Denture Placement Research Articles

Changes in the oral environment after placement of removable dentures in low caries risk patients

Japan has a high distribution of aged citizens. Dental treatment significantly contributes to a high QOL in the elderly. Many people lose teeth because of caries and/or periodontal diseases. It is important to find the causes for this and to take preventive measures. In particular, systemic diseases in the elderly tend to worsen the oral environment, leading to an increased risk of caries. The caries activity test is useful in understanding the oral environment. A simple chairside test can measure the patient’s unstimulated and stimulated salivary flow rate, unstimulated and stimulated salivary buffering capacity, and salivary microbial counts, including mutans streptococci, lactobacilli and Candida. Information on these oral environment factors can aid in preventing caries based on individual risk, and extending the life of dental restorations. In Japan, missing teeth are usually replaced by fixed or removable prostheses. Using the saliva test, Narhi reported that salivary microbial counts were greater in elderly with dentures than in those with natural dentition. Our cross-sectional study, which used the same saliva test, reported that there were large differences in the number of cariogenic bacteria in the oral environment of elderly with fixed prostheses compared with those who had removable prostheses. Although these studies suggested that removable dentures may influence salivary microbial counts, it is still unknown whether they contribute to an increase in the counts. We did a follow-up study that examined the oral environment over time of low caries risk patients after initial placement of removable prostheses.

A study to evaluate the location and frequency of denture-related ulcerations and postinsertion adjustments in complete denture patients

Background and Aims: Removable complete denture is one of the most common treatment modalities for completely edentulous patients. After denture insertion, patient very often faces problems with the denture even after complete care is taken during fabrication procedure. Most common complaint is traumatic ulcers. The present study aimed to locate the most common areas of ulcerations due to complete dentures, how frequently they occur and how many times patient visits for adjustment after insertion of complete denture. Materials and Methods: Two hundred and twenty-one patients were selected and were delivered complete dentures. Dentures were fabricated for all the patients. Each step of denture fabrication was controlled and guided by a prosthodontist. After placement of dentures, patients were evaluated at every recall visit and their dentures were adjusted. All the details of each visit (area of ulceration) and number of visits were recorded in a self-designed format. Descriptive statistical analysis was done using SPSS version 13 software. Chi-squared test was used to evaluate the correlation between mucosal injuries and postinsertion day and the relationship between lesions, patient age, and patient gender. Results: All the 221 patients required denture adjustment due to mucosal injuries. No significant difference was found between denture-related injuries between males and females. Injuries related to mandibular dentures were significantly higher than those related to maxillary dentures. In mandible, the most common area of mucosal injury is posterior one-third of alveololingual sulcus; while in maxilla, the most common area of mucosal injury is labial frenum. Conclusion: Postinsertion adjustments are an important aspect of rehabilitating patient with complete dentures. Most of the denture-related injuries were in limiting areas. Proper border molding techniques, accurate secondary impressions, and use of pressure indicating paste during denture insertion are main requisites for decreasing denture-related mucosal injuries.

Integrating 3D facial scanning in a digital workflow to CAD/CAM design and fabricate complete dentures for immediate total mouth rehabilitation.

PURPOSETo integrate extra-oral facial scanning information with CAD/CAM complete dentures to immediately rehabilitate terminal dentition.MATERIALS AND METHODSTen patients with terminal dentition scheduled for total extraction and immediate denture placement were recruited for this study. The patients were submitted to a facial scanning procedure using the in-office PritiMirror scanner with bite registration records in-situ. Definitive stone cast models and bite records were subsequently submitted to a lab scanning procedure using the lab scanner (iSeries DWOS; Dental Wings). The scanned models were used to create a virtual teeth setup of a complete denture. Using the intra-oral bite records as a reference, the virtual setup was incorporated in the facial scan thereby facilitating a virtual clinical evaluation (teeth try-in) phase. After applying necessary adjustments, the virtual setup was submitted to a CAM procedure where a 5-axis industrial milling machine (M7 CNC; Darton AG General) was used to fabricate a full-milled PMMA immediate provisional prosthesis.RESULTSTotal extractions were performed, the dentures were immediately inserted, and subjective clinical fit was evaluated. The immediate provisional prostheses were inserted and clinical fit, occlusion/articulation, and esthetics were subjectively assessed; the results were deemed satisfactory. All provisional prostheses remained three months in function with no notable technical complications.CONCLUSIONTen patients with terminal dentition were treated using a complete digital approach to fabricate complete dentures using CAD/CAM technology. The proposed technique has the potential to accelerate the rehabilitation procedure starting from immediate denture to final implant-supported prosthesis leading to more predictable functional and aesthetics outcomes.

