CLINICAL RESEARCH

e-ISSN 1643-3750
© Med Sci Monit, 2023; 29: e940322
DOI: 10.12659/MSM.940322

Received:
Accepted:
2023.03.11
2023.03.31 Assessment of Periodontal Health Among
Available online:
Published:
2023.04.13
2023.05.04 Removable and Fixed Partial Denture Wearers in
Aseer Region of Saudi Arabia

Authors’ Contribution: ABD 1 Asim Alsir Elmahdi 1 Department of Prosthodontics, College of Dentistry, King Khalid University, Abha,
Study Design A ACEF 2 Mohamed Fadul A. Elagib Saudi Arabia
Data Collection B 2 Department of Periodontics and Community Dental Sciences, College of Dentistry,
Statistical Analysis C BCD 3 Ahmed Babiker Mohamed Ali King Khalid University, Abha, Saudi Arabia
Data Interpretation D CDF 1 Hoda Lotfy Abouzeid 3 Department Restorative Dental Sciences, College of Dentistry, King Khalid
Manuscript Preparation E CDE 4 Abosofyan Salih Atta University, Abha, Saudi Arabia
Literature Search F 4 Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid
Funds Collection G ADFG 2 Shahabe Saquib Abullais University, Abha, Saudi Arabia
CEF 5 Prasad Vijayrao Dhadse 5 Department of Periodontics, Datta Meghe Institute of Higher Education and
Research, Deemed to be University, Wardha, India

Corresponding Author: Mohamed Fadul A. Elagib, e-mail: [email protected]

Financial support: This study was supported by the Deanship of Scientific Research at King Khalid University through the Large Groups Project (grant
no. RGP-2/255/44
Conflict of interest: None declared

Background: Prosthetic rehabilitation will have harmful effects on periodontal structure if the patient fails to maintain an
oral hygiene protocol. This study aimed to evaluate oral hygiene in fixed and removable partial denture wear-
ers in the Aseer Province of Saudi Arabia.
Material/Methods: This was a cross-sectional study done on 286 prosthesis wearers aged between 25 and 55 years; 142 were
men and 144 women. Clinical examination was done using 3 periodontal parameters: plaque index, gingival
index, and calculus surface index.
Results: It was found that 72% and 25% of patients used fixed and removable partial prostheses, respectively. Most
patients were in the 45-55 year age group (38.1%), were medically fit (78%), and used toothbrush and paste
(70.6%). Most patients were instructed regarding the use of oral hygiene measures for their prostheses (71.3%).
However, around half of the study group (52.8%) had odor from their prostheses. Most fixed prostheses were
in the posterior teeth (73.2%) and had 3 units or more (58.7%). Removable partial dentures were mostly tooth-
tissue supported (74%). A statistically significant difference was found for plaque index and gingival index be-
tween natural teeth and abutments in terms of various prosthetic parameters (P£0.001). The higher preva-
lence of gingival inflammation, plaque, and calculus accumulation in this study may be correlated to improper
oral hygiene methods used by patients.
Conclusions: It can be concluded that there is a need to reinforce meticulous oral hygiene practices among patients using
prosthodontic appliances.

Keywords: Periodontal Diseases • Saudi Arabia • Dental Prosthesis • Dental Prosthesis Design

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Background the same conclusion regarding periodontal status and associ-

