Denture-bearing Tissues Research Articles

An Overview of Prosthetic Implant Attachments in EdentulousPatients

Edentulism is an unresolved health care issue of sustained significance and prevalence in the aged population. Adaptation to wearing complete dentures is a complex process and must be considered from both somatic and psychological standpoints. The difficulties of wearing dentures have been attributed to deficiencies of the denture-bearing tissues, reduced salivary flow,vulnerable tissue and severe ridge resorption. The prosthetic management of the edentulous patient has always been a major challenge. Complete maxillary and mandibular dentures have been the traditional treatment option. However, most of the patients report problems adapting to the mandibular denture due to lack of comfort, retention and stability. It is well known that implantretained/supported overdentures provide improved retention, support, stability, function, and comfort for patients

Case Report: Impression Making for Flabby Ridge: An Innovative Approach

A flabby ridge is an area of mobile soft tissue found superficially, which affects both maxillary and mandibular alveolar ridges. It is a common finding in long term denture wearers, where the rate of bone resorption is very fast leading to development of hyperplastic soft tissue over the alveolar bone. Fabricating a denture over the flabby ridge poses a problem to the dentist because masticatory forces can displace this mobile denture-bearing tissue, leading to altered denture positioning and loss of peripheral seal. Forces exerted during the act of impression making can result in distortion of the mobile tissue leading to ill-fitting dentures. All these factors compromise the retention, stability, and support of the complete denture. This paper presents a case report for a patient with Kelly’s Combination Syndrome, wherein, an innovative impression technique was used to record the flabby ridges during the process of denture construction. The resultant denture was more comfortable for the patient and did not exert undue pressure over the hypermobile tissues.

Effect of brushing simulation on the surface roughness of soft-tissue liners: An in vitro study.

Soft denture liners evenly distribute functional loads over denture-bearing tissues. The liners aid in more evenly distributing the pressures of mastication to the underlying tissues by absorbing some of the masticatory forces. The study aimed to evaluate the brushing simulation influence on the surface roughness property of soft-tissue liners. A total of eight samples of Avue brand soft-tissue liners with the composition of varnish base and varnish catalyst were suspended into a standard template extracted and numbered sequentially and surface roughness was calculated using a stylus profilometer. A total of 30,000 cycles brushing were done, where the first group samples were brushed with Colgate toothpaste and the second group brushed with Dabur Red toothpaste using a toothbrush simulator (ZM3.8 SD Mechatronik). The data of both pre- and postbrushing values were recorded manually and statistically uploaded on SPSS software version 22 and values were represented in clustered bar graph forms. The significance value of Ra was 0.321. The significance value of Rq was 0.211. The significance value of Rz was 0.354, hence statistically, insignificant. In the present study, the surface roughness of soft-tissue liners is reduced to a minimal extent after brushing simulation.

A Novel Approach of Prosthodontic Management of Flabby Tissue in Maxillary Anterior Region: A Case Report

A fibrous which is also called as hyperplastic ridge is a superficial area of mobile soft tissue affecting the maxillary or mandibular alveolar ridges. It develops when alveolar bone gets replaced by hyperplastic soft tissue and is a common finding particularly in the upper anterior region seen in long term denture wearers. Masticatory forces often displace this mobile denture-bearing tissue, which leads to altered denture positioning and loss of peripheral seal. Forces exerted during the act of impression making results in distortion of the mobile tissue. Unless it is managed appropriately by special impression techniques, such ‘flabby ridges’ adversely affect the support, retention and stability of complete dentures. This paper presents prosthodontic management of a patient with flabby ridges with special impression technique.

A Simplified Impression Technique for a Flabby Maxilla - A Clinical Report

Flabby maxillary ridge is the most commonly encountered clinical condition during routine dental practice. The presence of these displaceable denture-bearing tissues often poses difficulty during fabrication of complete dentures resulting in compromised support, retention and stability. Many impression techniques and materials have been proposed in various literatures to help overcome this difficulty. These techniques vary in philosophies but are often quite time-consuming to perform, and rely on materials not commonly in use in contemporary dental practice. The purpose of this paper is to describe an impression technique for flabby ridges, using conventional impression material.

