Impact of unilateral removable partial dentures versus removable partial dentures with major connector on oral health-related quality of life of elder patients: a clinical study

Goguta et al. BMC Oral Health (2023) 23:182 https://doi.org/10.1186/s12903-023-02870-x BMC Oral Health Open Access RESEARCH Impact of unilateral removable partial dentures versus removable partial dentures with major connector on oral health-related quality of life of elder patients: a clinical study Luciana Goguta1, Mirela Frandes2*, Adrian Candea1, Codruta Ille1 and Anca Jivanescu1 Abstract Objective This study aimed to establish the survival rate of unilateral removable partial dentures (u-RPD) comparative with bilateral RPD (bi-RPD) with major connector in elder patients, as well as to determine both their treatment satisfaction and oral health. Methods The study sample included 17 patients treated with u-RPD and 17 patients treated with bi-RPD with a major connector. The patients were followed over five years with recalls every 6 months. A 5- points Likert scale was used to determine the satisfaction of the patients. The Oral Health Impact Profile-14 (OHIP-14) questionnaire was used to evaluate their oral health after each type of administrated treatment. The local oral examined aspects included the maintenance of the abutment teeth periodontal health, the fractures of the removable dentures, the fractures of the connectors, the chipping of the aesthetic material. Kaplan–Meier survival analysis was conducted to evaluate the performance of the two treatments. Results The mean survival time in years was 4.882 ± 0.114, 95% CI (4.659; 5.106) and 4.882 ± 0.078, 95% CI (4.729; 5.036), for the u-RPD and the bi-RPD, respectively. The five-year survival rates for the two dentures were 94.1% for u-RPD vs. 88.2% for bi-RPD with a major connector, without a statistically significant difference between them (Logrank test χ2(1) = 0.301, p = 0.584). The patients receiving u-RPD presented significantly higher satisfaction scores compared to the patients receiving bi-RPD, 4.88 ± 0.48 vs. 4.41 ± 0.62, Mann-Whitney U test, p = 0.026. Conclusion Patients receiving u-RPD presented higher levels of treatment satisfaction and better oral health than patients receiving bi-RPD. The survival rates of the treatments u-RPD and bi-RPD were similar. Keywords Patient satisfaction, Removable partial dentures, Oral health, Quality of life, Survival analysis *Correspondence: Mirela Frandes 1 Department of Prosthodontics, Faculty of Dentistry, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania 2 Department of Functional Sciences - Biostatistics and Medical Informatics, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania © The Author(s) 2023. 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The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Goguta et al. BMC Oral Health (2023) 23:182 Background Due to an increasing aging population retaining more teeth at an older age, in the era of fixed partial dentures, the removable partial dentures (RPD) are still used to restore edentate patients. Psychological factors are important in patients suffering from tooth loss and/or in those awaiting prosthetic care with fixed or removable dentures [1, 2]. Also, it was demonstrated that denture satisfaction is the strongest predictor of oral healthrelated quality of life (OHRQoL) [3]. It would be correct to state that removable dental prostheses, given suitable pretreatment and follow-up regimes, can provide satisfactory solutions [4]. It was suggested that RPDs improve mastication in extremely shortened dental arches subjects, but without achieving normal mastication levels [5]. Also, it was shown that the ability of chewing and the OHRQoL status in patients with partially dentition are significantly related and influenced by denture status and nonclinical characteristics [6]. Conventional RPD design is frequently bilateral [7] and consists of a major connector that bridges both sides of the arch. However, some patients cannot and will not tolerate such an extensive appliance. For these patients, fixed partial denture (FPD) may not be a predictable option and it is not always possible to provide implantretained restorations [8]. In these cases, the patients are preferring to realize the mastication using only the remaining natural teeth, instead of wearing and using the removable denture with major connector. There are many patients who are not even aware of the importance of hygiene and maintenance of the removable dentures [9, 10]. Studies have suggested that at least two teeth on each side should be splinted when extra-coronal distal extension attachment prostheses are used [11, 12]. It is important to protect the periodontal health of the abutment when restored with distal-extension extra-coronal [13]. Stress on the terminal abutment can be reduced by using an extra - coronal resilient attachment that allocates more loads onto the distal edentulous ridge [14–16]. The new fabrications techniques for RPD like subtractive CAD-CAM (computer aided design – computer aided manufacturing) or additive SLM (selective laser sintering) and SLS (selective laser melting) are offering promising results [17–20]. The RDP retention includes the selection of the potential abutment teeth taking into the account their prognosis, their position in the arch, as well as the planned prosthesis design. Retainer selection mainly depends on the remaining tooth substance, the intra- and inter-maxillary relationships, esthetics, and financial aspects. The benefits of dental implants as additional retainers are the increased supportive area for the RDP, the minimized Page 2 of 7 load of the soft tissue, as well as the reduced extension of the base of the prosthesis to enhance the patient’s comfort [21]. The aim of this clinical study was to establish the survival of unilateral RPD (u-RPD) compared to bilateral RPD (bi-RPD) with major connector, to assess the overall satisfaction of the patients wearing these dentures as well as their OHRQoL. Methods Study design and patients The study was realized in the Department of Prosth (...truncated)