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6 Patient assessment for partial dentures

An assessment for a partial prosthesis begins in much the same way as for a complete denture – why does the patient want the treatment, and what are the risk factors that can alter your chances of success? The main obvious difference, however, is the presence of standing natural teeth. The health and prognosis for these teeth must be adequately assessed in order to plan the treatment effectively for removable partial prostheses – and whilst the method of partial denture design will be covered later, the necessary clinical information and indices will be mentioned here as part of the initial assessment stage.

The patient and the rationale for treatment

 Why does the patient want new or improved dentures?

 Do the current dentures cause pain?

 Is there any difficulty chewing or speaking?

 Are the dentures of a satisfactory appearance?

Prosthodontic history

 What type of denture is the patient currently wearing?

 How old is the prosthesis and where was it/they made?

 For how many years has the patient been wearing partial dentures?

 How many prostheses has the patient received before?

 Is the patient willing to attend for the necessary appointments, including review appointments?

Clinical examination

Before considering removable partial prostheses, it is important to carry out a full and comprehensive extra- and intraoral assessment. The following aspects can then be considered.

 Intraoral access – Can the denture-bearing anatomy be palpated easily, and can any existing prostheses be easily inserted and removed from the mouth?

 Plaque control – Wearing removable partial dentures in the presence of poor plaque control poses a significant risk to the dentition, for the progression of root caries and soft tissue disease. If the basic periodontal examination (BPE) codes are anything but 0, you should be carrying out at least a plaque score and providing tailored oral hygiene instruction.

 Tooth mobility and periodontal pocket depths – Whether teeth are pathologically mobile or present with deep bleeding pockets is often overlooked during a partial denture assessment. It is often assumed that the expected future loss of teeth warrants an acrylic partial denture – in reality, it is important to determine which teeth might be capable of helping to support a removable partial denture down their long axis, and use them accordingly. Teeth may also present with mobility because of occlusal trauma, especially if there is a lack of posterior support. This is unlikely to improve without the provision of a removable prosthesis to replace posterior units.

 Gag reflex – Can the denture-bearing area and connector sites be palpated without eliciting a gag reflex? If not, where are the trigger zones? These are most often the dorsum of the tongue, or the posterior palate.

 Ulceration – Are there any existing signs of ulceration, and do they correspond to the extensions of a prosthesis?

 Temporomandibular disorder – Are there currently any signs of muscle pain or temporomandibular joint derangement?

 Dry mouth – Does the patient complain of a dry mouth? Is this medication-induced? A dry mouth will significantly increase the risk of root caries and gingivitis when wearing a partial denture.

 Retained roots – Could these be retained as overdenture abutments and what is the space between root surface and opposing tooth? Do not forget that healthy retained roots will prevent alveolar resorption, improve proprioception and chewing ability. Further, there is a large psychological benefit to retaining natural teeth and tooth roots.

 Worn or compromised teeth – Could worn teeth be restored directly or indirectly prior to the provision of removable prostheses? Could the removable prosthesis overlay the worn teeth to restore their form and function? Can an extra coronal restoration be placed with elements that will facilitate partial denture stability and retention, such as milled shoulders, rest seats and guide planes. These are questions that are often overlooked when planning removable partial prostheses and will be discussed further later in the book.

Ridge assessment

Ridge form may be less critical with removable partial dentures, particularly if there are bounded saddles – but atrophic ridges and thin fibrous bands of tissues should still be noted, because these can cause problems, especially with free-end saddle presentations.

Partial denture classification

In relation to ridge and saddle configuration, it is important to be able to communicate the type of partial denture effectively to colleagues and the wider dental team. Chapter 28 describes the Kennedy partial denture classification system, which is probably the most ubiquitous. It is also very important to decide whether you will maintain the natural tooth contacts in the current intercuspal position, or whether you will be changing (or reorganising) the occlusion. It will not be possible to plan or design a partial denture effectively without deciding this first. This is covered further in Chapter 23.

Assessment of existing prostheses

Partial dentures should be assessed in the same way as for complete dentures in relation to retention and stability. It is, however, also important to appraise the connector design, and the path of insertion, even if the dentures are made totally in acrylic. Material choice and connectors are discussed later in Chapters 28 and 31.

Radiographic assessment

As well as a thorough periodontal and restorative assessment, it is important to assess potential abutment teeth radiographically for any potential periapical pathology and to assess the bony support available. It is also important to assess the angulation of the long axis of the tooth. Non-axially loading a tooth can exacerbate occlusal trauma and bony loss.