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 ( ISSN: 2814-2098 )                                                                       RATSIMANDRESY NAOMY NAMBOARINTSOA
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https://ijojournals.com/                                                                              Volume 08 || Issue 03 || March, 2025 || 

 

 

 

  

Authors : Ratsimandresy Naomy Namboarintsoa1, Razanadraisoa Albertine1,  Rabarijaona 

Haritiana Sergio Nicko1,  Lalanirina Gaël Lauricia1, Nambininarivo Fitiavantsoa Antsatiana2, 

Andrianasolo VV1, Ralaiarimanana Liantsoa Fanja Emmanuel1. 

1 Dental Prosthetics Section at Institut d’Odonto-Stomatologie Tropicale de Madagascar 

(IOSTM) – University of Mahajanga Madagascar 

2 Private dental surgery in Mahajanga Madagascar 

Corresponding author: Ratsimandresy Naomy Namboarintsoa, Dental Prosthetics Section at 

Institut  

d’Odonto-Stomatologie Tropicale de Madagascar (IOSTM) – University of Mahajanga 

Madagascar IOSTM, PB : 98 

 

ABSTRACT 

The metal partial denture (MPD) is defined as a metal device that restores a partially 

edentulous arch. It provides dual support for hard (dental) and soft (mucosal) tissues. The aim 

of this study was to identify the sources of imbalance in the MPD. 

An analytical study of 92 practitioners in Antananarivo and Mahajanga, making dental 

prostheses was carried out in 2023.  

It was shown that 38% of the practitioners surveyed had already experienced prosthetic 

instability at least once. 

Several factors were found to be responsible for this imbalance in the MPD, such as: 

professional status (p=0.02), number of years in practice (p=0.001), practitioners not casting the 

model (p=0.002), not having a paralleling machine in the dental practice (p=0.001), not tracing 

the framework (p=0.01), and so on.  

“FACTORS LEADING TO IMBALANCE IN REMOVABLE PARTIAL METAL PROSTHESES IN ANTANANARIVO AND MAHAJANGA MADAGASCAR."

FACTORS LEADING TO IMBALANCE IN REMOVABLE PARTIAL METAL 

PROSTHESES IN ANTANANARIVO AND MAHAJANGA MADAGASCAR

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                       RATSIMANDRESY NAOMY NAMBOARINTSOA
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https://ijojournals.com/                                                                              Volume 08 || Issue 03 || March, 2025 || 

 

 

 

 

 

 

 

  

 

 

 

 

  

 

“FACTORS LEADING TO IMBALANCE IN REMOVABLE PARTIAL METAL PROSTHESES IN ANTANANARIVO AND MAHAJANGA ADAGASCAR."

In the future, in order to improve the analysis, the sample should be extended to make it more 

representative.

Key words: Retention, stabilisation, sustentation, metal partial denture

Introduction

  Despite  constant  developments  in  fixed  and  implant  prosthetics,  the  removable metal  

partial dentures (RMPD)  remains  a  useful  and  necessary  treatment  option  for  many  of  our  

patients,  particularly  those  with  limited  financial  resources  [1,  2,  3].  However,  several  clinical  

studies have highlighted the high failure rate of MPD, notably due to a lack of retention and the  

presence  of  deleterious  effects  on  the  teeth  supporting  the  clasps  [4,5].  This  is  why  the  

prognosis of MPD depends on the prosthetic design carried out by the practitioner.

Practitioners must rationally manage the complexity of the clinical situation in order to obtain  

an  optimal  prosthetic  design  that  meets  the  requirements  of  the  Housset  triad:  retention,

support and stabilisation [6-8].

  Retention is the action that opposes the vertical forces that tend to move the prosthesis  

away from its bearing surfaces. Sustentation is the action that opposes the vertical forces that  

tend  to push  the prosthesis  away from  the bearing  surfaces.  Finally,  stabilisation  is  the  action  

that  counteracts  the  horizontal  rotational  forces  to  which  the  prosthesis  is  subjected.  These  

three  criteria  apply  to  all  types  of  prosthetic  restoration  but  take  on  particular  importance  in  

partial  removable  prostheses, which  are  more  exposed  to  the  various  factors  of  imbalance.