ation with age of the patient, duration of prosthesis, and po-
Prosthodontics is a branch of dental surgery that deals with the sition of the finish margin. Periodontal status is linked to the
replacement of damaged and missing teeth. The word prosth- presence or absence of an oral hygiene practice and pathogenic
odontics originates from 2 separate words “prostho,” which bacteria and increased specific inflammatory mediators, such
means to replace, and “dontist,” which means someone who as interleukins, prostaglandins, and C-reactive protein (CRP) [9].
deals with teeth. Prosthetic replacement of the missing teeth It has also been found that these cytokines cause the upregu-
using fixed or removable partial dentures (RPD) to restore the lation of endothelin secretions (secreted by endothelial cells)
function and esthetic of the oral cavity will have an insidious after exposure to pathogenic bacteria and represent potential
harmful effect if the patient does not meticulously follow oral mediators of inflammation and vasoconstriction. [10]. Some
hygiene procedures to preserve and prevent further deterio- studies have shown a correlation between high levels of nitrous
ration of the complex and soft dental structure [1,2]. oxide [10,11] and vitamin C with elevated levels of CRP and re-
sultant endothelial damage in periodontitis patients [12,13].
A fundamental concept of up-to-date dental prosthetics is for
the applied prosthetic rehabilitation to enhance the structural Nevertheless, tooth decay, gingival inflammation, and peri-
and biological durability of oral health and to not induce any odontal disease are quoted as the most common biological
harmful effects to either the remaining natural teeth structure complications of fixed prosthodontic appliances [14,15]. The
or the health of the dental periodontium. Many factors asso- risk of the periodontal problems and caries of the abutment
ciated with prosthodontic treatment, such as a history of oral teeth in a patient wearing a prosthodontic appliance is well
disease, age, and additional retentive areas, present prosth- known by every dental practitioner. However, there is currently
odontic patients with a risk of dental plaque accumulation. less awareness about structured periodontal maintenance af-
ter RPD delivery [16]. The patient with a fixed partial denture
Recall and maintenance visits for the patient wearing a remov- has little awareness about the need for interdental brushes
able or fixed partial denture is of great importance to prevent and floss to clean abutment teeth and pontics, owing to igno-
and treat any dental disease that can affect and compromise rance of their benefit and lack of instructions from their den-
the life span of the abutment teeth and adjacent remaining nat- tist concerning the maintenance of a fixed partial denture [17].
ural teeth. Bidara et al [1] observed minimal evidence related
to recall schedules in patients with removable and fixed partial In 2018, AlQahtani discussed patient awareness and accep-
prostheses. Zlataric et al [2] noted that the values obtained for tance of dental implants as a treatment modality for replace-
the abutment teeth were significantly higher for all periodon- ment of missing teeth in the Aseer region of Saudi Arabia [18],
tal variables than the values obtained for non-abutment teeth. while in 2023, Rownaq et al presented the assessment of cur-
Momiaz et al [3], in their study evaluating the periodontal sta- rent knowledge, awareness, and attitudes toward dental im-
tus of denture wearers in a rural Brazilian community, found plants as a treatment option for replacement of missing teeth
that all denture wearers displayed periodontal problems in the in the Riyadh region of Saudi Arabia [19]. However, there is
sextant, where the denture was recorded. Do Amaral et al [4], no published data in the Aseer region of Saudi Arabia cover-
after a longitudinal assessment over 12 months of the peri- ing the conventional prosthetic replacement of missing teeth.
odontal condition of the abutment and non-abutment teeth
in patients with RPD, found that the abutment teeth showed Therefore, the present study aimed to evaluate the oral hy-
higher values for probing depth, gingival recession, gingival in- giene level in 286 fixed prosthesis and removable partial den-
flammation, and plaque. Yeung et al [5] showed a higher prev- ture wearers in the Aseer region of Saudi Arabia, and to develop
alence of plaque, gingivitis, and gingival recession, especially a follow-up protocol to help patients maintain their prosthe-
on surfaces near the RPD elements. Correia et al [6] found that ses, remaining teeth, and oral hygiene. The null hypothesis
abutment teeth had higher values of all periodontal variables was that there was no difference in the oral hygiene levels of
(P<0.001) and concluded that the maintenance and follow- patients who used dental prostheses and those who did not
up of removable partial denture rehabilitation are mandatory. use them in our community.

Periodontal and gingival indices for fixed partial denture abut-

ment teeth are higher than those of non-abutment teeth. This Material and Methods
problem is exaggerated with other factors such as patient age,
duration of the prosthesis, and location of the crown margin. Ethics Approval and Patient Consent
Al-Sinaidi and Preethanath [7] and Ayoub and Rashid [8] evalu-
ated the periodontal status of abutment teeth compared with The Institutional Review Board and the Scientific Research
their respective teeth in another side of the arch, and reached Committee of the College of Dentistry of King Khalid University,

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Periodontal health in partial denture wearers
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CLINICAL RESEARCH

Abha, Saudi Arabia, approved the study (IRB/REG/2019- Results

2020/24). The study participants signed informed consent
before the start of the study. Demographic Characteristics of Participants