CAD/CAM produces dentures with improved fit

ObjectivesResin polymerisation shrinkage reduces the congruence of the denture base with denture-bearing tissues and thereby decreases the retention of conventionally fabricated dentures. CAD/CAM denture manufacturing is a subtractive process, and polymerisation shrinkage is not an issue anymore. Therefore, CAD/CAM dentures are assumed to show a higher denture base congruence than conventionally fabricated dentures. It has been the aim of this study to test this hypothesis.Materials and methodsCAD/CAM dentures provided by four different manufacturers (AvaDent, Merz Dental, Whole You, Wieland/Ivoclar) were generated from ten different master casts. Ten conventional dentures (pack and press, long-term heat polymerisation) made from the same master casts served as control group. The master casts and all denture bases were scanned and matched digitally. The absolute incongruences were measured using a 2-mm mesh.ResultsConventionally fabricated dentures showed a mean deviation of 0.105 mm, SD = 0.019 from the master cast. All CAD/CAM dentures showed lower mean incongruences. From all CAD/CAM dentures, AvaDent Digital Dentures showed the highest congruence with the master cast surface with a mean deviation of 0.058 mm, SD = 0.005. Wieland Digital Dentures showed a mean deviation of 0.068 mm, SD = 0.005, Whole You Nexteeth prostheses showed a mean deviation of 0.074 mm, SD = 0.011 and Baltic Denture System prostheses showed a mean deviation of 0.086 mm, SD = 0.012.ConclusionsCAD/CAM produces dentures with better fit than conventional dentures.Clinical RelevanceThe present study explains the clinically observed enhanced retention and lower traumatic ulcer-frequency in CAD/CAM dentures.

Management of flabby ridge case: An arduous task in undergraduate practice

A fibrous or flabby ridge is a superficial area of mobile soft tissue affecting the maxillary or mandibular alveolar ridges. It can develop when hyperplastic soft tissue replaces the alveolar bone and is a common finding particularly in the upper anterior region of long-term denture wearers. Masticatory forces can displace this mobile denture-bearing tissue, leading to altered denture positioning and loss of peripheral seal. Unless managed appropriately, such “flabby ridges” adversely affect the support, retention, and stability of complete dentures. Many impression techniques have been proposed to help overcome this difficulty. This paper presents case report for prosthodontic rehabilitation of a patient with flabby ridge with McCord and Ahmad impression technique.

Parafunctional Behaviors and Its Effect on Dental Bridges.

Parafunctional behaviors, especially bruxism, are not uncommon among patient visiting dentists’ clinics daily and they constitute a major dental issue for almost all dentists. Many researchers have focused on the definition, pathophysiology, and treatment of these behaviors. These parafunctional behaviors have a considerable negative impact on teeth and dental prothesis. In this review, we focused on the impact of parafunctional behaviors on dental bridges. We summarized the definitions, epidemiology, pathophysiology, and consequences of parafunctional behaviors. In addition, we reviewed previous dental literature studies that demonstrated the effect of bruxism or other parafunctional behaviors on dental bridges and dental prothesis. In conclusion, parafunctional behaviors are common involuntary movements involving the masticatory system. They are more prevalent among children. These behaviors have deleterious effects on dental structures. Causes of parafunctional behaviors include anxiety, depression, smoking, caffeine intake, sleep disorders, or central neurotransmitter dysfunction. Bruxism and other similar masticatory system activity cause dental fracture, loss, and weardown of enamel or teeth. They can also affect different types of dental protheses both fixed and removable types. Parafunctional behaviors shorten the life expectancy of these protheses, and damage residual dentition and denture-bearing tissues.

How fast can treatment with overdentures improve the masticatory function and OHRQoL of atrophic edentulous patients? A 1-year longitudinal clinical study.

