Conventional Mandibular Complete Dentures Research Articles

Evaluation of Implant Overdenture Retention with Two Different Attachments at 23mm Standard Inter-Implant Distance

Purpose: Evaluation of implant overdenture retention at 23mm standard inter-implant distance using OT Equator and locator attachments. Materials and methods: Twelve completely edentulous patients were selected for this study. For all patients, conventional complete dentures were constructed. Mandibular dentures were replicated into stereolithographic implant placement guide using CBCT. Every participant received 2-implants in the anterior mandibular area with inter-implant distance of 23 mm. After the osseointegration period, the mandibular conventional dentures were converted into implant retained overdentures attached with Locator attachment for (group I) (six patients) and OT Equator attachments for (group II) (six patients). Retention was evaluated for conventional mandibular complete dentures (T0), 3-months (T3) and, 6-months (T6) after overdenture insertion using digital force-meter. Results: Results revealed that there was a statistically significant difference between the study groups representing mean retention force (P<0.05) except at T0 (baseline evaluation with conventional dentures) with higher mean values for group I (Locator attachment) than group II (OT Equator attachment). Conclusion: Regarding the limitations of this study: -Inter-implant distance of 23 mm for 2-implant overdentures could be considered a reliable modality for edentulous mandible. -Locator attachment may be preferable than OT Equator attachment regarding 2-implant overdenture retention at 23 mm inter-implant distance.

The Effect of Flexible Acrylic Resin Lingual Flanges on The Retention of Mandibular Complete Dentures

. Purpose: To evaluate the effect of flexible lingual flanges on the retention of conventional mandibular complete denture. Material and methods: Ten completely edentulous patients were selected for this study with ages ranged from 50-60 years. All patients had received heat cured acrylic resin denture without modification (Group І) then heat cure lingual flanges were removed and replaced by flexible lingual flanges (Group ІІ). All patients were instructed to use their resin dentures for equal periods of three months when retention of denture base were measured after one month and at the end of three months, period of two week interval was left between each group as a washing period. Results: The results of this study showed that there was a significant difference between them, as the flexible lingual flanges (group ІІ) was better than the heat cured acrylic resin denture base (group І). Conclusion: Within the limitation of this study, it was concluded that retention of the mandibular denture modified with flexible acrylic resin “versacryl” was higher than that of the conventional heat cured acrylic resin denture. Retention was increased by time in each study group. The use of flexible acrylic resin in mandibular complete dentures (as lingual flange) could be considered as an alternative effective treatment

Effect of different processing techniques of denture bases on the supporting structures of maxillary implant retained overdentures

Objectives: This study was conducted to evaluate the effect of two different processing techniques of denture bases on bone height changes in implant retained maxillary overdenture.Materials and methods: Fourteen completely edentulous patients were recruited to participate in this study. Inclusion criteria: These patients had adequate bone in the maxillary arch to receive four hybrid implants, exhibited angle class I ridge relationship and adequate inter-occlusal space. Exclusion criteria were: V shaped edentulous ridges, patients with neuromuscular diseases and temporomandibular joint disorders, diabetic and smoking patients. Patients were randomly divided into two groups. Group I: Seven patients received a maxillary implant retained overdenture fabricated from (PMMA) base processed by the compression mold technique. Group II: Seven patients received maxillary implant retained overdenture fabricated from thermoplastic biocompatible base processed by the injectable mold technique. All patients received conventional mandibular complete dentures. Bone height around dental implants was measured after insertion, 6 months, and 12 months post-insertion.Results In this study, bone height changes around dental implants for group I and group II at the first follow up period were 0.56 mm and 0.49 mm respectively, however, at the 2nd follow up period (6-12 months), they were 0.41mm and 0.34 mm consequently. There were no statistically significant differences between the studied groups regarding the average bone loss around the dental implants as as shown by independent t-test.Conclusion Injection and compression molded processing techniques have similar effects on bone height changes in maxillary implant-retained overdentures.

