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Journal of Prosthodontic Research 54 (2010) 97–101

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Original article
Evaluation of factors affecting the continuing use and patient satisfaction
with removable partial dentures over 5 years
Shigeto Koyama DDS, PhDa,*, Keiichi Sasaki DDS, PhDb, Masanori Yokoyama DDS, PhDb,
Tomofumi Sasaki DDS, PhDb, Soshi Hanawa DDS, PhDb
a
Maxillofacial Prosthetics Clinic, Tohoku University Hospital, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
b
Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Japan
Received 14 July 2009; received in revised form 30 October 2009; accepted 24 November 2009
Available online 18 January 2010

Abstract
Purpose: The purpose of this retrospective study was to investigate factors that affected the continuing use of RPDs and the patients’ satisfaction 5
years after delivery.
Methods: Sixty-seven patients treated with 90 RPDs delivered at the Tohoku University Hospital (Sendai, Japan) between 1996 and 2001
participated in this study. The patients were re-examined 5 years after delivery. Data were collected from clinical records and a questionnaire was
used to evaluate the patients’ delivery use of the RPDs. The RPD treatment was divided into three categories labeled as ‘successful’, ‘remake’, and
‘failure’. Twelve factors that might affect the continuing use and 15 factors regarding satisfaction were evaluated. Stepwise logistic regression
analysis was used to assess statistical significance.
Results: Fifty-five RPDs were regarded as successful, 21 were remake, and 14 failure. Statistically significant associations were found between the
continuing use and the patient’s age (P = 0.002), location of the edentulous area (P = 0.047), number of occluding pairs of teeth (P = 0.038), number of
occlusal rests (P = 0.038), pain while using RPDs (P = 0.006), color of the artificial teeth (P = 0.021), and tooth shape and set-up (P = 0.022).
Conclusions: These findings suggest that the continuing use of RPDs is related to factors such as the patient’s age, location of edentulous area,
number of occluding pairs of teeth, and number of occlusal rests, satisfaction including pain while using RPDs, color of the artificial teeth, and
tooth shape and set-up.
# 2009 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.

Keywords: RPDs; Continuing use of RPDs; Patient satisfaction; Multivariate analyses

1. Introduction periodontitis, and alveolar bone resorption. There are some

Conventional clasp-retained removable partial denture
(RPD) serve as the first prosthodontic treatment option for
partially edentulous patients, because the RPD offer a
comparatively low cost and noninvasive alternative to an
attachment-retained RPD or a fixed partial denture (FPD) [1].
Patient satisfaction with RPDs has been associated with
aesthetics, patient personality, physical adaptability and social
adaptation [2–12].
Although treatment with RPDs is noninvasive with regard to
the structure of the remaining dentition, long-term use of RPDs
has been associated with the increased risk of caries,
* Corresponding author. Tel.: +81 22 717 8300; fax: +81 22 717 8371.
E-mail address: koyama@mail.tains.tohoku.ac.jp (S. Koyama).
reports indicating that RPDs can adversely affect the remaining
dentition and surrounding oral tissues [13–19]. Reasons for
patient dissatisfaction with RPDs delivery related to condition,
number, and alignment of the abutment teeth and the condition
of the mucosa and periodontal tissues [3,20].
There are a few alternatives to conventional RPDs such as
implant-supported restorations, maintaining a shortened dental
arch (SDA) [21–24] and conventional FPDs [24]. There are
several follow-up studies of short and long-term treatment
outcomes with RPDs [25–32] but the factors that affect
treatment outcome have not been properly identified. Clinical
and social factors also affect patients’ satisfaction with their
RPDs. Therefore, it is important to study how the use of RPD is
correlated with patient satisfaction. Relationship between
continuing use of RPDs and patients’ satisfaction can help
dentists in discussing a treatment plan and help the patient to

1883-1958/$ – see front matter # 2009 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.
doi:10.1016/j.jpor.2009.11.007
98 S. Koyama et al. / Journal of Prosthodontic Research 54 (2010) 97–101

Table 1 Table 2
Distribution of subject for analysis. Results of evaluation of analyzed variable regarding 12 factors that might affect
RPD continuing use with stepwise logistic regression analysis.