The aim of this prospective clinical study was to evaluate the masticatory function (MF) and subjective perception of patients with poor denture-bearing tissue in relation to change and the time required to identify an improvement in these parameters after rehabilitation with mandibular overdentures (MO) by two narrow-diameter two-piece implants. Twenty-three edentulous patients were selected for MO installation. The masticatory function (MF) was evaluated with the masticatory performance (MP) and swallowing threshold (ST) tests. In the MP test, each volunteer was instructed to masticate a portion of Optocal (standardized artificial test food) for 40 masticatory cycles. During the swallowing threshold test, the patients were instructed to chew a new portion of Optocal cubes until they felt the desire to swallow. The MF tests were performed while complete denture (CD) wearers (baseline) and 1, 3, 6, and 12months after MO loading. In addition, the subjective perception was assessed through the questionnaires Dental Impact on Daily Living (DIDL), Geriatric Oral Health Assessment Index (GOHAI), and Oral Health Impact Profile in Edentulous (OHIP- EDENT) at the baseline and 3, 6, and 12months after MO loading. A significant improvement in masticatory function (p<.05) was observed already in the first month of loading. Three months after MO loading, a significant improvement (p<.05) was found in the subjective perception of patients. The effect size indicates that the MO had the greatest impact on the domains related to function and comfort of all questionnaires and in relation to psychosocial domain of the GOHAI. The level of patient satisfaction increased significantly after the MO loading and reached >90% satisfied patients at 12months. The MO improved both the MF of the patient and their oral health-related quality of life and satisfaction regarding the prosthesis in a short time period.

Mandibular implant-retained overdenture relining procedure with an attachment system: A step-by-step demonstration of the technique

Background and OverviewBecause of continuous alveolar bone resorption, implant-retained overdentures need to be relined. The purpose of this study was to describe a method for relining an implant-retained overdenture. Case DescriptionThe authors present a step-by-step technique. A 65-year-old patient sought care for trauma and pain in the oral mucosa underneath his mandibular implant-retained overdenture. The overdenture had been fabricated 4 years previously. In addition, the patient mentioned the denture’s lack of stability during function. On the basis of the patient’s dental history, and clinical and radiographic examination results, the authors found alveolar bone resorption. Conclusions and Practical ImplicationsIn this case report, the authors describe the technique, analyze the procedure of implant-retained overdenture relining with a Locator attachment system (Locator abutment, H3, SP MB SZL03 for internal hex implants; MIS Seven), and describe how to restore the contact of the denture base with the denture-bearing tissues. The goal of this technique for the general dentist is to eliminate patients’ tissue trauma and pain and increase the stability and support of the prosthesis.

Advances in Soft Denture Liners: An Update.

Soft denture liners are used in complete and partial removable dentures to distribute functional loads homogeneously on the denture-bearing tissues. These materials are recommended in cases of irregular bone resorption, bony undercuts, thin atrophic mucosa, immediate prosthesis, healing after implant placement, and for patients with bruxism and xerostomia. The resilient lining materials can be categorized as plasticized acrylic resins or silicone elastomers. The plasticized acrylic resin comprises of acrylic polymers and copolymers, a liquid containing an acrylic monomer and plasticisers, such as ethyl alcohol and/or ethyl acetate responsible for preserving the material softness. The silicone elastomers, consisting of dimethylsiloxane polymers, with a chemical composition similar to that of the silicone impression materials devoid of leachable plasticisers, retain their elastic properties for prolonged periods. Most of the currently available materials have several disadvantages, including color stability, long-term resiliency, abrasion resistance, bond strength and porosity. Several modifications have been done recently to overcome of these disadvantages of the soft liners. The current review summarizes the recent developments in soft liners.

DISPLACEABLE TISSUE: A CLINICAL CHALLENGE FOR A PROSTHODONTIST

A fibrous or flabby ridge is a superficial area of mobile soft tissue affecting the maxillary or mandi bular alveolar ridges. Restoration of such ridges often requires s pecial consideration in impression making. Masticat ory forces can displace this mobile denture-bearing tissue, leadin g to altered denture positioning and loss of periph eral seal. Forces exerted during the act of impression making can res ult in distortion of the mobile tissue. Unless mana ged appropriately by special impression techniques, suc h ‘flabby ridges’ adversely affect the support, ret ention and stability of complete dentures. This paper describe s a technique especially applicable for mandibular edentulous flabby ridges. The choice of the impression materia l, as well as the design of the impression tray, fo cuses on preventing distortion of the displaceable residual ridges during impression making. The use of this te chnique helps in maintaining the contour and capturing the detail of the tissues, as well as in accurately determini ng the extent of the muccobuccal denture extensions.

