Evaluation of fixed partial denture in relation to gingival recession and other factors Faiza M. Abdul Ameer,B.D.S., M. Sc. (1) Zainab M. Abdul Ameer,B.D.S., M. Sc (2) ABSTRACT Background: Gingival recession may be due to faulty dental treatment. The aim of this study was to investigate the distribution of fixed partial dentures according to age, sex, location and type of material used in construction and discovers the influence of fixed partial denture characteristics (quality, duration, number of abutments and pontics) on frequency of Materials and Methods: A total of 16 patients were selected from patients attending for dental examination at college of dentistry, University of Baghdad. The subjects had cast or ceramic fixed partial denture or dentures for at least 3 years. The distributions of restoration according to age, sex, location and type of material were investigated. Number of abutments and pontics, quality and duration of restoration since worn in relation to gingival recession were evaluated. Results: Females asked more for fixed partial dentures in younger age group than males, and in upper anterior region more than other regions. The percentage of cast fixed partial denture was more than ceramic type. A higher percentage of patients had gingival recession related to restoration with poor marginal integrity and longer period since worn. A high significant difference was found between lengths of fixed partial denture and recession and low significant differences between quality of restoration and presence of Conclusion: The study concluded that fixed partial denture characteristics (quality, duration, number of abutments and pontics) had significant and high significant effects on frequency of Keywords: Gingiva, recession, fixed restoration, (J Bagh Coll Dentistry 5; 17(3): 13-16) INTRODUCTION Inflamed gingivae can be caused by accumulations of bacterial plaque on restorations with poor marginal integrity (1,2) or bulky contours with poor emergence profiles. (3) Conversely, patients with adequate plaque control may have persistent gingival inflammation secondary to violation of the biologic width or hypersensitivity to components of selected dental alloys. (4,5) The causes of gingival recession are not well understood, but are thought to be associated with trauma or the loss of periodontal ligament attachment, or both, and are most common at sites with inherently thin gingiva. However, the progressively thicker form of the investing tissues more apically, coupled with the presence of underlying crestal bone, means that recession tends to be selflimiting unless there is progressive periodontal ligament attachment loss. (3,6) Consequently, progressive gingival recession indicates progressive alveolar bone loss associated with active periodontal disease. according to age, sex, location and type of material used in construction and discovers the influence of fixed partial denture characteristics (quality, duration, number of abutments and pontics) on frequency of (1) Lecturer, Department of Prosthodontics, College of Dentistry, Baghdad University. (2) Lecturer, Department of Conservative Dentistry, College of Dentistry, Baghdad University. The aim of this study was to investigate the distribution of fixed partial dentures Restorative Dentistry 13
MATERIALS AND METHODS A total of 16 persons (68 men and 92 women) ranging in age from 26 to 7 years were examined. Subjects were selected consecutively from patients attending for dental examination at College of Dentistry University of Baghdad. The only criteria for selection were that the subject had cast or ceramic fixed partial denture or dentures in his oral cavity for at least 3 years. Plaque was removed and the teeth dried before examination. Each root surface (buccal \ labial and palatal \ lingual) was recorded as either exposed, if the cementoenamel junction was clearly visible above the gingival margin, or not visible. The maximum length of gingival recession on each palatal \ lingual and buccal \ labial surface was measured from the cementoenamel junction to the gingiva, with a pocket measuring probe marked at millimeter intervals. Location of restorations; anteriorly or posteriorly and in upper or lower jaw, number of abutments, number of pontics, duration in years of wearing the prostheses, type of material used in construction of restoration and quality of restoration were evaluated. Means and standard deviations were calculated for age groups. The t- test for variance was calculated. The level of significance set at P<.5. RESULTS Table 1 shows the mean ages of the patient, which were about 46. (±14.53) for males and 39.94 (±14.) for females. Table 2 shows the distribution of fixed partial dentures according to type of material and location; 142 (88.75%) patients wore cast fixed partial dentures and 18 (11. %) patients worn ceramic fixed partial dentures. A high percentage of patients had cast fixed partial dentures in the upper anterior regions, while a much lower percentage had ceramic fixed partial dentures in the same region. The distribution of fixed partial dentures according to the presence of gingival recession and number of abutments and pontics, quality and duration are shown in figure 1, figure 2 and figure 3 respectively. The t-test showed significant and high significant levels of differences for all test groups at probability level <.5. DISCUSSION The results of this study showed clearly, that females asked more for fixed partial dentures in the younger age group than males. This finding is in agreement with the results of Albino et al (7) and Luan et al. (8) A high percentage of patients had cast and ceramic fixed partial denture in the upper anterior region compared with upper and lower posterior region. This is because maxillary central incisors are the most frequently involved teeth by trauma in early age, (9) and need to be replaced by fixed restoration as soon as they are lost due to their aesthetic