5410 Journal of Applied Sciences Research, 8(11): 5410-5414, 2012 ISSN 1819-544X

This is a refereed journal and all articles are professionally screened and reviewed

ORIGINAL ARTICLES

The Effect of Two Different Types of Direct Retainers in Mandibular Unilateral Distal Extension Removable Partial Denture (Microbiological Study)
1

Dr. Islam Mubarak A. Moustafa, 1Dr. Mohamed Sabry Badawey, 2Dr. Zeinab Abdul-Khalek Ibrahim and 1Dr. Azza Farahat
Removable Prosthodontic Department, Faculty of Oral and Dental Medicine, Cairo University, Egypt Medical Microbiology and Immunology Department, Faculty of Medicine, Cairo University, Egypt

1 2

ABSTRACT Objective: The purpose of the present study was to evaluate the microbiological effect of different types of direct retainers in mandibular unilateral distal extension partial dentures. Materials & Methods: fourteen patients were selected, divided into two groups. The first group received attachment retained removable partial denture (RPD). However, the second group received clasp RPD. The gingival fluid samples were collected from the highest scored site around the abutment teeth. Before RPD insertion, two weeks, four weeks and eight weeks after RPD insertion. Results: Study group (attachment retained RPD group) showed statistically significant higher values of microbial count than the control group (Clasp retained RPD group). Conclusions: Attachment retained RPD induced higher bacterial count than clasp retained RPD. Key words: Unilateral distal extension, extra-coronal attachment, RPD, micro biological. Introduction The restoration of unilateral distal extension partially edentulous cases has always been a challenge to prosthodontists. The main problem lies in choosing a restoration that provides adequate support, retention and stability without jeopardizing the health and the integrity of the remaining oral structures (Innim et al, 2001) Clasp retained removable partial denture remains the most commonly used restoration despite the many problems associated with its use. However, it is has been associated with increased gingivitis, periodontitis and abutment mobility. Those complications may be attributed to plaque accumulation in the absence of satisfactory oral hygiene measures (Vanzeveren et al, 2003). Osseointegrated implants may be considered a successful treatment modality for unilateral distal extension partially edentulous cases. Implant supported prostheses provide superior biomechanical qualities. However, certain conditions might contra-indicate their use (Palmer et al, 2002) Extra-coronal attachments may be utilized successfully in unilateral distal extension cases providing good esthetics and retention. Moreover, favorable stress distribution to the abutment teeth is also an advantage (Berg & Caputo, 1992).The complicated design of the extra-coronal attachments may require specific oral hygiene measures and motivation of the patient. It is important to choose the restoration that does not jeopardize the health of the remaining structures. At the same time, this restoration must be well tolerated by the patient. Materials and Methods Fourteen partially edentulous patients were selected from the Out-patient Clinic, Faculty of Oral & Dental medicine, Cairo University. Patients were randomly divided into two groups each included seven patients. Group-A: Received attachment retained RPD. However, Group-B: Received clasp retained RPD. For Group-A: Construction of attachment retained RPD: A rubber base impression was made using putty impression material in the patient's custom tray. The first and the second premolars on the edentulous side were prepared to receive two porcelain veneered crowns. Wash impression was made in light body rubber base over the putty impression. Metallic crowns-attachment assembly was trial -inserted intra-orally.
Corresponding Author: Dr. Islam Mubarak A. Moustafa, Removable Prosthodontic Department, Faculty of Oral and Dental Medicine, Cairo University, Egypt E-mail: islammubarak@hotmail.com

541 11
J. Appl. Sci. Res., 8(11): 541 10-5414, 2012

Po orcelain facing gs were added to t those crown ns after that (Fi ig.1).

owns assembly y with porcelain n tried -in patie ents mouth. Fig. 1: Cro Th hen, crowns-at ttachment assembly were tem mporary cemen nted in the patie ent`s mouth. On O the dentulou us side, a distal l occlusal rest seat on the sec cond premolar and a mesial occlusal o rest se eat on the first t molar were pr repared. Th he crowns-att tachment assem mbly were th hen checked, adjusted and overall rubbe er base pick-u up impression n was made Th he metal frame ework of the RPD R was tried in the patient`s s mouth to ver rify its passive fit, the accurac cy of the fram mework, complete seating of the t rests in thei ir rest seats. Ja aw relation wa as then made using u wax wafe er technique, mounting m of ca asts and arrangement of acryl lic resin teeth were carried-o out. he RPD was th hen finished, po olished and ins serted in patien nt`s mouth Th Th he crowns-atta achment assem mbly was cemented using gla ass ionomer cem ment and direc ct pick-up of th he attachment t retentive elem ment was made e. Group-B Clasp C retained RPD: R ventional clasp p retained RPD D were construc cted according g to the followin ng design: A conv - RPI clasp on the last l abutment tooth t of the ed dentulous side (mesio-occlus sal rest- proxim mal plate- I- bar b rm). retentive ar - Ling gual bar and/or sublingual bar r as a major con nnector. - Indir rect retainer in the form of cin ngulum rest on n the canine in the intact side. . - Doub ble Aker`s clas sp on the first molar m and seco ond premolar of the intact side. - A me eshwork dentu ure base. Clinical ev valuation: Clin nical attachmen nt level: Clinical evaluation of o the attachme ent level aroun nd the abutmen nt teeth was car rried-out :at the e RPD insertio on, two weeks, four weeks, eight e weeks aft ter denture inse ertion. nical attachmen nt level was measured m using g a graduated periodontal p probe at the mid-buccal, m mi id- Clin lingual, me esio- and disto o-buccal line an ngles of the fi irst and second d premolars. Th he mean attach hment level was w calculated and recorded. Isolation of micro-organi isms: t site for gingival fluid collection c base ed on the high hest scored si ite around abu utment tooth for f -The test gingival flu uid sample collection. -The gingival fluid was collected with micro ca apillary pipette es at the entran nce of the ging gival sulcus an nd ching the marg ginal gingiva of f the abutment teeth (Fig. 2). gently touc

