GORDON
36. Johnson DL, Holt RA, Duncanson MG Jr. Contours of the edentulous palate. J Am Dent Assoc 1966;113:35-40. 37. Widstrom E. Loss of teeth and the frequency and condition of removable and fixed dentures in Finnish immigrants in Sweden. Swed Dent J 1982;6:61-9. 38. O’Leary DO. New priorities for quality of care evaluation. J Am Dent Assoc 1988;117:147-8. 39. Korduner G, Marken K-E. Re-examination of complete denture patienta.1. Deviationsbetweenobservers.ActaOdontolScand 1967;25:361-
42. Skinner EW, Chung P. The effect of surface contact in the retention of a denture.J PROSTHETDENT 1951;1:229-35. 43. Gordon SR. Training examiners to measure denture dislodging force in vitro [Abstract]. J Dent Rest 1987;66:351. 44. Gordon SR, Kaste L, Fox C, McGuire S. Training examiners to measure denture dislodging force in vivo [Abstract]. J Dent Res 1988;67:137. 45. Woerhle P. The influence of the maxillary ridge and arch shape on retention and stability of complete maxillary dentures [Thesis]. Harvard School of Dental Medicine, 1987.
II.
40. Yoshizumi DT. An evaluation of factors pertinent to the success of complete denture 8ervice.J PROSTHET D~~~1964;14:866-78. 41. Silverman MM. Accurate measurement of vertical dimension by phonetics and the speaking centric space. Dent Digest 1951;57:261.
Patient use of removable partial four-year telephone interviews
Reprint requests to: DR STEVEN R. GORDON 140 BR~~KST. %LLESLEY,MA 02181
dentures:
Two- and
Robert D. Cowan, D.D.S., MS.,* John A. Gilbert, D.M.D., M.L.A.,** Dean A. Elledge, D.D.S., M.S.,*** and F. Dudley McGlynn, Ph.D.**** University of Missouri-Kansas
City, School of Dentistry, Kansas City, MO.
Two telephone surveys requested patients to report on their use of removable partial dentures that were constructed by undergraduate dental students. In the first survey, of the 431 patients called, 290 were contacted and interviewed 24 to 33 months after their removable partial denture(s) had been inserted. Of these, 258 patients reported using their prostheses and 238 had no apparent problems. In the second survey, the 236 trouble-free removable partial denture wearers from the 5rst survey were called and 169 were contacted and interviewed 48to 57 months after the removable partial dentures had been inserted. Of these, 156 reported still using their prosthesis and 152 had no apparent problems. These data are provided, along with some interpretive caveats, for dentists to use in discussing treatment options with patients. (J PROSTHET DENT 1991$6:668-70.)
K
nowledgeabout patients’ use of removable partial dentures would be helpful to dentists and patients as they make decisionsabout prosthodontic treatment. Unfortunately, current knowledge about patient use of removable partial dentures is unsatisfactory, since the few studies reported were based on small samplegroups and did not produce uniform estimatesof prosthesisuserates.
LITERATURE
REVIEW
Some investigators found fairly high use rates for removable partial dentures. Derry and Bertraml evaluated 54 patients 2 years after they had received 65 removable partial dentures. Ninety-one percent of the patients reported using their prostheses.Bergman et ah2 reported *Director, Advanced Education in General Dentistry. **Director, Clinical Practice and Quality Assurance. ***Assistant Professor, Department of Fixed Prosthodontics. ****Professor and Chairman, Department of Behavioral Science. 10/l/25406
similarly high use rates among 30 patients after 2 years. Schwalmet ah3obtained l- and 2-year usedata from 92 of 161 patients who received 102removable partial dentures constructed by undergraduate dental students. Ninetythree percent of the removable partial dentures were still in use. Other investigators found fairly low userates for removable partial dentures. Koivumaa et ah4 found that over 19% of the prosthesesdelivered to 90 patients were not worn 12 to 15 months later. Carlssonet ah5 reevaluated these same patients 4 years after the prostheseswere inserted and found that 36% were not wearing their removable partial dentures. Benson and Spolskys acquired ratings of acceptance (satisfaction) from 77 patients, of whom 11 reported poor acceptance,20 reported fair acceptance, and 46 reported good acceptance.The mean length of time the removable partial dentures were worn was 3.6 years. As with the literature on prosthesisuse,there are too few studiesand too few sampledpatients to provide adequate information to
MAY
1991
VOLUME
66
NUMBER
6
PATIENT
Table
USE
I.