Study Design This study included 286 patients (142 men and 144 women)
aged between 25 and 55 years old. Most patients were in the
The study was a prospective cross-sectional clinical survey 45-55 year age group (38.1%) and had no medical history (78%).
conducted on 286 patients who wore prosthodontic applianc- More than half of the patients (60.5%) gave a history of using
es and attended the Diagnostic clinic at College of Dentistry, the removable or fixed prosthesis for over 3 years. Oral hygiene
King Khalid University, Abha, Saudi Arabia, from May 2021 to habits varied among the patients, including a minor propor-
November 2021. Those patients between the ages of 25 and tion (1.4%) that neglected it. However, most of these patients
55 years were considered for further examination. Exclusion (70.6%) used toothbrush and paste. Most patients (71.3%) re-
criteria included patients with any systemic conditions except ported having been instructed regarding the use of oral hy-
diabetes mellitus, periodontal therapy in the last 6 months, giene measures for their prostheses. A total of 25% of patients
systemic antibiotics within the last 3 months, and pregnan- used various oral hygiene aids (floss, tape) to clean their teeth
cy and lactation. and fixed prostheses. However, around half of the study group
(52.8%) complained of odor from their prostheses (Table 1).
Patient Characteristics
Distribution of Prostheses
A detailed description of study patients’ characteristics was col-
lected by using various parameters to understand the factors that Table 2 shows the distribution of prostheses based on various
may account for observed differences in prevalence of periodon- regions and units. While 72% of patients used fixed prosthe-
tal problems across studied parameters In this study, the follow- ses and 25% used removable partial dentures, only 3% had
ing data were recorded: age (25-34, 35-44, and 45-55 years); sex both. Most of the fixed prostheses were in the posterior teeth
(male or female); the presence of any previous medical history (73.2%) and had 3 units or more (58.7%). Removable partial
(no and yes); duration since prosthesis was used (Less than 1 dentures were mostly tooth-tissue supported (74%).
year, 1 year, 2 years, and 3 years and more); oral hygiene habits
(none, once daily, twice daily, and after every meal); method of Periodontal Status Based Around Prostheses
oral hygiene (none, miswak, toothbrush and paste, and both);
whether instructions were given by treating dentist for the hy- Table 3 shows the periodontal status of patients using differ-
giene of prosthesis (no and yes); use of oral hygiene aids to clean ent types of prostheses. There was a statistically significant
(no and yes); and odor from the prosthesis (no and yes). Details difference in the PI and CSI (P=0.026 and P=0.002, respective-
regarding prosthesis distribution based on various regions and ly) for different types of prostheses (fixed and removable). A
units, periodontal status based on various characteristics of the difference was not observed for GI between different types of
prosthesis, and periodontal parameters of natural and retainer prostheses (P=0.230). Based on the fixed prosthesis location,
teeth in different types of prostheses were collected. Following PI (P=0.001) and GI (P=0.001) showed a statistically signifi-
this, the periodontal parameters of plaque index (PI), gingival in- cant difference. However, no significant difference was found
dex (GI), and calculus surface index (CSI) were recorded. for CSI (P=0.407). PI (P=0.001), GI (P=0.001), and CSI (P=0.016)
showed a statistically significant difference based on the num-
Statistical Analysis ber of fixed prosthesis units observed. Removable partial den-
tures, type of support, number of abutment teeth, and number
A subject-level analysis was performed for each of the pa- of edentulous areas showed no statistically significant differ-
rameters using the Statistical Package for the Social Sciences ence in periodontal parameters tested in this study.
(SPSS) software for Windows, version 16.0 (IBM Corp, Armonk,
NY, USA). Frequency and percentage were calculated as sum- Comparison of Periodontal Parameters with Different
mary measures for condensing the raw data. A pairwise com- Types of Prostheses
parison using a paired-sample t test was made to compare
abutment teeth periodontal status with natural teeth among Table 4 shows a comparison of periodontal parameters of nat-
prosthesis wearers; one-way analysis of variance (ANOVA) with ural and retainer teeth in different types of prostheses. A sta-
the Bonferroni post hoc test was done to highlight the statis- tistically significant difference was found for PI and GI between
tical difference between pairs of each type of different pros- natural teeth and abutments (P£0.001). Similarly, the compar-
theses. A calculated P value of less than 0.05 was considered ison between the natural teeth and abutments for fixed par-
statistically significant. tial dentures when the bridge was anterior, posterior, and a

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Table 1. Demographic data of the patients.