Ensuring  the  stabilitý and  oral  integration  of  a  MPD involves  finding  a  satisfactory  balance  

between these three principles. If one of them is not ensured, this compromises the ac�on of  

the  other  two: it  is  the  balance  and  therefore  the  durabilitý  of  the  prosthesis  that  risks  being  

compromised. Hence  the  interest  of  the  present  study  with  the  objective  of  determining  the  

factors of MPD imbalance.

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                       RATSIMANDRESY NAOMY NAMBOARINTSOA
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https://ijojournals.com/                                                                              Volume 08 || Issue 03 || March, 2025 || 

 

 

 

 

 

  

  

 

 

  

socio-professional characteristics  n % 

Gender   

Male 62 67.4  

Female 30 32.6 

Professional    

General practitionner 80 87,0 

Specialist 12 13,0 

Number of years of service   

Less than or equal to 15 years 48 52,2 

16 and over 44 47,8 

Total 92 100,0 

 

Sex ratio = 2.07 

“FACTORS LEADING TO IMBALANCE IN REMOVABLE PARTIAL METAL PROSTHESES IN ANTANANARIVO AND MAHAJANGA MADAGASCAR."

Material and methods

  This study  was carried  out  in dental  surgeries in the  city of  Antananarivo, Madagascar,

among 92 practitioners making dental prostheses. This was a cross-sectional analytical study.

Apart  from  the  socio-professional  profile  of  the  practitioners,  the  variables linked  to  the 

different stages in the production of the MPD were studied. Practitioners were asked whether 

they had ever had a case of prosthetic imbalance. In order to identify any manufacturing errors,

the MPD manufacturing steps described in the MPD manufacturing guide described by J Schittly,

Exbrayat and Borel were used as a reference [9].

Results

Table I:Distribution of practitioners by socio-professional characteristics

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                       RATSIMANDRESY NAOMY NAMBOARINTSOA
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https://ijojournals.com/                                                                              Volume 08 || Issue 03 || March, 2025 || 

 

 

 

 

 

Variables  Proportion of 

practitionners with 

prosthetic 

imbalance 

p value Odds  Ratio (OR) [CI
95 %

]  

Professional status  

General 

praticionner 

42,5 

0,02 0,06 [0,01 – 0,54] 

Spcialist 8,3 

Year of practise  

< 15 years 22,9 
0,001 4,04 [1,65 -9,90]  

15 years and more 54,5 

Possession of a paralleling device in the dental practice 

Yes 22,2 
0,01 0,15 [0,05- 0,52] 

No 64,86 

Drawing of the framework by practitionner 

Yes 25 
0,002 0,15 [0,04- 0,54] 

No 75 

 

 

“FACTORS LEADING TO IMBALANCE IN REMOVABLE PARTIAL METAL PROSTHESES IN ANTANANARIVO AND MAHAJANGA MADAGASCAR."

Table  I  provides  information  on  the  socio-professional characteristics  of  the  practitioners.  In 

terms of  gender, males predominated, with a sex ratio equal to 2.07. In terms of professional 

status, general practitioners predominated at 87%. In terms of year of practice, those who had 

worked for less than 15 years predominated at 52.2%.

Table  II: Distribution  of practitioners according  to  the existence  of  a  prosthetic  imbalance  and 

professional  status,  year  of  practice,  possession  of  a  paralleling  device  in  the  dental  practice 

and drawing of the framework

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                       RATSIMANDRESY NAOMY NAMBOARINTSOA
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https://ijojournals.com/                                                                              Volume 08 || Issue 03 || March, 2025 || 

 

 

 

 

  

 

 

 

  

  

 

“FACTORS LEADING TO IMBALANCE IN REMOVABLE PARTIAL METAL PROSTHESES IN ANTANANARIVO AND MAHAJANGA MADAGASCAR."

