International Journal of Medical Science and Clinical Research Studies

ISSN(print): 2767-8326, ISSN(online): 2767-8342

Volume 04 Issue 11 November 2024
Page No: 2100-2105
DOI: https://doi.org/10.47191/ijmscrs/v4 -i11-26, Impact Factor: 7.949

Removable Partial-Denture Construction in Patients with Diabetes Mellitus

FX Ady Soesetijo1, Agus Sumono2*
1
Departement of Prosthodontic, Faculty of Dentistry, Jember University, Jember 68121-Indonesia
2
Departement of Basic Dental Science/Biomaterials, Faculty of Dentistry, Jember University, Jember 68121-Indonesia

ABSTRACT ARTICLE DETAILS

Prosthetic rehabilitation with denture treatment is aimed at stomatognathic system Published On:
restoration. Diabetes Mellitus (DM) patients who require Removable Partial Denture (RPD) 19 November 2024
therapy are found in many dental and oral health centers. DM patients with complex oral
manifestations need to receive serious attention by the dentist. Initially, the patient's examination
should begin by knowing the history of the disease, so that it can help determine the appropriate
measures for the patient and the diagnosis of the disorders that occur in the oral cavity. The main
issue is the decline in quality and quantity of periodontal tissue. Therefore, determining the denture
design should consider the kind of denture support as well as the appropriate denture base
materials. The successful treatment is largely determined by the mastery of theory, laboratory and
clinical skills, as well as good cooperation between the dentist and their patient.
Available on:
KEYWORDS: diabetes mellitus, removable partial-denture design, denture base materials https://ijmscr.org/