OF REMOVABLE
Reported
PARTIAL
DENTURES
use 24 to 33 months
after insertion % of patients treated
No. of patients
431 Total patients treated Patients interviewed 290 (67.3%) Reported use Wearing original .prosthesis without complaint Wearing original prosthesis but with complaint Total wearing original prosthesis Not wearing original prosthesis Patients not contacted Reasons for patient noncontact Known “Deceased” Known “No longer at residence or workplace” Known “Wrong telephone number” Known “Telephone disconnected/no longer in service” No answer to three attempts at communication
patients who are faced with decisions about prosthodontic treatment. This article presents the results of a a-year and I-year longitudinal survey on patients’ use of removable partial
dentures constructed by undergraduate dental students. It is intended to provide additional information for dentists to use when discussingremovable partial dentures with their partially edentulous patients.
METHOD Between Sept. 1, 1984, and May 31, 1985, the undergraduate students of the University of Missouri-Kansas City, School of Dentistry, inserted 523 removable partial dentures for 431 patients. In May 1987 an attempt was made to interview the 431 patients by telephone. In May 1989an attempt wasmadeto againinterview thosepatients who reported still using their prosthesescomfortably during the 1987interview. In both 1987and 1989,as many as three attempts to contact each patient were made during specified 2-week periods. When contact wasmade, the interviewer identified himself or herself, obtained permission to conduct a brief interview, and asked“Are you still wearing the partial denture madeat the school?” If the answer was“yes,” the interview wasended with thanks. If the answer was “no,” then up to four additional questionswere asked. They were (1) “Can you tell me why you are not wearing the partial?” (2) “Have you had a new partial made?” (3) “Do you wish to have a new partial made?” (4) “At the present time are you wearing an old partial or no partial at all?.” The answersgiven were recorded along with charted information about the patient’s name, age, and sex.
RESULTS Table I showsthe results from the 1987interviews and reflects prosthesis use reported 24 to 33 months after
THE
JOURNAL
OF PROSTHETIC
DENTISTRY
238 20 258 32 141
% of patients interviewed
(82.0) (6.9) (89.0)
(11.0) (32.7)
11 9 15 19
(2.6) (2.1) (3.5) (4.4) (20.2)
87
insertion. The table showsthat although 32.7% of the patients could not be contacted, the various reasonsfor noncontact were not related to prosthesisuse in any obvious way. Among the 290 patients who were contacted and interviewed, 258 (89%) were wearingtheir removable partial denture(s) between 24 and 33 months after they were inserted and 238 (82%) were doing so without complaint. Among the 20 patients who were wearing their prostheses but reported problems, 10 reported minor discomfort and seven reported a poor fit. Gagging, affected taste, and a broken clasp were reported by one patient each. Table II showsthe results from the 1989interviews, reflecting removable partial denture use48 to 57 months after insertion among 169 of the 238 patients who reported prosthesisusewithout complaint in 1987. Again, the various reasonsfor noncontact that are noted in the table are seeminglyunrelated to prosthesisuse. Among the 169patients who were contacted and interviewed, 156(91.3%) were continuing to wear their removable partial denture(s) 48 to 57 months after they were inserted and 152or 89.9% were doing so without complaint. Among the four patients who reported wearing their prosthesis but who reported problems with it, two mentioned poor fit, one mentioned discomfort, and one reported that the acrylic resin portion of the prosthesis had partially fractured.
DISCUSSION
AND
CONCLUSIONS
The data reported were obtained from a large patient population and during a longer period of time than any data reported heretofore. They are intended for usein discussingtreatment options with partially edentulous patients.. The dentist can state that a seriesof 290 telephone interviews with patients who received removable partial denturesfrom undergraduate dental students showed82%
COWAN ET AL
Table
II.