importance. () In the lower anterior region only one case was reported with cast fixed partial denture. This is because lower anterior teeth had smaller size than upper anterior or upper and lower posterior teeth and if sufficient tooth structure is not removed, technicians cannot fabricate restorations with optimal contours and esthetics, therefore bulky and over contoured restorations may result. (11) This study showed that patients with cast fixed partial dentures were more than those with ceramic fixed partial denture. This is probably related to the financial factor. (12) A high percentage of patients with fixed partial dentures had 2 abutments and 1 pontic (36.87%) while a lower percentage was recorded with patients having 2 abutments and 3 pontics fixed partial dentures (6.87%). This result may be due to the fact that a high percentage of patients had lost one tooth in young age needing to be replaced by fixed restoration later on. (13) A statistical significant difference was found between length of fixed partial dentures and presence of A high significant difference was found between lengths of fixed partial denture and It has been found that high percentage of patients with gingival recession had fixed partial dentures with poor marginal integrity. This is because bacterial plaque retained on relatively rough restoration surfaces and on the exposed dental cement between the tooth and the restoration is difficult for the patient and dentist to remove, and is responsible for the inflammatory changes seen in the periodondium adjacent to sub gingival restoration margins. (1,2,14) It has been found that a low significant difference was noticed between quality of restoration and presence of gingival recession, Restorative Dentistry 14
and significant difference between quality of restoration and absence of In studying the distribution of fixed partial denture in relation to duration of restorations worn, it was found that most patients presented with gingival recession after 6 years. This might be related to the fact that gingival recession appears to increase gradually with age. (15) In the first group after 3-5 years duration, high percentage of patients had gingival recession; this might be due to the fact that Iraqi population during the past years suffered from poor security circumstances which lead to neglect and improper oral hygiene. Oral hygiene and gingival inflammation had strongest relationship with gingival recession than other (16) factors. Also the quality of restoration regarding the materials, laboratory and clinical work recently is not as good as the oldest fixed partial dentures. A significant difference between duration of restorations and presence or recession was also found. Table 1: Mean age of patients with fixed partial dentures. Sex Number Mean age SD Males 68 46. ±14.53 Females 92 39.94 ±14. Table 2: The Distribution of fixed partial dentures according to type of material and location (numbers and percentages). Material Anterior Anterior Posterior Posterior Total upper lower upper lower Cast 67 (41.87) 1 (o.62%) (15.62%) 49 (.62%) 142 (88.75%) Ceramic 12 2 (1.%) 4 (2.%) 18 (11.) (7.%) (%) Total 79 (49.37%) 1 (.62%) 27 (16.87%) 53 (33.12) 16 (%) 45 35 15 5 1A 1P 2A 1P 2A 2P 2A 3P 3A 2P Figure 1: The distribution of fixed partial dentures according to numbers of abutments and pontics and presence of A: abutments, P: pontics Restorative Dentistry 15
6 Poor marginal integrity BULKY GOOD Figure 2: The distribution of fixed partial dentures according to quality of fixed partial dentures and presence of 45 35 15 5 3-5 years 6- years 11-15 years 16 and over Figure 3: The distribution of fixed partial dentures according to duration and presence of REFERENCES 1. Spear F, Townsend C. Esthetics: a multidisciplinary approach. Presented at the 77 th Annual Meeting of the American Academy of Periodontology, Vancouver, B.C. 1991 Oct 2. 2. Lang P, Kiel RA, Anderholden K. Clinical and microbiological effects of sub gingival restorations with overhanging or clinically perfect margins. J Clin Periodontol 1983; : 563-78. 3. Perel M L. Axial crown contours. J Prosthet Dent 1971; : 642-9. 4. Chiche G, Kokich V, Candill R. diagnosis and treatment planning of esthetic problems. In: Chiche G, Pinault A, eds. Esthetics of anterior fixed prosthodontics. Chicago: Quintessence Pub Co Inc; 1994: 39. 5. Lamster IB, Kalfus D, Steigerwald PJ, Chasens A. Rapid bone loss of alveolar bone associated with non precious alloy crowns in two patients with nickel hypersensitivity. J Periodontol 1987; 58: 486-92. 6. Kieser JB. Periodontics: A practical approach. London, United Kingdom: Wright, 199. 7. Albino JE, Tedesco LA, Conny DJ. Patient perceptions of dental facial esthetics shared concerns in orthodontics and prosthodontics. J Prosthet Dent 1984; 52: 9-13. 8. Luan WM, Baelum V, Chen X, Fejerskov O. Tooth mortality and prosthetic treatment patterns in Urban and rural Chinese age -8 years. Community Dent Oral Epidemiol 1989; 17: 221-6. 9. Yagot KH. Traumatic injuries of permanent incisors in pedodontic clinic. Iraqi Dental J 1985; 12: 55-63.. Bello A, Jarvis RH. A review of esthetic alternatives for restoration of anterior teeth. J Prosthet Dent 1997; 78: 437-. 11. Drago CJ. Clinical and laboratory parameters in fixed prosthodontic treatment J Prosthet Dent 1996; 76: 233-8. 12. Widstorn 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. 13. A- Makadsi FB, Al-Sahar WF. A study of posterior tooth loss in 15 year old Iraqi students. Iraqi Dent J 1985; 12: 155-64. 14. Saltzberg DS. Scanning electron microscope study of the junction between restorations and gingival cavosurface margins. Restorative Dentistry 16
15. Wright PS, Hellyer PH. Gingival recession related to removable partial dentures in older patients. J Prosthet Dent 1995; 74: 62-7. 16. Mirza KB, Ghali RF. Local factors contributing to The 5 th scientific conference of the College of Dentistry University of Baghdad. 1995. Restorative Dentistry 2