I never thought that I would find myself disagreeing with any dental pronouncement of the estimable Dr. Gordon Christensen, nor feeling strongly enough about it that I would want it to appear in print. However, his article "What Has Happened to Removable Partial Prosthodontics?" (January JADA) demonstrates the answer to his question.
I don’t follow everything that I was taught 30 years ago at New York University College of Dentistry. But what I did learn, and what I did help teach at Harvard School of Dental Medicine in the early 1970s, and what I still do in practice, has continued to result, not in "acceptable" partial dentures, but excellent partial dentures. Dentures that continue to function and fit comfortably and securely on the teeth to which they were designed to anchor for a decade and more are not magic. The key word is "design."
Dr. Christensen recommends that a "diagnostic cast" be made, and then the impression tray be fabricated immediately. What happened to diagnosis? What about case design? This is the best excuse a dental insurance company can use to justify not paying for models.
Tooth contour, position and restorations needed all make up part of the diagnosis. Tissue undercuts have to be considered. How many dentists remember what a "surveyor" is? Without planning your design and modifying teeth prior to the impression, a dentist might as well send the impression to the lab and tell them to "make me a denture." There are times when the surveyor alone reveals why the patient has not had a successful denture in the past, and needs teeth and even bone reshaped prior to denture construction.
The goal of dental education for removable partial dentures should be to provide minimum competence, but also to understand the fundamentals of design. Having a dental laboratory technician in on the ground floor of dental learning means the student won’t do it himself or herself at first. Later, when the dentist is in private practice, it will only make it harder for him or her to tell the lab technician exactly what he or she wants in a prescription.
The neophyte, having only knowledge of "time-consuming RPD [removal partial denture] techniques," is not a liability. How will you learn how to do it right if you are only taught ways of cutting corners by "successful practitioners" doing "clinically acceptable" RPDs? Is that a measure of success?
A partial denture can be an excellent, long-term, well-fitting service that is especially suitable for people on a budget who cannot afford many units of bridgework or implants.
There may be simple ways to make clinically acceptable RPDs, but my patients deserve more than that.
