Original Article

PROSTHESIS AND ABUTMENT RELATED COMPLICATIONS IN

PATIENTS WEARING HEAT CURE ACRYLIC RESIN PARTIAL
REMOVABLE DENTURES
1
MUHAMMAD RIZWAN MEMON
2
NASEEM SHAIKH
3
KASHIF ALI CHANNAR
4
MUHAMMAD SHAHZAD
ABSTRACT
The objective of this study was to determine the frequency of prosthesis and abutment related
complications in patients wearing polymethylmethacrylate heat cure acrylic resin partial removable
dental prostheses. A descriptive cross sectional study was conducted from July 2014 to June 2015,
at Liaquat University of Medical and Health Sciences Jamshoro. Data relating to 110 patients were
collected using a structured proforma by taking history, clinical and radiographic examination. Data
related to Kennedy classification, prosthesis and abutment related various complications as well as
post-fitting duration of prosthesis were recorded. According to Kennedy classification the majority of
patients were wearing type III (56.3%) prosthesis. The most prevailing complications related to abut-
ment and prosthesis were Plaque/Calculus (90%), pocketing (71%), Caries (65%), gingival recession
(58%) discoloration of prosthesis (49%), mobility of abutment (47%) and abutment loss (27%). On the
other hand the least prevalent complications were denture base fracture (06%), clasp fracture (06%)
and wearing off of artificial teeth (9%). Most of the complications occurred in prostheses that were not
older than 5 years.
Key Words: Complications, Removable Dental Prosthesis, Removable partial Dentures.

INTRODUCTION vorable responses especially affecting the abutments

Loss of natural teeth leading to partial edentulism
not only affects the quality of life but also impairs the
mastication, aesthetics and speech.1 The quality of life
and the age of life are increasing with time, the number
of loss of teeth are also increasing in elderly peoples
around the globe specially in USA and UK. It has been
reported in a survey that 250,000 lacs population under
age of 40 years are using removable partial dentures
(RPD).2
Partial dentures wearing is beneficial for the pa-
tients but there are certain disadvantages and unfa-
1
Correspondence Author: Muhammad Rizwan Memon, BDS,
FCPS, Assistant Professor, Institute of Dentistry, Liaquat Uni-
versity of Medical and Health Sciences, Jamshoro, Sindh
Email: muhammad.rizwan@lumhs.edu.pk Cell: +92-333-9307810
2
Naseem Shaikh, BDS, MSc Lecturer, Institute of Dentistry, Li-
aquat University of Medical and Health Sciences, Jamshoro,
Sindh
3
Kashif Ali Channar, BDS, FCPS, Assistant Professor, Institute
of Dentistry, Liaquat University of Medical and Health Sciences,
Jamshoro
4
Muhammad Shahzad, BDS, FCPS, Assistant Professor, Institute
of Dentistry, Liaquat University of Medical and Health Sciences,
Jamshoro
Received for Publication: September 23, 2016
Revised: November 9, 2016
Approved: November 10, 2016
and supporting tissues. Some researches have been
done to assess the advantages and disadantages of
RPDs on supporting tissues like gingiva, periodon-
tium and bone, leading to gingivitis, periodontitis and
occurance of teeth mobility.3 RPDs produce favorable
environment for plaque deposition inspite of maintain-
ing oral hygiene that increases the risk of periodontal
problems surrounding the abutments.4 Certain studies
have reported that the formation of plaque biofilm is
increased due to wearing of RPDs that leads to caries
and periodontal problems.5,6
Designing and construction of RPDs is extremely
important. Poor planning and faulty construction should
be avoided. They can cause unwanted force application
on abutment teeth as they acts as a fulcrum point to
which torque forces are applied. Abutment failure, metal
framework fractures and failure of components, such
as clasps and artificial teeth, are the major causes of
prosthesis failure in literature affecting the prolonged
existence of these prostheses.3,7
The adverse effect on abutments by partial den-
tures also depends on the type of denture base material
used. Acrylic resin and cobalt-chromim are used in the
fabrication of partial dentures affecting the success
of prosthesis. Cobalt-chromium denture base seems

