Maxillary Complete Denture Research Articles

Use of mini implants for the two-implant retained mandibular overdenture: A prospective study

BackgroundThe two-implant retained mandibular overdenture utilizing nonsplinted implants is a proven treatment modality for completely edentulous patients. However, a lacuna still exists regarding the suitability of mini dental implants for this purpose. The purpose of the study was to evaluate implant stability and crestal bone loss in single-piece mini dental implants loaded with immediate or conventional loading protocols to retain a mandibular overdenture. MethodTwenty-four completely edentulous patients were rehabilitated using conventional maxillary complete denture and a mandibular two-implant retained overdenture utilizing nonsplinted single piece mini implants. The implants were loaded with immediate or conventional loading protocols. Implant stability (with Periotest TM) and crestal bone loss (with radiovisiograph and radiographic grid) were evaluated at the time of loading and at one, two, and six months after loading. Statistical analysis was done with the Independent Samples “t” test and One-Way ANOVA. ResultsMean Periotest Values observed were significantly more negative in implants loaded with the conventional loading protocol. Crestal bone loss was significantly lesser in the immediate loading protocol but was still higher than the requisite 1.5 mm postulated by established criteria. ConclusionTwo single-piece nonsplinted mini implants may be sufficient to retain a mandibular overdenture utilizing the immediate loading protocol. Further studies with a longer duration of observation and larger sample size are required.

Effect of flask closure method on occlusal vertical dimension of complete upper and lower dentures

The movement of teeth during processing of complete dentures disturbs the harmonious occlusal scheme established at the final wax try-in stage. Aims and objectives: to investigate the effect of RS flask closure on occlusal vertical dimensions of complete dentures. The mean occlusal vertical dimension of complete maxillary and mandibular dentures fabricated by the conventional flask closure were measured and compared with that of dentures fabricated by RS flask closure. Design: A pre-test post-test control group experimental design. Methods: Thirty sets of complete maxillary and mandibular wax trial dentures were randomly assigned to experimental groups. Fifteen sets were assigned to conventional flask closure and the remainder to RS flask closure. Compression molding with a long curing cycle was performed for the processing of the dentures. Pre-processing and post-processing occlusal vertical dimensions were determined. Results: The mean occlusal vertical dimensions of wax trial dentures assigned to either group were similar. The data produced substantial evidence to reject the null hypothesis that the post-processing mean occlusal vertical dimensions of both groups were equal. Conclusion: The occlusal vertical dimensions produced by dentures clamped by the RS flask closure were significantly less than those produced by dentures clamped by the conventional flask closure.

Phonetic contouring of polished surface of denture base for speech enhancement

The three main factors in complete denture construction are mechanics, esthetics, and phonetics. Out of which phonetics is generally given least importance as the tongue tends to adapt and patients tend to return to normal speech after a post insertion practice period of several weeks to several months. This may not be acceptable to certain group of people in accordance with their needs to speak socially or vocationally. An accurate approximation of palatal contours of a maxillary complete denture to patient’s tongue can improve intelligibility and decrease the post- insertion practice period. This article outlines a technique to replicate the patient’s palatal anatomy onto the polished palatal surface of a complete denture.

Prong maxillary complete denture for better facial aesthetic: A case report

Denture teeth and denture flange are two very important aspects of a complete denture. For aesthetic purpose while fabricating the complete denture prosthesis, restoring the labial fullness is a sensitive procedure. There are some clinical situations where the labial flange gives poor facial aesthetics. It is more occur in proclined maxillary anterior ridge or thick labial cortical plate with severe labial undercut. In this article we are presenting a case with thick labial cortical plates and severe labial undercut. So, we have modified the complete denture and delivered a prong (flangeless) denture to give more aesthetic appearance to the patient.