Prosthodontic rehabilitation of patient with flabby ridges with different impression techniques – Case reports

A fibrous or flabby ridge is a superficial area of mobile soft tissue affecting the maxillary or mandibular alveolar ridges. It can develop when hyperplastic soft tissue replaces the alveolar bone and is a common finding particularly in the upper anterior region of long term denture wearers. Masticatory forces can displace this mobile denture-bearing tissue, leading to altered denture positioning and loss of peripheral seal. Forces exerted during the act of impression making can result in distortion of the mobile tissue. Unless managed appropriately by special impression techniques, such ‘flabby ridges’ adversely affect the support, retention and stability of complete dentures. This paper presents three case reports for prosthodontic rehabilitation of patient with flabby ridges with three different impression techniques.

Maintenance Requirements Associated With Mandibular Implant Overdentures: Clinical Results After First Year of Service

The aim of this clinical study was to evaluate the prosthodontic maintenance requirements during the first year of service of mandibular overdentures supported by interforaminal implants and to assess the influence of attachment type, implant number, and bite force on these requirements. Fifty-nine patients treated with mandibular implant overdentures between the years 2004 and 2009 and appearing in the 12th-month recall were included in this study. The overdentures constituted 4 groups: 2 single interforaminal implants (1 group with locator and 1 group with ball attachments), 3 single interforaminal implants, 3 splinted interforaminal implants (bar), and 4 splinted interforaminal implants (bar). During the examination, prosthetic parameters such as occlusion, tissue adaptation, condition of the retentive mechanism (matrice and patrice), and the condition of the denture-bearing tissues were evaluated and recorded. No statistically significant relation was found between attachment type, bite force values, implant number, and the occurring complications except the need for relining, which was found significantly more in the ball attachments than in other attachment groups (P = .03). After 12 months following the overdenture insertion, there seems to be no relation between occurring complications and patient-related factors, such as maximum bite force, age, and gender, as well as factors related to the overdentures such as number and type of attachments.

Impact of xerostomia on oral complaints in a group of elderly Turkish removable denture wearers

The aim of this study was to examine the correlation of subjective dry mouth assessment (xerostomia) with age, sex, denture type, wear duration, denture stability, subjective discomfort, soreness in denture-bearing tissues, and dissatisfaction with chewing, tasting, or speaking in a group of elderly Turkish removable denture wearers. The participants of this study were 229 healthy subjects, 101 males (mean age: 68.1±5.2 years) and 128 females (mean age: 66.4±4.2 years), all aged 60 years and above. A self-administered structured questionnaire on sensation of dry mouth, its effects in the oral mucosa and ability in the oral functions were given to the participants. Associations of the categorical variables were examined using the χ2-test (p<0.05). Satisfaction in the ability of speaking, tasting foods, chewing hard food was determined statistically significant in patients without dry mouth (p<0.05). Overall satisfaction of dentures was significantly higher in patients without dry mouth (p<0.05). Participants with having dry mouth reported soreness in denture-bearing tissues in both complete and removable partial denture (RPD) wearers. It was also found that oral dryness significantly affects oral functions in terms of the satisfaction with removable denture and the ability in the oral functions independent to education level or gender.

The Evaluation of Denture Retention and Ease of Removal from Oral Mucosa on a New Gel-Type Denture Adhesive

The purpose of this study was to evaluate the effect of a new gel-type denture adhesive on denture retention and ease of removal from the oral mucosa after use. Eleven complete denture wearing patients (3 males and 8 females; age range, 58-84 years; mean age, 73.7 years) with compromised maxillary denture-bearing tissues were included in the study. Denture retention and ease of removal were evaluated for a new gel-type denture adhesive. The results were compared with those obtained with and without a cream-type denture adhesive. Retention was evaluated by measuring unilateral bite force until these dentures were dislodged on the balancing side. Ease of removal was evaluated by scoring the remaining area of colored denture adhesives on the oral mucosa. Denture retention and ease of removal were also subjectively evaluated using questionnaires. A significant improvement in objective denture retention was observed when either the creamtype or gel-type denture adhesive was used (p<0.05). A significant difference in objective ease of removal was observed between cream-type and gel-type denture adhesive when subjects had rinsed their mouth once (p<0.05). Subjective assessment showed no significant differences in either retention or ease of removal between gel-type and cream-type denture adhesives (p=0.26, 0.24). Objectively, denture retention was higher with the cream-type than with the gel-type denture adhesive. Removal of the gel-type denture adhesive from the oral mucosa was easier than that of the creamtype. Subjectively, there were no differences in either retention or ease of removal.

