Flexible Partial Dentures

An Overview And Analysis Of Indications For RPD Therapy

How Many RPDs Do You Need To Graduate From
ULSD?

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How Many RPD Patients Does It Take To Graduate
From ULSD?

?
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Indications for Partial Denture Therapy

Partial Edentulism
So that means an overwhelming population of patients are
candidates for RPDs.
The challenge with any RPD is proper diagnosis, treatment
planning, design and recall.
Managing patient expectations can be dificult when assessing
the possibilities for achieving satisfactory esthetic and
functional outcomes.

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So Why Dont More People Get Partials?

In Dentistry theres only one four-letter word you need to know:

CA$H! - A dentist I met at RAM who shall go unnamed

Patient concerns about money and esthetics together go a long

way to impede patients from getting RPDs.

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But Cant RPDs be Esthetic?

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What does this guys Facebook look like?

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A Smile For All Occasions

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And For All Seasons

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At School

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At Disneyland

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At Social Functions

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At The Game

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At Work

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At The Movies

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He Just Cant Stop Smiling

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Who Wants to Have This in Their Mouth?

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What If We Could Replace Multiple Teeth Without
Ugly Metal Clasps?

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What Could Possibly Go Wrong?
https://www.youtube.com/watch?v=ZEXTlHScPYA (Most likely iFlex material)

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Video of unbreakable denture

(On Flash Drive)

A patient in a local dental ofice broke a flex partial in half (it was
a sample for patient education purposes, not an actual patients
personal prosthesis). This gives me room for reasonable doubt
regarding the unbreakable claim.

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What Exactly IS a Flexible Partial Denture?

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Additional Alternative Denture Materials

Titanium frames for those with allergy to other metals

Acetal resins strong clasps but more flexibility than cast metal
iFlex called unbreakable which most likely refers to fracture.
Also stain free, light weight, flexible, highly translucency,
repairable and rebasable.
Karadent nylon acrylic hybrid, good for transitional appliances

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So Whos in Charge?

In 1956, the US company Valplast developed super-polyamide, a type of nylon, as

a material for use in dentures. Dentures for which all the structural elements
other than the artificial teeth are manufactured from this thermoplastic resin
without the use of metal have been mostly known by the company name,
Valplast, but are also called flexible dentures or nylon dentures, and have
become widely used worldwide (Fig. 1) [5,6]. In Japan, these dentures were
individually imported and used on a trial basis before they were approved by the
Ministry of Health, Labour and Welfare, and it became common to call them by
names such as non-clasp dentures or metal-free dentures. Since their
approval under the pharmaceutical afairs law in April 2008, numerous
thermoplastic resins have been developed, and these have mistakenly been
known by the names of their manufacturer, supplier, or laboratories; however, in
general, the name non-clasp dentures has taken root among general clinicians.

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Flexible Partial Denture Advantages

Great for patients with allergy to metal or acrylic base

Highly esthetic
Increased patient satisfaction
Potentially easier to design/fabricate without any occlusal rests
May be a good indication for periodontally involved teeth

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Disadvantages

Documented issues with wear/longevity

Documented incidence of sof tissue/tooth/periodontal damage
No proven track record
Lack of reliable clinical guidelines for new (relatively) materials
and designs
More expensive
Harder to repair

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What Does The Literature Say?

Chromium cobalt metal framework partial dentures are really

strong. And they can last a long time.

Flexible partials are highly esthetic but wear out much faster than
metal framework partial dentures do. Moreover, they are very
dificult to repair, usually requiring replacement.

The literature supports what you would you would expect

regarding patient satisfaction: flexible partials are more satisfying
to patients than metal framework partials.

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What about Hybrid materials?

A case report from Japan details the treatment of a patient with

a nylon/metal hybrid denture that used a metal clasp in the
posterior, metal framework, and nylon clasps in the anterior.
Metal rests were employed on the abutment teeth without
compromising the function or esthetics. One of the nylon clasps
lacked reciprocation but afer two years of function there was no
mobility to that abutment tooth and no clinical signs of gingival
inflammation.

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Hybrid Nylon Metal Denture from Japan

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Nylon vs. Acrylic

While the nylon material may pose less of an allergy problem,

the nylon is sensitive to brush abrasion and is relatively dificult
to polish. The roughness may promote bacterial or fungal
retention and growth. Moreover, the nylon doesnt have a good
reline potential like acrylic does. The material does discolor over
time and in some reported cases, gingival inflammation has
developed in certain documented cases with the use of the nylon
material.