Two canine tooth supported overdenture with ready-made attachments (3 year prospective study)

Purpose: To study the effect of two ready-made intra-radicular cemented attachments on abutment teeth periodontium of two canine tooth supported mandibular overdenture (OD) in 3 years study period. Materials and Methods: Ten patients with edentulous maxilla & a mandibular arch with only two canines remaining were selected based on certain criteria. All patients received maxillary complete dentures and an attachment-retained mandibular OD ; 1) Group [A] received magnetic attachment-retained OD, and 2) Group [B] received O-ring attachment-retained OD. Modified Gingival index (MGI), clinical attachment loss (CAL) and marginal bone changes (MBC) were investigated along a 3 years follow up period. Results: MGI results showed no statistically significant difference both in inter- & intra-group results. CAL results showed significant differences between successive periods of the same group with no difference between the two groups in comparable periods. Comparison of ∆ CAL values between groups in comparable periods also showed no statistical difference, but the sum of ∆ CAL in all 3 years showed statistical difference. Comparison of ∆ MBC values between groups in comparable periods showed statistical difference in the 2nd & 3rd follow-ups as well as in all 3 years combined. ∆ MBC & ∆ CAL, showed a weak positive correlation coefficient 0.368 in group 1, and a strong positive correlation 0.942 in group 2. Conclusion: It can be concluded that the two canine-supported mandibular overdenture, retained either by ball and socket or magnetic attachments, is an acceptable treatment modality with predictable clinical results from a periodontal point of view.

Comparison of stud and telescopic crown attachments for mini-implant retained mandibular complete overdentures

Objectives: Is to make a radiographic and bite force comparison between stud and double telescopic crowns as two different attachment systems for two interforaminal mini implants retaining mandibular complete overdenture. Subjects and materials: Randomized, controlled, clinical study was done on 20 completely edentulous patients that divided into 2 equal groups, in The first group (study group), patients were treated by two mini-implants (with ball abutments) of 2.4mm diameters and 13mm lengths (in the canine regions) retaining mandibular overdentures and by conventional maxillary complete dentures, in The second group (control group), patients were treated by two mini-implants (with square head abutments) of 2.4mm diameters and 13mm lengths (in the canine regions) retaining mandibular overdentures and by conventional maxillary complete dentures. Results: At the end of the 12 months, a total loss of 0.69 mm for group I (with ball abutments), and 1.64 mm for group II (with square head abutments) was detected. For Maximum Bite Force, there was no significant difference between the two groups at all follow-up periods. Conclusion: Mandibular overdentures retained by two mini implants considered an acceptable treatment modality over the one-year observation period. Ball attachments are more favorable than telescopic attachments, in regard to the reduction of the peri-implant bone loss, while, the type of the attachment has less effect on the maximum bite force.

Evaluation of Oral Health Related Quality of Life in Different Telescopic Two-implant Supported Mandibular Overdenture

AIM: The purpose of the study was to evaluate patient’s oral health related quality of life using oral health impact profile (OHIP14) in rigid and non-rigid telescopic two-implant supported mandibular overdenture patients. METHODS: Twelve completely edentulous patients received two mandibular interforaminal implants to retain telescopic overdenture opposed by maxillary complete denture. Group I (six patients) had rigid telescopic connection and Group II (six patients) received non-rigid telescopic attachments. OHIP14 questionnaire was translated in Arabic and orally asked the patients, answers were collected soon after denture insertion and use (within 1 week), 6 and 12 months after using the overdenture to assess patient’s quality of life. RESULTS: There was no statistical significant difference regarding quality of life using OHIP14 questionnair between the two groups. CONCLUSION: Telescopic two-implant mandibular overdenture showed high quality of life, great satisfaction, and acceptance among patients; regardless to the type of attachments rigid or non-rigid.

Accuracy of a titanium maxillary complete denture baseplate fabricated by using the electron beam melting technique: An in vitro study

