Edentulous Subjects Research Articles

Cone-beam Computed Tomographic Evaluation of the Anatomical Changes of Temporomandibular Joint Use of Pre-post Dentures: A Time-control Study

The growth of the temporomandibular joint (TMJ) gets affected by multiple factors like aging, occlusion state, and by the movement of the jaw while masticating and swallowing. Radiographic imaging is often utilized as a vital diagnostic adjunct in the evaluation of certain examinations of the TMJ. In this in vivo study, 30 male participants with mean age 55 years, having edentulous maxillary and mandibular arches from the Outpatient Department of Prosthodontics, were randomly selected. Group I (n = 30) patients who were edentulous for the last 4-5 years but without wearing dentures. Whereas group II (n = 30) patients who were edentulous for the last 4-5 years but were wearing dentures for this period. Maxillary and mandibular dentures were fabricated and delivered to subjects. Subjects were subjected to the TMJ analysis with the help of CBCT. Radiological images of dentomaxillofacial structures were analyzed by a specialist with a dual monitor inside a darkened silent room. On the monitor, three times measurements were recorded followed by calculation of mean value. The recordings were taken on both sides and thus, 210 sites were analyzed altogether, followed by the statistical analysis using SPSS software version 15.0. The mean ages of group I and II were 59.00 ± 6.74 and 58.27 ± 6.75 years, respectively. The intra- and intergroup comparisons were done using a one-sample t-test. Differences in mean intercondylar width in groups I and II were not found to be statistically significant. The difference in mean length of glenoid fossa was not statistically significant at any of the above observation periods. A continuous decline in mean length of glenoid fossa was observed with time in both groups. The range of change in articular eminence length was found to be statistically significant for both the groups (p < 0.05). This study shows that the articular eminence flattening is correlated with age; on the other hand, the rate of deformation was found significantly more in total edentulous subjects as compared to subjects having normally maintained occlusion. The anatomical changes inside the TMJ have been much greater expressed within the completely edentulous subjects in whom the angle of sagittal condyle path declines and so does the articular eminence height. It is essential to provide the edentulous patient with early prosthetic and occlusal rehabilitation after extractions to prevent the anatomical changes in TMJ.

Evaluation of oral stereognosis, masticatory efficiency, and salivary flow rate in complete denture wearers.

Aim:The aim of the present study was to evaluate the improvement in oral stereognostic ability, masticatory efficiency, and difference in salivary flow rate in nonexperienced denture wearers, before, after, and 6 months after rehabilitation with complete dentures.Settings and Design:Invivo – Observational study.Materials and Methods:Seventy edentulous subjects were selected who came for rehabilitation with complete dentures for the first time. The study was conducted in three stages–before denture insertion, after denture insertion, and 6 months after denture insertion. Oral stereognostic ability was evaluated by asking the subjects to identify six heat cured acrylic resin samples by oral manipulation without seeing it. The unstimulated salivary flow rate was estimated by measuring the time taken to collect 5 ml of the whole saliva. Masticatory efficiency of the subjects was assessed with the help of preweighed chewing gums. The chewing gums were desiccated after the chewing strokes and weighed again.Statistical Analyses Used:Data were tabulated and analyzed statistically using pairedt-test, one-way ANOVA test, and the post hoc test.Results:Oral stereognostic ability increased immediately on insertion of complete dentures and was still higher 6 months post insertion of dentures. Comparison of the means of masticatory efficiency after denture insertion and 6 months after denture usage gave highly significant values (p< 0.001). The salivary flow which increased immediately following denture insertion returned to almost normal 6 months after denture insertion.Conclusion:The study support the hypothesis that the presence of dentures improve oral sterognostic ability and masticatory efficiency.

Evaluation of Psychological Stress Marker in Partially Edentulous Indian Adults Restored with Fixed Dental Prosthesis - A Prospective Cohort Study.