INTRODUCTION of denture must be precise, especially by considering the

In the case of partial tooth loss (partially correct selection of denture base materials, retention,
edentulous), one alternative treatment to choose is the stabilization, extension base, and biomechanical response.
creation of Removable Partial Denture (RPD), since it is The design principle should consider the widest possibility of
relatively easily manufactured and relatively cheap. Besides, load distribution; the load equal division; as well as the load
the prosthesis is easily removed and reassembled. reduction on the RPD support tissue.4
RPD base has a variety of materials, namely acrylic Salivary flow decrease also occur in DM patients,
resin; polyamide resin (thermoplastic nylon); metal frame, or which results in complaint on xerostomia. In addition, there
a combination of metal frame and acrylic. It is also possible is also a change in saliva composition caused by impaired
to combine metal frame and nylon. RPD construction should secretion of submaxillary and parotid glands as a result of
be done carefully, especially when diagnosing patients with hormonal disorders. This can lead to stability disorders as
DM. well as denture retention. Thus, special care is required before
DM is an endocrine disease characterized by the and during prosthodontic treatment for DM patients. 5
increase of glucose concentration in the blood circulation Based on the background mentioned above, this
system. The increasing glucose concentrations are caused by article will discuss a study of appropriate RPD construction
relative or absolute insulin deficiency, or as a result of tissue techniques in cases of patients with DM.
resistance to insulin activity. Such insulin deficiency can
Diabetes Mellitus (DM)
cause disturbance in the metabolism of carbohydrate, lipid
DM is a metabolic disorder in which the insulin
and protein.1,2
hormone does not work properly. Insulin is a hormone
Patients with DM also experience oral tissue decline
produced by the pancreas gland that serves to control blood
in quantity and quality, including the dental support and
sugar levels by converting carbohydrates, fats and proteins
periodontium; as well as mucosa and alveolar bone structure
into energy. DM is a chronic disease characterized by blood
underlying it, with oral manifestations including: gingivitis
glucose levels exceeding the normal value of ≥ 200 mg / dl,
and periodontitis; apthose stomatitis; susceptibility to caries;
or fasting blood ≥ 126 mg / dl. This may be due to a lack of
burn mouth syndrome and candidiasis.3 Therefore, the design
formation or activation of insulin produced by β cells from
2100 Volume 04 Issue 11 November 2024 Corresponding Author: Agus Sumono
Removable Partial-Denture Construction in Patients with Diabetes Mellitu
the Langerhans cells in pancreas or any damage to these Candidiasis infection
cells.6,7 Oral candidiasis is an opportunistic bacterial
The classification of DM according to the American infection occurring in a hyperglycemic state. It can lead to
Diabetes Association is as follow.8,9 salivary dysfunction due to a large amount of fluid loss from
a. Type I DM the body, and reduce salivary flow. In addition, it also causes
In this diabetes type, the body cannot produce complications in the form of microangiopathy that most often
insulin, so it depends on insulin. It generally occurs appear in patients with controlled or uncontrolled DM.
in childhood and adolescence, but may also occur at Therefore, candidiasis is often found in patients with DM and
older age due to alcohol, pancreatic surgery, or along with various factors, such as immune deficiency, saliva
progressive failure of pancreatic β cells. flow decrease, malnutrition and the use of denture with poor
b. Type II DM oral hygiene.
It is known as Non-Insulin Dependent Diabetes
Burn mouth syndrome
Mellitus (NIDDM), which is caused by a
Burn mouth syndrome usually appears without
combination of pancreatic β cell insufficiency and
