Nonprecious Alloy vs Precious Alloy Telescopic

Crown–Retained Removable Partial Dentures:

Survival and Maintenance Needs
Karina Zierden, Dr Med Dent1/Luisa Kurzrock, Dr Med Dent2/
Bernd Wöstmann, Prof Dr Med Dent3/Peter Rehmann, Prof Dr Med Dent4

Purpose: The purpose of this retrospective clinical study was to evaluate the clinical outcomes
of nonprecious alloy (NPA) vs precious alloy (PA) telescopic crown–retained removable partial
dentures (TRPDs), the factors influencing survival, and the type and number of maintenance
procedures required during the observation period. Materials and Methods: This
retrospective clinical study is based on 462 patients with a total of 572 TRPDs on a total of
1,946 abutment teeth. The following parameters were analyzed with Kaplan-Meier analysis:
sex; alloy type; denture location; number and distribution of abutment teeth (Kennedy Class);
vitality of abutment teeth; dentition in the opposing arch; and participation in follow-up visits.
Results: The mean observation period was 3.87 ± 3.15 years (2.99 ± 2.52 years for NPA-
TRPDs and 5.36 ± 3.53 years for PA-TRPDs; maximum 11.01 years). During the observation
period, 4.2% (n = 24) of the TRPDs ceased functioning and 8.3% (n = 161) of the abutment
teeth had to be removed. The calculated 5- to 10-year survival probabilities were 96.1% and
84.0%, respectively, for the TRPDs. The number of abutment teeth was the only parameter
that significantly (P < .05) impacted this probability, whereas the vitality of the abutment teeth
and the type of alloy significantly (P < .05) impacted the survival probability of the abutment
teeth. NPA-TRPDs needed significantly earlier initial treatment than PA-TRPDs (P < .05).
Conclusion: The type of alloy seems to have no impact on TRPD survival, but seems to have
an influence on the survival of the abutment teeth. There are also differences in maintenance
between NPA- and PA-TRPDs. Int J Prosthodont 2018;31:459–464. doi: 10.11607/ijp.5820

N owadays, more and more people aged 65 years

and above are partially edentulous. Due to better
prophylactic programs, people are able to keep their
their rigid connection to the abutment teeth and their
primarily axial loading. However, it is precisely because
of this rigid connection that there is an increased risk
natural teeth for longer; therefore, more people in for tooth fracture.10 The treatment and laboratory pro-
this age require partial dentures. Telescopic crown– cedures are also demanding,3,7,11 resulting in higher
retained removable partial dentures (TRPDs) are a costs for the patients. Apart from their rather com-
well-established treatment option for restoring patients mon need for maintenance measures,5,13–17 TRPDs of-
with a residual dentition,1–20 especially in Germany (ie, fer high oral comfort for patients.18 Implant-supported
“German crowns”). Parallel-sided or conical-shaped dentures, as well as removable partial dentures
inner and outer crowns are primarily used; in the lat- (RPDs) with metal clasps, show good survival rates
ter group, the degree of taper is kept within a defined nearly comparable with those of TRPDs17,19,23 and are
range of inclination.12 TRPDs are tooth-preserving be- therefore a reliable treatment option for patients with
cause they reduce any existing tooth mobility9 due to a reduced dentition. Even though RPDs with metal
clasps are slightly lower in oral comfort compared to
TRPDs or implant-supported dentures, they still offer
1Assistant,Department of Prosthodontics, Dental Clinic,
functional denture stability, as well as good retention
Justus-Liebig-University, Giessen, Germany.
2Private Practice, Nordrhein-Westfalen, Germany. and satisfactory esthetic results.23
3Professor and Chairman, Department of Prosthodontics,

Dental Clinic, Justus-Liebig-University, Giessen, Germany.