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Partials are a Problem, Period

Only 40% of RPD patients are wearing their prosthesis afer 5 years.
Why?
An improperly designed denture can result in periodontal instability of
abutment teeth, damage to hard and sof tissues or damage to the
prosthesis.
Even a properly designed RPD could have abutment teeth that became
periodontally involved for non-prosthetic reasons or could have
changes to the tissue or underlying bone.
It is abundantly clear that no matter what kind of partial you are
making, treatment planning, proper design/fabrication and recall are
paramount to successful clinical outcomes.

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So If Flexible Partials are weak, why not just make
a flipper?

Clinical judgment is key. The right indication on the right patient

may result in a prosthesis with good longevity.
The literature suggests that only one third of RPDs were
considered satisfactory according to NHANES III criteria.
The literature is ambiguous with regards to the need for partial
denture therapy since some articles state that partial edentulism
is increasing; others find the opposite to be true. Regardless of
the any change in the trend, the need in the state of Kentucky is
well-established and, unfortunately, unlikely to change in the
near future.

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So What Does This All Mean?

Recommendations:
For the best longevity of the prosthesis, you save money by getting well-designed, high quality
metal framework partial dentures. Flexible partials are more expensive and wear out faster.
Theyre hard to fix, too.
If you are interested in the ultimate party teeth then a flexible partial is a fantastic option.
Alternative hybrid materials are on the market and worth consideration as well.
Experience and judgment are critical to a good outcome with any partial and especially with a
flexible partial.
Flexible partials are not recommended as a permanent prosthesis at this time.
Hybrids have a better clinical prognosis than flexible partials.
Flexible partials stain with relative ease and require meticulous cleaning that is technique
sensitive to prevent increased roughness of the surface.
More research is needed and innovation required in order to create better clinical outcomes for
RPD therapy.

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But metal frame RPDs are DINOSAURS...

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If Thats True Then Flexible Partials are Like
Furbies

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References

J Tenn Dent Assoc. 2015 Spring-Summer;95(1):35-7; quiz 38-9.

Combination PROP: A Case Report of a Hybrid Flexible and Traditional Partial Removable Dental Prosthesis.

J Prosthet Dent. 2013 Jan;109(1):5-8. doi: 10.1016/S0022-3913(13)60002-5.

The combination of a nylon and traditional partial removable dental prosthesis for improved esthetics: a clinical report.

Med J Armed Forces India. 2015 Dec;71(Suppl 2):S306-12. doi: 10.1016/j.mjafi.2012.08.020. Epub 2012 Dec 29.
Comparative clinical evaluation of removable partial dentures made of two diferent materials in Kennedy Applegate class II partially edentulous situation.

Gen Dent. 2014 Mar-Apr;62(2):32-6.

Flexible removable partial dentures: a basic overview.

J Prosthodont Res. 2014 Jan;58(1):3-10. doi: 10.1016/j.jpor.2013.12.002. Epub 2014 Jan 22.
Clinical application of removable partial dentures using thermoplastic resin-part I: definition and indication of non-metal clasp dentures.

J Clin Diagn Res. 2013 Oct;7(10):2372-3. doi: 10.7860/JCDR/2013/5020.3527. Epub 2013 Oct 5.
Flexible thermoplastic denture base materials for aesthetical removable partial denture framework.

Niger Postgrad Med J. 2017 Jul-Sep;24(3):143-149. doi: 10.4103/npmj.npmj_54_17.

Comparison of patient satisfaction with acrylic and flexible partial dentures.

J Prosthet Dent. 2002 Jul;88(1):37-43.

Quality of removable partial dentures worn by the adult U.S. population.

J Prosthet Dent. 2017 Sep;118(3):273-280. doi: 10.1016/j.prosdent.2017.01.008. Epub 2017 Mar 23.
Removable partial dentures: The clinical need for innovation.

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References, cont.

Thermoplastic Resins for Flexible Framework Removable Partial Dentures

Meda Negrutiu1, Cosmin Sinescu1, Mihai Romanu1, Daniela Pop1, Sorin Lakatos1
Department of ProsthesesTechnology and Dental Materials, Faculty of Dental Medicine, Victor Babes University of
Medicine and Pharmacy Timisoara

Titanium framework removable partial denture used for patient allergic to other metals: A clinical report and
literature review
DDS, Odont Dr Mauno Knnen (Acting Professor)a,'Correspondence information about the author DDS, Odont Dr
Mauno Knnen, DDS Juha Rintanen (Dentist)a, DDS Antii Waltimo (Assistant Professor)a, DDS, PhD Pentti
Kempainena
Institute of Dentistry, University of Helsinki, Helsinki, Finland
aDepartment of Prosthetic Dentistry.

Contemp Clin Dent. 2011 Oct-Dec; 2(4): 313317.

Flexible denture base material: A viable alternative to conventional acrylic denture base material
J. P. Singh, R. K. Dhiman, R. P. S. Bedi, and S. H. Girish

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