Characteristics Frequency Percent (%)

25-34 years 94 32.9
Age 35-44 years 83 29.0
45-55 years 109 38.1
Male 142 49.7
Sex
Female 144 50.3
None 223 78.0
Medical status
Previous medical problem 63 22.0
Less than 1 year 15 5.2
1 year 37 12.9
History of prosthesis
2 years 61 21.3
3 years and more 173 60.5
None 4 1.4
Once/day 103 36
Oral hygiene habits
Twice/day 114 39.9
After meals 65 22.7
None 4 1.4
Miswak 63 22
Method of oral hygiene
Toothbrush, paste 202 70.6
Both 17 5.9
Yes 204 71.3
Oral hygiene given for prosthesis
No 82 28.7
Yes 51 25.0
Using of oral hygiene aids to clean
No 153 75.0
Yes 151 52.8
Complain of odor from prosthesis
No 135 47.2

combination of anterior or posterior showed a statistically sig- significant difference for PI and GI (P£0.001). In contrast, CSI
nificant P value for all periodontal parameters. Several fixed showed a significant difference (P=0.023) with tooth-support-
prostheses, either for crowns or retainers for the bridge, when ed removable partial dentures only. Similarly, a comparison be-
comparing natural and abutment teeth, showed statistically tween natural teeth and abutment for removable partial den-
significant P values for both PI and GI (P£0.001). CSI showed tures according to the number of edentulous areas showed a
only a statistically significant value (P=0.03) with a bridge re- statistically significant difference (P£0.001) in PI and GI but
placing a missing tooth or teeth. not for CSI. PI for the abutment teeth of removable partial den-
tures compared with that of remaining natural teeth showed
Comparison of Periodontal Parameters with Removable a significant difference (P£0.001) when the abutment teeth
Support were located posteriorly. Compared with the GI of the remain-
ing natural teeth, GI for abutment teeth of removable partial
Table 5 shows a comparison of periodontal parameters of dentures was statistically significant wherever the abutment
natural and abutment teeth according to removable support was positioned. CSI showed a significant difference when the
type. Periodontal parameters compared in the remaining natu- abutment teeth were located anteriorly compared with the re-
ral teeth and abutment for tooth-supported and tooth-tissue- maining natural teeth (P=0.034).
supported removable partial dentures showed a statistically

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Table 2. Distribution of prostheses based on various regions and units.

Fixed Prosthesis Frequency Percent (%)

Anterior 42 19.7
Fixed Location Posterior 156 73.2
Both 15 7.0
1 unit (Crown) 57 26.8
Number of units 2 units 31 14.6
3 units and more 125 58.7
Tooth support 21 26.0
Removable prosthesis
Tooth tissue support 60 74.0
One area 19 22.6
Number of edentulous areas Two areas 33 41.9
More 27 35.5
Anterior 5 6.2
Position of abutment teeth Posterior 31 38.3
Both 44 54.5
Total 81 100.0