4Assistant Professor, Department of Prosthodontics, Dental Clinic,
T he request for cost-effective dental prostheses
has moved increasingly into focus. Therefore, it is
desirable to keep the manufacturing costs of dental
Justus-Liebig-University, Giessen, Germany.
prostheses as low as possible by using nonprecious
Correspondence to: Dr Karina Zierden, Department of Prosthodontics, alloys (NPAs) instead of precious alloys (PAs). NPAs
School of Dental Medicine, Justus-Liebig-University, Schlangenzahl 14, are tooth-friendly due to low thermal conductivity and
35392 Giessen, Germany. Fax: +49 641 99 46 139.
high hardness values, which allow a minimal material
Email: karina.zierden@dentist.med.uni-giessen.de
thickness, and are more cost effective. However, the
©2018 by Quintessence Publishing Co Inc. manufacturing of NPA-TRPDs is more complicated

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Survival Rates and Maintenance Needs of NPA- vs PA-TRPDs

Table 1   N
 umber of TRPDs Categorized by Number of Abutment Teeth
No. of abutment teeth 1 2 3 4 5 6 7 8
No. of TRPDs (total n = 572) 21 125 173 130 79 35 8 1

Table 2   N
 umber of TRPDs Categorized by Years Under Observation
Time (y) 1 2 3 4 5 6 7 8 9 10
No. of TRPDs under observation (total n = 572) 572 447 356 281 230 190 154 126 81 44

because NPAs are more rigid (230 to 430 HV) in com- available (variable: vitality of abutment teeth). The
parison to PAs (50 to 300 HV). Due to these material variable number of abutment teeth is shown in Table 1.
properties, it is more difficult to achieve acceptable All patients with a residual dentition were offered
retention between primary and secondary crowns treatment with either TRPDs or RPDs with metal
when manufacturing NPA-TRPDs. clasps. As in Germany, TRPDs are a standard treat-
Nevertheless, no information has been found re- ment option for patients with three or less remaining
garding whether NPA-TRPDs show results compa- teeth per arch, whereas patients with more than three
rable with those of PA-TRPDs. Thus, it was the aim remaining teeth per arch often receive RPDs with
of the present study to evaluate possible differences metal clasps, often because of the costs. The TRPDs
between NPA-TRPDs and PA-TRPDs regarding needs were delivered as part of the clinical courses taught
for maintenance and clinical performance. The follow- in the department under the strict supervision of ex-
ing null hypothesis was tested: the (1) survival rates perienced full-time teachers following a standardized
and (2) maintenance needs would not differ between protocol. The patients individually decided whether to
NPA-TRPDs and PA-TRPDs. receive an NPA-TRPD or PA-TRPD; the costs were the
most decisive factor for most of the patients. All TRPDs
Materials and Methods were fabricated in the same dental laboratory. After
incorporation of the TRPDs, all patients were asked to
The data of 637 patients who received TRPDs at participate in a continuous annual follow-up program.
the Department of Prosthodontics, Justus-Liebig- The statistical analysis was performed using a
University, Giessen, Germany, between 2004 and 2015 Kaplan-Meier estimate with 95% confidence intervals
were included in this study. Patients with dental im- (CIs) for survival analysis. Survival was defined as the
plants (n = 152) or maxillary defects after oral cancer time between incorporation (start point value) of the
surgery (n = 9), patients who never showed up after TRPDs and the time the TRPDs had to be renewed
denture placement (n = 8), and cases in which the (end point value). Maintenance was defined as ini-
data about the type of alloy were missing (n = 6) were tial adjustments directly following denture insertion
excluded from the study. This resulted in a conve- and maintenance needs during the functional period
nience sample of 462 patients (209 women, 253 men; starting 30 days after insertion.
mean age 61.5 ± 10.0 years) who received 572 TRPDs The variables of sex, denture location, number and
on a total of 1,946 abutment teeth. distribution (Kennedy Class) of abutment teeth, vital-
A total of 259 TRPDs were placed in the maxilla, and ity of abutment teeth, type of alloy, dentition in the
313 were placed in the mandible (variable: denture lo- opposing arch, and participation in follow-up visits
cation). Kennedy Class was used to measure the vari- were analyzed as covariates of the survival function
able number and distribution of abutment teeth; 479 (log rank test, P < .05). Additionally, a Cox regression
of the arches were classified as Kennedy Class I, 79 as was carried out to analyze the impact of the covariates
Kennedy Class II, and 14 as Kennedy Class III. A total on the survival probability and to calculate the hazard
of 360 of the TRPDs were manufactured with NPAs ratio (HR) for the risk of TRPD ceasing function.
and 212 with PAs (variable: type of alloy). Regarding This study was approved by the ethics committee of
the variable opposing dentition, 231 of the patients the Justus-Liebig-University, Giessen, Germany (Reg
had combined dentures with fixed and removable No.164/11) and registered in the German Clinical Trials
parts opposing the restoration area, 165 had remov- Register (DRKS-ID: DRKS00009701).
able dentures, 120 had fixed partial dentures, 42 had
no dental prosthesis or natural dentition, and 14 had Results
implant-supported prostheses.
There were 1,473 abutment teeth that showed vi- The mean observation time was 3.87 ± 3.15 years (2.99
tality, 249 treated by root canal (145 of these teeth ± 2.52 years for NPA-TRPDs and 5.36 ± 3.53 for PA-
were treated with a metal core), and 224 with no data TRPDs; maximum 11.01 years). The number of TRPDs