Statement of problemElectron beam melting (EBM) is a promising additive manufacturing technique for fabricating denture baseplates; however, studies evaluating its accuracy are sparse. PurposeThe purpose of this in vitro study was to compare the fit accuracy of titanium maxillary complete denture baseplates fabricated by using the EBM technique with those fabricated by using the conventional casting technique and to evaluate the dimensional accuracy of the EBM baseplate by using a 3-dimensional inspection software program. Material and methodsDefinitive casts of an edentulous maxilla were prepared. After the casts were optically scanned, computer-aided designs for the EBM baseplate were created by using a software program for standard tessellation language file editing. The EBM baseplates were fabricated with an EBM machine by using a Grade II titanium powder as the raw material. The cast baseplates were fabricated with a lost-wax casting technique by using refractory casts duplicated from the definitive casts. After fitting the EBM and cast baseplates to their corresponding definitive cast, they were embedded in a Type IV stone. The embedded baseplates on the casts were sectioned at 3 regions: posterior palatal seal, molar, and premolar. The maximum gaps between the baseplate and definitive cast were measured in these 3 regions. The virtual casts obtained by scanning the EBM baseplate were superimposed on the computer-aided design to evaluate the dimensional accuracy. Distribution color maps were then generated, and the mean absolute deviations and root mean square deviations were calculated. One-way analysis of variance and t tests were used for statistical analysis (α=.05). ResultsNo significant differences in the maximum gaps among the 3 regions were found in the cast or EBM baseplate groups (P>.05). The EBM baseplate group showed significantly lower values than the cast baseplate group in all regions (premolar: P=.008; molar: P=.003; posterior palatal seal: P=.004). The mean maximum gap for the 3 regions in the cast baseplates was 168.0 μm and that in the EBM baseplates was 60.7 μm. The distribution color map of the EBM baseplate showed a favorable dimensional accuracy. The mean absolute deviation value was 19.7 μm, and the root mean square deviation value was 25.1 μm. ConclusionsThe EBM baseplates had a significantly higher fit accuracy than the cast baseplates. Thus, the fit accuracy of the EBM technique is suitable for fabricating metal baseplates.

Suction cup induced palatal hyperplasia in maxillary complete denture: A case report

Although various methods have been applied for getting a Complete Denture with perfect retention, but it is difficult to attain. Residual ridge resorption creates an ill-fitting denture, hence causing difficulty while eating and even dislodging during talking, even adding to the patient's embarrassment. Suction cup has been widely used for the retention & stability of dentures, but is known to carry few complications like palatal perforations and oro-antral communications. Here we present a case report of palatal hyperplasia due to the suction cup.

Masticatory efficiency in complete denture and single implant-retained mandibular overdenture wearers with different occlusion schemes: A randomized clinical trial

Statement of problemHow the masticatory function of complete denture wearers is influenced by the positioning and occlusion of posterior teeth or by the presence of a single mandibular implant is unclear. PurposeThe purpose of this randomized crossover clinical trial was to evaluate the masticatory efficiency of wearers of bimaxillary complete dentures and of wearers of maxillary complete denture and single implant-retained mandibular overdentures, both with bilateral balanced occlusion and lingualized occlusion. Material and methodsParticipants received 2 sets of complete dentures with interchangeable teeth in the mandibular prosthesis to allow a change in the occlusion scheme. Subsequently, 1 implant was placed in the mandibular symphysis region, and the mandibular complete dentures were converted to overdentures. The masticatory efficiency was measured by the sieve method for both occlusal schemes. ResultsRepeated measures ANOVA showed no statistically significant difference in the masticatory efficiency with the 2 occlusal schemes for conventional complete dentures (P=.707) or overdentures (P=.407). When comparing the type of prosthesis, statistical differences were found for masticatory efficiency (P=.012), with improved mastication for the overdentures. ConclusionsA mandibular single implant improved the masticatory efficiency of patients with complete dentures, but the occlusal scheme did not influence this factor.

Comparison of Marginal Bone Levels Around Tissue-Level Implants with Platform-Matched and Bone-Level Implants with Platform-Switching Connections: 1-Year Results of a Prospective Cohort Study with a Split-Mouth Design.