Discussion reported a similar result and noted that the abutment teeth
scored significantly higher PI, GI and probing pocket depth
This study was performed to evaluate the oral hygiene of the than non-abutment teeth (P<0.05). In a study regarding com-
patients who had removable and fixed prostheses and com- plications associated with the crown and fixed partial denture,
pare 3 periodontal indices (PI, GI, and CSI) of the abutment Edalia et al [23] reported that 86.8% of crowns and 57.7% of
teeth with those of the controlled non-abutment teeth. While abutments showed clinical signs of gingivitis. In present study,
a small group of patients in the present study stated that they the prevalence of gingival inflammation among fixed prosthe-
were not instructed on oral hygiene methods for their pros- sis patients in this group is high. There is a significant increase
theses by their treating dentist, most were instructed to use in gingival inflammation as measured by the GI in retainer
oral hygiene measures for their prostheses. This result agrees than in natural teeth. The prevalence of gingival inflammation
with that of the study by Al Qabba and Rayyan [20], in which among removable prosthesis patients in this group is also high.
a similar proportion (75%) of patients were instructed on a
particular procedure of oral hygiene regarding their prosthe- The higher prevalence of gingival inflammation, plaque, and
ses. Contrary to this, Almutairi [21] reported that only a small calculus accumulation in the present study group may be cor-
proportion of patients received instructions about cleaning related with the improper oral hygiene methods used by the
the pontics and involved teeth of their fixed partial denture. patients and lack of post-prosthetic instructions regarding
A few among them failed to follow instructions. methods and demonstrations of the cleansing of the prosthe-
sis. This result is consistent with that of Geiballa et al [17],
The harmful effects of partial dentures in patients who did who reported inadequate post-prosthetic instructions regard-
not maintain periodontal health through meticulous oral hy- ing the fixed partial denture hygiene. Al Qabba and Rayyan [20]
giene have been thoroughly discussed by many authors. It is showed that most of their patients did not receive fixed den-
apparent that there is a relationship between partial dentures ture oral hygiene instructions, while Harini et al [24] conclud-
and the accumulation of plaque [22]. Amaral et al recognized ed that many patients (75%) did not use any interdental aids
the association between periodontal damage of the teeth in a to clean their fixed partial dentures.
group with direct and indirect retainers compared with a con-
trol group [4]; the position and number of replaced missing In the present study, the prevalence of gingival inflamma-
teeth of fixed partial denture abutment in this study showed tion, plaque and calculus accumulation for abutment teeth of
a statistically significant difference for PI and GI between the fixed partial dentures compared with that of adjacent natural
anterior and posterior teeth. Al-Sinaidi and Preethanath [7] remaining teeth showed statistically significant differences,

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Table 3. Periodontal status based on various characteristics of prostheses.

Characteristics of prosthesis Mean SD P value

Types

Fixed (n=205) 1.24a 0.46 0.026*

PI Removable (n=73) 1.33a,b 0.57

Both (n=8) 1.68b 0.37

Fixed 1.23 0.62 0.230

GI Removable 1.21 0.63

Both 1.60 0.37

Fixed 0.68 a
0.30 0.002**

CSI Removable 0.83b 0.44

Both 0.54a,b 0.35

Location of FPD

Anterior 1.15a 0.48 0.001*

PI Posterior 1.24a 0.43

Both 1.78 b
0.46

Anterior 1.11 a
0.69 0.001*

GI Posterior 1.21a 0.57

Both 1.91b 0.46

Anterior 0.68 0.32 0.407ns

CSI Posterior 0.66 0.29

Both 0.77 0.35

Number of Units of FPD

1 unit 1.18a 0.41 0.001**

2 units 1.44b 0.49

PI
3 units 1.09 a
0.41

More than 3 units 1.53b 0.46

1 unit 1.20a,b 0.50 0.001**

2 units 1.46 a,c

0.53
GI
3 units 1.02b 0.63

More than 3 units 1.52c 0.65

1 unit 0.69 b
0.27 0.016*

2 units 0.81a 0.24

CSI
3 units 0.63b 0.31

More than 3 units 0.62 b

0.32
ns
not significant; * P<0.05; ** P<0.001, a,b,c Bonferroni post hoc test, means with different letters are statistically significant. PI – plaque
index; GI – gingival index; CSI – calculus surface index; FPD – fixed partial denture; SD – standard deviation.

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Table 4. Comparison of periodontal parameters of natural and retainer teeth in different types of prostheses.

