular removable partial denture op-posing a mandibular complete denture.J Prosthet Dent. 1972;27:140-150.

18. Saunders TR, Gillis RE, DesjardinsRP. The maxillary complete denture op-posing the mandibular bilateral distalextension partial denture: Treatment con-siderations. J Prosthet Dent. 1979;41:124-128.

19. Shen K, Gongloff RK. Prevalenceof the combination syndrome among den-ture patients. J Prosthet Dent. 1989;62:642-644.

20. Gupta S, Lechner SK, DuckmantonNA. Maxillary changes under complete den-tures opposing mandibular implant-supportedfixed prostheses. Int J Prosthodont. 1999;12:492-497.

21. Lechner SK, Mammen A. Combi-nation syndrome in relation to osseointe-grated implant-supported overdentures: Asurvey. Int J Prosthodont. 1996;9:58-64.

22. Thiel CP, Evans DB, Burnett RR.Combination syndrome associated with amandibular implant-supported over-denture: A clinical report. J Prosthet Dent.1996;2:107-113.

23. Mitrani R, Brudvik JS, Phillips KM.Posterior implants for distal extension re-movable prostheses: A retrospectivestudy. Int J Periodontics Restorative Dent.2003;23:353-359.

24. Keltjens HM, Kayser AF, Hertel R,et al. Distal extension removable partialdentures supported by implants and resid-ual teeth: Considerations and case re-ports. Int J Oral Maxillofac Implants. 1993;8:208-213.

25. Halterman SM, Rivers JA, Keith JD,et al. Implant support for removable partialoverdentures: A case report. Implant Dent.1999;8:74-78.

26. Giffin KM. Solving the distal exten-sion removable partial denture base move-ment dilemma: A clinical report. J ProsthetDent. 1996;76:347-349.

27. Kuzmanovic DV, Payne AGT, Pur-ton DG. Distal implants to modify theKennedy classification of a removable par-tial denture: A clinical report. J ProsthetDent. 2004;92:8-11.

28. Campbell RL. A comparative studyof the resorption of the alveolar ridges indenture wearers and no-wearers. J AmDent Assoc. 1960;60:143-153.

29. Josefowicz W. The influence ofwearing dentures on residual ridges: Acomparative study. J Prosthet Dent. 1970;24:137-144.

30. Sennerby L, Carlsson G, BergmanB, et al. Mandibular bone resorption in pa-tients treated with tissue-integrated pros-theses and in complete denture wearers.Acta Odontol Scand. 1988;46:135-140.

31. Mori S, Sato T, Hara T, et al. Effectof continuous pressure on histopathologi-cal changes in denture-supporting tissues.J Oral Rehabil. 1997;24:37-46.

32. Ohara K, Sato T, Imai Y, et al. His-tomorphometric analysis of bone dynam-ics in denture supporting tissue undermasticatory pressure in rat. J Oral Rehabil.2001;28:695-701.

33. Imai Y, Sato T, Mori S, et al. A his-tomorphometric analysis on bone dynam-ics in denture supporting tissue undercontinuous pressure. J Oral Rehabil. 2002;29:72-79.

34. Kordatzis K, Wright PS, Meijer HJ.Posterior mandibular residual ridge resorp-tion in patients with conventional denturesand implant overdentures. Int J Oral Max-illofac Implants. 2003;18:447-452.

35. Adell R, Lekholm U, Rockler B, etal. Marginal tissue reactions at osseointe-grated titanium fixtures. (I). A 3-year longi-tudinal prospective study. Int J OralMaxillofac Surg. 1986;15:39-52.

36. Schierano G, Bassi F, Gassino G,et al. Cytokine production and bone re-modeling in patients wearing overdentures

on oral implants. J Dent Res. 2000;79:1675-1682.

37. Wowern N, Gotfredsen K. Implant-supported overdentures, a prevention ofbone loss in edentulous mandibles? A5-year follow-up study. Clin Oral ImplantsRes. 2001;12:19-25.

