successful of prosthodontic treatment is determined by the sound teeth and
periodontal tissue. A conventional denture fabrication in patient with
periodontal disease lead to lack of retention and stability. Therefore, a
special denture designs such as swing lock are needed to overcome this problem.
Swing lock prosthesis is a frame removable partial denture, consist of buccal
hinge or labial bar which attached to framework by hinge mechanism at one of
the end that allow it to open and close, while the other end work as lock
mechanism. This prosthesis can be used for partial edentulous condition which
use some or all teeth surfaces and undercuts for its optimum retention and
stability. This case will discuss about swing lock design for removable partial
denture in patient with periodontal disease. It can be concluded that swing
lock design in patient with periodontal disease would maintain periodontal
tissue and improve its retention and stability.
swing-lock, removable partial denture, periodontal disease
and prosthetic can not be separated from periodontal tissue health. Considering
assessment of periodontal tissue is important before fabrication of removable
partial denture, since periodontal disease often lead to problem of making a
prosthesis.1When gingivitis or periodontitis are found in oral
cavity, a preliminary treatment should be done before prosthesis is made.
Severe periodontal disease often lead to lack of supporting tissue which cause
the missing of teeth.2
loss cause an uncomfortable, inferior mastication function, disturbed
pronounciation, and inferior esthetic for patients which lead to lack of
confident, especially in patients with anterior tooth loss. This can be
overcome by using a removable partial denture.3
removable partial denture fabrication should concern about condition of natural
teeth and periodontal tissue. The relationship between teeth and periodontal
tissue cannot be separated. Periodontal disease can affect stability and
retention of conventional removable partial denture. Furthermore, it can reduce
periodontal tissue health.4
lock removable partial dentures in patient with periodontal disease first
introduced by Simmon in 1963, which first recognized by Ackerman as
maxillofacial prosthesis in patient who had a maxillofacial cancer surgery. 5,6
disease represents a group or condition which cause inflammation and damage of
gingival, periodontal, cementum, or even alveolar bone. Periodontal disease is
an inflammation and recession in gingival and periodontal. Prayitno11
said that periodontal disease is a group of lesion in tissue around teeth which
support the teeth in its socket.7
of periodontal disease consist of local and systemic factors. Local factor is
occur in tissue around the teeth, while systemic factor related to gingival and
general condition.12 Local factor causing inflammation which is the
main pathology process of periodontal disease, while systemic factor control
tissue response to local factor. Therefore, the effects of these factors are
relate to one another.7,8
its primary factor as an etiology of periodontal disease, secondary factor
affects its primary factor, which has a role in periodontal disease. Frame
removable partial denture is a secondary factor which affects in plaque
accumulation on tooth surface. The using of prosthesis would affect periodontal
removable partial denture introduced by Ackerman in 1955, Simmons in 1963,
Brown in 1970, and Stewart et al in 1983.5Swing lock prosthesis is a
frame removable partial denture, consist of buccal hinge or labial bar which
attached to framework by hinge mechanism at one of the end that allow it to
open and close, while the other end work as lock mechanism.9This
prosthesis can be used for partial edentulous condition which use some or all
teeth surfaces and undercuts for its optimum retention and stability. There are
some indications of designing swing-lock in patient with partial edentulous,
such as there are only some natural teeth for conventional removable partial
denture, lack of support from the main abutment, inappropriate position of
abutment, and lack of retention and stability.9This type of denture
also support mobile teeth as a splint. Veneer resin which place on labial arm
are esthetically cover the recession area.10
36 – year –old woman came to a dental hospital and asked for fabrication of new
removable partial denture because her loose-fitting denture. Extraoral
examination showed a normal facial profile, tapered face shape, symmetric eyes,
nose, and ears, no TMD, and no other abnormalities. Intraoral examination
showed no occlusion, U-shaped hard palate, a moderate depth of maxilla and
mandibular vestibulum, normal relationship of maxilla and mandibular, U-shaped
maxilla ridge, knife edge shaped mandibular anterior and right posterior ridge,
and knife edge shaped and flat mandibular left posterior ridge.