Reported use 48 to 57 months after insertion for patients comfortable after 2 years No. of patients
Total patientsin 48- to 57-month survey 238 Patients interviewed 169 (71.0%) Reported use Wearing original prosthesis without complaint Wearing original prosthesis hut with complaint Total wearing original prosthesis Not wearing original prosthesis Patients not contacted Reasons for patient noncontact Known “Deceased” Known “No longer at residence or workplace” Known “Wrong telephone number” Known “Telephone disconnected/no longer in service”
No answerto three attemptsat communication
reported using their removable partial dentures without complaint between24 and 33 months later. The dentist can further state that when the 238 patients who reported using their removablepartial dentureswithout complaint after 2 to 2% years were interviewed 2 years later, 71% reported still usingtheir prostheseswithout complaint. This percentage is no doubt low, since only 169 of the 238 patients could be contacted. It should alsobe noted that the percentagesof reported use are inaccurate to someunknown degree. First is the limitation imposedby the lossof patients to follow-up interviews. Nearly one third of the patients in both surveys could not be contacted. In addition, there is little doubt that someof the patients interviewed saidthey were using their prosthesiseven though they were not, becausethey felt an affirmative responsewas desired. Similarly, the number of patients who reported wearing their removable partial denture despite having problems is probably too low, sincethe interview format did not request specific information about their problems and their remarks were spontaneous.Another consideration that should be noted is that a student-treated patient pool may not necessarily apply to the private dental practice due to differences in patient population and treatment planning criteria. For information regarding the clinical and radiographic aspectsof removablepartial denturesafter 1 and 5 years of service, pleaserefer to the survey reported by Kratochvil et a1.7 Derry and Bertram’ introduced their 1970clinical survey study by stating “There seemsto be agreement among membersof the dental professionthat the removablepartial denture is something to be avoided.“’ The results of this longitudinal survey do not support sucha pessimistic view,.but rather add support for the long-term value of restoring partially edentulouspatients with removable partial dentures.
670
% of patients interviewed
152 4 156 13 69
% of patients in I-year survey
(89.9)
(2.4 (92.3)
(7.7) (29.0)
6
Gw (2.1)
5 12 13 33
(5.0) (5.5) (13.9)
SUMMARY A 2-year and I-year longitudinal survey of 431 patients requiring 523 removable partial dentures wasmade to determine the rate of useand degreeof successof their prostheses,which wereconstructed by undergraduate students. Data were accumulated by telephone interviews. Rates of response,rates of success,patient comments, and limitations of the survey are discussed.Clinical application of this information prior to prosthodontic treatment is suggested.
REFERENCES 1. Derry A, Bertram U. A clinical surveyof removable partial dentures after 2 years usage. Acta Odontol Stand 1970;28:581-98. 2. Bergman B, Hugoson A, Olason C-O. Periodontal and prosthetic conditions in patients treated with removable partial dentures and artificial crowns. A longitudinal two-year study. Acta Odontol Stand 1971; 29621-38. 3. Schwalm CA, Smith DE, Erickson JD. A clinical study of patients 1 to 2 years after placement of removable partial dentures. J PROBTHET DENT 1977;38:380-91. 4. Koivumaa KK, Hedegard B, Carlsson GE. Studies in partial dental prosthesis. I. An investigation of dentogingivally supported partial dentures. Suom Hammaslaak Toim 1960,56:248-306. 5. Carlsson GE, Hedegard B, Koivumaa KK. Studies in partial denture prosthesis. IV. Final results of a 4-year longitudinal investigation of dentogingivally supported partial dentures. Acta Odontol Stand 1965;23:443-72. 6. Benson D, Spolsky VW. A clinical evaluation of removable partial dentures with I bar retainers. Part I. J PROSTHET DENT 1979;41:246-54. 7. Kratochvil FJ, Davidson PN, Tandarte JG. Five-year survey of treatment with removable partial dentures. Part I. J PROSTHET DENT 1982;48:237-44. Reprint requests to: DR. ROBERT D. COWAN SCHOOL OF DENTISTRY UNMm’ZTY OF MISSOURI-KANSAS KANSAS CITY, MO 64108-2795
CITY
MAY
1991
VOLUME
65
NUMBER
6
36. Johnson DL, Holt RA, Duncanson MG Jr. Contours of the edentulous palate. J Am Dent Assoc 1966;113:35-40. 37. Widstrom E. Loss of teeth and the frequency and condition of removable and fixed dentures in Finnish immigrants in Sweden. Swed Dent J 1982;6:61-9. 38. O’Leary DO. New priorities for quality of care evaluation. J Am Dent Assoc 1988;117:147-8. 39. Korduner G, Marken K-E. Re-examination of complete denture patienta.1. Deviationsbetweenobservers.ActaOdontolScand 1967;25:361-
42. Skinner EW, Chung P. The effect of surface contact in the retention of a denture.J PROSTHETDENT 1951;1:229-35. 43. Gordon SR. Training examiners to measure denture dislodging force in vitro [Abstract]. J Dent Rest 1987;66:351. 44. Gordon SR, Kaste L, Fox C, McGuire S. Training examiners to measure denture dislodging force in vivo [Abstract]. J Dent Res 1988;67:137. 45. Woerhle P. The influence of the maxillary ridge and arch shape on retention and stability of complete maxillary dentures [Thesis]. Harvard School of Dental Medicine, 1987.