This clinical study was conducted to compare the influence of a platform-switched bone-level implant and a platform-matched tissue-level implant on marginal bone loss during the first year after loading. Edentulous subjects who applied for two-implant-retained mandibular overdentures and showing sufficient bone volume for implants with 4.3-mm diameter and 12-mm length were enrolled. For standardization reasons, all subjects received a platform-matched tissue-level implant and a platform-switched bone-level implant in the anterior mandible. Since implants from the same manufacturer were used, both implants had identical implant thread designs and surface properties. All subjects received two-implant-retained mandibular overdentures with opposing maxillary complete dentures, and the implants were loaded after 6 weeks. Marginal bone loss was monitored via panoramic radiographs obtained immediately after loading and at the 6- and 12-month recalls after implant loading, and periodontal parameters, such as pocket probing depths, Plaque Index scores, and bleeding on probing, were also measured and recorded. Twenty-six patients received 26 bone-level and 26 tissue-level implants. No statistically significant differences were detected between the bone loss of the two groups for all the measurements (P > .05). Additionally, no significant difference was detected between the measured periodontal parameters of the two groups (P > .05). Within the limitations of this prospective clinical study with a follow-up time of 12 months, it can be concluded that the platform-switching bone-level design and the platform-matching tissue-level design show similar bone loss in the anterior edentulous mandible.

English

This article describes the fabrication of a hollow maxillary complete denture using silicone putty and a double flask technique. A successful complete denture directly depends on retention, stability and support accompanied by good aesthetics. However, in case of atrophic edentulous ridges the challenge lies in the fact that there is a significantly lesser denture bearing area that can lead to a number of problems. The most important of these is an increased interarch space resulting from excessive resorption of upper or lower arch. This can lead to a resulting heavy complete denture that further deteriorates the bone condition due to excessive and continuous load, accelerating bone resorption. Moreover, there is no effective support to deal with any kind of harmful lateral forces and this can lead to dislodgment of the denture. The operator’s efficiency lies in applying the basic principles of fabricating a denture and innovating various steps to counter critical situations. Various methods such as asbestos, silicone putty, modelling clay, thermocol, salt, wax have been used for creating a hollow space inside the denture. Out of the various methods that have been used for fabrication of a hollow space inside a complete denture, silicone putty method is one of the more convenient and accurate method for achieving the objective, thereby rendering a lighter prosthesis. A hollow maxillary denture is highly advantageous as it reduces the weight of acrylic resin, thereby preserving the residual alveolar ridge. It also helps in stability of the denture by indirectly reducing the lateral forces.

Effect of Diode Laser on the Candida Albicans Colonization in Complete Denture Wearers

This study aimed to investigate the effect of diode laser on Candida albicans colonization in complete denture patients. A total of 40 complete maxillary dentures wearers were studied in this cross-sectional study. Dentures were then randomly divided into two groups. In the first group, as the control group, no intervention was made. In the second group, the mucosal surface of dentures was exposed to laser irradiation by the diode laser with a wavelength of 940 nm with 100 mW for 30 seconds before delivery. Samples were collected from the mucosal surface of the upper dentures on the determined days. All collected colonies were counted. Clinical outcome was evaluated regarding the colonization of Candida albicans reported by CFU. The difference in colony counts results between the two groups was evaluated by the Mann-Whitney test. Statistical significance was assumed if p<0.05. The results showed that laser irradiation was significantly effective in reducing Candida colonization. The lower density of the colonies was seen in the laser group compared to the control group on the 15th and 60th days after denture delivery (P = 0.002) and (P = 0.003), respectively. Generalization our data into the clinical setting, it can be proposed that a direct laser-based approach can significantly reduce the colonization of Candida albicans. It can also be concluded that laser light at specific wavelengths could be a promising novel strategy for preventing denture stomatitis.

Stability of masticatory movements after placement of implant-supported denture

The purpose of this study was to clarify the stability of masticatory movement after placement of implant-supported denture. Fourteen patients (patient group) with mandibular implants denture and maxillary complete denture and 30 dentate adults (control group) were asked to chew a boiled fishpaste, and the masticatory movement was recorded using MKG. For the 10 cycles beginning with the 5th cycle of mastication, the parameters representing the stability of masticatory movement were calculated. Data collected at 1, 3, 6, 9months and 1, 2, 3years after insertion of implants denture were compared between sessions and also between the patient and control groups. The mean and standard deviation of the values in the patient group at 1month after insertion of implants denture were large, but gradually decreased 6 to 9months after insertion of implants denture. Each parameter maintained almost the same value from 1 to 3years. The parameter values of the patient group were significantly larger than those of control group from 1 to 9months after insertion of implants denture, but 1year after insertion of implants denture, there was no significant difference between the two groups in 5 out of 7 parameters. From these results, it was suggested that a certain duration, about 9months to 1year, was necessary for patients with implants denture to adapt to the new masticatory function and that the timing of functional evaluation should be set to 1year after insertion of implants denture.

