Denture Construction Research Articles

Comparison in Bone Density Changes for Two Different Designs in Treatment of Mandibular Bilateral Free End Saddle with Osseointegrated Implants

AIM: The aim of this study is to evaluate two different designs in mandibular bilateral free end saddle cases with the use of osseointegrated implants. The designs evaluated were OT-strategy extracoronal attachment and bar attachment. Radiographic evaluation was carried out for implants and natural abutment in terms of bone density.
 MATERIALS AND METHODS: This study was conducted on 10 patients with bilateral distal extension area with missing molars bilaterally; the patients were divided into two groups after implant insertion on the second molar area. Group I: Patients received extracoronal attachment distal to the last natural abutment teeth with the construction of metallic removable partial denture (RPD). Group II: Patients received bar attachment with the construction of metallic RPD. Both groups have the maxillary arch edentulous with the construction of complete maxillary dentures within our study. Radiographic evaluation for bone density was done for both groups at the time of prosthesis insertion, 3, 6, and 9 months later. A comparison between the two groups regarding each follow-up period was performed by an independent t-test.
 RESULTS: Although there were some differences between both designs in the 1st-time intervals, generally, there were no significant differences between the two designs all over the 3-time intervals.
 CONCLUSION: From the results of this study, it was concluded that: Although there were no significant differences between both designs, bar-attachment showed better results which should be confirmed with more future researches.

Analysis of pre-prosthetic surgeries performed in a private dental institution

Pre-prosthetic surgery is part of the oral and maxillofacial surgery, which concerns restoration of facial form and oral function. Pre-prosthetic surgery is a surgery done to obtain a better anatomic environment and to provide proper supporting structures for denture construction. The aim of this study was to analyse the various pre-prosthetic surgeries performed in a private dental institution. In this retrospective study, digital case records of all patients who underwent pre-prosthetic surgeries in Saveetha Dental College and Hospital from June 2019 to March 2020 were reviewed. Demographic details of patients and types of pre-prosthetic surgeries performed were recorded from digital case records. Retrieved data was analysed using IBM SPSS Software Version 23.0. Descriptive statistics and tests of association for categorical variables by Chi square tests were done and results were obtained. P value <0.05 was considered statistically significant. In this study, we observed that pre-prosthetic surgery was more commonly performed in the age group of 51-60 yrs (23.3%). Pre-prosthetic surgeries were done more in males than females. The most common type of pre-prosthetic surgery was valvuloplasty (62.2%), followed by frenectomy (20.7%). Statistically, a significant association was found between pre-prosthetic surgery and age group; pre-prosthetic surgery and gender; pre-prosthetic surgery and quadrant involved (p<0.05) Within the limits of this study, it can be concluded that the most common pre-prosthetic surgery performed was valvuloplasty. Pre-prosthetic surgery was performed more in males and the age group of 51-60 years, mostly in the third quadrant.

Fabrication of maxillary single complete denture opposing deranged mandibular occlusion using customized broadrick occlusal plane analysis (BOPA): A case report

Fabrication of a single complete denture (SCD) is a difficult especially when the opposing natural plane is deranged. There are various problem associated with opposing arch like Mal-aligned, attrition, tilted or supra-erupted teeth with makes it difficult to achieve balanced occlusion which is important for stability of the SCD. Primary objective of any restoration is to achieve harmonious occlusal plane to facilitate natural mandibular movements without interference and ease of mastication. This clinical report describes restoration of mandibular teeth (with severe attrition and deranged occlusion) by establishing normal plane of occlusion with the help of broadrick occlusal plane analysis (BOPA) followed by construction of a complete denture in maxillary arch with metal occlusion.

Managing Edentate Older Adults

Whilst increasing numbers of older people retain natural teeth, a sizable proportion of older people are still edentate. Replacement of missing teeth is important for function, aesthetics and to facilitate social interactions. The process of providing oral rehabilitation for edentate older adults can be challenging, but clinicians can utilise a number of treatment options including removable or implant retained prostheses. In this article, complete denture construction will be described using both conventional and copy denture techniques. Recent innovations in the process for constructing complete dentures using computer aided design and manufacturing (CAD-CAM) techniques will also be discussed. Dental implants can be used to help retain removable complete prostheses for edentate patients and the use of implant-retained overdentures is presented as a treatment alternative.