II.
40. Yoshizumi DT. An evaluation of factors pertinent to the success of complete denture 8ervice.J PROSTHET D~~~1964;14:866-78. 41. Silverman MM. Accurate measurement of vertical dimension by phonetics and the speaking centric space. Dent Digest 1951;57:261.
Patient use of removable partial four-year telephone interviews
Reprint requests to: DR STEVEN R. GORDON 140 BR~~KST. %LLESLEY,MA 02181
dentures:
Two- and
Robert D. Cowan, D.D.S., MS.,* John A. Gilbert, D.M.D., M.L.A.,** Dean A. Elledge, D.D.S., M.S.,*** and F. Dudley McGlynn, Ph.D.**** University of Missouri-Kansas
City, School of Dentistry, Kansas City, MO.
Two telephone surveys requested patients to report on their use of removable partial dentures that were constructed by undergraduate dental students. In the first survey, of the 431 patients called, 290 were contacted and interviewed 24 to 33 months after their removable partial denture(s) had been inserted. Of these, 258 patients reported using their prostheses and 238 had no apparent problems. In the second survey, the 236 trouble-free removable partial denture wearers from the 5rst survey were called and 169 were contacted and interviewed 48to 57 months after the removable partial dentures had been inserted. Of these, 156 reported still using their prosthesis and 152 had no apparent problems. These data are provided, along with some interpretive caveats, for dentists to use in discussing treatment options with patients. (J PROSTHET DENT 1991$6:668-70.)
K
nowledgeabout patients’ use of removable partial dentures would be helpful to dentists and patients as they make decisionsabout prosthodontic treatment. Unfortunately, current knowledge about patient use of removable partial dentures is unsatisfactory, since the few studies reported were based on small samplegroups and did not produce uniform estimatesof prosthesisuserates.
LITERATURE
REVIEW
Some investigators found fairly high use rates for removable partial dentures. Derry and Bertraml evaluated 54 patients 2 years after they had received 65 removable partial dentures. Ninety-one percent of the patients reported using their prostheses.Bergman et ah2 reported *Director, Advanced Education in General Dentistry. **Director, Clinical Practice and Quality Assurance. ***Assistant Professor, Department of Fixed Prosthodontics. ****Professor and Chairman, Department of Behavioral Science. 10/l/25406
similarly high use rates among 30 patients after 2 years. Schwalmet ah3obtained l- and 2-year usedata from 92 of 161 patients who received 102removable partial dentures constructed by undergraduate dental students. Ninetythree percent of the removable partial dentures were still in use. Other investigators found fairly low userates for removable partial dentures. Koivumaa et ah4 found that over 19% of the prosthesesdelivered to 90 patients were not worn 12 to 15 months later. Carlssonet ah5 reevaluated these same patients 4 years after the prostheseswere inserted and found that 36% were not wearing their removable partial dentures. Benson and Spolskys acquired ratings of acceptance (satisfaction) from 77 patients, of whom 11 reported poor acceptance,20 reported fair acceptance, and 46 reported good acceptance.The mean length of time the removable partial dentures were worn was 3.6 years. As with the literature on prosthesisuse,there are too few studiesand too few sampledpatients to provide adequate information to
MAY
1991
VOLUME
66
NUMBER
6
PATIENT
Table
USE
I.