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 Zierden et al

1.0 Survival
Censored 1.0

0.8 0.8
Cumulative survival

Cumulative survival
0.6 0.6

0.4 0.4
1
2
3
0.2 0.2 4
Censored
Censored
Censored
0.0 0.0 Censored

0 2 4 6 8 10 12 0 2 4 6 8 10 12
Time (y) Time (y)

Fig 1   Outcome probability of all TRPDs (target event: renewal; n = Fig 2   Outcome probability of all TRPDs dependent on the number of
572; Kaplan-Meier). abutment teeth (target event: renewal; n = 572; Kaplan-Meier).

remaining at risk after a specific observation period is

1.0 Survival
shown in Table 2. During the observation period, 4.2% Censored
(n = 24) of the TRPDs ceased functioning, and 8.3%
(n = 161) of the abutment teeth were removed. 0.8
Cumulative survival
Survival of TRPDs 0.6

The mean ± standard deviation (SD) expected survival 0.4

time of the TRPDs was calculated to be 10.31 ± 0.14
years (95% CI: 10.04 to 10.57). The outcome probability 0.2
for all TRPDs was 96.1% after 5 years and 84.0% after
10 years (Fig 1). The reasons for renewal were loss of 0.0
abutment teeth (n = 20) and technical failures (n = 4).
0 2 4 6 8 10 12
The number of abutment teeth was the only pa- Time (y)
rameter influencing TRPD survival that was signifi-
Fig 3   Outcome probability of all abutment teeth (target event: tooth
cant (P < .05). Thus, TRPDs with one abutment tooth loss; n = 1,946; Kaplan-Meier).
(n = 21) showed a significantly lower mean survival
time, which was 7.67 ± 0.62 years (95% CI: 6.45 to 8.88
years), in contrast to TRPDs with three abutment teeth survival time of 9.33 ± 0.17 years (95% CI: 8.99 to
(n = 173), which was 10.55 ± 0.16 years (95% CI: 10.24 9.67 years) in contrast to abutments with PA primary
to 10.86 years) (Fig 2). None of the other parameters crowns (n = 716), which showed a mean survival time
showed any significant impact (P > .05) on the final of 10.01 ± 0.12 years (95% CI: 9.78 to 10.24 years) (Fig
clinical outcome. Thus, part one of the null hypothesis 4). Cox regression showed that abutment teeth with
could not be rejected. NPA-TRPDs had a significantly higher risk for remov-
al in comparison to abutment teeth with PA-TRPDs
Survival of Abutment Teeth (HR: 2.04).
A significant difference (P < .01) was observed
The expected survival time of the abutment teeth was between mean survival time of vital abutment teeth
calculated to be 9.79 ± 0.10 years (95% CI: 9.60 to 9.99 (n = 1,473), which was 9.91 ± 0.10 years (95% CI: 9.71
years). The outcome probability for all abutment teeth to 10.10), and that of endodontically treated abut-
was 92.0% after 5 years and 68.9% after 10 years (Fig ment teeth with post-and-core buildups (n = 145;
3). A total of 8.3% (n = 161) of the abutment teeth were 9.21 ± 0.31 years [95% CI: 8.59 to 9.83]) and those
removed during the observation period. The reasons without post-and-core buildups (n = 104; 8.34 ± 0.46
for removal were: periodontal disease (n = 83), frac- years [95% CI: 7.43 to 9.26]) (Fig 5). Cox regression
ture of the abutment teeth (n = 57), and decay (n = 21). also showed a significantly higher risk for removal of
The type of alloy showed a significant impact on the endodontically treated abutment teeth without post-
survival of the abutment teeth (P < .05). Abutments and-core buildups in comparison to vital abutment
with NPA primary crowns (n = 1,430) showed a mean teeth (HR: 2.9).