Men Women Total
Variables P Odds ratio 95% CI
Number of patients 18 49 67
Range of age (years) 46–81 45–84 45–84 Gender
Mean age (years)  SD 66.9  8.1 64.1  9.2 66.0  9.5 Men 0.350 0.504 0.120–2.121
Number of RPDs (maxilla/mandible) 13/9 32/36 45/45 Women 1 Referent
Age
65 0.002* 5.873 1.906–18.102
understand the risks of dissatisfaction. The aim of this <65 1 Referent
retrospective study was to investigate factors effecting Previous experience wearing RPDs
continuing use of RPDs and patient satisfaction 5 years after Yes 0.528 0.420 0.028–6.220
No 1 Referent
RPDs delivery using multivariate analyses.
Location of RPD
2. Methods of research Mandible 0.838 0.875 0.243–3.156
Maxilla 1 Referent

One hundred and sixty-one subjects treated with conven- Location of edentulous area
Kennedy I 0.053 9.972 0.0.975–101.986
tional clasp-retained RPDs were identified from files in the
Kennedy II 0.047* 11.283 1.029–123.674
Department of Prosthetic Dentistry at Tohoku University Kennedy III 0.871 0.775 0.035–17.028
Dental Hospital (Sendai, Japan). All RPD treatments had been Kennedy IV 1 Referent
performed by predoctoral students under the supervision of Number of occluding pairs of teeth
clinical instructors from 1996 through 2001. 5–14 0.038* 3.349 1.067–10.515
Each subject was contacted by telephone and asked to 0–4 1 Referent
participate in a follow-up examination. The 67 subjects who Number of missing teeth
agreed to participate in the study were then sent letters with 9–13 0.456 2.204 0.276–17.590
information about the study and a questionnaire with questions 1–8 1 Referent
about how the evaluated the RPDs and how satisfied they were. RPD on opposite jaw
All of the subjects were medically stable, and the subjects with Yes 0.954 1.037 0.301–3.568
masticatory dysfunction, dysphagia and any other major No 1 Referent
diseases that could adversely affect oral health were not Material of RPD substructure
involved in this study. Each subject was also scheduled for a Acrylic resin 0.304 0.396 0.068–2.314
follow-up clinical examination. The distribution of subjects’ Metal 1 Referent
age, gender, and number of RPDs is presented in Table 1. Number of abutment teeth
Eighteen men and 49 women (aged 45–84 years, mean: 3 0.729 1.310 0.284–6.040
66.0  9.5 years) treated with 90 conventional clasp-retained <3 1 Referent
RPDs (45 in the maxilla and 45 in the mandible) were included Type of clasp
in the study. All the design of the clasp retainer was Wire 0.783 1.359 0.154–12.029
Wire and cast 0.791 0.815 0.180–3.693
circumferential clasp (wire 22%, wire and cast 20%, and cast
Cast 1 Referent
58%). Before RPDs placement, oral hygiene had been applied
to patients completely. However, the subjects had not received Number of occlusal rests
<Number of clasps 0.038* 3.490 1.074–11.344
regular maintenance, including oral hygiene instructions, Number of clasps 1 Referent
scaling, and root planning after RPDs placement. There were *
P < 0.05.