38. Nakai H, Niimi A, Ueda M. Osseousproliferation of the mandible after place-ment of endosseous implants. Int J OralMaxillofac Implants. 2000;15:419-424.

39. Jang YJ, Emtiaz S, Tarnow DP.Single implant-supported crown used asan abutment for a removable cast partialdenture: A case report. Implant Dent.1998;7:199-203.

40. McAndrew R. Prosthodontic reha-bilitation with a swing-lock removable par-tial denture and a single osseointegratedimplant: A clinical report. J Prosthet Dent.2002;88:128-131.

41. Mijiritsky E, Karas S. Removablepartial denture design involving teeth andimplants as an alternative to unsuccessfulfixed implant therapy: A case report. Im-plant Dent. 2004;13:218-222.

42. Asvanund C, Morgano SM. Resto-ration of unfavorably positioned implantsfor a partially edentulous patient by usingan overdenture retained with a milled barand attachments: A clinical report. J Pros-thet Dent. 2004;91:6-10.

43. Jivraj SA, Chee WWL. Use of aremovable partial denture in the manage-ment of chronic screw loosening. J Pros-thet Dent. 2005;93:13-16.

44. Uludag B, Celik G. Fabrication of amaxillary implant-supported removablepartial denture: A clinical report. J ProsthetDent. 2006;95:19-21.

45. Jackson TR. Removable partialoverdentures with natural root structureand osseointegrated fixtures. Dent ClinNorth Am. 1990;34:711-728.

46. Ganz SD. Combination naturaltooth and implant-borne removable partialdenture: A clinical report. J Prosthet Dent.1991;66:1-5.

47. Amet EM. A unique method ofcombining teeth and endosseous implantsfor a stable removable prosthesis. J OralImplantol. 1993;19:216-220.

48. Cho GC, Chee WL. Apparent intru-sion of natural teeth under an implant-supported prosthesis: A clinical report.J Prosthet Dent. 1992;68:3-5.

49. Rieder CE, Parel SM. A survey ofnatural tooth abutment intrusion withimplant-connected fixed partial dentures.Int J Periodontics Restorative Dent. 1993;13:335-347.

50. Sheets CG, Earthman JC. Naturaltooth intrusion and reversal in implant-assisted prosthesis: Evidence of and a hy-pothesis for the occurrence. J ProsthetDent. 1993;70:513-520.



51. Schlumberger TL, Bowley JF, MazeGI. Intrusion phenomenon in combinationtooth-implant restorations: A review of the lit-erature. J Prosthet Dent. 1998;80:199-203.

52. Chee WWL. Treatment planning:Implant-supported partial overdentures.J Calif Dent Assoc. 2005;33:313-316.

53. Spencer AJ. The estimation ofneed for dental care. J Public Health Dent.1980;40:311-327.

54. US Department of Health and Hu-man Services. Oral Health in America: AReport of the Surgeon General. Rockville,MD: National Institute of Dental andCraniofacial Research; 2000.

55. Kayser AF, Witter DJ. Oral functionneeds and its consequences for dentulousolder people. Community Dent Health.1985;2:285-291.

56. Oosterhaven SP, Westert GP,Schaub RMH. Perception and significanceof dental appearance, the case of missingteeth. Community Dent Oral Epidemiol.1989;17:123-126.

57. Narby B, Kronstrom M, SoderfeldtB, et al. Prosthodontics and the patient:What is oral rehabilitation need? Conceptualanalysis of need and demand for prosth-odontic treatment. Part 1: A conceptualanalysis. Int J Prosthodont. 2005;18:75-79.

58. Zitzmann NU, Sendi P, MarinelloCP. An economic evaluation of implanttreatment in edentulous patients–Preliminary results. Int J Prosthodont.2005;18:20-27.

59. Sendi PP, Palmer AJ, Marinello CP.Some principles of cost-effectivenessanalysis in dentistry. Acta Med Dent Helv.1999;4:63-67.