Managing the unstable mandibular complete denture – tooth placement and the polished surface

Constructing satisfactory conventional mandibular complete dentures is often challenging in comparison to the upper counterpart partially due to differences in the anatomy of the denture-bearing area. This problem is exaggerated in the atrophic mandible, where supporting structures are frequently ill-defined and suboptimal in quality. Implant-retained prostheses offer well recognized benefits but are not always a feasible options, so conventional methods must be relied upon. The importance of impression quality and registration has been reviewed previously. This article aims to discuss the influence of tooth placement, the polished surfaces and the neutral zone on the success of lower dentures. Clinical relevance: This article highlights the importance that polished surface contouring and tooth prescription can have on the outcome of lower dentures. Techniques for assessing and recording the neutral zone are explained, along with alternative occlusal schemes.

Biting Force and Muscle Activity in Implant-Supported Single Mandibular Overdentures Opposing Fixed Maxillary Dentition.

This study aimed to investigate the relation between biting force and masticatory muscle activity in patients treated by 3 modalities of single mandibular dentures. Forty implants were placed in 10 patients with completely edentulous mandibles. The study was divided into 3 treatment stages. Initially, each patient received a conventional mandibular complete denture. At the second stage, 4 mandibular implants were placed and the denture was refitted to their abutments. Third stage comprised connecting the denture to the implants through ball attachments. During each treatment stage, maximum biting force and muscle activity were measured during maximum clenching and chewing of soft and hard food. Biting force demonstrated a statistically significant increase by time for the 3 treatment stages. The highest muscle activity was recorded for the conventional denture followed by the implant-supported overdenture without attachment, whereas the lowest values were recorded for the implant-supported overdenture with attachment. Biting force was related mainly to the quality of denture support. Muscle activity was higher in patients with conventional denture than with implant-supported prostheses (with or without attachments).

Prospective cohort pilot study of 2-visit CAD/CAM monolithic complete dentures and implant-retained overdentures: Clinical and patient-centered outcomes

Statement of problemPresently, no studies have evaluated clinical outcomes or patient-centered outcomes for complete dentures fabricated with computer-aided design and computer aided manufacturing (CAD/CAM) technology. PurposeThe purpose of this prospective cohort pilot study was to evaluate the clinical and patient-centered outcomes for CAD/CAM monolithic dentures fabricated in 2 visits. Material and methodsTwenty participants with an existing set of maxillary complete dentures opposing either mandibular complete dentures or implant-retained overdentures that required replacement were recruited in this study. A 2-visit duplicate denture protocol was used to fabricate 40 arches of monolithic dentures with CAD/CAM technology. A 100-mm visual analog scale (VAS) instrument was then used to record 12 outcomes at baseline and at 1-year follow-up. Predetermined values were assigned to grade the VAS rating of each outcome as favorable (70.1-100) and unfavorable (≤70). Favorable ratings were sub-divided as excellent (90.1-100), good (80.1-90), and fair (70.1-80). The clinical outcomes were evaluated independently by 2 experienced prosthodontists at baseline and at 1-year follow-up. Patients evaluated the corresponding patient-centered outcomes during the same time intervals. Additional descriptive variables were also recorded. Each clinical and patient-centered outcome was summarized by medians and ranges. Differences in all ratings recorded at baseline and at 1 year were tested by 1-sided sign test (α=.05). ResultsOf 20 participants, 3 were lost to follow-up, and 3 were unsatisfied with the digital dentures and withdrew from the study. These 3 participants were considered treatment failures. Of the 14 remaining participants, 9 had implant-retained mandibular overdentures, and 5 had conventional mandibular complete dentures. For clinical outcomes, the 12 studied outcomes were favorably evaluated by the 2 prosthodontist judges at the 1-year follow-up. Evaluations showed minimal differences between baseline and 1 year. An average of 5 emails (0-11) per patient were sent to the laboratory technicians to communicate the improvisation the CAD design of the dentures. An average of 3.3 denture adjustments were needed after insertion (0-10) during the 1-year period. For patient-centered outcomes, median ratings of all 14 participants indicated each of the 12 studied outcomes was favorable at the 1-year recall. Statistically significant improvements in patient ratings from baseline to 1 year were observed for the absence of denture sore spots and treatment time to make the dentures (P<.05). Minor complications related to loss of retention, excessive wear of teeth and the need for additional visits were observed in 5 participants. No other adverse clinical outcomes related to the CAD/CAM dentures were noted in the 14 evaluated participants, and all dentures were intact and in good condition at the 1-year follow-up. ConclusionsClinical and patient-centered outcomes for CAD/CAM monolithic dentures fabricated using a 2-visit protocol were evaluated favorably at a 1-year follow-up. However, the proportion of excellent and good ratings for overall satisfaction and assessment was higher for patients than clinicians. A considerable amount of the clinician’s time and effort was devoted to aiding in the digital process for the fabrication of CAD/CAM dentures.