Techniques of hollow maxillary dentures: a literature review

Clinically, the management of severy atrophic maxilla might represent a significant challenge for the attending dentists and surgeons to successfully perform and achieve fabricated complete maxillary dentures. Making a hollow denture base for these defects has also been previously reported as a valid approach that can be used to decrease the weight of the maxillary prosthesis. Many modalities have been proposed for these procedures with favorable outcomes, and variable events of disadvantages and adverse events. This literature review aims to collect enough evidence regarding the different reported techniques of the hollow maxillary denture, according to the different studies. Many techniques have been previously reported as using magnets, using implants, intramucosal inserts, springs, suction disks, lightweight dentures, and modified impression techniques. Many materials have been previously used with the 3D spacers of the lightweight denture techniques as dental stone, silicon putty, cellophane-wrapped asbestos, light-body coated gauze, modeling clay, salt, thermocol, caramel, and glycerine soap. Favoring one of the modalities over the other requires the inauguration of future studies with an adequate sample size to validate the efficacy and safety of these modalities. All of this information is furtherly discussed within the manuscript based on the collected evidence from the different studies in the literature.

English

Removable prosthesis is probably one of the oldest types of dental therapy used to rehabilitate patients with complete or partial edentulousness. The main function of the edentulous alveolar ridge is to provide a major area of support for the dentures.1 Ill-fitting prosthesis leads to a condition where there is no longer adequate support of bone due to RRR. Hence, rehabilitation of such cases pose a clinical challenge, as there is a decreased denture foundation area for support, retention and stability.2 Residual ridge resorption (RRR) is the severe atrophy of alveolar bone underlying the mucoperiosteum. RRR affects the alveolar bone morphology, resulting in a decreased denture foundation area and increased inter-alveolar ridge space. The increase in inter-ridge distance provides a huge restorative space which results in a heavier complete denture due to greater volume of denture base material. This increase in restorative space amalgamates with the long lip length of the patient which gives rise to huge challenge to the success of the complete denture. Also, decreased denture foundation area increases the heaviness of the prosthesis and negatively affects the retention of the denture due to gravity.3 Various weight-reduction techniques have been used in the past using a rigid three-dimensional spacer, such as dental stone (Ackerman, 1955), cellophanewrapped asbestos, silicone putty during laboratory preparation to keep denture base content out of the intended hollow cavity of the prosthesis. The following case report describes a distinct lab technique for construction of hollow maxillary complete denture for a patient with severe RRR.

Management of maxillary single denture fractures: An enigma

Background: The patient’s first complete denture experience is predominantly with the single maxillary denture. The opposing mandibular dentition is usually intact or restored by fixed partial dentures or removable partial dentures. In many instances no attempt has been made to restore a partially edentulous mandibular arch. One of the most common prosthodontic failures encountered is the fracture and failure of the single maxillary denture. This often results in continuous repair of the denture. Often, remaking the denture is the best course to follow. Objective: This article will describe the clinically related causes of single maxillary complete denture fracture and propose preventive and corrective measures. Methods: Electronic searches were performed for articles published in PubMed and manual searches were performed in various journals relevant to the topic of removable prosthodontics. Key words such as maxillary, single, denture, reinforcement were used, Initially, 432 articles were found of which 177 articles were selected by electronic and manual searches from 2005 up to 2020 with few classic articles. After exclusion of 152 articles based on the exclusion criteria, 25 articles were finally included in the review. Conclusion: Factors that contribute to the fracture and failure of the single maxillary denture have been discussed to summarize this review, reinforcements within prostheses undoubtedly had some efficacy in improving the mechanical properties, but the levels varied by material, form, and position of the reinforcement.