no organized recall procedures for checking and patients. The
authors received approval from the Ethics Committee of
Tohoku University Graduate School to perform the study. Each original RPDs was replaced within 5 years); and ‘failure’ (not
subject received information about the study and signed a using the RPDs or only sporadic use during the first 5 years). To
consent form. simplify the analytical process, statistical analyses included
At 5 years after the subjects received their RPDs, they were two groups; those with successful treatment and those who had
re-examined by 6 well-trained examiners who worked as full- RPDs remade or did not use them. Date, time, and reason were
time prosthodontists, with more than 5-year clinical experience recorded for the failed RPDs. Date of repair or re-treatment of
and including 3 specialists, at Tohoku University Dental the RPDs was also recorded. Condition of the RPDs at the
Hospital. The examinations were performed from 2001 to 2006. follow-up clinical examination was compared with that of the
Data were collected from the patients’ charts and also from a time the RPDs was first inserted. At follow-up examinations,
questionnaire concerning their assessment and use of the RPDs. the subjects were required to fill out a questionnaire rating the
Available patient records were reviewed to evaluate the status level of their satisfaction with various aspects of RPD function
of the RPD according to the following criteria: ‘successful’ and structure. Each question had a response alternative ranking
(using the original RPDs daily for 5 years); ‘remake’ (the from 1 (poor) to 5 (excellent). Then the degree of satisfaction
 S. Koyama et al. / Journal of Prosthodontic Research 54 (2010) 97–101 99

Table 3 Table 4
Results of evaluation of analyzed variable for satisfaction in RPD function Results of evaluation of analyzed variable for satisfaction in RPD structure
group with stepwise logistic regression analysis. group with stepwise logistic regression analysis.
Variables P Odds ratio 95%CI Variables P Odds ratio 95%CI
Speech problem Color of artificial teeth
Lower 0.573 1.280 0.331–1.846 Lower 0.021* 2.921 1.175–7.256
Higher 1 Referent Higher 1 Referent
Facial support Shape of artificial teeth
Lower 0.466 1.404 0.299–1.735 Lower 0.376 1.558 0.240–1.723
Higher 1 Referent Higher 1 Referent
Stability of RPDs Size of RPD
Lower 0.235 1.635 0.726–3.682 Lower 0.769 3.344 0.366–3.896
Higher 1 Referent Higher 1 Referent
Fitness of RPDs Tooth shape and set-up
Lower 0.138 1.942 0.215–1.237 Lower 0.022* 4.975 1.255–19.608
Higher 1 Referent Higher 1 Referent
Ease of placement and removal Weight of RPD
Lower 0.329 1.572 0.257–1.577 Lower 0.702 1.239 0.412–3.726
Higher 1 Referent Higher 1 Referent
*
Pain while using RPDs P < 0.05.
Lower 0.006* 1.965 1.215–3.175
Higher 1 Referent
shape of artificial teeth, (iii) size of RPD, (iv) tooth shape and
Mastication ability at anterior teeth
set-up, and (v) weight of RPD. The data were analyzed with
Lower 0.352 1.477 0.297–1.540
Higher 1 Referent statistical software (SPSS 11.0; SPSS Inc., Chicago, IL).
Stepwise logistic regression analysis was used to detect
Mastication ability of posterior teeth
Lower 0.629 1.225 0.358–1.863
correlations between RPD continuing use (the criterion
Higher 1 Referent variable) and 12 factors that might affect continuing use and
15 factors regarding satisfaction (the explanatory variables). P-
Ease of mastication and swallowing
Lower 0.060 2.874 0.956–8.634 value <0.05 were deemed statistically significant.
Higher 1 Referent
Sense of taste
3. Results
Lower 0.355 1.549 0.612–3.921
Higher 1 Referent Fifty-five of the 90 RPDs were regarded as successful, 21
*
P < 0.05. were remake, and 14 were failure. Sixty-one percent of the
original RPDs were still being used after 5 years. There were
statistically significant correlations between the use of RPD and
was assembled into two categories, i.e. the lower group patient age (P = 0.002), location of the edentulous area
including 1 and 2, and the higher group including 3, 4, and 5. (P = 0.047), number of occluding pairs of teeth (P = 0.038),
The independent variables that might affect RPD continuing and the number of occlusal rests (P = 0.038) (Table 2).