Natural Retainer
Type of prosthesis P value
Mean SD Mean SD

Fixed 1.20 0.46 1.56 0.62 0.001**

PI Removable 1.29 0.60 1.64 0.57 0.001**

Both 1.44 0.40 2.09 0.53 0.01*

Fixed 1.18 0.63 1.62 0.72 0.001**

GI Removable 1.15 0.65 1.65 0.62 0.001**

Both 1.36 0.38 2.01 0.58 0.001**

Fixed 0.67 0.30 0.71 0.46 0.09ns

CSI Removable 0.82 0.43 0.89 0.60 0.095ns

Both 0.43 0.38 0.73 0.35 0.01*

Natural Retainer
Fixed position P value
Mean SD Mean SD

PI Anterior 1.15 0.47 1.28 0.61 0.092ns

Posterior 1.19 0.43 1.63 0.61 0.001**

Both 1.66 0.54 1.96 0.53 0.026*

GI Anterior 1.07 0.69 1.41 0.82 0.001**

Posterior 1.16 0.58 1.66 0.69 0.001**

Both 1.78 0.59 2.07 0.36 0.074ns

CSI Anterior 0.68 0.32 0.61 0.58 0.406ns

Posterior 0.65 0.30 0.74 0.43 0.002**

Both 0.69 0.40 0.76 0.38 0.432ns

Natural Retainers
Number of fixed units P value
Mean SD Mean SD

PI 1 unit 1.16 0.41 1.39 0.65 0.003**

2 units 1.39 0.50 1.85 0.59 0.001**

3 units and more 1.05 0.39 1.46 0.53 0.001**

GI 1 unit 1.19 0.50 1.52 0.75 0.001**

2 units 1.41 0.53 1.96 0.72 0.001**

3 units and more 0.96 0.62 1.42 0.65 0.001**

CSI 1 unit 0.68 0.28 0.70 0.52 0.798ns

2 units 0.81 0.24 0.84 0.30 0.532ns

3 units and more 0.62 0.31 0.70 0.44 0.03*

ns
not significant; * P<0.05; ** P<0.001. PI – plaque index; GI – gingival index; CSI – calculus surface index; SD – standard deviation.

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Table 5. Comparison of periodontal parameters of natural and abutment teeth according to removable support.

Natural Retainer
Different types of support P value
Mean SD Mean SD
Tooth support 1.21 0.40 1.59 0.50 0.001**
PI
Tooth-tissue support 1.34 0.64 1.72 0.61 0.001**

Tooth support 1.04 0.50 1.53 0.51 0.001**

GI
Tooth-tissue support 1.22 0.67 1.75 0.65 0.001**

Tooth support 0.76 0.36 0.86 0.38 0.023*

CSI
Tooth-tissue support 0.79 0.47 0.87 0.65 0.084
Natural Retainer
P value
Mean SD Mean SD
1 Area 1.30 0.61 1.63 0.56 0.006**

PI 2 Areas 1.26 0.46 1.69 0.55 0.001**

More 1.37 0.71 1.72 0.66 0.001**

1 Area 1.24 0.47 1.69 0.56 0.001**

GI 2 Areas 1.11 0.55 1.62 0.63 0.001**

More 1.19 0.84 1.77 0.67 0.001**

1 Area 0.84 0.36 0.98 0.58 0.094

CSI 2 Areas 0.70 0.43 0.77 0.57 0.197

More 0.83 0.53 0.88 0.61 0.294

Natural Retainer
P value
Mean SD Mean SD
Anterior 2.02 0.88 2.30 0.97 0.094

PI Posterior 1.20 0.52 1.60 0.49 0.001**

Both 1.33 0.55 1.70 0.58 0.001**

Anterior 2.06 0.89 2.50 0.71 0.04*

GI Posterior 1.06 0.42 1.55 0.48 0.001**

Both 1.17 0.70 1.73 0.67 0.001**

Anterior 1.42 0.67 2.07 1.01 0.034*

CSI Posterior 0.73 0.45 0.81 0.51 0.093

Both 0.75 0.33 0.76 0.39 0.748

* P<0.05; ** P<0.001. PI – plaque index; GI – gingival index; CSI – calculus surface index; SD – standard deviation.

except for the PI of the anterior abutment teeth. This may be et al [6], who showed that the abutment teeth for removable
explained by the visibility of the involved teeth and easy ac- partial dentures had a higher value in all periodontal variables
cessibility of the patient to remove debris. Periodontal pa- when compared with adjacent non-abutment teeth. Yeung et
rameters for removable partial dentures showed statistically al [5] found that the periodontal parameter of the periodon-
significant differences according to abutment position, sever- tium is significantly affected in the abutment tooth’s side ad-
al edentulous areas, and support type. A similar finding was jacent to removable partial denture elements by less than 3
reported by Zlataric et al [2], Do Amaral et al [4], and Correia mm. This result does not agree with results of other studies