Effect of resilient liner on masticatory efficiency and general patient satisfaction in completely edentulous patients

Objectives: To assess the effect of resilient lined denture on patient masticatory efficiency, general patient satisfaction and denture quality as compare to conventional complete denture over a period of one year. Material and methodology: A total of 28 completely edentulous patients (14 males and 14 females) aged 45 to 60 years, having well-formed ridges were selected following iclusion exclusion criteria. These were divided into two equal groups, i.e. control (provided conventional mandibular complete denture –group 1) and experimental (provided mandibular denture lined with acrylic soft denture liner – group 2). All patients were clinically evaluated to assess the denture quality, and administered questionnaires for masticatory efficiency and patients general satisfaction level at three intervals i.e. one month (T0), 6 months (T1) and 1 year post-insertion (T2). Results: Statistical analysis for individual question for masticatory efficiency showed significantly higher score (P.05) on inter-group comparison. Time dependant intra-group comparison for patient general satisfaction score also showed no significant difference in scores for almost all the questions for both the groups. Statistical analysis for denture quality showed dentures in experimental group have significantly higher (P

Do flexible acrylic resin lingual flanges improve retention of mandibular complete dentures?

Objectives:The aim of this study was to compare the retention of conventional mandibular complete dentures with that of mandibular complete dentures having lingual flanges constructed with flexible acrylic resin “Versacryl.”Materials and Methods:The study sample comprised 10 completely edentulous patients. Each patient received one maxillary complete denture and two mandibular complete dentures. One mandibular denture was made of conventional heat-cured acrylic resin and the other had its lingual flanges made of flexible acrylic resin Versacryl. Digital force-meter was used to measure retention of mandibular dentures at delivery and at 2 weeks and 45 days following denture insertion.Results:The statistical analysis showed that at baseline and follow-up appointments, retention of mandibular complete dentures with flexible lingual flanges was significantly greater than retention of conventional mandibular dentures (P < 0.05). In both types of mandibular dentures, retention of dentures increased significantly over the follow-up period (P < 0.05).Conclusions:The use of flexible acrylic resin lingual flanges in the construction of mandibular complete dentures improved denture retention.

Impact of replacing conventional complete dentures with implant-supported fixed complete dentures.

The aim of this study was to assess the impact of replacing conventional mandibular complete dentures with implant-supported fixed complete dentures (ISFDs) on the oral health-related quality of life (OHQOL) of edentulous patients and on the associated kinesiographic parameters. The patients had their complete dentures replaced by ISFDs and were assessed after 1, 2, 3, 6, and 12 months. An improvement of general OHQOL was observed 2 months after treatment with ISFDs. Kinesiographic recordings revealed significant mandibular vertical and horizontal opening increases and a greater vertical intrusion of the maxillary complete dentures during clenching after the treatment with ISFD.