clinical signs, although the pain and burning are very strong.
insulin resistance in tissues, especially in the skeletal
In uncontrolled DM patient, factors that cause the occurrence
muscle and hepatic cells.
of burn mouth syndrome are salivary glands dysfunction,
c. Other type of DM
candidiasis and abnormalities in the nerve. The nerve disorder
This type includes genetic defects of β cell function,
will support the symptoms of paresthesia and tingling, and
genetic defect of insulin action, pancreatic exocrine
pain/burning feeling caused by pathological changes in oral
disease, endocrinopathy, due to drugs/chemicals,
nerves.
infection, rare immunological causes and other
genetic syndromes associated with DM. Periodontal damage
d. Gestational DM If DM is not controlled well, it can cause damage to
This type occurs in pregnant women whose the body in general or in the oral cavity. The increase of
symptoms subsequently disappear after childbirth. periodontal destruction in DM patients is reflected through
Women who suffer from this type of DM have a risk the loss of bone attachment, the increase of gingival pocket
for the occurrence of Type II DM. depth, the increase of gingival inflammation, and the
presence of probing bleeding. Starting from a declining body
Oral Manifestation of DM 10,11
endurance system, DM causes the collagen fibers as the main
Manifestations in oral cavity can be found in DM
support of periodontal tissue to collapse that affects the
patients, such as gingivitis and periodontitis, dysfunction of
shaking of teeth due to the loss of contact with alveolar
salivary glands and xerostomia, candidiasis, burn mouth
processus. However, the severity of periodontal disease can
syndrome, and oral acute infection.
be reduced if DM is under appropriate control.
Gingivitis and periodontitis
Dental caries
Gingivitis is an inflammation of the gingiva that is
DM may be a predisposing factor for an increase in
easy to cure, where the gingival tissue looks reddish with
the incidence and number of caries. This condition is thought
swelling and easily bleeds when brushed. Gingivitis will lead
to be due to the high quantity of glucose in blood circulation
to the formation of periodontal pocket with alveolar bone
and saliva that acts as a cariogenic substrate.
resorption, so the tooth is shaken and finally comes off.
RPD Design
Xerostomia and salivary glands dysfunction
RPD is a prosthesis that replaces some or part of the
Hyperglycemia results in the elevated amounts of
original tooth that is lost in the arch of the jaw. This prosthesis
urine, so that the fluid in body is reduced and salivary
can be installed and removed by the patient himself. Its main
secretion is also reduced. The reduced saliva can cause
function is to restore mastication, along with other functions
xerostomia. In a healthy oral cavity, saliva contains
such as phonetic, esthetic and maintaining oral tissue health.
antimicrobial enzymes, for example: lactoferrin, peroxidase,
Owal B. et al12 stated that if a person with partial
lysozyme and histidine that interact with oral mucosa and can
tooth loss is not immediately replaced with RPD, it will have
prevent excessive candida growth. In situations where there
an impact on tissue damage such as: the remaining teeth
are changes in the oral cavity caused by decreased salivary
undergoing drifting, tilting and migration; over eruption;
flow, so that the antimicrobial enzymes in the saliva do not
chewing efficiency decreased; temporo-mandibular disorder;
function properly, then the oral cavity becomes susceptible to
excessive pressure on the buffer tissue; change in voice tone;
poor mucosal states which causes painful lesions. DM
as well as declining oral hygiene.
patients with salivary gland dysfunction may also have
The RPD design is the most important and it is also
difficulty in chewing and swallowing resulting in appetite
the critical factor for success or failure. It includes 4 (four)
decrease and malnutrition.
sequential stages, namely: 1) Determining the classification