Background:Clinical studies have established mastication as a stress relaxation behavior in humans. Absence of teeth compromises mastication, increasing psychologic stress in individuals depicted by many physiologic changes in body. Quantitative level of psychologic stress bio-markers serve as indicators of underlying physical ailment. Lesser literatures are available in determining the role of alpha amylase stress bio marker in partially edentulous clinical situations.Aim:The purpose of this clinical study was to evaluate the levels of salivary alpha-amylase (sAA) stress biomarker in partially edentulous subjects before and after restoration with fixed dental prosthesis.Material and Methods:Forty partially edentulous patients with missing mandibular first molar were selected for this study. Two questionnaires, state trait anxiety inventory (STAI) and perceived stress scale (PSS) was used to evaluate stress and anxiety levels of participants. The recruited participants were treated with metal ceramic fixed dental prosthesis (FDP). A visual analog scale (VAS) was used to determine the patient satisfaction .Unstimulated salivary samples were collected preoperative, 3rd and 6th month post FDP placement. Level of sAA was estimated. Data obtained in the form of mean ± SD was subjected to statistical analysis using paired sample t-test (α=.05).Results:The salivary alpha amylase level was highest with mean of 36.73 μM/min/mg ptn before restoration with FDP. In the third month after prosthesis placement, the enzyme values decreased to16.62 μM/min/mg ptn and least value of 8.58 μM/min/mg ptn was detected in sixth month (P < 0.05).Conclusion:The salivary alpha amylase stress biomarker decreased after tooth replacement with FDP.

Quantitative and qualitative assessments of intraosseous neurovascular canals in dentate and posteriorly edentulous individuals in lateral maxillary sinus wall

ObjectiveKnowledge and evaluation of the blood supply within the maxillary sinus before sinus augmentation are vital to avoid surgical complications. The lateral maxilla is supplied by branches of the posterior superior alveolar artery and infraorbital artery forming intraosseous anastomoses (IA) within the bony lateral antral wall. This study was undertaken to (i) measure mean diameter of IA and its distance from the alveolar ridge within dentate and posteriorly edentulous subjects and, (ii) qualitatively display the relationship of IA throughout its course within the lateral maxillary sinus in cone beam computed tomography (CBCT). MethodMaxillary CBCT images of two-hundred-and-fifty-seven consecutive patients (163 men, 94 women, mean age 42 years) were analyzed. Samples were later divided into dentate (n = 142) and posteriorly edentulous (n = 115) jaws. Using both alveolar ridge and tooth location as reference points, the distance and diameter of IA were assessed. ResultThe IA was seen in 63.7% of all sinuses with 68.2% in dentate and 62.4% in edentulous. Mean distance and diameter of IA across the posterior tooth locations were 17.9 ± 3.0 mm and 1.4 ± 0.5 mm (dentate) and 15.1 ± 3.0 mm and 1.0 ± 0.5 mm (posteriorly edentulous), respectively. In each sample, there were no significant differences in distance-alveolar ridge and no significant correlations in diameter-tooth location. A statistically significant Pearson coefficient correlation between diameter and distance in dentate state was observed (r = −0.6). ConclusionThis study reveals that dentate maxillary jaws present larger diameters as compared to posteriorly edentulous jaws, although the IA course remains the same. As these canal structures contain neurovascular bundles with diameters that may be large enough to cause clinically substantial complications, a thorough pre-surgical planning is therefore highly advisable.

Effect of denture adhesives on oral moisture: A multicenter randomized controlled trial

PurposeThe purpose of this study was to investigate the effect of denture adhesives on oral moisture in a 10-center parallel randomized clinical trial. MethodsTwo hundred edentulous subjects wearing complete dentures were allocated into three groups: cream-type adhesive, powder-type adhesive and control groups. The adhesives (and saline solution in the control group) were applied to the mucosal surface of the dentures for 4 days, and baseline data and data after the intervention for eight meals over 4 days were obtained. For the main outcome, oral moisture was measured with a moisture checking device. Secondary outcomes were denture satisfaction, masticatory performance, denture retention, and occlusal force. In addition to between-group and within-group comparisons of oral moisture, investigations for secondary outcomes were undertaken in subgroups classified according to the degree of oral moisture at baseline (normal subgroup and dry mouth subgroup). Intention-to-treat analysis was also performed. ResultsBetween-group and within-group comparisons of oral moisture showed no significant differences. The cream-type and powder-type denture adhesives were significantly effective in the dry mouth group for denture satisfaction ratings of ability to masticate, stability, retention, and comfort of mandibular dentures (p<0.05). The masticatory performance and retentive force of the dry mouth denture adhesive using groups were significantly improved after intervention (p<0.05). ConclusionsThe oral moisture of complete denture wearers was not influenced by the use of denture adhesives. Our findings showed that denture adhesives improved subjective denture satisfaction, masticatory performance, and retention for complete denture patients with oral dryness.

