The Impact of Removable Partial Dentures on the Health of Oral Tissues: A Systematic Review

Objectives: The aim of the present study was to review the available literature data to identify relevant studies for inclusion and to verify whether there is evidence to support the hypothesis that the insertion of an RPD into the oral cavity has a deterioration effect on the oral health status. Materials and methods: 570 articles were identified, from searching both electronic databases (e.g., PUBMED) and manual searching of relevant written journals using an agreed search protocol up to 31st December 2011. The extraction of data for inclusion was conducted by two independent reviewers. The main outcomes of intervention involved both methodology and assessment tools applied by investigators to assess the effect of a RPD in terms of plaque accumulation, caries incidence, and gingival tissue (inflammation). Results: 401 articles were excluded following an initial screening; 169 articles were included for the further review. At a second round screening, 163 articles were also rejected and six (Randomised Clinical Trials [RCTs]) articles were eventually accepted for inclusion. Based on the results, there was some scientific evidence supporting the hypothesis that RPDs placement may increase plaque accumulation and gingival inflammation. The importance of an established prevention program for RPD wearers (including good plaque control and OHI) either prior to or during treatment was emphasised by all investigators in the included studies. Among the limitations, however when evaluating the data, was the lack of homogeneity between the included studies (e.g., study design and duration, calibration details, clinical parameters to be evaluated, reporting of dropout rates and treatment intervention). Conclusion: The conclusion from this present review would indicate that there were insufficient RCTs to adequately address the original research question, although a number of suggestions may be recommended. There was no doubt from the evidence presented in the published literature that in the absence of good oral hygiene measures a RPD may promote accumulation of the plaque which may in turn lead to gingival inflammation. Furthermore, there also appears to be a higher risk of dental caries (particularly root caries) in RPD wearers in the absence of good oral hygiene measures. The importance of an integrated prosthodontics maintenance programme with regular recall visits including both oral and denture hygiene care of a RPD cannot be under-estimated and should be adopted as a gold standard in general dental practice