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Discussing the various space-replacement treatment modalities possible following extraction of an unrestorable upper central incisor

BDJ Student volume 32, pages 121–123 (2025)Cite this article

Insertion of an acrylic immediate partial denture following extraction will aid socket haemostasis, and serve as an aesthetic, space-maintaining, and functional interim replacement while a period of bony healing occurs over three-to-six-months.1 Construction of a permanent replacement will be necessary if a removable partial denture (RPD) is selected as the definitive treatment modality, and a chairside or laboratory reline may also be required during the interim phase. This is to account for the hard and soft tissue remodelling processes that occur following tooth loss, resulting in a significant loss of alveolar ridge volume.2 Although more costly than acrylic and subject to the patient's periodontal health, a cobalt-chrome RPD employs a rigid substructure to gain support from both the hard and soft tissues, utilising rest seats to transmit occlusal loads down the long axis of supporting teeth.3 Cobalt-chrome RPDs may also incorporate a gingivally-free design to minimise plaque accumulation, with no element of the RPD crossing the interproximal gingival margin in accordance with Scandinavian design principles.4 Had it not been deemed unrestorable, elective endodontic treatment of the upper central incisor and its maintenance as an overdenture abutment could also be considered to provide proprioception for increased biting forces, improved denture retention, and contribute to maintaining the alveolar bone.

Learning how to function with an RPD for processes such as mastication and speech can take time to develop neuro-muscular control for. Concerns regarding denture retention coupled with the psychological acceptance of wearing an RPD may be challenging for the patient.5 Furthermore, studies present a strong relationship between RPDs and both root caries and gingival recession associated with abutment teeth, regardless of adequate oral hygiene measures.6 Patient factors, such as a high smile line, also increase the difficulty of achieving an aesthetic result. Retention using ball-ended cribs on maxillary first permanent molars can avoid visible clasping of abutment teeth, and the use of an open-faced, or ‘gum-fit', design will conceal the junction between labial flange and mucosa, provided no significant labial resorption has occurred.7

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  1. Cardiff Dental School, Cardiff, United Kingdom

    Khaleel Jiwa

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  1. Khaleel Jiwa
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Correspondence to Khaleel Jiwa.

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Jiwa, K. Discussing the various space-replacement treatment modalities possible following extraction of an unrestorable upper central incisor. BDJ Student 32, 121–123 (2025). https://doi.org/10.1038/s41406-025-1546-4

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