Prosthodontics & Occlusion · patient case question
What would you do to prevent the problem of resorption at the distal abutment?
Patient case: Denosumab, Kennedy Class I RPD with a precision attachment on #21
Scenario: Patient with OSTEOPOROSIS taking DENOSUMAB. Kennedy Class I with a PRECISION ATTACHMENT on tooth #21. The chief complaint involves MOBILITY TYPE 3; the COLD TEST WAS NEGATIVE but the tooth was SENSITIVE TO PERCUSSION. A periapical shows one crown carrying the attachment system, bone resorption to the MIDDLE THIRD of the root, and an inflamed (not infected) periodontal ligament.
Show answer and explanation
Correct answer: A. Splint #21 to #22
- A. Correct per the source key. SPLINTING the terminal abutment to the adjacent tooth distributes the torquing load generated by the distal-extension base across two roots, increasing the effective root surface area and reducing the leverage applied to any single abutment.
- B. Substituting a clasp does not by itself resolve the load concentration on a lone terminal abutment.
- C. Rest position and design matter greatly in distal-extension cases, but simply adding a distal rest on the terminal abutment increases rather than reduces the tipping force — which is why mesial rests are favoured in Class I and II designs.
- D. Relining is essential maintenance in distal-extension RPDs and does reduce tissue-ward settling — but the question asks about preventing abutment resorption, for which splinting is the keyed answer.
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