2101 Volume 04 Issue 11 November 2024 Corresponding Author: Agus Sumono

Removable Partial-Denture Construction in Patients with Diabetes Mellitu
or topography of the toothless areas; 2) Determining the kind Nylon is a generic name of polyamide resin. This
of support (the tissue that will support denture); 3) Retention; material is more flexible than other denture base materials. Its
and 4) Stabilization. flexible nature supports the denture flexibility. The denture
The commonly used classification is Kennedy, retention is obtained by utilizing the undercut area. Nylon is
which categorizes partial tooth loss cases based on the monomer free, does not use metal clasp, and is more flexible
toothless area location. Kennedy divides it into four classes: and thinner than acrylic denture, so it will feel more
I. Bilateral free end; II. Unilateral free end; III. Unilateral comfortable for patients.15,16
bounded posterior; and IV. Anterior bounded. 13 RPD base with alloy material is also known as metal
There are three choices of denture support tissues, frame denture. The most commonly used alloy materials are
namely the support from the teeth and the periodontium NiCr and CoCr alloys. Alloy material is stronger than other
(tooth borne), the support from the mucosa and the base materials, so it can be made thinner and practical but still
underlying tissue bone (tissue borne), or the support from the rigid; more retentive and stable than other denture base
combination of the two (tooth-tissue borne). The best support materials. It is also a good thermal conductor and has good
for removable partial prosthesis can be obtained by dimensional stability. The disadvantage is only the aesthetic
considering several factors, namely: the buffer tissue problem that is less satisfactory for patients and difficult to be
condition, the length of the saddle, and the condition of the repaired if damaged.17
network occupied by the denture.13
GTSL Construction on Diabetic Patients
Retention is the ability of denture to stand in place
The successful GTSL treatment depends on the
against pressure from the opposite direction of the path of
diagnosis and the appropriate treatment plan and good
insertion. Good retention can be achieved by selecting the
cooperation between the dentist and the patient. The
potential buffer teeth that will be occupied by clasp retainer
maintenance of GTSL support tissues such as restorative
and selecting the appropriate clasp for each case. The
procedures, root canal treatment and tartar cleaning should be
retention assessment is performed when the denture is in a
completed first. Good oral hygiene and proper design
static state.
determination should also be noted.18,19,20
Stabilization is the denture ability to survive on the
Typically, diabetics have problems with periodontal
supporting tissue against any pressure that can change its
tissue. Therefore, all GTSL components must be compatible
position. The factors to be considered are the direction of
with their supporting tissues. The design principle should
fulcrum line, the clasp direction, and the artificial teeth
consider the distribution of loads received by the denture as
arrangement. The stabilization assessment is performed when
large as possible, so that the load received by the denture will
the prosthesis is in a function / dynamic state.
be evenly channeled throughout the supporting tissues. Equal
Denture Base Materials load distribution should also be taken into account, i.e. the
The basic materials for the removable denture base loads received by the buffer gear and the periodontium and
should ideally meet some criteria: non-toxic; not irritating the load received by the underlying mucosa and bone
and not affected by the oral environment (so that it does not alveolar. Load reduction can be done by minimizing the tooth
dissolve or absorbs mouth fluid), has a thermal expansion element in the bucco-lingual/palatal direction.21,22,23
corresponding to the dental material; has sufficient Fungal infections, stomatitis and dry mouth are
mechanical strength, does not change in shape at the time of common oral manifestations in DM patients. Therefore, RPD
manufacture and use; easy to be manufactured with design should also consider the selection of appropriate
affordable cost; easy to manipulate; easy to clean; as well as materials and denture construction with a primary focus on
having color according to the surrounding tissue color. stress reduction and efficiency of self cleansing and extra
Generally the element of artificial teeth is made of attention from patients to keep their oral hygiene. Acrylic
acrylic resin, while the base material is available in the resin denture base is preferably avoided, because in addition
laboratory in many choices, namely: acrylic resin, nylon resin to its rigid nature, it has a monomethyl methacrylate
and alloy. monomer residue which can trigger hypersensitivity reactions
Acrylic resin is an ethylene derivative that has vinyl as well as a dimethyl activator ingredient of toluidine that can
group. Compared to other materials, acrylic RPD base is the induce free radicals. If economic factor becomes the biggest
most economical. The plates are relatively thicker and there consideration, then it is recommended that acrylic material is
is also wrought wire clasp as retainer placed on the abutment combined with tissue conditioner material placed under the
tooth. The advantages of this base material are good base and contacted directly with the surface of the denture
appearance, easy manufacturing, good finishing surface, and supporting tissues. The tissue conditioner has a role as a stress
excellent chemical bond. However, in addition to the breaker in the chewing load, so that the load received by the
advantages, this material also has some drawbacks, namely denture support tissue is reduced. Similarly, metal frame
the presence of residual monomers, the unreliable strength denture is also a contra indication, with consideration of its
and poor flexibility, and absorbing water and dissolving in rigidity and easily corrodible metal. DM patients have high