Revisiting a Funding Model for University-led Dental Clinics: The Case of Complete Denture Fabrication Case of Complete Denture Fabrication

Objectives: University-led dental clinics are rarely seen as core to the national healthcare system. Thus, when publicly funded universities experience a decline in government support, dental clinic services operated by students are confronted by a potentially inadequate operating budget. Prompted by the need for strategic resource allocation, this study seeks to quantify the resources consumed in the construction of complete dentures by undergraduate students in an effort to identify opportunities for cost-cutting measures. Methods: Clinical cases were retrieved from the logbooks of graduating students of Class 2015, and patient records were reviewed to identify and quantify all clinical and laboratory procedures involved in constructing a set of complete dentures. Cost estimation was carried out using the activity-based method on the basis of direct medical costs. Results: A total of 83 patient records were reviewed. The average number of visits required to fabricate a set of complete dentures was 10 (range, 6–20 visits) with an average total cost of MYR2131±538 (€450±114). The number of visits contributed substantially to the total cost, and procedures requiring multiple visits included secondary impression and jaw relation recording. The major cost components were dental equipment (44%), laboratory costs (28%), dental consumables (17%), salaries (7%), and dental instruments (3%). Conclusion: The operating cost for training students in denture fabrication is substantial. Schools should formulate strategies to reduce the number of patient visits by ensuring that students optimize the time spent per visit. A financially sustainable model to fund dental training is necessary to ensure that quality of care is not compromised in university-led clinics.

Development of a tool to measure patient expectations with complete removable dentures

INTRODUCTION: Patients' expectations of complete removable dentures may play a role in determining their level of satisfaction with newly constructed complete removable dentures. AIMS AND OBJECTIVES: To develop a Patient Expectation Questionnaire using a validated satisfaction questionnaire as framework and subsequently determine patients' expectations of complete removable dentures. OBJECTIVES: 1. To formulate a patient expectations questionnaire using a validated satisfaction questionnaire framework-that will assesses their perceptions of new dentures 2. To determine patient expectations related to masticatory functional, pain, psychological discomfort and social disability with complete removable dentures. METHODOLOGY: All the aspects of the newly formed Patient Expectation Questionnaire (PEQ) was formulated following the framework of the OHIP-20 patient satisfaction tool. The expectation questionnaire was administered to patients at their first dental visit with the information sheet and informed consent form. RESULTS: A series of statistical tests was done to assess the validity and reliability of the Patient Expectation Questionnaire. These tests concluded that the newly formulated questionnaire was reliable. CONCLUSION: Patient expectations can be determined prior to treatment thereby allowing the clinician to manage these expectations and strive to meet the attainable ones during the construction of the complete removable denture. Amongst others masticatory efficiency and pain were identified as being high on the request list for new complete removable dentures.

The Impact of the Flexible Partial Denture Base on the Alveolar Mucosa in comparison to metallic denture: RCT and Histological Study

Statement of the problem: Flexible denture is usually chosen by patients whom esthetics is their top priority, who refuse preparation of the abutment teeth or who have allergy to the metal. Patients are looking for restoring their lost teeth. However, the purpose of denture construction should involve the maintenance of the surrounding tissue health. Aim of study: to correlate the type of denture base with the distribution of masticatory forces through examining the histological changes in the alveolar mucosa. Methods: 12 partially edentulous patients with the same missing teeth were selected from Prosthodontics outpatient clinic, Faculty of Dentistry, Cairo University. 6 Patients received metallic partial denture while the rest received flexible partial denture. 2 smear biopsies were taken on the day of delivery and 6 month after denture insertion, stained with PAP and examined histologically to assess the number of keratinized cells. Results: by Using paired-t-test it show that both types of denture bases altered alveolar mucosal keratinization but there was a significant difference in number of keratinized cells among pretreatment, after-metallic, and after-flexible denture insertion. Flexible partial denture showed thinner and less keratinized epithelium. Conclusion: Any prosthetic restoration placed in the oral cavity will induce some mucosal changes .The biocompatibility of the prosthesis with oral tissue should be considered in addition to patient’s and dentist’s preference

Is a Ridge Classification Helpful when Assessing Edentulous Patients?

The edentulous ridge classifications most commonly used have their limitations in treatment planning. They do not provide an indication of the complexities that may occur when constructing a new set of complete dentures. The new classification system suggested in this article helps with improved record-keeping, information exchange between colleagues, and communication between patient and clinician. CPD/Clinical Relevance: The new edentulous ridge classification system links the various edentulous ridge shapes to possible complications that could arise during denture construction.