Dental implant-retained mandibular overdenture therapy: A clinical study of patients' response

Background/purposeThe present study analyzed the subjective responses of patients to surgical placement of dental implants and the subsequent functioning of mandibular implant-retained overdentures as compared with the functioning of conventional dentures. This study sought to ascertain patient satisfaction and long-term effectiveness of tooth replacement with mandibular implant-retained overdentures. Materials and methodsPatients (n = 86) unable to adapt to a conventional mandibular complete denture were treated with four one-stage titanium plasma sprayed or sandblasted, large-grit, and acid-etched threaded implants supporting an overdenture retained by a cast bar and extracoronal attachments. These patients were evaluated clinically during periods ranging from 6 months to 12 years. Eighty-three patients provided answers to queries regarding their impressions and feelings both prior to and after treatment for the implant-retained overdentures. ResultsDuring the study period, none of the implants or restorations failed. Ninety-eight percent of patients responding to the questionnaire were satisfied with their new overdentures. Retaining and supporting mandibular overdentures with implants yielded improvements in comfort, providing the patients with not only effective oral rehabilitation but also greater self-confidence in social situations. ConclusionThe results indicate that mandibular arch rehabilitation by using implant-retained overdenture therapy serves as a predictable and effective treatment protocol.

Fabrication of bar-retained tooth-supported mandibular overdenture

The problem of stability and retention of conventional mandibular complete dentures is far from a solution that is universally satisfactory. However, the use of overdenture therapy preserves the sensation of proprioception, preserves the edentulous ridge, maintains the border seal and provides the patient with good speaking ability and chewing efficiency. The retention and stability of such prosthesis is enhanced greatly in bar-supported overdentures. This case report depicts the step by step procedure for the fabrication of a canine splint bar for a bar and clip-retained mandibular overdenture that opposes a conventional complete maxillary denture. The bar was fabricated from readily available castable bar system and female clips were attached by an indirect technique. The mode of retention was primarily through frictional resistance. It is a relatively simple and easy technique, overcoming the limitations of the direct technique for clip attachment.

Rehabilitation of an Edentulous Patient with Implant Supported Overdenture

ABSTRACTThe conventional mandibular complete dentures are often associated with advanced ridge resorption and loss of retention. Dental implants in the anterior mandible were documented as being highly successful treatment option for overdenture. It has been use to improve the retention of mandibular dentures and also to improve patient's satisfaction. Because of high success rates, as well as lower costs, it is common to treat edentulous patients with just two implants and ball attachments for retention of the overdenture, instead of four implants and a bar. In this article a simple process of converting existing conventional denture into an implant supported overdenture by housing the retentive elements directly into the impression surface of the denture through a simple chairside technique is described.How to cite this articleMhatre S, Ram SM, Mahadevan J, Karthik M. Rehabilitation of an Edentulous Patient with Implant Supported Overdenture. J Contemp Dent 2013;3(1):52-56.

The first-choice standard of care for an edentulous mandible: A Delphi method survey of academic prosthodontists in the United States

In 2002 and 2009, two consensus statements-one from a symposium in Canada and one from England-were issued that recommended that the first-choice standard of care for an edentulous mandible should be the two implant-retained mandibular overdenture (IRMOD). The authors conducted a survey to determine if, in 2011, U.S. academic prosthodontic experts' opinions were aligned with those in the two consensus statements. The authors administered a Delphi method survey to an expert panel of 16 nationally representative academic prosthodontists to determine if there is consensus on the first-choice standard of care for an edentulous mandible between the IRMOD and a conventional mandibular complete denture (CD). Consensus agreement was defined as a 70 percent agreement level among the panelists. The panel attained consensus favoring the IRMOD for nine of the 10 parameters assessed-retention, stability, speech, masticatory efficiency, comfort while eating soft foods and hard foods, confidence in intimate situations, satisfaction and self-esteem. The exception was esthetics for which only a majority (51-69 percent) favored the IRMOD. The panelists reached consensus that they would recommend an IRMOD instead of a CD as the first-choice standard of care for patients who are healthy or have mild systemic disease, but not for patients with severe systemic disease. Surveyed academic prosthodontists recommend an IRMOD as the first choice standard of care when restoring an edentulous mandible of a healthy patient or a patient with mild systemic disease.