Pakistan Oral & Dental Journal Vol 36, No. 4 (October-December 2016) 666
 Abutment related complications

to be more hygienic, but the most important factor in
the success of prosthesis is the ability of the patient to
maintain the oral hygiene.8
Therefore, it could be suggested that a proper
treatment plan according to the principles along with
suitable designing of prosthesis can be advantageous
in preserving more natural teeth along with mainte-
nance of healthy gingival and other osseous structures.
It could also be beneficent in reducing the stresses
on tissues thus maintaining the long term health of
periodontal tissues.3,7 The purpose of this study was to
determine the frequency of prosthesis and abutment
related complications in patients wearing polymethyl-
methacrylate heat cure acrylic resin partial removable
dental prostheses along with duration of prosthesis.
The results of this study will provide locally relevant
data that will be helpful for planning the treatment
for dentist and their patients.
Complications related to prosthesis that includes
artificial teeth fracture, denture base fracture, clasp
fracture and deformation and discoloration of prosthesis
was visualized with the help of eye sight and wearing
of artificial teeth was checked by holding denture in
hand. Data were entered and analysed by SPSS version
17. Descriptive analysis was made, frequency and per-
centages were computed for the categorical variables.
RESULTS
A total of 110 patients were included in this study.
Kennedy classification was observed in patients. It was
found that majority of the patients were having type
III 62 (56.36%) Kennedy classification (Fig 1). Another
important variable that was observed in the study was
duration for which patients worn prosthesis. Details
are shown in the Fig 2 that 75 patients were found in
a group of one to 5 years.

METHODOLOGY It was observed that, 27% of patients were found

to have abutment loss due to wearing of prosthesis.
A descriptive cross sectional study was conduct- It also shows that frequency of pocketing in abut-
ed from July 2014 to June 2015, at dental OPD of ments was 71%. Frequency of calculus/plaque was
Prosthodontics; Liaquat University of Medical and about 90%. This study has shown that about 47% of
Health Sciences Jamshoro by using non-probability
convenience sampling technique. The ethical clear-
ance was sought from the ethical review committee
of university.
A total of 110 partially edentulous patients wearing
heat cure acrylic partial dentures for at least one year
were included in this study. Medically compromised,
mentally handicapped, patients with manual dexterity
problem and diagnosed neurological and rheumatoid
problems that make denture handling difficult were
excluded.
After ensuring the inclusion criteria the purpose of
study was declared to the patient. Written consent was
taken from all the participants and detailed history was
taken from every study participant. Intraoral exam-
ination and prosthesis examination was performed and Fig 1: Kennedy Classification
where-ever necessary radiographic examination was
undertaken. All the data was recorded in pre-structured
proforma that comprised of two parts. Part-I consisted
of demographic data that also includes Kennedy Clas-
sification and duration of prosthesis.
Part 2 consisted of complications related to abut-
ment that includes abutment loss which was checked
visually, pocketing which was checked with the help
of Community Periodontal Index of Treatment Needs
(CPITN) probe and 3mm depth was considered as
pocket, calculus and plaque were visualized by means
of eye sight, while the mobility of abutment was checked
by applying force bucco-lingually on abutment with
the help of handle of mirror and 1mm movement of
abutment in bucco-lingual direction was considered
as mobile, gingival recession of abutment tooth was
visualized and noted by comparing it with gingival level
of adjacent teeth, caries was checked with the help of
probe and mirror according to criteria of WHO. Fig 2: Duration of Removable Partial Dentures

Pakistan Oral & Dental Journal Vol 36, No. 4 (October-December 2016) 667
 Abutment related complications

TABLE 1: COMPLICATIONS IN RELATION TO ABUTMENTS OF PATIENTS WEARING RPDS IN

DIFFERENT AGE GROUPS

Complications Age Groups

15-20 Years 21-40 Years 41-60 Years Above 61 Years Total
Abutment loss: 0 (0%) 3 (2.7%) 25 (22.7%) 2 (1.8%) 30 (27.3%)
Caries: 0 (0%) 25 (22.7%) 44 (40.0%) 2 (1.8%) 71 (64.5%)
Calculus or plaque: 0 (0%) 45 (40.9%) 50 (45.5%) 4 (3.6%) 99 (90.0%)
Gingival recession: 0 (0%) 18 (16.4%) 42 (38.2%) 4 (3.6%) 64 (58.2%)
Pocketing: 0 (0%) 27 (24.5%) 47 (42.7%) 4 (3.6%) 78 (70.9%)
Mobility: 0 (0%) 09 (8.2%) 39 (35.5%) 4 (3.6%) 52 (47.3%)