use were as follows: (i) gender (men or women), (ii) age (<65 There were statistically significant correlations between
or 65 years), (iii) previous experience wearing RPDs (yes or RPD use and pain while using RPDs (P = 0.006), color of the
no), (iv) location of RPD (maxilla or mandible), (v) location of artificial teeth (P = 0.021), and tooth shape and set-up
edentulous area (Kennedy classification, I/II/III/IV), (vi) (P = 0.022). No statistically significant association between
number of occluding pairs of teeth (0–4 or 5–14), (vii) number RPD use and other factors of satisfaction was found (Tables 3
of missing teeth (1–8 or 9–13), (viii) RPD on opposite jaw (yes and 4).
or no), (ix) material of RPD substructure (metal or acrylic
resin), (x) number of abutment teeth (<3 or 3), (xi) type of 4. Discussion
clasp (cast, wire, or wire and cast), and (xii) number of occlusal
rests (less than the number of clasps or equal to or greater than The number of patients participating in this study was sixty-
the number of clasps). The variables related to RPD function for seven, and the recall rate was 41.6%. They are relative low
satisfaction were as follows: (i) speech problem, (ii) facial numbers compared with the corresponding numbers in other
support, (iii) stability of RPDs, (iv) fitness of RPDs, (v) ease of studies. Two studies [19,32] showed particularly high recall
placement and removal, (vi) pain while using RPDs, (vii) rates because they either were based on a short-period recall or
mastication ability at anterior teeth, (viii) mastication ability at used systematic recall procedures. We, however, had no
posterior teeth, (ix) ease of mastication and swallowing, and (x) organized recall procedures for checking and the patients we
sense of taste. The analyzed variables related to RPD structure evaluated were left to their own initiative with regard to follow-
for satisfaction were as follows: (i) color of artificial teeth, (ii) up about the treatment they received. All investigators in this
100 S. Koyama et al. / Journal of Prosthodontic Research 54 (2010) 97–101
field agree that the successful use of RPDs requires patient
education, good oral self-care, and a regular recall system
[13,19].
It has been suggested that oral status, patient status and RPD
design are factors that determine long-term outcome of
prosthetic treatment with RPDs, however, the relationships
between these factors and use of RPD are not well documented.
Stepwise logistic regression analysis, indicated, however, that
in this sample of patients, RPD usage was related to 7 factors in
this study.
The results from the present study showed that 61% of the
RPDs were still being worn 5 years after delivery, more
commonly among subjects less than 65 years of age (71%)
when compared with those 65 years or older (37%). It is
possible that the increasing rate of RPD usage until 65 years of
age is related to the factors associated with aesthetics, oral
function, and social activity. Possible explanations for the lower
usage rate in patients 65 years or older could include impaired
oral motor functions resulting in poor ability to adapt to
wearing RPD [33]. An increasing number of patients with
severe diseases [6], age-related compromised oral status due to
missing teeth, age-related changes in the masticatory system,
age-related changes in patient personality [7], and greater
expectations about RPDs [8] could also explain why older
individuals did not wear their RPDs. On the other hand,
Wakabayashi et al. [2] stated that younger patients with RPDs
were less satisfied with respect to aesthetics than older patients.
In that study, patients 65 years or older were generally more
satisfied with their prostheses. However, the difference between
older and younger patients was statistically significant only
with respect to aesthetic dissatisfaction [5]. This suggests that
older patients in Tohoku University Hospital may tend to pay
less attention to their appearance peculiarly. As a result, the
need for an RPD and the rate of RPD usage would decrease with
age and there would be a correlation between the age of patients
and their regard for aesthetics. Frank et al. [25] found that the
patients most dissatisfied with their RPDs were those who had
been wearing RPDs in opposing jaw, patients younger than 60
years of age, and patients in poor health. Weinstein et al. [20]
found satisfaction to be related to prior experience with RPDs
rather than to the age of patients. Although patient satisfaction
can be influenced by previous experience of wearing RPDs
[6,20,25], in this study there was no correlation between
satisfaction and previous experience. This is probably due to a
high percentage of subjects who had previously been wearing
an RPD which could also explain why so many younger
subjects wore their RPDs.
