I’m missing a tooth! Now what? – Part II (Removable Partial Dentures)
I previously discussed the risks and complications of doing nothing to treat a missing tooth. For a patient who decides that they DO want to treat the missing tooth, there are several options. One option to treat missing teeth is a removable partial denture.
A removable partial denture (RPD) is a prosthesis that comes in and out of your mouth, and it replaces any missing teeth you may have. A single removable partial denture can replace 1 tooth or almost all the teeth on a single arch. They are typically the cheapest treatment option available. However, many find that having to take it in and out can become annoying.
The removable partial denture is traditionally made with a metal framework with pink plastic or acrylic. The metal framework goes across the roof of your mouth (upper jaw) or around the backs of the teeth (lower jaw), and hooks onto some of the remaining teeth. These hooks, or clasps, help the partial denture stay in place, so it is important to have these placed on healthy, stable teeth. The denture teeth are then placed in pink acrylic, which replaces any missing teeth the patient may have.
Typically, before getting removable partial dentures, the dentist has to prepare some of the remaining teeth with dimples and grooves, which are made so that the metal framework can slide into the teeth. The dimples and grooves are called rest seats. This is where the denture sits on top of the tooth to prevent the dentures from pushing down into the patient’s gums and makes the dentures very stable.
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There are a couple disadvantages to getting metal framework partial dentures. One such disadvantage is that there may be situations where the clasp is going to be visible when a patient smiles, which will not be esthetic (as shown in the photo below). Another issue is that some patients may have allergies to the metal used in the framework, or to the acrylic.
A newer, more esthetic, removable partial denture option is the “flexible” removable partial denture. These are made of a thermoplastic material. They are usually all pink, but some can be clear. There is no metal framework, and the prosthesis itself is usually thinner and lighter than the traditional, metal type. Also, since they are flexible, they do not break as easily as the traditional dentures.
However, although they are more esthetic, they do have some downsides. Some issues that typically arise with these types of dentures are that they tend to push into the gums upon biting more often than compared with the metal types. The main reason for this is because flexible dentures do not have rests to stop the denture from pressing into the gums. This, in turn, causes sore spots and irritations. Therefore, flexible dentures usually require more adjustments in order to get them comfortable.
Flexible dentures are also harder to tighten around supporting teeth. In other words, over time, partial dentures tend to get loose. This is because the constant insertion and removal of the dentures loosens up the clasps holding them in place. With the metal partial denture, simply tightening the metal clasps makes the denture much more secure. However, with flexible dentures, it is harder to tighten the clasps due to the nature of the material. They CAN be tightened, just not a lot. This makes them more limiting than the metal clasps.
Finally, relining or fixing broken teeth or adding more denture teeth to the flexible dentures are much more difficult. The special material they are made of requires the dentist to have to send the dentures to the lab in order to correct problems. This means that the patient has to go around without teeth for a few days (if they don’t have a backup set), which can be especially stressful if the removable partial denture is replacing front teeth. Now, sometimes the metal dentures have to be send back to the lab as well, but there are more procedures that can be performed IN the office as opposed to the flexible kind.
There is also a third kind of removable partial denture. This is more of a hybrid of the two kinds mentioned above. These “hybrid” partial dentures combine the benefits of the metal framework partial denture with those of the flexible partial denture. As mentioned earlier, of the 2 kinds of removable partial dentures, the metal framework provides the better support (due to the rest seats). The hybrid type of partial denture also has a metal framework with rests, but the clasps (which can be an eyesore in certain areas, and therefore a disadvantage of the metal frameworks) are made of the same type of thermoplastic material the “flexible” removable partial dentures are made of. They can be gum-colored, or tooth-colored or clear. This provides the patients with the support of the traditional partial denture, but the esthetics of the “flexible” partial denture. However, not all denture labs are able to perform this “linking” of the two different materials.
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The final type of removable partial denture is the interim partial denture. Some people know these as “flippers”. They are made of acrylic and are meant to be used on a temporary basis only. Some will have thin, metal clasps to help hold them in place. Usually, you will see these when a patient gets a tooth extracted and then an implant placed. These are used to help with esthetics (front teeth) or the bite (back teeth) as the implant is healing. These may also be used to transition a patient into complete dentures. It gets them slowly used to wearing dentures until they are ready to lose the rest of their teeth.
These interim dentures are made completely of acrylic so they are more prone to breaking. The metal clasps tend to be thin and distort easily as well. However, they are very affordable and can be made quickly. But, as I mentioned earlier, they are meant to be temporary only.
So, what are the pros and cons of removable partial dentures?
- They are the most cost effective treatment option to replacing missing teeth.
- Only 1 partial denture is needed per arch, no matter how many teeth are missing (of course, all the teeth cannot be missing). So, if you’re missing some teeth on your upper left jaw and some on your upper right side, one removable partial denture will replace all those missing teeth. With a bridge, you would need 2 different bridges to replace the teeth on both sides of the jaw (as will be discussed in the next section).
- They improve chewing function as well as esthetics (as opposed to doing no treatment).
- If a tooth is extracted after getting a removable partial denture, a dentist can usually add another tooth in it’s place, still utilizing the same denture.
- They are removable. They come in and out. It is highly recommended dentures be taken out at night (or 8 hours during the day), so that the gums are given a chance to rest from being under the dentures all day. Otherwise, the patient runs the risk of getting fungal infections under the dentures. Many patients find this cumbersome and annoying; in fact, many end up just keeping them in their nightstands and not wearing them at all. There are some patients who don’t want their significant others to know they’re missing teeth and refuse to remove these dentures, which can lead to other issues. Others are constantly worried that the dentures are going to fly out of their mouths while they talk or laugh.
- Patients have to get used to having something going over the roof of their mouths or around their teeth, as well as the bulkiness of the dentures. This causes lisping in most patients (although most start to talk normally after approximately 10 days).
- Denture teeth are not as strong as natural teeth. There can be a limitation to the types of foods a patient can eat.
- Can be unesthetic.
- They put more stress on the supporting teeth, which could potentially expedite tooth loss.
- They tend to accumulate more plaque in areas where the denture meets the supporting tooth, again, putting more stress on those teeth.
- They require relines over time. Peoples’ jaws tend to shrink when there is no longer any teeth. As the jaw shrinks, the denture doesn’t fit as well as it did originally, therefore needing relines. If the fit becomes really bad, then a new denture will have to be made.
These are all things that should be taken into consideration when thinking about getting into a removable partial denture.
SEE: I’m missing a tooth! Now what? – Part I
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