Influence of adhesives usage in complete dentures during adaptation period varying the degree of resorption of mandibular ridges

PurposeThis study evaluated the effect of the use of a powder-type adhesive on masticatory performance and oral health related quality of life (OHRQoL) in patients with normal and resorbed mandibular ridges during adaptation period with complete dentures. MethodsForty-two edentulous subjects (12 men, 30 women) were distributed in four groups: normal mandibular ridges with adhesive, n = 10; normal mandibular ridges without adhesive, n = 10; resorbed mandibular ridges with adhesive, n = 11; resorbed mandibular ridges without adhesive, n = 11. Masticatory performance was evaluated by sieving method and OHRQoL by Oral Health Impact Profile in Edentulous Adults (OHIP-EDENT) inventory at 30, 60 and 90 days after the insertion of new complete dentures. Data were analyzed using 2-way ANOVA test and Generalized Estimating Equations (GEEs), α = 0.05. ResultsThe use of adhesive resulted in better masticatory performance at 30 (35.76 ± 12.63%) and 60 days (30.06 ± 10.54%) after the insertion of the dentures and did not influence on OHRQoL in participants with normal ridges during the adaptation period. The use of adhesive did not interfere on masticatory performance during adaptation period and had a negative effect on masticatory discomfort/disability subscale OHRQoL at 30-day period [5.2(3.6, 6.8)] for resorbed mandibular ridges with new complete dentures. ConclusionsThe use of adhesive can improve masticatory performance of new complete dentures users with normal mandibular ridges in the initial adaptation period up to 60 days after insertion. For resorbed ridges subjects, the use of adhesive had a negative impact on masticatory discomfort/disability OHRQoL at 30 days after insertion.

Interim tissue changes following connective tissue grafting and two-stage implant placement. A randomized clinical trial.

To determine tissue changes at implants placed either conventionally or in combination with a connective tissue graft (CTG). Forty-eight partially edentulous subjects were randomized into two treatment Groups, and 46 completed the study. Group-A (NA =23) received crestal implant placement. In Group-B (NB =23), a CTG harvested from the palate was stabilized over the implant neck. At the time of implant placement (T0), Groups were categorized as having thin mucosa≤2.5mm at the surgical site (NSubgroup-AI =12, NSubgroup-BI =11) or thick mucosa>2.5mm (NSubgroup-AII =11, NSubgroup-BII =12). Mucosa thickness, width of keratinized tissue (WKT), crestal bone levels and relative bone thickness were determined at T0 and at the two-stage surgery (T1). At T1, on the alveolar crest, mucosa thickness significantly decreased in the thick mucosa Subgroups (-AII/-BII, both p=0.001), but increased at thin mucosa grafted sites (p=0.049). No significant changes were noted in the WKT for either group. Thin mucosa grafted Subgroups (-AI/-BI) demonstrated significant decreases in crestal bone levels (both p≤0.008). Crestal relative bone thickness decreased in all Subgroups (p≤0.027 for significant changes). Connective tissue grafting resulted in smaller reductions of mucosa thickness on the alveolar crest and appeared to have the greater effects at sites with initially thin mucosa.

Differences in the shape and direction-course of the nasopalatine canal among dentate, partially edentulous and completely edentulous subjects.

We aimed to analyze the nasopalatine canal shape and anatomical variations of the buccal bone wall and compare the effect of the presence or absence of the central maxillary incisors on the nasopalatine canal. The shape of the nasopalatine canal and the dimensions of the buccal bone wall were measured in 150 patients who underwent a cone-beam computed tomography study. We found that the most prevalent shape of the nasopalatine canal was funnel (31%) and the most common direction-course was slanted-straight (33%). The buccal bone wall in relation to the nasopalatine canal was thickest at the anterior nasal spine level and narrowest at the level of the most anterior-inferior point of the buccal cortex of the maxilla. A statistically significant difference was detected between morphology and direction-course of the nasopalatine canal and dental status. In sum, the study of the nasopalatine canal showed multiple variations. Precise knowledge of these variations may help to decrease the incidence of complications during implantology treatment and during facial and dental surgery.