Relationship between Polishing Techniques and Bacterial Count on Different Denture Base Materials

Introduction: Wearing of dentures cause alteration in the oral microflora and increasing in number of bacteria and candida. The polished and fitting surfaces of the denture are both affected. Different polishing techniques influence the total count of bacterial accumulation on the denture surface. Aim: To count the bacterial colonies after polishing three denture base materials before and after six months of denture wearing by different polishing techniques. Materials and Method: Eighteen patients were randomly selected for construction of maxillary partial denture. They were divided into 3 groups: Group 1: Patients received conventional heat-cured PMMA (Acrostone) denture. Group 2: Patients received thermoformed polyamide (NEWULTRA) denture. Group 3: Patients received thermoformed acetal (Bio Dentaplast) denture. In each group, three patients had their dentures polished by pre polishing with brown rubber disc and fine pumice with wet rag wheel, and the other three patients with the same technique but followed by tripoli compound with dry rag wheel. Evaluation of bacterial counting was conducted before denture wearing and after six months of denture wearing. Swabs were taken from the palate of the patients and bacteria were counted. Findings: No significant difference was found between technique no. I and no. II in decreasing the bacterial count between the tested materials. Thermoformed polyamide showed the highest bacterial count after six months of wearing denture polished by technique no. II followed by thermoformed acetal and heat-cured PMMA. Conclusion: The second polishing technique produced less surface roughness and bacterial colonization on the tested materials than the first one.

Quality of communicating design features for cobalt chromium removable partial dentures in Riyadh, Saudi Arabia

This survey aimed to investigate quality of communicating design features for the construction of cobalt chromium removable partial dentures (RPDs) among dentists in Riyadh, Saudi Arabia. A survey of nine commercial dental laboratories located in Riyadh was carried out. In each visit, master casts for cobalt chromium RPDs and dentists' prescriptions were examined. A quality score for the provided instructions was developed and ranged from 0 to 4. A zero score means that no instructions were sent from the dentist for the design of the RPD. A score of 4 means that instructions were provided for the design of four main elements of the RPD, i.e., shape of major connector, type of direct retainers, position of direct retainers, position of dental rests. 162 dentists' prescriptions for RPDs and related casts were assessed. The majority of RPD cases were designed by the dental technician alone (64.2%). Shape of the major connector was the most frequent element in dentists' prescriptions (35.8%). The mean quality score of dentists' instructions was 0.96 (sd=1.54). 18% of the provided instructions achieved quality score equal to 4. Prescriptions for Kennedy Class III cases achieved significantly higher mean quality score compared to Kennedy Class II cases (p<0.05). 16.7% of the evaluated casts had clearly defined rest seat preparation. The results of this survey indicate inadequate quality of communicating the design features of cobalt chromium RPDs among practicing dentists in Riyadh, Saudi Arabia. The reliance on the dental technician to design the cast RPDs seems to be high.

Facial measurements: A guide for vertical dimension.

Background:Leonardo de Vinci contributed several observations and drawings on facial proportion and the lower one third of the face. Many facial and body measurements to determine vertical dimension at occlusion. These facial measurements can be implemented in construction of complete denture patients.Aim:This study aims to correlate the vertical dimension at occlusion to 13 anthropometric measurements. Then correlating, which measurement is more accurate to the vertical dimension at occlusion.Methodology:20 male and female subjects were selected. Vertical dimension at occlusion and 12 anthropometric parameters were measured.Results and Conclusion:Twice the length of the eye and distance between the tip of the thumb and tip of the index finger is closest to the vertical dimension at occlusion in male patients and that vertical distance from the pupil to corner of the mouth, vertical height of the ear is closest to the vertical dimension at occlusion in female patients.

Prefabricated light-polymerizing plastic pattern for fabrication of cast partial framework of obturator prosthesis – A novel technique

This case report aims to report a novel application of a prefabricated light-polymerizing plastic resin for the construction of cast partial denture (CPD) framework for the fabrication of a definitive obturator. Prefabricated light polymerizing plastic patterns have been introduced in dental labs and are used in the fabrication of CPD framework. This novel technique shows how it minimizes laboratory time and cost by removing some of the steps involved during metal-based definitive obturator fabrication. A case of maxillectomy was rehabilitated using light polymerizing plastic pattern for the fabrication of metal-based definitive obturator.