TABLE 2: COMPLICATIONS IN PROSTHESES OF PATIENTS WEARING RPDS IN

DIFFERENT AGE GROUPS

Complications Age Groups

15-20 Years 21-40 Years 41-60 Years Above 61 Years Total
Artificial Teeth Fracture 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)
Denture Base Fracture 0 (0%) 2 (1.8%) 5 (4.5%) 0 (0%) 7 (6.4%)
Clasp Fracture or Deformation 0 (0%) 5 (4.5%) 2 (1.8%) 0 (0%) 7 (6.4%)
Discoloration 0 (0%) 14(12.7%) 36(32.7%) 4 (3.6%) 54(49.1%)
Wearing of Artificial Teeth 0 (0%) 0 (0%) 8 (7.3%) 2 (1.8%) 10 (9.1%)

patients were observed to have some sort of tooth
mobility problems, 58% of patients were observed
to have gingival recession relative to abutments. It
seems that 65% of the patients had developed caries
in their abutments due to wearing of prosthesis.
Details are given in Table 1.
It was seen that none of the patients developed
artificial teeth fracture as a complication of wearing
partial dentures. It was found that a very less number
of patients (07) developed denture base fracture. Out
of 110 patients 94% patients were free of any clasp
fracture or deformation at the time of examination.
Frequency of discoloration of prosthesis in patients
using RDPs was also witnessed in the present study.
It was observed that discoloration was frequent in 49%
of patients. About 9% of patients were having wearing
of artificial teeth. Details are given in Table 2.
DISCUSSION
This study has revealed the frequency of different
abutment and prosthesis related complications occur-
ring as a result of wearing RDPs. In this study it was
found that the frequency of calculus/plaque was very
high 90%. Other studies have also reported the higher
frequency of plaque/calculus.9-10 Dental Caries which is
also a well renounced complication in the literature, its
frequency in present study was 65%. Similarly another
study has found that more than 50% of the patients
suffering from dental caries as result of wearing RDPs.11
In current study main culprit for abutment caries was
the accumulation of plaque due to gingival coverage by
prosthesis and poor oral hygiene. Another study also
showed the development of caries predominantly in
the roots.12
Gingival recession was found in 58% of the study
group and these findings are similar to studies which
showed a positive relationship between wearing of RDP
and development of gingival recession.12-13 Poor oral
hygiene, poor retention and stability is contributing
to development of gingival recession.
In this study majority of patients (71%), had
pocketing in their abutments. Tuominen14 in his study
reported similar findings of periodontal pocketing in
majority of patients. Another study has also reported
the development of pocketing in patients wearing RDPs
but it says that it developed in those RDPs which were
reported as unsatisfactory again in terms of retention
and stability.12 Therefore a possible explanation for
development of pocketing may be poor retention and
stability.
Nearly half of the patients in present study were
found to have some degree of mobility. Literature also
agrees with these results.15 Possible reason for occur-
rence of mobility in present study may be the stress
applied by the clasps attached to the abutment teeth
or it may be the result of physiological aging process
and related changes in the periodontal tissue.
Abutment loss was seen in about 27% of patients.
Almost similar results were observed in a study by
Saito16 in which he found that 25% of patients suffered
from abutment loss for two years and 30% after four
years. In present study the major cause observed for

Pakistan Oral & Dental Journal Vol 36, No. 4 (October-December 2016) 668

loss of abutment teeth were periodontal problems and
uneven application of forces/stress by clasps of pros-
thesis.
Current study reported that denture base fracture
was only in 6%. These figures may increase with the
duration of wearing of prosthesis as one study has re-
ported that denture base fractures were found in 17%
of patients after a period of 5 years which increased to
45% after a period of 20 years.17
Majority of the patients (45%) in this study were
found with discoloration of prosthesis after their use.
Another study found discoloration on acrylic resins
due to drinks like tea, coffee and turmeric solutions.
Moreover, the discoloration increased as the duration
increased.18 Wearing off of artificial teeth was observed
in only 7% of the patients in present study. Study by
Whitman and co-workers19 has shown the wearing off
of acrylic dentures with the passage of time. Clasp
fractures were found among 6%. Other studies have
also reported that clasp fracture was observed in 19%
of the patients.20-21
CONCLUSION
Common complications seen were plaque/calculus,
pocketing, caries, gingival recession discoloration of
prosthesis, mobility of abutment and abutment loss.
On the other hand the least common complications seen
were denture base fracture, clasp fracture and wearing
of artificial teeth. Most of complications occurred in
prostheses were not older than 5 years.
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CONTRIBUTIONS BY AUTHORS
}
1 Muhammad Rizwan Memon:
2 Naseem Shaikh:
3 Kashif Ali Channar:
4 Muhammad Shahzad:
Pakistan Oral & Dental Journal Vol 36, No. 4 (October-December 2016)
Abutment related complications
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All the authors have contributed in de-
signing of the research protocol, data
collection and discussion writing of this
article collectively.
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