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Survival Rates and Maintenance Needs of NPA- vs PA-TRPDs

1.0
1.0

0.8
0.8
Cumulative survival

Cumulative survival
0.6 0.6

0.4 0.4
Vital
0.2 0.2 Endodontically treated with post-and-core build-up
NPA
PA Endodontically treated
NPA censored Censored
0.0 PA censored 0.0 Censored
Censored
0 2 4 6 8 10 12 0 2 4 6 8 10 12
Time (y) Time (y)

Fig 4   Outcome probability of all abutment teeth dependent on the Fig 5   Outcome probability of all abutment teeth dependent on abut-
type of alloy (target event: tooth loss; n = 1,946; Kaplan-Meier). ment tooth vitality (target event: tooth loss; n = 1,946; Kaplan-Meier).

Table 3   Initial Maintenance Interventions Categorized by Type of Alloy (n = 600)

No. of necessary interventions
Intervention NPA PA Total %
TRPDs
  Removal of pressure spots 119 80 199 33.2
  Adjustment of retention (lowering) 95 15 110 18.3
  Adjustment/correction of occlusion 56 52 108 10.0
  Adjustment/repair of acrylic material 27 26 53 8.8
 Relining 14 17 31 5.2
  New veneering of secondary crown 8 17 25 4.2
  Adjustment of retention (increasing) 6 1 7 1.2
  Repair of metal framework 0 1 1 0.2
Abutment teeth
  Recementation of primary crowns 32 17 49 8.2
  Insertion of dental core 7 5 12 2
  Manufacturing of new primary crowns 2 3 5 0.8
Total 366 234 600 100

Maintenance Needs maintenance more often than NPA-TRPDs. Thus, part

two of the null hypothesis could be rejected.
Almost all dentures (n = 488) needed initial adaptation None of the parameters analyzed showed a signifi-
and/or later maintenance. The most frequent initial cant impact on maintenance needs.
treatment was the removal of pressure spots (33.1%),
followed by adaptation (lowering) of retention in the Discussion
NPA group (25.9%); this was only necessary in 6.3% of
the PA group (P < .05) (Table 3). NPA-TRPDs needed Using a retrospective longitudinal study design,
significantly earlier initial treatment than PA-TRPDs this study aimed to evaluate the survival probabil-
(0.038 ± 0.007 years [~14 days] vs 0.151 ± 0.110 years ity and maintenance needs of NPA- and PA-TRPDs.
[~55 days], respectively). Also, dentures located in the Retrospective studies have natural shortcomings, as
mandible needed earlier initial treatment compared to they must rely on the data available; nevertheless,
those in the maxilla (0.036 ± 0.005 [~13 days] vs 0.307 they are helpful as long as data of higher evidence (eg,
± 0.099 years [~112 days], respectively). RCTs) are missing. This applies to the topic investi-
During the functional period, the first maintenance gated in the currenty study in particular. The differing
was necessary after a mean time of 2.27 ± 0.13 years. group sizes (NPA-TRPDs = 360; PA-TRPDs = 212) and
The most frequent reasons for maintenance dur- the differing mean observation periods (2.99 ± 2.52
ing the functional period were removal of pressure years for NPA-TRPDs and 5.36 ± 3.53 years for PA-
spots (19.0%); adjustment/correction of the occlusion TRPDs) could be seen as methodical difficulties and
(13.3%); recementation of the primary crowns (13.1%); therefore as weaknesses of the study. Furthermore,
and relining (12.5%) (Table 4). PA-TRPDs needed it would have been desirable to include other clinical