Impact of radiotherapy on implant-based prosthetic rehabilitation in patients with head and neck cancer: A prospective observational study on implant survival and quality of life-Preliminary results.

To study implant-based prosthetic rehabilitation of head and neck cancer patients with focus on implant survival and quality of life. The prospective observational study presents preliminary results of 29 edentulous head neck cancer patients (20 patients after radiotherapy) with 165 OsseoSpeed implants. Implant success after 1-year follow-up was evaluated by means of the Albrektsson criteria. Quality of life was analysed with the EORTC QLQ-C30, QLQ-H&N35, and OHIP 14 questionnaires. The overall implant survival rate after 1 year was 95.2% (157/165). Implant success measured by the Albrektsson criteria showed a lower success rate of 86.7% (143/165), mainly because of peri-implant marginal bone loss with a mean of 0.8mm after 1 year. Xerostomia (p=0.008), implant insertion within the radiation target volume (p=0.09), implantation in transplanted bone (p=0.05), and smoking (p=0.041) were the main reasons for implant failure, followed by D4 bone quality, maxillary implant site, and insufficient primary stability. Speaking, swallowing, eating, as well as social integration and individual self-confidence had considerably improved 1 year after denture placement compared to before treatment. Implant-based prosthetic rehabilitation of head and neck cancer patients is possible at a calculable risk and significantly improves patients' quality of life.

Digital immediate dentures treatment: A clinical report of two patients

The use of computer-aided engineering (CAE) and computer-aided design and computer-aided manufacturing (CAD-CAM) technology to fabricate complete dentures was introduced in 2011. Clinical procedures for digital immediate dentures can be identical to those for conventional immediate dentures and can be simplified by leaving all remaining dentition until the time of extraction and denture placement. Through the digital process, a single digital design and a definitive digital record are created which can be used to fabricate the immediate digital denture and surgical reduction guide for alveoloplasty. Digital immediate dentures can be relined using the same process as for conventional dentures. The definitive digital dentures can be fabricated with a reline impression and new centric relation record, using the existing digital immediate denture without additional clinical procedures. Providing patients with digital immediate dentures is a viable trend.

A Clinical Study to Examine the Effect of Complete Denture on Head Posture/Craniovertical Angle.

Edentulous patients show some significant changes in ridge relationship caused by resorption of alveolar ridge. The changes are characterized by an upward rotation of mandible, increase in mandibular prognathism that ultimately results in change of natural head posture. This clinical study was planned to know the effect of complete denture on head posture in different age groups of Indian completely edentulous population, after placement of complete denture at various time intervals. The sample consisted of completely edentulous patients without previous experience of the dentures. They were divided into 2 age groups: Group A (45-60) and Group B (61-75). During placement of complete denture craniovertical angle was measured with the help of custom made ruler protector device. Readings were taken before denture placement, immediately after denture placement, 30 minutes, 24 hours and 30 days after dentures placement. The results of this study indicated that in most of the patients (90%) despite their age, change in head posture (extension) occurred immediately after the denture placement. Thereafter reading remains same for measurement at 30 minutes and 24 hours of denture placement. However after 30 days, observation revealed that all the patients showed reduced craniovertical angle (flexion). Even though the values of craniovertical angle remain higher than its baseline in both groups, significant changes were noticed only in Group A. Findings revealed that head posture was significantly altered by the placement of dentures in completely edentulous patients. Within the time interval of 30 minutes and 24 hours extension of head posture remained constant with slight variation. Although after 30 days, changes remained significant for group 'A', but no significant changes were observed in the subjects of group 'B'.

Two Cases of Severe Dementia Showing Dramatic Improvement after Denture Placement

Severe dementia, including Alzheimer’s disease, is intractable and progressive. The purpose of this study was to document the improvement observed in two cases of severe dementia after denture placement. The subjects, two women in their 70s with severe dementia, were diagnosed with Alzheimer’s disease by the medical doctors in charge of their cases. In the first case, the subject’s symptoms included severe disorientation, impaired communication, and a tendency to wander. Two weeks after a lower complete denture placement, she was able to greet others. Five weeks later, she was able to communicate and precisely read an analog clock. Her condition continued to improve for at least 3 months. In the second case, the subject’s mouth was always open. She was bedridden in a vegetative state and hardly moved, talked, or laughed; it was impossible to communicate with her. Only a few seconds after an upper complete denture placement, she started to talk, albeit unintelligibly. Two weeks after a lower complete denture placement, she could communicate normally, laugh, and walk without help. Although the underlying mechanism has not yet been clarified, the author hypothesizes that positive signals from the oral area are transferred to the brain as positive stimulation via the trigeminal nerve, the largest cranial nerve.

