What Occlusal Scheme Should Be Used with Removable Partial Dentures?

ABSTRACT

PURPOSE: Multiple clinical studies have been published comparing different philosophies of complete denture occlusion and different types of denture teeth. However, it is unclear whether comparable data are available for occlusal schemes used with removable partial dentures (RPDs). Therefore, this review investigated the dental literature related to occlusal schemes for RPDs. MATERIALS AND METHODS: A PubMed search of English language articles was performed using the term "removable partial denture, occlusion" with 765 results. When the term "occlusion in removable partial prosthodontics" was used there were 784 results. Seventy-four articles were identified using the different search term of "RPD, occlusion" while use of the term "occlusal scheme, with removable partial dentures" listed 18 publications. The term "removable partial denture, occlusion, literature reviews" produced 38 potential publications related to the topic. Using the term "removable partial denture occlusion systematic review" resulted in 2 citations. Using the term "RPD occlusion literature review" resulted in one foreign language manuscript whereas using the term "RPD occlusion systematic review" resulted in one article unrelated to dentistry. The term "clinical studies of RPD occlusion" produced 5 results with none related to the topic. There were 23 results using the term "clinical studies of removable partial denture occlusion" with one potentially related to RPD occlusal schemes. RESULTS: A review of the titles and abstracts revealed 12 articles that appeared to contain specific information about the occlusal scheme used with RPDs. Following a detailed review of those publications, only 4 contained recommendations for RPD occlusion and were included in this review. The available information regarding the recommendations for occlusal schemes in these articles was based on expert opinion. A decision was made to include a hand search of 9 textbooks containing varying amounts of information related to occlusal schemes for RPDs, but no evidence-based references related to RPD occlusal schemes were found in the textbooks. Since this entire review is based on expert opinion, no attempt was made to critique the opinions expressed by these authors but rather to present their perspectives for evaluation by readers. CONCLUSIONS: The occlusion developed with RPDs should be physiologically harmonious, allowing the supporting structures to remain in a good state of health with functional stress distributed among all the occluding teeth. Multiple authors indicate the occlusion in maximum intercuspation/centric occlusion should incorporate bilateral posterior contacts with no deflective occlusal contacts. When most occlusal contacts on natural teeth are missing, it has been proposed that extension base RPDs have their occlusal contacts developed in centric occlusion. Regarding eccentric occlusal relationships, a balanced occlusal scheme has been recommended by multiple authors with one author advocating use of a lingualized balanced. An anterior guided (canine-protected) occlusion has also been recommended when the canines are present and not periodontally compromised. When RPDs oppose a complete denture, several authors indicate a bilateral balanced occlusion should be used to help stabilize the complete denture.