The influence of undercut depths on the accuracy of casts poured from irreversible hydrocolloid impression materials

ObjectivesTo evaluate the elastic recovery of a typical irreversible hydrocolloid impression material in terms of the amount of undercut identified and additional thickness of spacer provided before custom tray fabrication. MethodsThis study surveyed the undercut depths of the teeth surfaces and lingual sulci of one hundred partially dentate mandibular dental casts which were subsequently scanned and the data exported as STL files. A typical cast from each undercut category (0.5mm, 1mm, 1.5mm, 2mm, 2.5mm, 3mm, 4mm, 5mm) was 3D printed. Three custom trays were constructed with spacer thicknesses representing 20%, 30% and 50% compression against the wall of the custom trays on removal, impressions recorded, and casts fabricated in dental stone. Measurements for elastic recovery of irreversible hydrocolloid were done using an internal caliper and a digital caliper. All measurements were done by the principal investigator. Non-parametric analyses were used for comparisons of the undercut values between the 3D printed and poured casts to determine the amount of elastic recovery of the irreversible hydrocolloid impression material. ResultsThere was no statistically significant difference in measurements between the original 3D printed casts and the poured casts, irrespective of percentage compression (p > 0.05). ConclusionsIn removable partial denture construction, casts should be blocked out parallel to the path of insertion and then an additional 3mm of spacer applied as a standard technique before custom tray fabrication to ensure elastic recovery of the irreversible hydrocolloid impression. Clinical implicationsIn severe undercut situations, accurate impressions can be taken using irreversible hydrocolloid by blocking out all undercut surfaces on the teeth and lingual sulci before adapting additional three-millimetre wax spacer on casts when constructing custom trays thereby ensuring accurate and reliable impressions for removable prosthesis construction.

Oral health related quality of life by means of functional changes in Geriatric Oral Health Assessment Index (GOHAI) before and after insertion of new conventional complete dentures in completely edentulous patients.

The oral health-related quality of life determines the quantity to which oral health disrupts the regular life and common functioning of an individual. To evaluate the oral health problems of older adults, Geriatric Oral Health Assessment Index (GOHAI) can be used. GOHAI was developed by Atchinson and Dolan3 before and after complete denture therapy”. Study Design: Cross sectional study. Setting: Department of Prosthodontics, Lahore Medical and Dental College, Lahore. Period: February 18, 2018 to August 17, 2018. Material &amp; Methods: Patients will be selected for the study according to the criteria. Patient history and clinical examination was undertaken. Upper and lower complete dentures was made-up for 30 patients (both male and female) using standardized clinical and laboratory methods. Conventional procedures were applied to complete denture construction. Complete dentures were constructed in the similar dental laboratory within the institution by compression moulding method. Laboratory and clinical remount procedures, beside with occlusal corrections were carried out using a semi-adjustable articulator. The GOHAI questionnaire was completed on two different appointments. First questionnaire was documented before denture insertion and second questionnaire was recorded after complete denture insertion. Results: Before treatment mean GOHAI score was 20.46 ± 2.85 and after treatment mean GOHAI score was improved and was 26.32 ± 2.34. The mean GOHAI score was statistically improved p-value &lt; 0.001. For male patients, before treatment mean GOHAI score was 21.61 ± 2.59 and after treatment mean GOHAI score was improved and was 26.31±2.14. The mean GOHAI score was statistically improved in male patient, p-value &lt; 0.001. For female, before treatment mean GOHAI score was 19.34 ± 2.70 and after treatment mean GOHAI score was improved and was 26.44 ± 2.49. The mean GOHAI score was statistically improved in female patients, p-value &lt; 0.001. Conclusion: According to patient’s information enhancement in functional changes after placement of complete dentures.

Effect of addition of silver nanoparticles on flexural and impact strength of heat cure acrylic resin

Background and objectives: Heat cure denture base material is the most commonly used ma-terial for fabrication of removable prosthesis since its introduction in 1937. The unresolved problem of frequent fracture is one of the main drawbacks when used in denture construction. The purpose of this study was to evaluate the influence of silver nanoparticles on flexural and impact strength of heat-polymerized resin. Materials and methods: Silver nanoparticles were impregnated at 1%, 3% and 5% by weight to the monomer of methyl methacrylate with the aid of probe sonicator. Afterward, they were mixed with the acrylic powder. Sixty samples were prepared in total to observe its influence on flexural and impact strength. Results: Flexural strength values revealed a statistically significant difference (p<0.05) among the three concentrations. The results indicated a 22% reduction in the mean value for 3% while 1% and 5% caused 20% and 21% decrease respectively when compared to control. Regarding impact test, it demonstrated a statistically significant difference only for 5% that caused a dras-tic drop in impact value by 41% in contrast to the control group. Conclusion: Within the limitations of this study, it can be concluded that the addition of silver nanoparticles caused a reduction in mechanical strength of heat cure acrylic except for 3% which caused a minor non-significant increase in impact strength. Considering the negative effect on mechanical strength and jeopardizing the aesthetic value for acrylic, it can’t be consid-ered as a suitable additive to enhance the properties tested.