60. Drummond MF, O’Brien B, StoddardtG, et al. Methods for the Economic Evaluationof Health Care Programs. 2nd ed. New York,NY: Oxford University Press; 1997.

61. Lewis DW. Optimized therapy forthe edentulous predicament: Cost-effectiveness considerations. J ProsthetDent. 1998;79:93-99.

62. Zitzmann NU, Marinello CP.

Decision-making and treatment planning in theedentulous mandible restored with fixed or re-movable implant prostheses. World Dent.2001;1. Available at:www.worlddent.com/2001/05/articles/marinello.xml.

63. Hein C. The reformation of profes-sional roles within dentistry. Contemp OralHyg. 2003;4:28-30.

64. Schwab D. Why patients do notaccept treatment. J Prosthet Dent. 1999;8:66-68.

65. Owen P. Appropriatech: Prosth-odontics for the many, not just for the few.Int J Prosthodont. 2004;17:261-262.

Reprint requests and correspondence to:Eitan Mijiritsky, DMDMoshe-Sne Street, 22/aTel Aviv, IsraelPhone: 00972-3-6449139Fax: 00972-3-6449137E-mail: [email protected]

Abstract Translations

GERMAN / DEUTSCHAUTOR: Eitan Mijiritsky, DMD*. *Privat praktizierenderArzt, Tel-Aviv, Israel; Gastprofessor, zahnmedizinischeFakultat, Universitat von Chieti-Pescara, Chieti, Italien.Schriftverkehr: Eitan Mijiritsky, DMD, Moshe-Sne street,22/a, Tel-Aviv, Israel. Telefon (geschaftl.): 00972-3-6449139, Fax: 00972-3-6449137. Telefon (priv.): 00972-3-6476842. eMail: [email protected] in Verbindung mit herausnehmbaren Teilproth-esen: Eine literarische Studie

ZUSSAMENFASSUNG: Obwohl die Vorteile Implantatges-tutzter herausnehmbarer Prothesen fur Patienten mit komplettzahnlosem Kiefer mehr als offensichtlich sind und ausfuhr-lich dokumentiert wurden, gibt es doch nur wenige Studien,die sich mit der Kombination von Implantaten mit herausne-hmbaren Teilprothesen (IHTPs) bei Patienten mit teilweisezahnlosem Kiefer befassen. Dieser Artikel zielt darauf ab, dieLiteratur hinsichtlich der IHTP-Thematik zu untersuchen unddie Nachweise fur diesen klinischen Behandlungsansatz zubewerten. Eine Medline/PubMed-Suche von 1990–2006 ver-legte sich hauptsachlich auf den Einsatz von IHTPs undverwandten Themen. Diese wurde durch eine manuelle Sucheerganzt, um die entsprechenden erstklassig recherchiertenenglischen Artikel herauszufiltern, die zu diesem Thema inzahnmedizinischen Fachzeitschriften und -broschuren zumThema der herausnehmbaren Teilprothesen (HTPs) verfasstwurden.

SCHLUSSELWORTER: Herausnehmbare Teilprothesen,Zahnimplantate, Patienten mit teilweise zahnlosem Kiefer,kostengunstig, Behandlungsalternative

SPANISH / ESPAÑOLAUTOR: Eitan Mijiritsky, DMD*. *Practica Privada, Tel-Aviv, Israel; Profesor Visitante, Facultad de Odontologıa,Universidad de Chieti-Pescara, Chieti, Italia. Corresponden-cia a: Eitan Mijiritsky, DMD, Moshe-Sne street, 22/a, Tel-Aviv, Israel. Telefono comercial: 00972-3-6449139, Fax:00972-3-6449137, Telefono particular: 00972-3-6476842,Correo electronico: [email protected] junto con dentaduras parcialmente removibles:Revision de artıculos