Relationship between prosthodontic evaluation and patient ratings of mandibular conventional and implant prostheses

PurposeThe purpose of this study was to compare clinicians’ ratings of the state of oral tissues and their satisfaction with treatment to edentulous patients’ ratings of treatment success after provision of mandibular implant overdentures or conventional dentures.Materials and MethodsSixty subjects randomly received either mandibular overdentures retained by 2 implants (n = 30) or new conventional mandibular complete dentures (n = 30). All were given new conventional maxillary dentures. Baseline measures included clinical evaluation of the oral soft and hard tissues. Patients rated their general satisfaction before and after treatment, as well as their satisfaction with stability, speech, and esthetics on visual analogue scales. The treating prosthodontist rated the dentures for the same categories. Patient and clinician ratings were compared using correlations, t tests, and linear regression.ResultsNone of the clinical variables were significantly correlated with patient satisfaction before or after treatment. The prosthodontist rated mandibular implant overdentures significantly better than conventional dentures regarding general satisfaction, stability, speech, and esthetics. Implant overdentures were also easier to fabricate (P<.0001). The prosthodontists’ scores were not significantly correlated with patient scores for any question.ConclusionClinicians’ assessments of the quality of denture-supporting tissues are poor predictors of patient satisfaction with mandibular implant or conventional prostheses. Prosthodontists and patients both rate mandibular implant overdentures as significantly superior to conventional dentures, but patients and clinicians do not usually agree when evaluating individual prostheses.–Reprinted with permission of Quintessence Publishing. PurposeThe purpose of this study was to compare clinicians’ ratings of the state of oral tissues and their satisfaction with treatment to edentulous patients’ ratings of treatment success after provision of mandibular implant overdentures or conventional dentures. The purpose of this study was to compare clinicians’ ratings of the state of oral tissues and their satisfaction with treatment to edentulous patients’ ratings of treatment success after provision of mandibular implant overdentures or conventional dentures. Materials and MethodsSixty subjects randomly received either mandibular overdentures retained by 2 implants (n = 30) or new conventional mandibular complete dentures (n = 30). All were given new conventional maxillary dentures. Baseline measures included clinical evaluation of the oral soft and hard tissues. Patients rated their general satisfaction before and after treatment, as well as their satisfaction with stability, speech, and esthetics on visual analogue scales. The treating prosthodontist rated the dentures for the same categories. Patient and clinician ratings were compared using correlations, t tests, and linear regression. Sixty subjects randomly received either mandibular overdentures retained by 2 implants (n = 30) or new conventional mandibular complete dentures (n = 30). All were given new conventional maxillary dentures. Baseline measures included clinical evaluation of the oral soft and hard tissues. Patients rated their general satisfaction before and after treatment, as well as their satisfaction with stability, speech, and esthetics on visual analogue scales. The treating prosthodontist rated the dentures for the same categories. Patient and clinician ratings were compared using correlations, t tests, and linear regression. ResultsNone of the clinical variables were significantly correlated with patient satisfaction before or after treatment. The prosthodontist rated mandibular implant overdentures significantly better than conventional dentures regarding general satisfaction, stability, speech, and esthetics. Implant overdentures were also easier to fabricate (P<.0001). The prosthodontists’ scores were not significantly correlated with patient scores for any question. None of the clinical variables were significantly correlated with patient satisfaction before or after treatment. The prosthodontist rated mandibular implant overdentures significantly better than conventional dentures regarding general satisfaction, stability, speech, and esthetics. Implant overdentures were also easier to fabricate (P<.0001). The prosthodontists’ scores were not significantly correlated with patient scores for any question. ConclusionClinicians’ assessments of the quality of denture-supporting tissues are poor predictors of patient satisfaction with mandibular implant or conventional prostheses. Prosthodontists and patients both rate mandibular implant overdentures as significantly superior to conventional dentures, but patients and clinicians do not usually agree when evaluating individual prostheses. Clinicians’ assessments of the quality of denture-supporting tissues are poor predictors of patient satisfaction with mandibular implant or conventional prostheses. Prosthodontists and patients both rate mandibular implant overdentures as significantly superior to conventional dentures, but patients and clinicians do not usually agree when evaluating individual prostheses.