1. Panoramic Radiograph
Some root remains
Generally loss of alveolar bone
One third root apically embedded in alveolar
Picture 2. a. Maxillary full
denture, b. Swing-lock precision attachment with I bar on 31, 32, 41, and 42.
impression of maxilla and mandibular with mucostatic or non pressure impression
Picture 3. Impression and
individual tray (autopolimerized acrylic)
Remove some parts of tray which cover the flabby
tissue, so that window shaped exposed (window technique). Make some holes at
tray to allow the impression material out of the tray.
Picture 4. Individual Tray
Border molding of maxillary and mandibulary
individual tray using low fusing compound (green
5. Border Molding
Impression of maxilla and mandibular arch using
an elastomer impression material.
Picture 6. Impression
Working cast à laboratory
partial denture try in for mandibular
Picture 7. Metal Frame
Bite rim fabrication for maxillary and
Determination of alignment, vertical dimension
of occlusion, dan rest position.
Picture 8. Determination of
alignment, VDO, and rest position.
Arrangement of artificial maxillary anterior
teeth. Overbite 0 mm, overjet 2 mm.
inmaxillary anterior teeth.
Arrangement of artificial maxillary posterior
teeth with linguolized occlusion.
inmaxillary posterior teeth
Insertion of Maxillary and mandibulary dentures
hours after insertion. Control of mucosal condition
Picture 9. Insertion
Picture 10. After Insertion
maxillary full denture and removable frame partial denture with swing lock
design were fabricated for this patient, periodontal disease would not provide
an optimal support for the prosthesis, therefore, swing lock design was made to
provide an economical properties. Crown or splint were not needed to support
the periodontal tissue, especially for Class I and II Kennedy with anterior
principal, practice, and design of RPD which applied to swing lock prosthesis
would support the natural teeth with periodontal disease that admit occlusal
loading from retentive labial strut contact and lingual plate on antagonist
prosthesis for patient with periodontal disease provide a superior prognosis.
The design would maintain periodontal condition and provide well retention and
S, S Orlando. Association between dental prosthesis and periodontal disease in
a rural Brazilian Community. Brazillian Journal Oral Science. 2006;
J. The role of dental calculus and other local predisposing factors In:
Carranza clinical periodontology. 11ed. Philadelphia: W B Saunders Co; 2012: H.
Mazurat NM, Mazurat RD. Discuss before fabricating: communicating the realities
of partial denture therapy, part I: patient expectation. J Can Dent Assoc 2003;
Petridis Haralambos, Hempton TJ. Periodontal consideration in removable partial
denture treatment: a review of the literature. Int J Prosthodont 2001; 14(2):
5. Simmons JI. Swing-lock stabilisation and retention, A
preliminary clinical report. Tex Dent J 1963;81: 10-2
6. Ackerman AJ. The prosthetic management of oral and facial
defect following cancer surgery. J Prosthet Dent 1955; 5: 413-32
Loney RW. Removable Partial DentureManual. 2011; 1-71.
Jorge JH, Quishida CCC, Vergani CE, Machado AL, Pavarina AC, Giampaolo ET.
Clinical evaluation of failures in removable partial dentures. Journal of Oral
Science. 2012; 54(4): 337-342.
9. Jones JD, Garcia LT. Removable partial denture a
clinician’s guide. Philadelphia: Wiley-blackwell; 2009. p.166-9
10. Barker D, Cooper A. A novel use of a unilateral hinged
partial denture. Br Dent J 2006; 201(9):571-3
11. Antos EW, Renner RP, Foerth D. The
Swing-Lock partial denture: An Alternatif approach to conventional removable
partial denture service. The Journal Of Prosthetic Dentistry. The C.V. Mosby