Management of the flabby ridge: using contemporary materials to solve an old problem

The presence of displaceable denture-bearing tissues often presents a difficulty when making complete dentures. Unless managed appropriately, such 'flabby ridges' adversely affect the support, retention and stability of complete dentures. Many impression techniques have been proposed to help overcome this difficulty. While these vary in approach, they are similar in their complexity, are often quite time-consuming to perform, and rely on materials not commonly in use in contemporary general dental practice. The purpose of this paper is to describe an impression technique for flabby ridges that makes use of polyvinylsiloxane impression dental materials routinely available in general dental practice.

Impact of dry mouth on oral symptoms and function in removable denture wearers in Japan

The purpose of this study was to determine the association of dry mouth with oral symptoms and function, such as denture instability, discomfort, soreness in denture-bearing tissue, and dissatisfaction with chewing, tasting, or speaking in removable denture wearers. The subjects were 493 removable denture wearers with a mean age of 67.3 years. Perception of oral dryness was measured by a questionnaire. A multiple logistic regression analysis was used to determine the effect of the dry mouth on oral symptoms and function after controlling for age and gender. Oral dryness during eating was related to dissatisfaction with chewing (odds ratio, 10.5; P < .001) and speaking (odds ratio, 3.5; P < .05) and overall dissatisfaction (odds ratio, 6.3; P < .01) in complete denture wearers. Feeling of dry mouth was likely to be associated with soreness in denture-bearing tissues in both complete and removable partial denture wearers. There was a significant association of the perception of dry mouth among a group of denture wearers with oral symptoms and function.

Studies of changes in occlusion after the insertion of complete dentures (part II).

The aim of this clinical experimental study was to investigate whether, and what, changes in occlusion occur between 3 weeks and 1 year after insertion of complete dentures. Twenty-six edentulous patients, who already had their jaw relation registered for part I of this study some 357 days before, were re-examined. The same special non-arcon measuring articulator was used for determination of any positional differences between the presently recorded central condylar position with inter-occlusal gap and the equilibrated intercuspal position, from approximately 1 year previous. Differences were recorded electronically in the condylar area in three dimensions. The position of the condylar balls of the measuring articulator in maximum intercuspation had shifted, since the previous recording, by about 0.62 +/- 0.04 mm (0.04-1.76 mm) in the sagittal and 0.89 +/- 0.72 mm (0.01-3.06 mm) in the vertical direction. Whereas the differences measured in maximum intercuspation scattered in the sagittal plane uniformly around the centric condylar position, in the vertical plane they were shifted cranially about an average of 0.77 +/- 0.85 mm (1.06 mm caudally to 3.06 mm cranially). The results indicate that in half of the patients from the present sample the occlusion did not remain stable, which is assumed to be mainly caused by resorption of alveolar bone and abrasion of the acrylic teeth. Therefore, at each check-up visit not only the health of the denture-bearing tissues and the fit of the dentures, but also the mandibular posture and the occlusion should be examined carefully.

光重合型軟質裏装材の変色について

Soft linings to dentures are sometimes considered advantageous for patients who are capable of delivering a relatively heavy occlusal load to unfavourable denture-bearing tissues. The color change of heat and room temperature vulcanized soft lining materials have been discussed. The purpose of this study is to compare the color changes of two visible light curing soft lining materials. Tests were made on samples that were stored in four aqueous solutions and one oleaginous solution for 1, 2, 3, 4, 8 and 12 weeks. The aqueous solutions included saline, turmeric, instant coffee and red color No.102. The oleaginous solutions consisted of olive oil plus β-Caro-tene.The results were obtained as follows:1. Color difference of both visible light curing soft lining materials were larger than conven-tional soft lining materials such as silicone, fluoride and polyorefin.2. Two examined materials had almost the same color differences in both saline and red color No.102.3. Extreme color differences were observed in instant coffee, especially in the “Lite Line”.4. In the comparison of the “Lite Line”, which composed of a polyether urethane dimethacrylate resin material and the “Astron LC”, the former had a greater color difference than the latter in oleaginous solutions.