Individual factors associated with masticatory performance of complete denture wearers: A cross-sectional study.

The aim of this study was to assess whether differences in inter-individual clinical and prosthodontic variables affect masticatory performance (MP) of edentulous subjects who received new complete dentures. There were 204 edentulous participants who received new maxillary and mandibular complete dentures between October 2014 and March 2018 at a university clinic. MP was measured by a mixing ability test with a two-coloured chewing gum for 20 and 50 chewing cycles. The outcome variable was the degree of colour mixing of the chewed gum, expressed by the variation of hue (VOH) and measured by electronic colourimetric analysis. Explanatory variables included gender and age, quality of the dentures, classification of edentulous ridges and prognostic features, time since the insertion of the new dentures and patient-reported outcomes related to complete denture treatment. Bivariate correlation tests, multiple linear regression and a linear mixed model were used for data analysis. Mean VOH values were 0.57 (±0.13) and 0.43 (±0.16) for 20 and 50 chewing cycles, respectively. Mixing ability was higher in females than in males for 20 (P=0.036) and 50 (P=0.006) chewing cycles. No effects on the patient-reported outcome measures were observed. The time since denture delivery, gender, age and Prosthodontic Diagnostic Index (PDI) score were independently associated with masticatory performance at 20 and/or 50 chewing cycles. Overall masticatory performance tested by the linear mixed-effect model confirmed that VOH value was negatively influenced by male gender, older age and shorter time since denture delivery. Masticatory performance seems to be improved with the continuous use of newly inserted dentures and negatively influenced by advanced age.

Study of tongue-palate pressure patterns during the hold phase in the production of French denti-alveolar and velar stops

ABSTRACT The hold phase of the stop consonants is crucial for a successful production of the release and the acoustic burst. Concurrently, it is also associated with weak acoustic energy and minimal movement, so that conventional acoustic and kinematic approaches are not relevant to investigate motor control. This paper presents an innovative experimental method to study speech motor control during this phase, based on meticulous measurement of the time variation of the mechanical pressure exerted by the tongue against the palate and also characterizing tongue–palate interaction. The concept is based on using miniature transducers with enhanced response characteristics inserted in different locations of the complete denture of edentulous subjects without perturbing the articulation. The study was done with a French-speaking adult whose maxillary denture was duplicated and mounted with six strain gauge transducers. The experiment was done with denti-alveolar and velar stop consonants with two vowel contexts. The results illustrate the potential of such device to analyse speech motor control when contact constrains tongue movements.

A prospective cohort study on survival and success of one-piece mini-implants with associated changes in oral function: Five-year outcomes.

To investigate in a prospective cohort study the 5-year post-loading survival and success of one-piece mini dental implants (MDIs) in edentulous subjects with mandibular implant overdentures (IODs) and to report the associated changes of oral function with respect to patient age. Independently living edentulous patients were recruited and provided with new complete dentures. After an adaptation period, four one-piece MDIs (diameter 1.8mm) were installed in the interforaminal region and immediately loaded. At baseline pre-operative (BL), as well as at 1-year and 5-year follow-up examinations, chewing efficiency was assessed with a validated color-mixing ability test and maximum voluntary bite force (MBF) was recorded with a digital force gauge. Implant survival and success were evaluated at 5-year follow-up. Non-parametric tests served to analyze the differences between time points. Twenty patients participated in the study (5 men and 15 women; age at BL: n=10≤65years and n=10>65years). All patients were available for a 5-year follow-up (n=2 in their long-term care facility; n=1 only by telephone). The survival and success rates were both 100% after 61±5.7months. Chewing efficiency did not change over the first year (p=0.167), but was improved at 5year fup (n=19) compared to baseline (p=0.033) and to 1year (p<0.001). The MBF (n=19 at 5-year follow-up) increased continuously over time (p<0.001), but was less pronounced in the older cohort (p=0.009). Mini dental implants seem to be a successful treatment option for edentulous elderly patients with very high survival and success rates, and serve to improve long-term oral function.