Randomized clinical trial of complete denture cleaning methods in residents of care institutions

Aim: To evaluate the efficacy of ultrasonic bath and traditional brushing in the hygiene of complete dentures of dependent residents in long-term care institutions (LTCIs). Methods: A randomized cross-over clinical study was conducted in 17 maxillary complete denture wearers living in LTCIs. Cleaning protocols were brushing or ultrasonic bath, both applied with neutral liquid soap. Biofilm biomass were estimated by MTT reduction assay and specific microbial load (CFU) of Streptococcus spp., Staphylococcus spp. and Candida spp. were quantified by selective and differential culture media. Results: Ultrasound method showed higher percentage reduction of biofilm biomass and specific microbial loads of Streptococcus spp. compared to brushing (p<0.01). Reduction of microbial loads of the other microorganisms were not different between cleaning methods (p>0.05). Conclusions: The ultrasonic bath proved to be a feasible alternative method for the mechanical cleaning of complete dentures in LTCIs.

Prosthodontic rehabilitation of compromised upper and lower residual alveolar ridges: A case report

Residual ridge resorption is the reduction in size of the bony ridge under the mucoperiosteum. Obtaining retention and stability in a severely resorbed ridges using a conventional technique is a tedious task. The resorption occurs at a faster rate in mandibular arch as compared to the maxillary arch. In order to have a favorable prognosis for the denture therapy, impression technique selected should be based on the present state of the basal tissue support for mandible. In this article neutral zone concept was incorporated in to impression making in an effort to achieve successful mandibular complete denture. The anterior region of maxilla is the most affected area in edentulous patients. Complete denture wearers with flabby ridges may face a number of difficulties, of which major complaints would be pain, compromised stability, support, and retention and an ill-fitting denture. Special impressions often involve window technique for static impression of flabby area, which present multiple challenges. This article presents a case report of modified widow impression technique for maxillary anterior flabby tissues along with a hollow maxillary complete denture in a patient with resorbed maxillary and mandibular ridges with increased interridge distance to reduce the weight of the prosthesis and thereby enhances the retention.

Quantitative analysis of the selective pressure impression technique using CAD-CAM technology: A pilot clinical study

Statement of problemQuantitative 3D clinical analysis of the selective pressure impression technique directly measuring tissue displacement during impression making for complete maxillary dentures is lacking. PurposeThe purpose of this clinical study was to digitally compare impressions made of the edentulous maxillary ridge by using the selective pressure impression technique with different amounts of relief incorporated into custom tray designs. Material and methodsNine participants receiving maxillary complete dentures were enrolled in the study. An initial custom tray was fabricated in urethane dimethacrylate by using the alternative border molding technique without relief and scanned to create a standard tessellation language (STL) file from which 3 groups of custom trays were designed and 3D printed with 0.0-mm (no relief), 1.0-mm, and 3.0-mm relief over the anterior ridge and median palatal suture. Definitive impressions using each of the 4 custom trays were made with a consistent volume of light-body polyvinyl siloxane impression material. The definitive impressions were scanned, and the STL files were superimposed to investigate the topographical differences among the groups, each with respect to the no relief, 3D-printed custom tray definitive impression. Mean volumetric differences for all 3 groups were measured in areas where relief was used and statistically analyzed with the Friedman test (α=.05). ResultsNo significant difference was found among any of the 3 groups of superimposed impressions in areas of no relief, 1.0-mm, and 3.0-mm relief (P=.558). The mean difference ±standard deviation for each comparison in regions of the anterior ridge and median palatal suture were 0.07 ±0.06 mm for no relief, -0.03 ±0.07 mm for the 1.0-mm tray relief, and -0.04 ±0.09 mm for the 3.0-mm tray relief. The negative values in mean difference indicated less compression of underlying tissues compared with the reference border molded urethane dimethacrylate custom tray impression. ConclusionsAlthough results showed less compression when compared with that of the control group, custom tray relief of 1.0 mm and 3.0 mm over the anterior residual alveolar ridge and median palatal suture did not significantly impact the resulting impression topography when compared with no relief custom trays.