The usage rate of extension base RPDs was lower than that
of bounded saddle RPDs. Fisher [8] mentioned that most of the
failures encountered were related to jaws that comprise
terminal edentulous areas (classes I and II). Mandibular class
I RPDs often cause problems of discomfort and pain, especially
RPDs designed with bilateral distal extensions [1,13]. This can
be explained by the ongoing bone resorption in the edentulous
areas of the jaw being greater in younger patients and tends to
slow down in older patients [8]. It has been suggested that the
pressure of extended denture base could result in increased
bone resorption [34]. This resorption may lead to the pain
caused by use of RPD in older patients. In fact, pain was the
most common reasons for RPD replacement and failure to wear
RPDs in this study and was found to be associated with
dissatisfaction among RPD wearers (Table 3). These failures
and problems suggest that the long-term outcome of prosthetic
treatment with RPDs is related to morphological and oral
conditions and RPD design. The use of RPDs is determined by
the location of the missing dentition in relation to the retention,
support and stability of the prostheses. According to Jepson
et al. [9], the presence of anterior replacement teeth was
associated with significant increase in RPD acceptance. This
suggests that aesthetics in Kennedy Class IV dentition is
strongly related RPD usage. Subjects with few number of
occluding pairs of teeth wore their denture more often than
those with higher number (Table 2), which is in agreement with
findings in a study by Meeuwissen et al. [10]. The use of RPDs
is, therefore, expected to be high when the number of occluding
pairs of teeth is low and the RPD would have an impact on the
subject’s ability to chew. There is evidence that at least four
occlusal units will provide adequate oral function in SDA
[21,22]. This suggests a point of reference for dentists when
considering the need of distal extension RPDs [21]. Witter et al.
[23] proposed that reduced dentitions without replacement of
the missing teeth by an RPD, however, only cause problems
when the number of occluding teeth is too small. However, in
the present study statistical significant association between
number of missing teeth and use of RPD was not found. The
results indicate that in this study there is no correlation between
use of RPD with respect to number of missing teeth, but there is
correlation between use of RPD with respect to number of
occluding pair of teeth.
Surveys have indicated that a large percentage of RPDs are
fabricated without adequate rest seat preparation [35]. The
RPDs that are well supported with proper rest design and rest
seat preparation contribute to the sound reaction of the dento-
alveolar and muco-osseous supporting structures. In the present
study, use of RPDs was significantly associated with the
number of rests, suggesting that an appropriate number of rests
is an important factor in RPDs design (Table 2). Patient’s
satisfaction with RPDs is an important factor in prosthodontic
treatment [11,12,36]. Patients who continuously wear their
RPDs for years reported general satisfaction with improved
chewing ability, good fit, comfort, and appearance [1,13,14].
Patient’s satisfaction with RPDs also depends on the quality
of the denture and how well it functions. RPD design and type/
quality of the material are also factor which will have an impact
on patient’s oral comfort and function. Therefore, factors in the
two different groups (i.e., the structure group and the function
group) were involved with satisfaction, was analyzed. The
results related to both groups. That is, statistical analysis
identified three parameters related to satisfaction with use of
RPD: pain from the denture function group and the color and
tooth shape and set-up from the denture structure group. In
general, pain level when using RPDs affects the grades for
comfort while color and arrangement of the article teeth are
related appearance.
 S. Koyama et al. / Journal of Prosthodontic Research 54 (2010) 97–101
Although evidence-based indications and contraindications
for prescribing RPDs are still lacking, major principles
underlying clinical decision-making have been identified [1].