some fluids.14 glucose concentration in saliva and low salivary pH.
2102 Volume 04 Issue 11 November 2024 Corresponding Author: Agus Sumono
Removable Partial-Denture Construction in Patients with Diabetes Mellitu
Corrodible products in the form of metal cations can Oral mucous membrane loses its resilience because
aggravate the condition of DM patients, which can increase xerostomia indirectly affects the denture retention. Soft tissue
oxidative stress and cell death. resistance is an important factor for good adaptation of the
Neutral zone concept needs to be applied with prosthesis.28
attention to anatomical landmarks. This concept can be done Periodontitis is more common and severe in diabetic
by functional printing to achieve replicas depicting the tissues patients than in normal people. The functions of the cells
that are truly ready to receive denture. The neutral zone involved in this inflammatory response, including
principle in RPD construction is to maintain a balance among neutrophils, monosites and macrophages, are altered in
the muscles of the stomatognathic system. people with diabetes. Compliance, chemotaxis and neutrophil
phagocytosis are often impaired. These cells are the leading
DISCUSSION line of host defense, and inhibition of their function can
Periodontitis is inflammation of the tooth supporting increase periodontal damage. Other immune-inflammatory
tissues (gums and bones). In addition to damaging white responses are regulated in people with diabetes. For example,
blood cells, another complication of diabetes is the thickening macrophages and monosites often show the production of
of blood vessels that slows down the flow of nutrients and pro-inflammatory cytokines and mediators such as tumor
metabolite products from the body. This slow flow of blood necrosis factor-α (TNF-α) in response to periodontal
decreases the body's ability to fight infections. Meanwhile, pathogens, which can increase host tissue damage. High
periodontitis is a disease caused by a bacterial infection. This TNF-α levels are found in blood and gingival fluid sulcus. It
becomes more severe as bacterial infection in patients with is correlated with the increasing cell death, so that glycemic
diabetes gets worse. control may be an important factor of this response. 29
The association between DM and denture has been Periodontal conditions are closely related to the
known, and both tend to increase the incidence of oral quality of the denture support. DM patients generally have
candidiasis. Fungal proliferation can be induced by the poor periodontal health conditions, characterized by the
presence of denture in the mouth, especially in the palatinal decrease in blood supply to the tissues due to microvascular
mucosa. Compressed tissue by artificial teeth will cause the angiopathy. This affects the residual alveolar ridge
decline in local blood circulation. This can be worsened by resorption. Therefore, the denture construction should
the poor oral hygiene. Poor attention to oral hygiene can also consider the widest possible load distribution, share the
trigger proliferative lesions such as lichen planus, leukoplakia burden equally among its supporting tissues, and reduce the
or erythroplakia.24,25 load.
Hypo salivation may cause Candida albicans and McGivney et al30 stated that for GTSL design should
other species proliferations, and also may trigger other oral consider the biomechanical principle, which focuses on the
infections. Increasing glucose concentration can facilitate the distribution of load, retention and stabilization. Meanwhile,
attachment of fungi to epithelial cells and interfere neutrophyl Dula LJ31 suggested that hygienic design principles should be
polymorphic defense mechanisms. The manifestations of oral applied, by controlling dental plaque. The goal is to prevent
candidiasis can occur in various forms such as median caries and periodontal diseases. This principle is done by
rhomboid glossitis, athrophic glossitis, denture stomatitis and freeing the marginal of gingiva from attribute of denture.
angular cheilitis.25 The ideal GTSL design should minimize stress on
Jorgensen et al26 stated that flexible denture provides the supporting tissues (dental and alveolar bone); it should be
a dramatic increase in mastication, comfort and satisfaction. as simple as possible, involving only the essential soft and
The flexible denture supporting tissue is healthier with fewer hard tissues and taking into account the hygienic principles;
tissue changes than conventional denture. The above and it should also use a retainer in the form of a clutch,
restorations are best for DM patients, with the consideration because clutch causes a smaller torque compared to
that their flexibility can minimize the stress on the denture attachment.32,33,34
supporting tissues. The disadvantage is that the presence of Chewing force and its effects on the supporting gear
clasp resin covering the cervix at the marginal region of the and surrounding tissue need to be considered when designing
gingiva may cause changes in the character of the and constructing GTSL. Adequate planning requires an
periodontium and less hygienic structures. understanding of the power generated during mastication and
In general, diabetic patients who use artificial teeth its distribution to the supporting tissues. If these principles are
complain about the changes in taste sensation and other followed when designing and constructing the prosthesis, the
neurosensoric disorders such as burn mouth syndrome and resulting stress can be tolerated by the tissues, so that
disphagia. The causes of such complex symptoms are the periodontal health is maintained.35,36,37,38
variations in salivary flow, salivary changes in buffer GTSL with distal extensions (in free-end denture
capacity and peripheral neuropathy. The presence of cases) has no advantages, compared to dental support, since
retinopathy and neuropathy severely restricts the hand of the residual ridges should be used for support and retention.
patient in oral hygiene maintenance of the denture.27 Biomechanically, the distal extension has a tendency for