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Elmahdi A.A. et al:
Periodontal health in partial denture wearers
© Med Sci Monit, 2023; 29: e940322
CLINICAL RESEARCH

that reported no statistically significant difference in periodon- protocol and recall visits specially designed for every prosth-
tal variables between the abutment teeth and non-abutment odontics patient to check his/her personal compliance with
teeth in the oral cavity [25,26]. their specific instructions is recommended. We recommend
conducting a more detailed study with a larger sample size,
It is well documented that the control of gingival inflamma- including dental implant patients, and using new updates to
tion, plaque, and calculus accumulation can improve over- classify periodontal diseases and conditions.
all oral health. Comprehensive therapeutic methods, such as
mechanical and chemical plaque control methods, including Limitations were that the COVID-9 pandemic and lockdown
toothbrush, dentifrice, and mouthwash, are indicated to con- delayed the start of the study, it was only a clinical examina-
trol dental plaque [27]. Oral hygiene measures cause improve- tion for periodontal parameters, and no radiographic exam-
ment in gingival inflammation and in mucocutaneous lesions, ination was carried out to evaluate the quality of bone and
such as lichen planus [28]. Furthermore, many studies have bone loss around the abutment teeth of prostheses. Another
reported the association between bone diseases, periodon- limitation was the small sample size, which may have affect-
tal pathogens, and periodontal diseases. Specific periodontal ed the power of the study. Also, the cross-sectional design of
pathogens induce the activation of the immune response in our the study limited our ability to relate the time pattern with
body, which in turn controls periodontal disease and related the present periodontal status of the patients. We failed to in-
diseases, such as osteoporosis and rheumatoid arthritis [29]. clude implant prostheses in our study; however, today, the use
of implants is increasing exponentially for the replacement of
It should be emphasized that periodontal disease is multifacto- missing teeth. We can incorporate implant prostheses in fu-
rial in origin. Although plaque is the primary etiological factor ture studies. This study considered only clinical examination
causing this disease, the immune pathway’s altered response for periodontal parameters, and no radiographic examination
possibly modulates the body’s response toward pathogenic was carried out to evaluate the quality of bone and bone loss
bacteria in the plaque [9]. Damage to the endothelium, which around the abutment teeth.
leads to activation of specific heat shock proteins and the re-
sultant cross-reactive T cells, is a possible periodontal destruc-
tive mechanism. Some studies also show that in periodonti- Conclusions
tis, there is an imbalance in salivary nitrous oxide levels [30]
and that inflamed periodontal tissues produce elevated levels The findings from the present study showed that there is a
of nitrous oxide against the periodontopathogens. Decreased need for meticulous oral hygiene measures by patients with
vitamin C levels have also been found to have deleterious ef- prosthodontic appliances. It should be emphasized that fol-
fects on endothelial dysfunction and altered immune response low-up visits for the patient are equally essential to preserve
during the periodontal destructive pathway [9]. and maintain their remaining natural teeth. Our results showed
that, in our community, there indeed is a difference in the oral
The present study was aimed to evaluate periodontal sta- hygiene levels of the patients who used dental prosthesis and
tus in conventional prosthetic wearers in the Aseer region of those who did not use them. Furthermore, awareness of the
Saudi Arabia. This study points out the need for developing treating dentist regarding prosthodontics instruction and dem-
a follow-up protocol to help patients maintain their prosthe- onstration of oral hygiene aids indicated for the prosthodon-
sis, remaining teeth, and oral hygiene. However, this study’s tics appliances are necessary.
results should be interpreted with caution in terms of the re-
movable prosthesis, as most patients had fixed prostheses. Department and Institution Where Work Was Done
Future investigations would include details of medically com-
promised patients and a broader age group to increase gen- Department of Prosthodontics, College of Dentistry, King Khalid
eralizability results. University, Abha, Saudi Arabia.

From the results of the present study, it is evident that oral Acknowledgements
hygiene and daily care was the main problem for the fixed
and removable prosthodontic wearers. Therefore, emphasis The authors extend their appreciation to the Deanship of
should be on teaching our patients about proper oral hygiene Scientific Research at King Khalid University for funding this
methods and the use of dental floss for the remaining natu- work through large group Research Project under grant num-
ral teeth and prosthesis before delivery. A regular follow-up ber (RGP-2/255/44).

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 Elmahdi A.A. et al:
CLINICAL RESEARCH Periodontal health in partial denture wearers
© Med Sci Monit, 2023; 29: e940322

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