Graham et al. [37] stated that need for an RPD was evaluated
differently by the dentist and patients. The dentists focused on
physical function of the teeth whereas the patients focused on
the social aspects. It is important for both dentists and patients
to know why people stop wearing their RPDs, which are
intended for long-term treatment. Long-term follow-ups of
RPD would allow researchers to study use and patient
satisfaction with RPDs and multivariate analyses are useful
when controlling for the influence of confounding variables that
would confuse the prediction of the outcome of RPD treatment.
5. Conclusions
The following conclusions were drawn from the present
study:
1. Sixty-one percent of the RPDs were still in use after 5 years.
2. Statistically significant correlations were found between use
of RPD and patient age, location of edentulous area, number
of occluding pairs of teeth, and number of occlusal rests.
3. Statistically significant correlations were also found between
patient satisfaction with RPD and pain while using RPDs,
color of the artificial teeth, and tooth shape and set-up.
References
[1] Wöstmann B, Budtz-Jørgensen E, Jepson N, Mushimoto E, Palmqvist S,
Sofou A, et al. Indications for removable partial dentures: a literature
review. Int J Prosthodont 2005;18:139–45.
[2] Wakabayashi N, Yatabe M, Ai M, Sato M, Nakamura K. The influence of
some demographic and clinical variables on psychosomatic traits of
patients requesting replacement removable partial dentures. J Oral Rehabil
1998;25:507–12.
[3] Elias AC, Sheihan A. The relationship between satisfaction with mouth
and number and position of teeth. J Oral Rehabil 1998;25:649–61.
[4] Maupone G, MacEntee MI. Prosthodontic profiles relating to economic
status, social network, and social support in an elderly population living
independently in Canada. J Prosthet Dent 1998;80:598–604.
[5] Ozdemir AK, Ozdemir HD, Polat NT, Turgut M, Sezer H. The effect of
personality type on denture satisfaction. Int J Prosthodont 2006;19:364–70.
[6] Frank RP, Milgrom P, Leroux BG, Hawkins NR. Treatment outcomes with
mandibular removable partial dentures: a population-based study of
patient satisfaction. J Prosthet Dent 1998;80:36–45.
[7] Watson CL, Reeve PE, Barnes E, Lane AE, Bates JF. The role of
personality in the management of partial dentures. J Oral Rehabil
1986;13:83–91.
[8] Fisher RL. Factors that influence the base stability of mandibular distal-
extension removable partial dentures: a longitudinal study. J Prosthet Dent
1983;50:167–71.
[9] Jepson NJA, Thomasson JM, Steele JG. The influence of denture design on
patient acceptance of partial denture. Br Dent J 1995;178:296–300.
[10] Meeuwissen JH, van Waas MA, Meeuwissen R, Kayser AF, van’t Hof
MA, Kalk W. Satisfaction with reduced dentitions in elderly people. J Oral
Rehabil 1995;22:396–401.
[11] Klages U, Esch M, Wehrbein H. Oral health impact in wearing removable
prostheses: relations to somatization, pain sensitivity, and body conscious-
ness. Int J Prosthodont 2005;18:106–11.
101
[12] Knezovic ZD, Celebic A, Valentic-Peruzovic M, Jerolimov V. A survey of
treatment outcomes with removable partial dentures. J Oral Rehabil
2003;30:847–54.
[13] Chandler JA, Brudvik JS. Clinical evaluation of patients eight to nine years
after placement of removable partial dentures. J Prosthet Dent 1984;51:736–
7.
[14] Zlataric DK, Celebic A, Valentic-Peruzovic M. The effect of removable
partial dentures on periodontal health of abutment and non-abutment
teeth. J Periodontaol 2002;73:137–44.
[15] Tuominen R, Ranta K, Paunio I. Wearing of removable partial dentures in
relation to dental caries. J Oral Rehabil 1988;15:515–20.
[16] Wright PS, Hellyer PH, Beighton D, Heath R, Lynch E. Relationship of
removable partial denture use to root caries in older population. Int J
Prosthodont 1992;5:39–46.
