Melbourne Dental School - Theses
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ItemManagement of the mandibular Kennedy Class I situation using a removable partial denture supported by short implants and retained with a resilient attachment system: A within-subject crossover clinical trial( 2020)The mandibular Kennedy Class I (KCI) situation is regarded as one of the more challenging clinical situations to successfully manage with a conventional removable partial denture (CRPD). Acceptance of this treatment option is generally poor. Stabilising the distal extension bases of such dental prostheses through association with strategically placed dental implants has been described; however, the evidence-levels supporting this treatment concept are low. Clinical trials employing multiple objective and subjective measures comparing implant-retained removable partial dentures (IRRPD) with CRPDs, and even with the baseline situation (shortened dental arch (SDA)), are rare. The objective of this research project was to use multiple objective and subjective measures to compare these three situations and to determine if a) a removable dental prosthesis (CRPD and/or IRRPD) can significantly improve function, Oral Health Related Quality of Life (OHRQoL), and patient satisfaction relative to the SDA situation, and b) if implant association significantly improves the function, OHRQoL, and patient satisfaction over the CRPD. This clinical trial was conducted as a within-subject crossover trial, whereby each subject experienced both a CRPD and an IRRPD to manage a mandibular KCI situation comprising of less than twenty teeth. Seventeen subjects completed the clinical trial. Subjects were randomly allocated into one of two groups; group A – CRPD first, and group B – IRRPD first. At the completion of the first phase of the trial, the dental prosthesis being worn was converted to the other design. Both objective and subjective measurements were recorded at baseline, the time of each dental prosthesis insert, and after a minimum adaptation time of three months. Based on the objective tests, the presence of a lower dental prosthesis shows a tendency to improve the SDA situation, however this improvement is not significant when using a chewing test and when assessing maximum bite pressure. The CRPD demonstrated no significant improvement in OHRQoL and satisfaction relative to the SDA situation, whilst the IRRPD demonstrated significant improvements in physical pain and physical disability domains. When comparing the CRPD and IRRPD head-to-head, it is obvious that the IRRPD is significantly superior in terms of OHRQoL and patient satisfaction, however similar in terms of objective measures. As a result of this research, a decision-making treatment-planning rubric has been proposed to help assist patients, clinicians, and funding bodies (i.e., governments, insurance industry, etc.) in providing appropriate treatment in a cost-effective manner.