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 Zierden et al

Table 4   Maintenance Interventions During Period of Function Categorized by Type of Alloy
No. of necessary interventions
Intervention NPA PA Total %
TRPDs
  Removal of pressure spots 211 246 457 19.0
  Adjustment/correction of occlusion 133 188 321 13.3
 Relining 118 183 301 12.5
  Adjustment/repair of acrylic material 121 137 258 10.7
  New veneering of secondary crown 102 138 240 10.0
  Adjustment of retention (lowering) 112 27 139 5.8
  Repair of metal framework 57 45 102 4.3
  Adjustment of retention (increasing) 33 68 101 4.2
  Renewal of metal framework 16 26 42 1.7
Abutment teeth
  Recementation of primary crowns 160 156 316 13.1
  Insertion of a dental core 68 48 116 4.8
  Manufacturing of new primary crowns 9 5 14 0.6
Total 1,140 1,267 2,407 100.0

data (eg, periodontal parameters) in the study; un- abutment teeth for TRPDs, they should be treated
forutnately, the data available were inconsistent in this with a post-and-core build-up to achieve better sur-
regard. Nevertheless, a high degree of reproducibility vival rates for the TRPDs.
was guaranteed by the use of standard treatment pro- TRPDs with less than three abutment teeth showed
tocols for the fabrication of all TRPDs, as well as by a lower survival rate than TRPDs with three or more
the utilization of standardized documentation forms, abutment teeth, which is also presumed in other stud-
which are part of a computerized database software. ies,4,7,13,17 although there are others that have shown
Moreover, a modified Kaplan-Meier estimate specially contrary results.3,12,22 Nevertheless, TRPDs with only
designed for this type of study design was used to one abutment tooth still offer a higher oral comfort in
increase the reliability of the results.24 comparison to full dentures, and their mean survival
The calculated 5- and 10-year survival rates for time (7.67 ± 0.62 years) is sufficient. Therefore, they
NPA-TRPDs (95.9%) and for PA-TRPDs (96.5%; should be considered a treatment option for elderly
P > .05) in the present study are comparable with patients with a reduced dentition because they can
other publications.1–23 The calculated extraction rate be modified stepwise into a full denture, which is also
for the abutment teeth (8.3%) and the reasons for cost effective.
removal correspond to the data found in the litera- Nearly all of the observed TRPDs needed some kind
ture.6,8,9,13,20,22,23 The extraction rate is a good number, of maintenance procedure; thus, the need for mainte-
especially when considering that teeth with a critical nance was a bit higher in the present study compared
prognosis (eg, with a reduced periodontium) are often to the literature.3,6,7,14,15,16 The most common mainte-
used as abutment teeth for TRPDs.16 nance procedure was the removal of pressure spots,
Although the type of alloy showed no significant followed by recementation of primary crowns, adjust-
impact on TRPD survival (P > .05), it did have an ment/correction of the occlusion, and relining. These
impact on the survival of abutment teeth (P < .05). results are comparable with other studies.7,14,15
Despite the fact that abutment teeth with NPA-TRPDs More maintenance was necessary for PA-TRPDs.
showed a lower 10-year survival rate in comparison to It was apparent that NPA-TRPDs needed a reduction
abutment teeth with PA-TRPDs (67.7% vs 71.8%, re- of friction more often, whereas PA-TRPDs needed
spectively; P = .004), the use of NPA-TRPDs cannot be increasing of the friction. This might be explained by
advised against in general,8 as this result could be ex- their differing material properties and the technical
plained by the fact that there were differences in the problems resulting from trying to set an acceptable
mean observation time and in group sizes. The fact retention between primary and secondary crowns, es-
that vital abutment teeth showed a significantly higher pecially for the NPA-TRPDs. During the adaptation pe-
survival rate in comparison to endodontically treated riod, 79.1% of the necessary measurements could be
abutment teeth (P = .001) has also been documented carried out by the dentists themselves, whereas during
in other studies.3,4,7,11,21,22 The use of endodontically the period of function, 50% of the necessary mainte-
treated teeth as abutment teeth for TRPDs should nance measurements had to be carried out by dental
therefore be considered critically, especially with re- laboratories, which results in extra costs. Initial adap-
gard to the cost-benefit relationship. However, should tation was necessary earlier in NPA-TRPDs (13 days vs
successful endodontically treated teeth be used as 106 days for PA-TRPDs) and in dentures located in the