ABSTRACTO: A pesar de que los beneficios de una protesisremovible apoyada en implantes son rapidamente aparente parael paciente completamente edentuloso y han sido bien documen-tados, existe una falta de estudios relacionados con la combina-cion de implantes con dentaduras parcialmente removibles(IRPD por sus siglas en ingles) en pacientes parcialmente eden-tulosos. El objetivo de este artıculo es evaluar los artıculos sobrela IRPD y evaluar la evidencia de este metodo clınico. Unabusqueda en Medline/PubMed de 1990 a 2006, concentrandoseen el uso de IRPD y caracterısticas relacionadas, se suplementocon una busqueda manual para identificar artıculos pertinentesen ingles evaluados por colegas publicados en revistas odonto-logicas y libros de texto sobre dentaduras parcialmente re-movibles (RPD por sus siglas en ingles).


AQ: 2

AQ: 3


PALABRAS CLAVES: dentaduras parcialmente removibles,implantes dentales, pacientes parcialmente edentulosos, costoeficaz, tratamiento alternativo

PORTUGUESE / PORTUGUÊSAUTOR: Eitan Mijiritsky, Doutor em Odontologia*. *ClınicaParticular, Tel-Aviv, Israel; Professor Visitante, Faculdade deOdontologia, Universidade de Chieti-Pescara, Chieti, Italia.Correspondencia para: Eitan Mijiritsky, DMD, Moshe-Snestreet, 22/a, Tel-Aviv, Israel. Telefone Comercial: 00972-3-6449139, Fax: 00972-3-6449137, Telefone Residencial: 00972-3-6476842, e-mail: [email protected] em conjuncao com dentaduras parciais remov-ıveis: revisao da literatura

RESUMO: Embora os benefıcios das proteses removıveissuportadas por implante sejam imediatamente aparentes paraos pacientes totalmente desdentados e tenham sido bem docu-mentados, ha uma escassez de estudos relacionados a com-binacao de implantes com dentaduras parciais removıveis(IRPDs) em pacientes parcialmente desdentados. O objetivodeste artigo e revisar a literatura referente a IRPDs e avaliara evidencia para esta abordagem clınica. Uma busca emMedline/PubMed de 1990 a 2006, focalizando o uso deIRPDs e caracterısticas relacionadas, foi suplementada poruma busca manual para identificar artigos em relevantes emingles, revisados por pares, publicados em periodicos elivros-texto de odontologia sobre dentaduras parciais remov-ıveis (RPDs).

PALAVRAS-CHAVE: dentaduras parciais removıveis, im-plantes dentarios, pacientes parcialmente desdentados, atratamento alternativo a preco acessıvel

RUSSIAN /��: Eitan Mijiritsky, �� * * ��, Tel-Aviv, Israel; �� ,�� , �� Chieti-Pescara,Chieti, Italy. �� : Eitan Mijiritsky, DMD, Moshe-Sne street, 22/a, Tel-Aviv, Israel. �� (��.): 00972–3-6449139, ��: 00972–3-6449137, �� . ��:[email protected], �� (��.): 00972–3-6476842�� : ��

��: �� , �� ,�� (IRPD) � �� , ��.�� IRPD � �� . �� IRPD � �� Med-line/PubMed �� 1990 � 2006 . �� (RPD), ��!��!�� -��.

�� !��: �� , �� , �� , ��, ��



JAPANESE /

CHINESE /



KOREAN /



JOBNAME: AUTHOR QUERIES PAGE: 1 SESS: 1 OUTPUT: Mon Apr 2 16:32:41 2007/balt5/ziy�id/ziy�id/ziy00207/ziy2884�07z

AQ1— Is “porcelain-fused-to-metal” correct in the sentence beginning “Jang et al (39) in 1998described. . . ”? Please confirm throughout the text.

AQ2— Please confirm Reference 59.

AQ3— Is Reference a Web site or journal article? Please provide one or the other.

AUTHOR QUERIES

AUTHOR PLEASE ANSWER ALL QUERIES 1

Documents

Implants in Conjunction With Removable Partial Dentures… et al 2007, implantaten en... · Implants in Conjunction With Removable Partial Dentures: ... satisfied with their removable