Masticatory Efficiency Evaluation in Implant Retained Complete Overdenture With Different Occlusal Schemes

Objective: This study was conducted to evaluate the masticatory efficiency in immediately loaded implant retained mandibular complete over denture with two different occlusal schemes namely opposing conventional maxillary complete denture. Patients and Methods: Fourteen completely edentulous patients with age ranged from 51-61 years were selected from outpatient clinic of Removable Prosthodontics, Faculty of Dental Medicine, Al-Azhar University. One stage octa titanium implants with 3.75mm diameter and 14mm length were used. All Patients sharing in this study receiveimmediately loaded implant reteined mandibular overdenture. They were randomly divided into two equal groups (7 patients in each), the first group had the artificial teeth arranged in a median lingualized occlusio, while the second group had the artificial teeth arranged in a bilateral balanced occlusion. Masticatory efficiency measurements weretaken at the first time of overdenture placement and after six months of over denture use. Paired t-test was used to evaluate the masticatory efficiency before and after adaptation period for each group. Independent t-test was used to compare the masticatory efficiency measurements between both groups. Results: At the time of denture placement, therewas no significance difference in masticatory efficiency measurements between both groups. Masticatory efficiency was increased considerably after six months of denture use, and it was significantly higher than masticatory efficiency recorded at the time of new prosthesis placement in the same group. After six months of denture use, therewas a significance difference in masticatory efficiency measurements between both groups. Conclusions: It was concluded that using lingualized occlusion concepts was resulted in increased masticatory efficiency more than bilateral balanced occlusion after six months of denture use in patients received immediately loaded implant retained mandibular overdenture with ball and socket attachment.

Clinical evaluation of the Er,Cr:YSGG Laser therapy in the treatment of denture-related traumatic ulcerations: a randomized controlled clinical study.

The aim of this study was to evaluate the efficacy of Er,Cr:YSGG laser irradiation in reducing pain and on healing rate of traumatic ulcerations (TU) during a 2-week period after placement of new complete dentures. Denture-related TU are painful, and result in patient discomfort. Lasers are used in the treatment of different kinds of mucosal lesions; however, there are no published data available concerning the clinical outcome of the use of laser therapy in the treatment of TU. Thirty edentulous patients with newly fabricated complete dentures who subsequently developed one or more pairs of TU participated in this study. For each patient, ulcerations were randomly assigned to the test and control groups. In the test group, ulcerations were irradiated with Er,Cr:YSGG laser. In the control group, the same laser without laser emission was used. Pain was assessed with a visual analog scale (VAS). Healing of ulcerations (HU) was graded by a clinician. In the test group, laser irradiation provided significantly reduced pain immediately after treatment, and provided a significant healing effect 1 day after treatment, and these effects were maintained throughout the study. In the control group, baseline VAS scores were not statistically significant at baseline and 1 day after treatment, and HU scores were statistically significant 3, 7, and 14 days after treatment. Intergroup comparisons revealed that the differences in VAS and HU scores were statistically significant for all time periods after treatment, except for day 14. Based on these findings, it may be concluded that Er,Cr:YSGG laser is effective in the treatment of TU.

Restoration of Maxillary Anterior Teeth with Immediate Implant Placement into Extraction Sites: A Case Report with One Year Follow-Up

The demand for optimal esthetics has increased with the advent of the implant dentistry. It answers many questions concerning esthetics, like replacement of hopeless teeth in esthetic zone of maxillary arch. N ow a days immediate restoration of a single tooth loss by implant supported prosthesis is highly predictable treatment. This clinical report describes a protocol of an immediate tooth extraction, followed by placement of provisional denture in the prepare d socket of maxillary central incisors. Surgical and restorative techniques are prescribed in the text. A review program of 3, 6, and 12 months was followed.