Structural equation modeling of the impact of mandibular ridge form and denture quality on oral health-related quality of life in complete denture wearers

PurposeTo examine the effect of mandibular ridge form and denture quality on oral health-related quality of life (OHRQoL) in complete denture wearers by using structural equation modeling (SEM) analysis of data before and after new complete denture insertion. MethodsFour hundred thirty-two edentulous patients who visited the Dental Hospital of Tokyo Medical and Dental University for new complete dentures were recruited. An intervention study design was conducted, including complete denture fabrication with SEM analysis. Mandibular ridge form, mandibular denture stability, accuracy of jaw relation record, and the Oral Health Impact Profile for edentulous subjects (OHIP-EDENT-J) total score before and after new complete denture insertion were used in the hypothesized model. ResultsTwo hundred and thirty-seven participants completed the research. SEM analysis demonstrated adequate model fit. Path coefficients of mandibular ridge form to OHIP-EDENT-J before and after insertion, and mandibular denture stability to OHIP-EDENT-J before insertion, were significant. ConclusionsThis study demonstrated that mandibular denture stability and mandibular ridge form are important to ensure successful complete denture therapy.

Impact of patient characteristics on edentulous subjects' preferences for prosthodontic rehabilitation with implants.

The aim of this study was to assess the influence of patient characteristics on edentulous subjects' preferences for different prosthodontic treatments with implants. A cross-sectional study was carried out with 131 edentulous subjects referred for treatment at a university clinic. Participants received detailed information about available treatment options and were asked to rank their preferences among three alternatives for rehabilitation of the maxilla and mandible: conventional dentures (CD), 2-implant-retained overdentures (IOD), or 4-implant fixed dentures (IFD). Individual data and prosthodontic-related variables were assessed through interviews. Oral health-related quality of life impacts was measured using the Brazilian version of the Oral Health Impact Profile for edentulous subjects (OHIP-Edent). Descriptive statistics, bivariate tests, and binary and multinomial logistic regressions were used for data analysis. The majority of participants chose CD as their most preferred treatment for the maxilla (45.8%), while IFD was the most prevalent choice for the mandible (38.9%). Regression analysis showed that the OHIP-Edent "oral pain and dysfunction" (OPD) domain scores were positively associated with IOD preference for the maxilla (OR = 1.31; p=0.010) and mandible (OR = 1.46; p=0.002) and with IFD preference for the mandible (OR = 1.20; p=0.031). Subjects with lower levels of formal education and those with lower income levels were less likely to choose IFD. Level of education, income, and perceived quality of life impacts are potentially predictive variables of edentulous patients' preference for rehabilitation with implants. These factors may constitute important aspects to be considered by clinicians when treatment planning for edentulous patients.

Diversity of the oral microbiome between dentate and edentulous individuals.

Measurement of saliva microbes is promoted as a way to detect oral and systemic disease, yet there is a multitude of factors that affect the oral microbiome. The salivary microbiome is influenced by oral biofilm of shedding (epithelial) and non-shedding (tooth) surfaces. To gauge the ability of salivary microbial analytics to distinguish between edentulous and dentate oral conditions, we looked for differences in the saliva microbiome of subjects with and without teeth. Fifty-two dentate and 49 edentulous subjects provided stimulated saliva samples. 16S rRNA gene sequencing, QIIME-based data processing, and statistical analysis were done using several different analytical approaches to detect differences in the salivary microbiome between the two groups. Bacteria diversity was lower in the edentulous group. Remarkably, all 31 of the most significant differences in taxa were deficits that occur in the edentulous group. As one might expect many of these taxa are attributed to dental plaque and gingival sulcus associated bacteria. In sum, the measurement of 16S rRNA genes in the bacteria of the saliva can be used to reproducibly measure differences in the oral microbiome that occur with edentulism, mainly the lack of tooth and tooth-related structures.