Discussion

  According  to  professional  status,  there  was  a  significant  difference  between  general 

practitioners (GP) and  specialists  in  terms  of  the  existence  of  prosthetic  imbalance.  GPs  in 

particular had more prosthetic imbalance (p = 0.02 and OR = 0.06 with CI
95 % 

= [0.01 - 0.54]. This

result  may  be  explained  by  the  fact  that  specialist  practitioners  receive  more  training  in  the 

preparation of the MPD. In fact, they have mastered the various techniques involved in all the 

stages of making the MPD.

Practitioners with 15 years’experience or more had more prosthetic imbalance compared with 

those  with  less  than  15  years’  experience.  This  result  is  very  significant.  This  finding  could  be 

due  to  the  effect  of  the  possible  routine  that  can  happen  to  practitioners  with  more years  of 

practice.

The possession of a paralleling device in the dental practice and the drawing of the framework 

by  the  practitioner  are  factors  that  prevent  the  occurrence  of  prosthetic  imbalance  with 

respective p and OR values of p = 0.01 and OR = 0.15 with an IC95% = [0.05- 0.52] and p = 0.002 

and OR = 0.15 with an IC95% = [0.04- 0.54].

Parallelogram analysis and frame tracing are an essential part of the practitioner's duties. After 

taking  a  complete  medical  and  dental  history,  carrying  out  a  full  oral  examination  and 

performing a diagnostic set-up, the practitioner can make a fully reasoned choice based on the 

aids available [10].

The practitioner needs a simple parallelogram that allows accurate analysis of the study models,

because the parallelogram is an essential tool for choosing the insertion axis [11]. The choice of 

insertion  axis  is  one  of  the  most  important  phases  of  the  preprosthetic  clinical  examination,

because it is much more than an axis of insertion and disinsertion. It is also an area for studying 

the elements involved in supporting the prosthesis, and for preparing the remaining teeth and 

osteomucosal elements. Finally, it is the axis of prosthetic construction [12]. It is very rare that,

at  the  end  of  an  uncompensated  partial  edentulous  treatment,  the  existing  conditions  can  be

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                       RATSIMANDRESY NAOMY NAMBOARINTSOA
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“FACTORS LEADING TO IMBALANCE IN REMOVABLE PARTIAL METAL PROSTHESES IN ANTANANARIVO AND MAHAJANGA MADAGASCAR."

used without modification. The absence of intervention risks perpetuating or aggravating a pre-

existing  situation  of  imbalance.  The  practitioner  must  not  allow  himself  to  be  imposed  a 

prosthetic insertion axis by a given clinical situation without seeking, if necessary, to modify and 

adapt  it  to  make  possible  the  creation  of  a  prosthesis  with  a  therapeutic  vocation.  Hence  the 

importance of using a paralleling device [11].

Unfortunately,  these  design  and  analysis stages  are  often  delegated  to  the  dental  technician,

despite  his  limited  access  to  clinical  data.  Indeed,  if  the  dental  technician  carries  out  the 

paralleling analysis, no coronoplasty can be performed [13-15].

Conclusion

Practitioners  must  follow  each  clinical  step  in  the  preparation  of  the  PAPM.  The  use  of 

appropriate equipment such as the parallelogram is essential in order to be able to analyse the 

clinical case in depth.

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years of progress, current trends and open questions. Periodontol 2000. 2017;73(1):7 21

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review of new materials and processing methods. Braz Oral Res 2017;31(1):133-46

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                       RATSIMANDRESY NAOMY NAMBOARINTSOA
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“FACTORS LEADING TO IMBALANCE IN REMOVABLE PARTIAL METAL PROSTHESES IN ANTANANARIVO AND MAHAJANGA MADAGASCAR."

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