English

A considerable proportion of the population have detectable numbers of yeast in the mouth, yet very few of those people suffer from oral Candida infection. Placement of removable dentures in the oral cavity produces profound changes of the oral environment that may have an adverse effect on the integrity of the oral tissues, which might further change the oral microbial flora. Improper oral hygiene and negligence on denture care lead to candiasis. The denture cleansers currently available in the market are costly and are not readily available. The current study attempted at evaluating the effectiveness of house hold denture cleansers on Candida albicans. 2. PREPARATION OF DENTAL PLASTER MOULD SPACE: Wax patterns were obtained by pouring wax into the die space present within the metal mould. The wax patterns obtained were checked for voids and inaccuracies. The wax patterns were then invested in a dental flask, using dental plaster following the manufacturer's instructions for water-powder ratio, mixing time and setting time. Mechanical vibrator was used to prevent air trapping during investing. Once the plaster was completely set, dewaxing was done for 10 min. The mould space thus obtained was used for the preparation of the test samples. 3. PREPERATION OF TEST SAMPLES: The denture base resins used were in ratio of 1:3 monomer and polymer for all the groups. Separating medium was applied on to the dental

Denture Stomatitis: A Literature Review

Denture stomatitis is a denture-associated mucosal condition characterized by inflammation and erythema of the denture-bearing surfaces. The etiology is multifactorial, although, Candida albicans is the commonly associated pathogenic organism. Predisposing factors include poor oral and denture hygiene, ill-fitting dentures, nocturnal denture wearing, allergic reactions to denture base material and underlying systemic conditions. Usually, the patients are asymptomatic, although some patients may complain of burning sensations, bleeding from mucosal surfaces, bad smell and impaired taste sensations. Denture stomatitis can be managed by elimination of predisposing factors, placement of dentures in antiseptic solutions, and the use of antifungal agents. Surgical interventions may be required in severe inflammatory states.

The path of placement of a removable partial denture: a microscope based approach to survey and design.

This article reviews the topic of how to identify and develop a removable partial denture (RPD) path of placement, and provides a literature review of the concept of the RPD path of placement, also known as the path of insertion. An optimal RPD path of placement, guided by mutually parallel guide planes, ensures that the RPD flanges fit intimately over edentulous ridge structures and that the framework fits intimately with guide plane surfaces, which prevents food collecting empty spaces between the intaglio surface of the framework and intraoral surfaces, and ensures that RPD clasps engage adequate numbers of tooth undercuts to ensure RPD retention. The article covers topics such as the causes of obstructions to RPD intra-oral seating, the causes of food collecting empty spaces that may exist around an RPD, and how to identify if a guide plane is parallel with the projected RPD path of placement. The article presents a method of using a surgical operating microscope, or high magnification (6-8x or greater) binocular surgical loupes telescopes, combined with co-axial illumination, to identify a preliminary path of placement for an arch. This preliminary path of placement concept may help to guide a dentist or a dental laboratory technician when surveying a master cast of the arch to develop an RPD path of placement, or in verifying that intra-oral contouring has aligned teeth surfaces optimally with the RPD path of placement. In dentistry, a well-fitting RPD reduces long-term periodontal or structural damage to abutment teeth.

A clinical study to compare between resting and stimulated whole salivary flow rate and pH before and after complete denture placement in different age groups.

Purpose:This study compared the flow rate and pH of resting (unstimulated) and stimulated whole saliva before and after complete denture placement in different age groups.Materials and Methods:Fifty healthy, non-medicated edentulous individuals of different age groups requiring complete denture prostheses were selected from the outpatient department. The resting (unstimulated) and stimulated whole saliva and pH were measured at three stages i.e., i)Before complete denture placement;ii)Immediately after complete denture placement; andiii)After 2 to 3 months of complete denture placement. Saliva production was stimulated by chewing paraffin wax. pH was determined by using a digital pH meter.Results:Statistically significant differences were seen in resting(unstimulated) and stimulated whole salivary flow rate and pH obtained before, immediately after, and after 2 to 3 months of complete denture placement. No statistically significant differences were found between the different age groups in resting (unstimulated) as well as stimulated whole salivary flow rate and pH.Conclusion:Stimulated whole salivary flow rates and pH were significantly higher than resting (unstimulated) whole salivary flow rates and pH obtained before, immediately after, and after 2 to 3 months of complete denture placement. No age related variations in whole salivary flow rate and pH were observed in healthy, non-medicated individuals.Clinical Implications:The assessment of salivary flow rate, pH in different age groups is of prognostic value, which is an important aspect to be considered in the practice of removable prosthodontics.