A comparative evaluation of border molding using two different materials in mandibular edentulous arches- an in-vivo study

Brief Background The purpose was to compare and evaluate border moulding using two different materials on mandibular edentulous arches. Materials and Methods This clinical study was performed on 15 healthy edentulous subjects who reported to the department of Prosthodontics. All the subjects were first given complete dentures, fabricated with low fusing compound as the border moulding material, followed by complete dentures with putty as the border moulding material. Retention was measured at 3 stages: Border moulding; Complete denture insertion; 6 weeks follow up. Patient’s satisfaction was measured with a 10 point visual analogue scale for both the dentures pre treatment and at the follow up visit. Results Putty border moulding showed higher retention as compared to low fusing compound border moulding with significant difference at all stages- stage 1 (p=0.011), stage 2 (p=0.009) and stage 3 (p=0.0054). The time taken for border moulding was significantly lower in Group 2 than Group 1(P=1.6E-48). According to VAS scores, in terms of aesthetic and comfort parameters, patients were satisfied in both groups without any significant difference, however, retention in Group 2 was higher as compared to group 1(P=0.05) Summary and Conclusions There was a statistically significant difference in the retention, between the groups. Group 2( Putty) had higher retention compared to Group 1(low fusing compound).Time taken for border moulding was significantly lower for Group 2( putty). No significant difference in patient’s satisfaction was observed for aesthetic and comfort parameters. In functional parameter, retention was better in Group 2(putty) subjects. Key Words: Low fusing compound, PVS (putty), border molding, mandibular edentulous arch.

Evaluation and comparison of freeway space in edentulous and dentulous patients with and without head-stabilizing device

Objectives: The purpose of this study was to compare and evaluate freeway space with and without head-stabilizing device. Materials and Methods: A head posture-fixing device was used to fix the head posture in a natural head position. The goniometer (ISICO, 17 Transparent, 360°, Galaxy informatics India, Karol Bagh, New Delhi-India) axis was used in various studies to standardize head posture changes. The digital calipers with measuring range of 0–150 mm/0”–6” and resolution of 0.01 mm/0.0005” was used. Chin–tip of the nose (Niswonger’s method) was taken as the reference point. Results: Freeway space without head-stabilizing device for dentulous and edentulous subjects was 4.8 mm and with stabilizing device was 2.2 mm, which was near to the precise value, and was found to be significant with head-stabilizing device. Conclusion: There was a significant difference between all tested groups. These results clarified that freeway space with head-stabilizing device obtained excellent reproducibility compared to the conventional methods.

A clinical evaluation on the effect of astringent on keratinization of oral mucosa before and after the insertion of complete denture.

Conventional complete dentures still remain a viable method of treatment for many patients in this era of fixed prosthesis like dental implants. All patients undergoing complete denture treatment need nonsurgical preprosthetic treatment for the preparation of healthy denture bearing mucosa as well-keratinized healthy mucosa is desirable for a complete denture. To evaluate and compare the keratinization before and after denture insertion at intervals of 1 week and 1 month. The present study was conducted on 24 completely edentulous male subjects divided into control and study groups. Each patient in study group was asked to massage with astringent on the denture bearing mucosa over a 4-week period. Exfoliative cytology was used to collect the surface cells from the palatal mucosa and buccal mucosa. The first smear was taken before the denture insertion. The second and third smears were taken after the stimulation treatment with astringent gel for each patient after 1 week and after 4 weeks. Each smear was stained with the Papanicolaou's technique. The number of basal cells, intermediate cells, and superficial cells were recorded to calculate the degree of keratinization. Descriptive statistics, paired samples t-test, independent t-test, and repeated-measures analysis of variance. The result showed statistically significant increase in the keratinization of palatal mucosa after 4 weeks of astringent therapy and no effect was noted in the keratinization of buccal mucosa. Astringent has shown to increase keratinization of palatal mucosa, and so it can be used to increase the quality of the denture bearing mucosa; moreover, the astringent stimulation has no effect on the keratinization of buccal mucosa.

Retention and patient satisfaction with bar-clip, ball and socket and kerator attachments in mandibular implant overdenture treatment: An in vivo study.