OF REMOVABLE
Reported
PARTIAL
DENTURES
use 24 to 33 months
after insertion % of patients treated
No. of patients
431 Total patients treated Patients interviewed 290 (67.3%) Reported use Wearing original .prosthesis without complaint Wearing original prosthesis but with complaint Total wearing original prosthesis Not wearing original prosthesis Patients not contacted Reasons for patient noncontact Known “Deceased” Known “No longer at residence or workplace” Known “Wrong telephone number” Known “Telephone disconnected/no longer in service” No answer to three attempts at communication
patients who are faced with decisions about prosthodontic treatment. This article presents the results of a a-year and I-year longitudinal survey on patients’ use of removable partial
dentures constructed by undergraduate dental students. It is intended to provide additional information for dentists to use when discussingremovable partial dentures with their partially edentulous patients.
METHOD Between Sept. 1, 1984, and May 31, 1985, the undergraduate students of the University of Missouri-Kansas City, School of Dentistry, inserted 523 removable partial dentures for 431 patients. In May 1987 an attempt was made to interview the 431 patients by telephone. In May 1989an attempt wasmadeto againinterview thosepatients who reported still using their prosthesescomfortably during the 1987interview. In both 1987and 1989,as many as three attempts to contact each patient were made during specified 2-week periods. When contact wasmade, the interviewer identified himself or herself, obtained permission to conduct a brief interview, and asked“Are you still wearing the partial denture madeat the school?” If the answer was“yes,” the interview wasended with thanks. If the answer was “no,” then up to four additional questionswere asked. They were (1) “Can you tell me why you are not wearing the partial?” (2) “Have you had a new partial made?” (3) “Do you wish to have a new partial made?” (4) “At the present time are you wearing an old partial or no partial at all?.” The answersgiven were recorded along with charted information about the patient’s name, age, and sex.
RESULTS Table I showsthe results from the 1987interviews and reflects prosthesis use reported 24 to 33 months after
THE
JOURNAL
OF PROSTHETIC
DENTISTRY
238 20 258 32 141
% of patients interviewed
(82.0) (6.9) (89.0)
(11.0) (32.7)
11 9 15 19
(2.6) (2.1) (3.5) (4.4) (20.2)
87
insertion. The table showsthat although 32.7% of the patients could not be contacted, the various reasonsfor noncontact were not related to prosthesisuse in any obvious way. Among the 290 patients who were contacted and interviewed, 258 (89%) were wearingtheir removable partial denture(s) between 24 and 33 months after they were inserted and 238 (82%) were doing so without complaint. Among the 20 patients who were wearing their prostheses but reported problems, 10 reported minor discomfort and seven reported a poor fit. Gagging, affected taste, and a broken clasp were reported by one patient each. Table II showsthe results from the 1989interviews, reflecting removable partial denture use48 to 57 months after insertion among 169 of the 238 patients who reported prosthesisusewithout complaint in 1987. Again, the various reasonsfor noncontact that are noted in the table are seeminglyunrelated to prosthesisuse. Among the 169patients who were contacted and interviewed, 156(91.3%) were continuing to wear their removable partial denture(s) 48 to 57 months after they were inserted and 152or 89.9% were doing so without complaint. Among the four patients who reported wearing their prosthesis but who reported problems with it, two mentioned poor fit, one mentioned discomfort, and one reported that the acrylic resin portion of the prosthesis had partially fractured.
DISCUSSION
AND
CONCLUSIONS
The data reported were obtained from a large patient population and during a longer period of time than any data reported heretofore. They are intended for usein discussingtreatment options with partially edentulous patients.. The dentist can state that a seriesof 290 telephone interviews with patients who received removable partial denturesfrom undergraduate dental students showed82%
COWAN ET AL
Table
II.