무치악치조제의 개선을 통한 보철치료

상악과 하악의 크기부조화가 있거나 악간관계가 불안정한 환자의 치료목적은 안정적인 교합접촉을 부여하는 것이다. 중등도의 정신지체 환자로 부족한 수직고경, 수평적 악골관계 부조화, 광범위한 치질소실로 인하여 보철치료가 필요하였다. 두부계측학적 평균치를 기준으로 악골위치를 판별하고, 연조직 측모분석 후 수평 골삭제량을 결정하였다. 수술 부위의 안정적인 치유 및 설정된 상하악관계에 대한 의치 적응여부를 평가하였다. 만족할만한 심미성과 안정적 교합상태를 얻었으나, 추가적인 교합변화의 가능성을 고려한 정기적인 관리가 필요할 것으로 사료된다. If the maxillomandibular relationship is unstable or requires treatment for improved function and esthetics, the first treatment objective is to provide stable occlusal contacts. The patient has moderate mental retardation. Due to inadequate vertical overjet, horizontal arch malrelation and excessive tooth loss, full mouth rehabilitation was required. The purpose of treatment planning is to establish physiologic maxillomandibular relation. Using cephalometrics for occlusal analysis is an aid to make a decision. The amount of horizontal bone reduction was calculated with evaluating soft tissue profile. After provisional denture placement, healing of the surgical site and newly adapted arch relationship was evaluated. The patient satisfied with esthetics and showed stable holding contacts. Periodic examination is needed to exclude occlusal disharmony.

Immediate Denture in Patient With Undiagnosed Ameloblastoma: Case Report

Ameloblastoma is an odontogenic tumor that commonly affects the posterior region of the mandible and is frequently associated with an unerupted tooth. Woman, 67, complained of a hard swelling in the right mandibular premolar region that appeared after tooth extraction and placement of an immediate denture. Intraoral examination showed buccal and lingual cortical plate expansion. Occlusal and panoramic radiographs showed multilocular radiolucency with a well-defined margin. Fine needle aspiration was nonproductive.

Oral rehabilitation of two siblings with Ectodermal Dysplasia : a case report

Ectodermal dysplasia (ED) is a congenital syndrome characterised mainly by abnormalities of two or more tissues of ectodermal origin namely skin, nails, hair and teeth. Two brothers of 14 years and 10 years of age respectively reported with chief complaint of multiple missing teeth. Thorough medical and dental examinations were performed and findings were in accordance with the typical features of Ectodermal Dysplasia. Pedigree analysis, dermatoglyphic analysis and skin biopsy were also performed. The elder brother was treated with a maxillary removable overdenture and a mandibular removable partial denture. In the younger brother aesthetic composite restoration was done in maxillary anteriors followed by placement of maxillary and mandibular removable partial dentures.

Clinical performance and satisfaction of removable prostheses with self-adjusting magnetic attachments

Conventional magnetic attachments have rigid assemblies and are unable to compensate for the movement of the prosthesis under function, which may result in the deepening of periodontal pockets and an increase in the mobility of abutment teeth. The purpose of this study was to evaluate the clinical performance and satisfaction of participants with removable prostheses with self-adjusting magnetic attachments that allow vertical and rotational movement. The clinical performance of 17 prostheses with 22 self-adjusting magnetic attachments in 16 participants was analyzed for a mean of 3.1 years. Periodontal indices, including probing pocket depth and tooth mobility, were measured at denture placement (baseline) and from 0.5 to 5 years after insertion. Control data were obtained from the remaining teeth, which were restored by resin or metal coping. Prosthetic parameters, including the reduction of retention in self-adjusting magnetic attachments, reline, or fracture of dentures, were also recorded. A visual analog scale questionnaire on participant satisfaction with stability, comfort, and cleaning of the prostheses was completed. The Wilcoxon signed rank test and 1-way analysis of variance (α=.05) were performed on data collected atthe time of prostheses placement and final follow-up evaluation. No significant differences were found in terms of probing pocket depth and tooth mobility between the baseline and postinsertion data for self-adjusting magnetic attachments and control teeth. Retention in all prostheses was stable, without reduction. Higher visual analog scale scores for "easy cleaning" were noted. No significant difference between baseline and postinsertion was noted regarding the periodontal conditionofself-adjusting magnetic attachments and control teeth with resin or metal coping materials.

A technique to correct incisal plane error in maxillary immediate denture therapy

This article describes a predictable technique for rectifying an asymmetrical incisal plane after the placement of a maxillary immediate denture. The inability to have a wax trial placement precludes an esthetic evaluation of the maxillary anterior teeth, which may lead to esthetic errors. After correction of the incisal plane, a rebase procedure and a clinical remount follow after appropriate healing time for the patient after extraction.

Oral health status of Thai elderly: tooth loss and denture placement

Oral health status of Thai elderly: tooth loss and denture placement