541 12
J. Appl. Sci. Res., 8(11): 541 10-5414, 2012

Fig. 2: Col llection of ging gival fluid sam mples. A stan ndardized amo ount of gingiva al fluid was tak ken using mic cro capillary pi ipettes. The co ollected gingiv val samples we ere cultured in n blood agar and Mitis Salivar rius agar. Results: - The results of the present p study revealed r that: On comparing g the Control group (Attachm ment RPD grou up) and the st tudy group (C Clasp retained RPD), There was no statist tically signific cant difference e between mea an bacterial co ounts along the e study period. (Table.1):Table 1: Com mparison between bacterial counts (l log10 values of CFU U) in the two grou ups Group Clasp reta ained RPD Atta achment retained RPD R Mean log10 SD Mea an log10 SD D 1 P-v value

Period At insertion n 2.40 0.74 2.35 5 0.3 34 0.9 903 2 weeks 2.55 0.44 2.87 7 0.14 0.2 214 4 weeks 2.62 0.42 3.41 1 0.7 75 0.4 414 8 weeks 2.66 0.36 3.49 9 0.8 88 0.3 377 *: Significant t at P 0.05 -As shown in n (Table 2):- There e was no statistica ally significant dif fference between mean m streptococci differentiation counts along the stu udy period. Table 2: Com mparison between Streptococci coun nts (log10 values of f CFU) in the two groups g Group Clasp reta ained RPD Atta achment retained RPD R Mean log10 SD Mea an log10 SD D 1 Period At insertion n 2 weeks 4 weeks 8 weeks *: Significant t at P 0.05 P-v value

1.52 1.63 1.70 1.75

0.32 0.21 0.30 0.41

1.60 0 1.73 3 1.85 5 2.00 0

0.2 27 0.2 20 0.4 47 0.3 33

0.7 774 0.5 528 0.4 463 0.0 077

-Regarding g the effect of time t on the mic crobial count ( (log10 values of f CFU) in Cont trol group: tically significant increase in n the mean ba acterial counts along the follow-up interval ls. There was no statist s incr rease in mean s streptococci co ounts along the follow-up inte erval. Moreover, there was no significant o time on micr robial count (lo og10 values of CFU) in Study y group: The effect of There was a statistic cally significan nt increase in mean m bacterial l counts after 2 week and fro om 2 weeks to o4 m insertion to 4 weeks and fr rom insertion t to 8 weeks. Mo oreover, there was w non-signif ficant increase in weeks, from mean bacte erial counts Fro om 4 weeks to 8 weeks. There was no statisti ically significa ant increase in mean Streptoc cocci counts af fter 2 week, fro om 2 weeks to o4 f the dentu ure insertion to 4 weeks. It w was found also that there was sa weeks, from 4 weeks to 8 weeks and from ean Streptococ cci counts from m the denture in nsertion to 8 we eeks. significant increase in me