2103 Volume 04 Issue 11 November 2024 Corresponding Author: Agus Sumono

Removable Partial-Denture Construction in Patients with Diabetes Mellitu
lateral movement during function and can also cause IV. Moodley A, Wood NH, Shangase SL. The
leverage. relationship between periodontitis and diabetes: a
Diabetic patients are more susceptible to infection brief review. SADJ 2013; 68: 262-264.
and severe damage from the mouth tissue. Therefore, the V. Thalib B & Purnama I. The comparison of body
dentist is obliged to fully educate and motivate the patients mass index of elderly used and did not use full
on the importance of maintaining good oral hygiene and denture. J Dentofasial; 2011: 10(3): 140-143.
making periodic visits to the dentist. This will ensure the VI. Chipkin SR, Klugh SA, Chasan-Taber L. Exercise
long-term health of the oral tissues by preventing chronic and diabetes. Cardiol Clin 2001; 19 (3): 489-505.
infections such as denture stomatitis and denture hyperplasia VII. Pierce NS. Diabetes and exercise. Br J Sports Med
that can lead to more serious conditions. 1999; 33: 161-173.
In patients who wear denture, problems in the VIII. Kerner W & Bruckle J. Definition, classification
tolerance of the dentures will arise. Dry mucosa causes the and diagnosis of diabetes mellitus. Exp. Clin.
uncomfortable use of denture, due to the lack of salivary Endocrinol Diabetes, 2014; 122: 384-386
secretions that may contribute to the adhesion of the denture. IX. American Diabetes Association. Diagnosis and
In addition, there is a decrease in surface tension between the classification of diabetes mellitus. Diabetes care
dry mucosa and the denture, which results in disruption of 2004; 27(1): 5-10
denture retention and stabilization. X. Straka M. Oral manifestation of diabetes mellitus
DM can cause predisposing factor disorders in the and influence of periodontal treatment on diabetes
patient's mouth. If it is not carefully controlled it can cause mellitus. Bratisl Lek Listy 2011, 112(7): 416-420.
serious bodily harms. Prosthodontic treatment, especially the XI. Shrimali L, Astekar M, Sowmya GV. Correlation
preparation of RPD, is intended to restore the stomatognathic of oral manifestation in controlled & uncontrolled
system. Therefore, the dentist should alert the DM patient diabetes mellitus. Inter J Oral & Maxillofac Pathol
before undergoing further treatment. In addition, the 2011; 2(4): 24-27.
examination should be preceded by a history of the disease XII. Owal B , Jorgensen EB, Davenport J, Mushimoto
first, so it can help to determine the appropriate actions for E, Palmqwist S, Rener R, Sofou A. Removable
patients and the process of diagnosis of disorders and partial denture design: A need to focus on hygienic
disorders that occur in the oral cavity. principles? Int J Prosthodon 2002; 15 (4): 371-
378.
CONCLUSION XIII. Loney RW. Removable partial denture manual.
Diabetes Mellitus is a complex disorder that has Canada: Dalhaus University 2011: 4-5.
many problems in the oral and systemic cavities. A multi- XIV. Azevedo A, Machado AL, Vergani CE,
disciplinary approach is essential for the successful Giampaolo ET, Pavarina AC. Hardness of denture
management of diabetes mellitus. RPD construction can be base and hard chair-side reline acrylic resin. J
done after completion of a complete patient evaluation Appl Oral Sci., 2005; 13(3): 291-295.
through the patient's medical history, examination and XV. Negrutiu M, Sinescu C, Romanu M, Pop D,
diagnostic model creation. Before starting the prosthesis- Lakatos S. Thermoplastic resin for flexible
making procedure, the OH of diabetic patients should be framework removable partial dentures. TMJ 2005;
evaluated and should be improved through periodontal 55: 295-299.
therapy and conservative care, in order to support adequate XVI. Kaplan P. Flexible removable partial dentures:
supporting tissue quality. The success of RPD treatment is design and clasp concept. Dentistry Today 2008;
strongly determined by the mastery of theory and good 27: 122-123.
cooperation between dentists and patients. XVII. Rathod N, Pawar S, Naitam DN, Pasam N. Metal
denture base an approach to overcome the failure
REFERENCES of acrylic denture base. IJRID 2015; 5(2): 69-75.
I. Cawson RA & Odell EW. Cawson’s essentials of XVIII. Carr AB, Mc Givney GP, Brown DT. Mc
oral pathology and oral medicine. 7th ed. Edinburg: Cracken’s Removable Partial Prosthodontics, 11th
Churchill-Livingstone 2008: 358, 386. ed., India: Elsevier 2005: 145-162.
II. Wilkins EM. Clinical practice of dental hygienist XIX. Stewart KL, Rudd KD, Kuebker WA. Clinical
10ed. Wolters Kluwer, Philadelphia : Lippincott Removable Partial Prosthodontics, 2nd ed., India:
Williams & Wilkins: 1068-1075, 1079. AIPD 2005: 97-116.
III. Soell M, Hassan M, Milliauskaite A, Haikel Y, XX. Walmsley AD. Acrylic partial dentures. Dent
Selimovick D. The oral cavity of elderly patients Update 2003; 30: 424-429.
in diabetes. Diabetes Metab 2007; 33(1): 10-18. XXI. Davenport JC, Basker RM, Heath JR, Ralph JP &
Glantz PO. Prosthetics: a system of design. BDJ
2000; 189: 586-590.