Reported use 48 to 57 months after insertion for patients comfortable after 2 years No. of patients
Total patientsin 48- to 57-month survey 238 Patients interviewed 169 (71.0%) Reported use Wearing original prosthesis without complaint Wearing original prosthesis hut with complaint Total wearing original prosthesis Not wearing original prosthesis Patients not contacted Reasons for patient noncontact Known “Deceased” Known “No longer at residence or workplace” Known “Wrong telephone number” Known “Telephone disconnected/no longer in service”
No answerto three attemptsat communication
reported using their removable partial dentures without complaint between24 and 33 months later. The dentist can further state that when the 238 patients who reported using their removablepartial dentureswithout complaint after 2 to 2% years were interviewed 2 years later, 71% reported still usingtheir prostheseswithout complaint. This percentage is no doubt low, since only 169 of the 238 patients could be contacted. It should alsobe noted that the percentagesof reported use are inaccurate to someunknown degree. First is the limitation imposedby the lossof patients to follow-up interviews. Nearly one third of the patients in both surveys could not be contacted. In addition, there is little doubt that someof the patients interviewed saidthey were using their prosthesiseven though they were not, becausethey felt an affirmative responsewas desired. Similarly, the number of patients who reported wearing their removable partial denture despite having problems is probably too low, sincethe interview format did not request specific information about their problems and their remarks were spontaneous.Another consideration that should be noted is that a student-treated patient pool may not necessarily apply to the private dental practice due to differences in patient population and treatment planning criteria. For information regarding the clinical and radiographic aspectsof removablepartial denturesafter 1 and 5 years of service, pleaserefer to the survey reported by Kratochvil et a1.7 Derry and Bertram’ introduced their 1970clinical survey study by stating “There seemsto be agreement among membersof the dental professionthat the removablepartial denture is something to be avoided.“’ The results of this longitudinal survey do not support sucha pessimistic view,.but rather add support for the long-term value of restoring partially edentulouspatients with removable partial dentures.
670
% of patients interviewed
152 4 156 13 69
% of patients in I-year survey
(89.9)
(2.4 (92.3)
(7.7) (29.0)
6
Gw (2.1)
5 12 13 33
(5.0) (5.5) (13.9)
SUMMARY A 2-year and I-year longitudinal survey of 431 patients requiring 523 removable partial dentures wasmade to determine the rate of useand degreeof successof their prostheses,which wereconstructed by undergraduate students. Data were accumulated by telephone interviews. Rates of response,rates of success,patient comments, and limitations of the survey are discussed.Clinical application of this information prior to prosthodontic treatment is suggested.
REFERENCES 1. Derry A, Bertram U. A clinical surveyof removable partial dentures after 2 years usage. Acta Odontol Stand 1970;28:581-98. 2. Bergman B, Hugoson A, Olason C-O. Periodontal and prosthetic conditions in patients treated with removable partial dentures and artificial crowns. A longitudinal two-year study. Acta Odontol Stand 1971; 29621-38. 3. Schwalm CA, Smith DE, Erickson JD. A clinical study of patients 1 to 2 years after placement of removable partial dentures. J PROBTHET DENT 1977;38:380-91. 4. Koivumaa KK, Hedegard B, Carlsson GE. Studies in partial dental prosthesis. I. An investigation of dentogingivally supported partial dentures. Suom Hammaslaak Toim 1960,56:248-306. 5. Carlsson GE, Hedegard B, Koivumaa KK. Studies in partial denture prosthesis. IV. Final results of a 4-year longitudinal investigation of dentogingivally supported partial dentures. Acta Odontol Stand 1965;23:443-72. 6. Benson D, Spolsky VW. A clinical evaluation of removable partial dentures with I bar retainers. Part I. J PROSTHET DENT 1979;41:246-54. 7. Kratochvil FJ, Davidson PN, Tandarte JG. Five-year survey of treatment with removable partial dentures. Part I. J PROSTHET DENT 1982;48:237-44. Reprint requests to: DR. ROBERT D. COWAN SCHOOL OF DENTISTRY UNMm’ZTY OF MISSOURI-KANSAS KANSAS CITY, MO 64108-2795
CITY
MAY
1991
VOLUME
65
NUMBER
6