[17] Locker D, Ford J, Leake JL. Incidence of and risk factors for tooth loss in a
population of older Canadians. J Dent Res 1996;75:783–9.
[18] Aquilino SA, Shugars DA, Bader JD, White BA. Ten-year survival rates of
teeth adjacent to treated and untreated posterior bounded edentulous
spaces. J Prosthet Dent 2001;85:455–60.
[19] Bergman B, Hugoson A, Olsson C-O. Caries, periodontal and prosthetic
findings in patients with removable partial dentures: a ten-year longitudi-
nal study. J Prosthet Dent 1982;48:506–14.
[20] Weinstein M, Schuchman J, Lieberman J, Rosen P. Age and denture
experience as determinants in patient denture satisfaction. J Prosthet
1988;59:327–9.
[21] Käyser AF. Shortened dental arches and oral function. J Oral Rehabil
1981;8:457–62.
[22] Witter DJ, De Haan AFJ, Kayser AF. Shortened dental arches and
periodontal support. J Oral Rehabil 1991;18:203–12.
[23] Witter DJ, Allen PF, Wilson NHF. Dentists’ attitudes to the shortened
dental arch concept. J Oral Rehabil 1997;24:143–7.
[24] Thomason JM, Moynihan PJ, Steen N, Jepson NJA. Time to survival for the
restoration of the shortened lower dental arch. J Dent Res 2007;86:646–50.
[25] Frank RP, Brudvik JS, Leroux B, Milgrom P, Hawkins N. Relationship
between the standards of removable partial denture construction, clinical
acceptability, and patient satisfaction. J Prosthet Dent 2000;83:521–7.
[26] Wagner B, Kern M. Clinical evaluation of removable partial dentures 10
years after insertion: success rates, hygienic problems, and technical
failures. Clin Oral Investig 2000;4:74–80.
[27] Yeung ALP, Lo ECM, Clark RKF, Chow TW. Usage and status of cobalt-
chromium removal partial dentures 5–6 years after placement. J Oral
Rehabil 2002;29:127–32.
[28] Vermeulen AH, Keltjens HM, van’t Hof MA, Kayser AF. Ten-year
evaluation of removable partial denture: survival rates based on retreat-
ment, not wearing and replacement. J Prosthet Dent 1996;76:267–72.
[29] Vanzeveren C, D’Hoore W, Bercy P, Leloup G. Treatment with removable
partial dentures: a longitudinal study Part I. J Oral Rehabil 2003;30:447–8.
[30] Drake CW, Beck JD. The oral status of elderly removable partial denture
wears. J Oral Rehabil 1993;20:53–60.
[31] Cowan RD, Gilbert JA, Elledge DA, McGlynn FD. Patient use of
removable partial dentures: two- and four-year telephone interviews. J
Prosthet Dent 1991;65:668–70.
[32] Derry A, Bertram U. A clinical survey of removable partial dentures after
two years usage. Acta Odontol Scand 1970;28:581–98.
[33] Newton JP, Yemm R, Able RW, Menhinick S. Changes in human jaw
muscles with age and dental stage. Gerodontology 1993;10:16–22.
[34] Imai Y, Sato T, Mori S, Okamoto M. A histomorphometric analysis on
bone dynamics in denture supporting tissue under continuous pressure. J
Oral Rehabil 2002;29:72–9.
[35] Sato Y, Shindoi N, Koretake, Hosokawa R. The effect of occlusal rest size
and shape on yield strength. J Prosthet Dent 2000;389:503–7.
[36] Koyama S, Sasaki K, Kawata T, Atsumi T, Watanabe M. Multivariate
analysis of patient satisfaction factors affect the usage of removable partial
dentures usage. Int J Prosthodont 2008;21:499–500.
[37] Graham R, Mihaylov S, Jepson N, Bond S. Determining ‘‘need’’ for a
removable partial denture: a qualitative study of factors that influence
dentist provision and patient use. Br Dent J 2006;200:155–8.