Aim:The aim of this in vivo study was to evaluate and compare the retention and patient satisfaction in implant supported mandibular overdenture with three different attachment system.Materials and Methods:After evaluation of prosthetic space, fifteen edentulous subjects received two implants in the inter-foramina region of the mandible and were divided into 3 groups with 5 subjects each, delayed loading protocol was followed in all the patients. The retention force and satisfaction level with the attachments at baseline and after 6 months was measured in a standardised way using retentive device and VAS questionnaire. The study was based on evaluation of retention and patient satisfaction. 15 subjects were included in the study. The results obtained were statistically analyzed using one-way ANOVA test, and multiple comparisons were carried out using the Bonferroni tests.Results:At the end of six months, the retention force and satisfaction level was higher in Group 3 (Kerator attachment) as compared to Group 1 (ball and socket attachment) and Group 2 (bar and clip attachment) and patient satisfaction was equal in groups 1, 2 and 3 but the total number of interventions is significantly higher in the attachment bar. Analysis of variance with repeated measures showed significant differences in retention force among the three attachment types.Conclusion:(1) Group 3 (kerator attachment) exhibit higher retentive capacities than Group 1 (ball and socket attachment) and Group 2 (bar and clip attachment). (2) patient satisfaction was higher in Group 3 (Kerator attachment) in compare to Group 1 (ball and socket attachment) and Group 2 (bar and clip attachment).

Hard and soft-tissue evaluation of bar-clip, ball-socket, and kerator attachments in mandibular implant overdenture treatment: An in vivo study.

Aim:The aim of this in vivo study was to evaluate and compare the soft and hard tissue changes in implant supported mandibular overdenture with three different attachment system.Settings and Design:In vivo – observation study.Materials and Methods:After evaluation of prosthetic space, fifteen edentulous subjects received two implants in the inter-foramina region of the mandible and were divided into 3 groups with 5 subjects each, delayed loading protocol was followed in all the patients. The crestal bone loss, modified sulcular bleeding index, plaque index values were evaluate with the attachments at baseline and after 6 months was measured in a standardised way.Statistical Analysis Used:Oneway ANOVA test and post hoc Bonferroni multiple test.Results:At the end of six months modified sulcular bleeding index and plaque index values was higher in Group 2 (bar and clip attachment) as compared to Group 1 (ball and socket attachment) and Group 3 (Kerator attachment) and crestal bone loss was equal in groups 1, 2 and 3. Analysis of variance with repeated measures showed significant differences in modified sulcular bleeding index and plaque index among the three attachment types.Conclusion:(1) Group 2 (bar-and-clip attachment) exhibited higher Modified Sulcular Bleeding Index and Plaque Index values than Group 1 (ball-and-socket attachment) and Group 3 (kerator attachment). (2) Crestal bone loss was equal in Group 1 (ball-and-socket attachment), Group 2 (bar-and-clip attachment), and Group 3 (kerator attachment).

Comparative study of evaluation of the oral stereognostic ability between diabetic and nondiabetic complete denture wearers with and without denture

The diabetic subjects would have impaired oral stereognostic ability (OSA) compared with normal subjects due to diabetic neuropathy and microcirculatory disturbances. This study was conducted to compare the OSA between diabetic and nondiabetic complete denture wearers with and without denture. In this in vivo study the present comparative study comprised of seventy edentulous subjects (36 males and 34 females), aged from 35 to 84 rehabilitated with complete dentures (among them 35 were diabetic and 35 subjects were nondiabetic complete denture wearer). The OSA tests were conducted using acrylic test samples of 12 shaped forms, which were placed in patient's mouth for a given period of time for identification and scored according to three-point scale as OSA score and the identification time was also recorded. The data obtained were analyzed using Chi-square test, t-test, and Pearson's correlation coefficient (P < 0.05). In this study, diabetic complete denture wearers got the mean OSA score of 12.43 ± 3.93 without dentures, which was lower than nondiabetic complete denture wearer group (14.82 ± 4.44). There was a significant difference (P = 0.020*) in the identification of test pieces. Within limitations of this study, diabetic complete denture wearers showed decreased OSA than nondiabetic subjects, particularly it was significant while not wearing dentures. Oral stereognosis may be used as one of the clinical aids in predicting patient's performance to a prosthesis. Based on their response, we can educate the patient about the prognosis.