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Survival Rates and Maintenance Needs of NPA- vs PA-TRPDs

mandible (14 days vs 112 days for TRPDs in the maxilla);  5. Behr M, Kolbeck C, Lang R, Hahnel S, Dirschl L, Handel G.
a reason for this could be that nearly 26% of the NPA- Clinical performance of cements as luting agents for telescopic
double crown-retained removable partial and complete over-
TRPDs needed a reduction in retention for initial adap-
dentures. Int J Prosthodont 2009;22:479–487.
tation due to their material properties and the resulting   6. Saito M, Notani K, Miura Y, Kawasaki T. Complications and fail-
difficulties setting an acceptable retention. During the ures in removable partial dentures: A clinical evaluation. J Oral
period of function, only the variable opposing dentition Rehabil 2002;29:627–633.
seemed to influence the maintenance need. Therefore,  7. Wöstmann B, Balkenhol M, Weber A, Ferger P, Rehmann P.
Long-term analysis of telescopic crown retained removable
fixed dental prostheses and natural teeth as opposing partial dentures: Survival and need for maintenance. J Dent
dentition caused an earlier need for maintenance than 2007;35:939–945.
removable dental prostheses. This might be caused by  8. Coca I, Lotzmann U, Pöggeler R. Long-term experience with
the fact that patients with fixed dental prostheses or telescopically retained overdentures (double crown technique).
Eur J Prosthodont Restor Dent 2000;8:33–37.
natural teeth achieve higher chewing forces than pa-  9. Bergman B, Ericson A, Molin M. Long-term clinical results
tients with removable dentures. Further studies based after treatment with conical crown-retained dentures. Int J
on a higher level of evidence are needed to validate Prosthodont 1996;9:533–538.
the outcomes of this treatment modality. 10. Wenz HJ, Hertrampf K, Lehmann KM. Clinical longevity of
removable partial dentures retained by telescopic crowns:
Outcome of the double crown with clearance fit. Int J
Conclusions Prosthodont 2001;14:207–213.
11. Koller B, Att W, Strub JR. Survival rates of teeth, implants, and
Within the limitations of this retrospective study, it double crown-retained removable dental prostheses: A sys-
can be concluded that NPA-TRPDs are a viable alter- tematic literature review. Int J Prosthodont 2011;24:109–117.
12. Wenz HJ, Lehmann KM. A telescopic crown concept for the
native to PA-TRPDs in clinical use. The type of alloy restoration of the partially edentulous arch: The Marburg dou-
seems to have no significant influence on the sur- ble crown system. Int J Prosthodont 1998;11:541–550.
vival of the TRPDs, but did show a considerable im- 13. Eisenburger M, Gray G, Tschernitschek H. Long-term results of
pact on the long-term success of the abutment teeth. telescopic crown retained dentures—A retrospective study. Eur
J Prosthodont Restor Dent 2000;8:87–91.
Though PA-TRPDs showed a slightly higher need for 14. Hofmann E, Behr M, Handel G. Frequency and costs of tech-
maintenance in comparison to NPA-TRPDs, most of nical failures of clasp- and double crown-retained removable
this maintenance could be carried out by the dentists partial dentures. Clin Oral Investig 2002;6:104–108.