Management of Flabby and Compressible Ridge in Maxilla Using Double Tray Impression Technique―A Case Report

Construction of complete dentures and its performance in function depend on accurate impression of the denture bearing and limiting areas. Complete denture fabrication in clinically compromised situations such as flabby ridges is a challenging task for the clinician. In this case report, a newer technique was proposed of impression making of the flabby ridge using a double tray to ensure an accurate and easy impression of these tissues.

The Value of Panoramic Radiograph as a Screening Tool Prior to Complete Denture Construction: A Restrospective Study

Objective: The aim of this study was to determine the frequency of detecting abnormal radiographic findings from a diagnostic panoramic radiograph of edentulous patients prior to complete denture constructions. Methods: We reviewed the dental records and panoramic radiographs of 194 edentulous patients receiving complete denture treatment over a 5-year period. We identified cases with recorded abnormal radiographic findings which did or did not require intervention prior to complete denture fabrication. Results: Radiographic abnormalities were detected in 24 of 194 cases (13%), of which 11 cases (6%) required intervention prior to denture construction. Of those 11 cases, 7 had a retained root which required extraction and 4 had irregular ridges which required alveoloplasty. The remaining 170 patients (87%) had no abnormal findings detected on their panoramic radiographs. Conclusion: Abnormal radiographic findings that affect denture construction were only found in 6% of patients, similar to the previous reports. Therefore, taking panoramic radiographs prior to complete denture construction offers insignificant clinical value and should, thus, be discontinued as a screening tool.

Study of Early Adhesion of Some Oral Microflora Representatives to Basic Materials of Removable Dentures

An increase in the number of removable denture constructions being produced leads to an increase in the number of complications, which, in turn, reduces the timing of the effective use of orthopedic structures. At present, the problem of treating prosthetic stomatitis and their prevention has not been resolved. Considering the current socio-economic situation, orthopedic treatment of the patients with removable dentures will be relevant for some more time.&#x0D; Microbiological studies of the ability of basic materials to adhere different types of microorganisms onto their surfaces were performed. There were used 7 different types of resins manufactured according to different technologies.&#x0D; Having performed a series of microbiological studies on the adhesive ability of basic materials, the following results were obtained. The control was glass, the average index of adhesion to which was 0.69±0.02. The greatest adhesive ability to various types of microorganisms was found in acrylic resins based on polymethyl methacrylate, namely auto-polymer resin Protacryl and resin Sinma. Accordingly, the smallest adhesive properties were seen in non-monomer resins, such as Polian, Nylon, Biocryl with adhesion indices of 0.75±0.04, 0.72±0.03, 0.78±0.03, respectively.

The Value of Panoramic Radiograph as a Screening Tool Prior to Complete Denture Construction: A Restrospective Study Complete Denture Construction: A Restrospective S

Objective: The aim of this study was to determine the frequency of detecting abnormal radiographic findings from a diagnostic panoramic radiograph of edentulous patients prior to complete denture constructions. Methods: We reviewed the dental records and panoramic radiographs of 194 edentulous patients receiving complete denture treatment over a 5-year period. We identified cases with recorded abnormal radiographic findings which did or did not require intervention prior to complete denture fabrication. Results: Radiographic abnormalities were detected in 24 of 194 cases (13%), of which 11 cases (6%) required intervention prior to denture construction. Of those 11 cases, 7 had a retained root which required extraction and 4 had irregular ridges which required alveoloplasty. The remaining 170 patients (87%) had no abnormal findings detected on their panoramic radiographs. Conclusion: Abnormal radiographic findings that affect denture construction were only found in 6% of patients, similar to the previous reports. Therefore, taking panoramic radiographs prior to complete denture construction offers insignificant clinical value and should, thus, be discontinued as a screening tool.

Flangeless denture: an innovative technique for management of labial undercut in completely edentulous patient: a case report

&lt;p class="abstract"&gt;Labial ridge undercut is more commonly seen in maxilla than mandible in completely edentulous individuals and it possess a great threat to the final esthetic outcome. Construction of a labial flange in conventional manner might compromise the facial support and muscles of facial expression, limit function, and compromise aesthetics for a better prognosis, an unconventional approach is needed for the construction of complete denture. This case report describes an innovative, economical, nonsurgical treatment option for fabrication of complete denture in a patient with a prominent labial undercut to enhance the facial aesthetics of the patient.&lt;/p&gt;