5413
J. Appl. Sci. Res., 8(11): 5410-5414, 2012

Comparison between mean percentage (%) increases in bacterial counts (log10 values of CFU) of the two groups: The percentage increase in bacterial counts of the two groups was calculated according to the following formula: Bacterial counts (after) Bacterial counts (before) x 100 Bacterial counts (before) The % increase in bacterial counts of study group (attachment retained RPD) showed statistically significantly higher value than control group (Clap retained RPD) from the denture insertion to 4 weeks and from the denture insertion to 8 weeks. The % increase in streptococci counts of study group showed statistically significantly higher value than control group from the denture insertion to 8 weeks. Discussion: The significant increase in mean bacterial counts (CFU) throughout the follow-up period may be due to the complicated design of the attachment retained RPD which may complicate the oral hygiene maintenance and consequently increasing the mean bacterial counts in agree with Budtz-Jorgensen et al., 1998 The percentage increase in the bacterial counts of the attachment RPD group showed higher values than the clasp RPD group throughout the follow-up period. Those results may be due to preparation of the abutments sub-gingivally to create the finish lines of the crowns. This may change the micro flora of the gingival crevice. The inability of a patient to pass dental floss through inter-proximal spaces of the splinted crowns may lead to inadequate oral hygiene and higher bacterial count when compared to that reported in the clasp RPD group. These findings agree with Stewart et al., 2003. Sorensen, 1989and Goodacare, 1990, added that the sub-gingival margins of the crowns may greatly increase the frequency of periodontal diseases. Moreover, the surface roughness, the marginal fit and the crown contour may mediate plaque accumulation and influence gingival health. Other studies have indicated more severe gingival tissue reactions when the gingiva is covered with dentures; whereas, an open space design of minor connectors may be less conducive to increases in plaque accumulation, gingival inflammation, and pocket depth (Chandler et al., 1984, and Nada et al., 1987). The clasp retained RPD group showed significant increase in mean Streptococci counts and percentage increase in streptococci counts from the denture insertion to 8 weeks than those of the attachment group which may be due to more inflammatory conditions accompanying the attachment retained RPD than the clasp retained RPD. Those findings agreed with Beighton et al, 1991 who reported that wearing RPDs predisposing one to high salivary levels of mutants streptococci. The results revealed that there was no statistically significant difference between the mean probing depths in the two studied groups along the study period which may be due to the short follow-up period. Some clinical studies showed that on providing regular recall system with control, re-instruction and remotivation, the removable partial dentures might not cause any damage of the periodontium (Kapur et al., 1994; Bergman et al., 1996; Wo stmann, 1997). Conclusions: Within the limitations of the present study, the following conclusions that: The attachment retained RPD causes increase in the bacterial count and streptococci microorganism more than the clasp retained RPD. The attachment retained RPD needs more precise and meticulous oral hygiene measures and frequent recall visits to obtain the predicted efficacy than clasp RPD. References

Beighton, D., P.H. Hellyer, E. Lynch, M.R. Heath, 1991. Salivary levels of mutans streptococci, lactobacilli, yeasts, and root caries prevalence in non-institutionalized elderly dental patients. Community Dent Oral Epidemiol., 19: 302-7. Berg, T and A.A. Caputo, 1992. Comparison of load transfer by maxillary distal extension removable partial dentures with a spring-loaded plunger attachment and I-bar retainer. J Prosthet Dent., 68: 492-499. Bergman, B., A.. Ericson and M. Molin, 1996. Long-term clinical results after treatment with conical crownretained dentures. International Journal of Prosthodontics, 9: 533.

5414
J. Appl. Sci. Res., 8(11): 5410-5414, 2012

Budtz-Jrgensen Eand Isidor, F., 1990. A 5-year longitudinal study of cantilevered fixed partial dentures compared with removable partial dentures in a geriatric population. J Prosthet Dent., 64: 42-7. Chandler, J.A. and J.S. Brudvik, 1984. Clinical evaluation of patients eight to nine years after placement of removable partial dentures. J Prosthet Dent., 51: 736-43. Goodacre, C.J., 1990. Gingival esthetics. J Prosthet Dent., 64: 1-12. Innim Park, Miho Eto, Noriyuki Wakabayashi, Masayuki Hideshima and Takashi Ohyama, 2001. Dynamic retentive force of a mandibular unilateral removable partial denture framework with a back-action clasp. J Med Dent Sci., 48: 105-111. Kapur, K.K., R. Deupree, R.J. Dent and A.L. Hasse, 1994. A randomized clinical trial of two basic removable partial denture designs. Part I: Comparisons of five-year success rates and periodontal health. Journal of Prosthetic Dentistry, 72: 268. Nada, M., S. Gharrphy and M.S. Badawy, 1987. A two year longitudinal study on the effect of removable partial denture design on the health of the remaining teeth. Egypt Dent J 33: 85-95. Palmer, R.M., B.J. Smith, L.C. Howe and P.J. Palmer, 2002. Implants in Clinical Dentistry, 1st edn. London: Martin Dunitz Ltd. Sorensen, J.A., 1989. A rationale for comparison of plaque-retaining properties of crown systems. J Prosthet Dent., 62: 264-269. Steward, K.L., R.D. Phoenix, D.R. Cagna and C.F. Defreest, 2003. Stewarts clinical removable partial prosthodontics. 3rd ed. Chicago: Quintessence., p: 1-18. Vanzeveren, C., W. DHoore, P. Bercy, G. Leloup, 2003. Treatment with removable partial dentures: a longitudinal study. PartII. J Oral Rehabil., 30(5): 459469. Wo stmann B., 1997. Tragedauer von klammerverankerten Einstu ckguprothesen im u berwachten Gebrauch. Deutsche Zahna rztliche Zeitschrift, 52: 100.