themselves and therefore did not incur any extra costs. 15. Behr M, Hofmann E, Rosentritt M, Lang R, Handel G. Technical
failure rates of double crown-retained removable partial den-
According to the cost-benefit relation of both alloys
tures. Clin Oral Investig 2000;4:87–90.
(PA and NPA), the use of NPA rather than PA saves 16. Widbom T, Löfquist L, Widbom C, Söderfeldt B, Kronström M.
nearly 40% of the costs; thus, in the clinical situation of Tooth-supported telescopic crown-retained dentures: An up to
a partial dentition with three remaining teeth, the use 9-year retrospective clinical follow-up study. Int J Prosthodont
of NPA should be preferred. 2004;17:29–34.
17. Zitzmann NU, Rohner U, Weiger R, Krastl G. When to choose
which retention element to use for removable dental prosthe-
Acknowledgments ses. Int J Prosthodont 2009;22:161–167.
18. Grossmann AC, Hassel AJ, Schilling O, Lehmann F, Koob A,
The authors would like to thank Dr Hermann for performing the Rammelsberg P. Treatment with double crown-retained re-
statistical analysis and his statistical advice. The authors report no movable partial dentures and oral health-related quality of life
conflicts of interest related to this study. in middle- and high-aged patients. Int J Prosthodont 2007;20:
576–578.
19. Rehmann P, Rudel K, Podhorsky A, Wöstmann B. Three-year
References analysis of fixed and removable telescopic attachment-retained
implant-supported dental prostheses: Survival and need for
maintenance. Int J Oral Maxillofac Implants 2015;30:918–924.
  1. Schwarz S, Bernhart G, Hassel AJ, Rammelsberg P. Survival of 20. Hultén J, Tillström B, Nilner K. Long term clinical evaluation of
double-crown-retained dentures either tooth-implant or solely conical crown retained dentures. Swed Dent J 1993;17:225–234.
implant-supported: An 8-year retrospective study. Clin Implant 21. Piwowarczyk A, Köhler KC, Bender R, Büchler A, Lauer HC, Ottl
Dent Relat Res 2014;16:618–625. P. Prognosis for abutment teeth of removable dentures: A retro-
 2. Schwindling FS, Dittmann B, Rammelsberg P. Double-crown- spective study. J Prosthodont 2007;16:377–382.
retained removable dental prostheses: A retrospective study of 22. Dittmann B, Rammelsberg P. Survival of abtument teeth used
survival and complications. J Prosthet Dent 2014;112:488–493. for telescopic abutment retainers in removable partial dentures.
 3. Stober T, Bermejo JL, Beck-Mussoter J, et al. Clinical perfor- Int J Prosthodont 2008;21:319–321.
mance of conical and electroplated telescopic double crown- 23. Rehmann P, Orbach K, Ferger P, Wöstmann B. Treatment out-
retained partial dentures: A randomized clinical study. Int J comes with removable partial dentures: A retrospective analy-
Prosthodont 2012;25:209–216. sis. Int J Prosthodont 2013;26:147–150.
  4. Szentpetery V, Lautenschlager C, Setz JM. Frictional telescopic 24. Lucarotti PS, Holder RL, Burke FJ. Analysis of an administra-
crowns in severely reduced dentitions: A 5-year clinical out- tive database of half a million restorations over 11 years. J Dent
come study. Int J Prosthodont 2012;25:217–220. 2005;33:791–803.

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