2104 Volume 04 Issue 11 November 2024 Corresponding Author: Agus Sumono

 Removable Partial-Denture Construction in Patients with Diabetes Mellitu
XXII. Zarb GA, Bolender CL. Prosthodontics treatment partial denture by means of the periotest method. J
for edentulous patients, 12th ed., USA: Mosby Oral Rehabil 2007; 34: 222-227.
2004: 298-328. XXXVI. Kelly E. Changes caused by a mandibular
XXIII. Sykes LM, Sukha A. Potential risk of serious oral removable partial denture opposing a maxillary
infections in the diabetic patient: a clinical report. complete denture. J Prosthet Dent 2003; 90: 213-
J Prosthet Dent 2001; 86: 569-573. 219.
XXIV. Lofty-Kamran MH, Jafari AA, Falah-Tafti A, XXXVII. Piweo warczyk A, Kohler KC, Bender R, Buchler
Tavakoli E, Falahzadeh MH. Candida A, Lauer HC. Prognosis for abutment teeth of
colonization on the denture of diabetic and non- removable dentures; a retrospevtive study. J
diabetic patients. Dent Res J 2009; 6(1): 23-27. Prosthodont 2007;16: 377-382.
XXV. Gugenheimer J, Moore PA, Rossie K, Myers D, XXXVIII. Svanberg GK, King GJ, Gibbs CH. Occlusal
Mongelluzzo MB, Block HM, Weyant R. Insulin cinsiderations in periodontology. Periodontol
dependent diabetes mellitus and oral soft tissue 2000; 9: 106-117.
pathologies: II. Prevalence and characteristics of
Candida and Candidal lesions. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 2000; 89(5): 570-
576.
XXVI. Jorgensen BE, Bochet G, Grundman M. Aesthetic
consideration for the treatment of partially
edentulous patients with removable dentures.
Pract Periodontics Aesthet Dent. 2000; 12 (8):
765-774.
XXVII. Ship JA. Diabetes and oral health: an overview. J
Am Dent Assoc 2003; 134: 410.
XXVIII. Abbas NA, Mousa MM, Nada MA.
Ultrastructural, histological and histochemical
study of denture bearing mucosa of complete
denture with soft liner in diabetic patients. Egypt
Dent J 1987; 33: 5-24.
XXIX. Loe H. Periodontal Disease: the sixtth
complication of diabetes mellitus. Diabetic care
1993; 16(1): 329-334.
XXX. Mc givney GP, Castleberry DJ. Mc cracken’s:
removable partial prosthodontics. 8th ed. St Louis:
Mosby 1989: 1989.
XXXI. Dula LJ, Ahmedi EF, Krasniqi ZDL, Shala KS.
Clinical evaluation of removable partial denture
on the periodontal health: a retrospective study.
The Open Dent J 2015; 9: 132-139.
XXXII. Lee HE, Wu JH, Wang CH. Biochemical analysis
of distal extension removable partial dentures with
different retainers. J Dent Sci 2008; 3: 133-139.
XXXIII. Kapur KK, Deupree R, Dent RJ, Hasse AL. A
randomized clinical trial of two basic removable
partial denture design. Part I: Comparison of five
years success rates and periodontal health. J
Prosthet Dent 1994; 72: 268-282.
XXXIV. Bergman B, Hugoson A, Olson CO. A 25-years
longitudinal study of patients treated with
removable partial dentures. J Oral Rehabil 1995;
22: 595-599.
XXXV. Jorge JH, Giampaolo ET, Vergani CE, Magano
AL, Pavarina AC, Cardoso de Oliveira MR.
Clinical evaluation of abutment teeth of removable

2105 Volume 04 Issue 11 November 2024 Corresponding Author: Agus Sumono