Lower Dentures Research Articles

A pilot randomised controlled trial evaluating mini and conventional implant retained dentures on the function and quality of life of patients with an edentulous mandible

BackgroundTotal tooth loss (edentulism) can be a debilitating condition, impacting on ability to chew, speak and interact with others. The most common treatment is with complete removable dentures, which may be successful, but in the lower jaw, bone resorption that worsens over time makes denture-wearing difficult. Two dental implants in the mandible to retain the lower denture has been advocated as the gold standard of treatment, but has not been universally provided due largely to financial constraints and also patient fear. Mini implants (MI) are cheaper and less invasive than conventional implants (CI), but may not have equivalent longevity. Therefore, it is unknown whether they represent a cost-effective treatment modality over time. The aim of this pilot randomised controlled trial was to assess the feasibility of carrying out a trial on this cohort of patients, and to inform the study design of a large multicentre trial.MethodsForty-six patients were randomly allocated to receive either two mini implants or two conventional implants in the mandible to retain their lower dentures. Quality of life (QoL) questionnaires, pain and anxiety scores, and an objective “gummy jelly” chewing test were carried out at multiple timepoints, along with detailed health economics information. Implants were placed one-stage, and an early loading protocol was utilised. Patients were reviewed 8 weeks post-placement, and finally at 6 months. Implant failure, recruitment and retention rates were recorded and analysed.ResultsThe pilot study demonstrated that it is possible to recruit, randomise and retain edentulous (mainly elderly) patients for an implant trial. We recruited to target and retention rates were acceptable. The large number of questionnaires was onerous for participants to complete, but the distribution of scores and feedback from participants helped inform the choice of primary and secondary outcomes in a full trial. The chewing test was time-consuming and inconsistent. Implant failure rate was low (1/46). The data on indirect costs gathered at every visit was viewed as repetitive and unnecessary, as there was little or no change between visits.ConclusionsThe pilot study has shown that acceptable recruitment and retention rates are achievable in this population of patients for this intervention. The results provide valuable information for selection of outcome variables and sample size calculations for future trials.Trial registration(ISRCTN): 87342238 Trial registration date: 05/07/2013.

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

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

Prognoses of new complete dentures from the patient's denture assessment of existing dentures.

The aim was to determine prognostic factors affecting frequent post-delivery adjustments of new complete dentures using patients' assessments of existing complete dentures. A total of 125 edentulous participants (56 men, 69 women; mean age, 76.4years) who required new complete dentures evaluated existing dentures using the patient's denture assessment (PDA), a questionnaire regarding the self-assessment of dentures composed of 22 question items and containing six subscales: "function," "lower denture," "upper denture," "expectation," "esthetics and speech," and "importance." Moreover, the numbers of post-delivery adjustments of new dentures were recorded. A multiple logistic regression analysis was performed to identify significant factors for frequent adjustments of new dentures with five subscales of the PDA (excluding "importance"), level of mandibular ridge resorption, and age as independent variables. The analysis showed that "function," "esthetics and speech," and level of mandibular ridge resorption were significant variables for a frequent number of post-delivery adjustments of new complete dentures. The results suggested that patients' assessments of existing dentures using the PDA might allow a prediction of prognosis for complete denture treatments. Additionally, low "function" scores and high "esthetics and speech" scores for existing dentures and high levels of mandibular ridge resorption were significant prognostic factors affecting frequent post-delivery adjustments of new complete dentures. It may be difficult for edentulous persons to adapt to new complete dentures, especially those who have complaints about mastication and swallowing with existing dentures and poor mandibular ridges, but are satisfied with esthetics and speech.

Success Assesment of Patients Rehabilitated with Removable Prosthesis

The aim of this study is to determine the level of patient satisfaction with dentures rehabilitated a the School of Dentistry, from 2011 to 2013, using the OHIP-49 instrument, OHIP-19 edent and WHO criteria for oral health surveys. Materials and Methods: A previously validated survey instrument was applied by telephone to a sample of 152 patients from the University of Costa Rica. Correlation coefficients and logistic regression were carried out in order to correlate socio-demographic characteristics with general and specific satisfaction levels. Results: the general satisfaction generated by the patient on a scale of 1 to 10 was 9.3. Satisfaction derived from specific categories was 8.54, with factors such as mastication and daily use without pain being the less satisfactory. The lower dentures were the least accepted in factors such as mastication and free use of pain. By applying the correlation coefficient, high and positive relationship was found related to mastication. Logistic regression found that patients older than 56, who do not exercise and drink alcohol, are more likely to generate lower levels of satisfaction. Conclusions: The percentage of overall satisfaction of patients rehabilitated with dentures was above 85%. Less satisfactory qualities were mastication and daily use without the presence of pain.

Success Assesment of Patients Rehabilitated with Removable Prosthesis

The aim of this study is to determine the level of patient satisfaction with dentures rehabilitated a the School of Dentistry, from 2011 to 2013, using the OHIP-49 instrument, OHIP-19 edent and WHO criteria for oral health surveys. Materials and Methods: A previously validated survey instrument was applied by telephone to a sample of 152 patients from the University of Costa Rica. Correlation coefficients and logistic regression were carried out in order to correlate socio-demographic characteristics with general and specific satisfaction levels. Results: the general satisfaction generated by the patient on a scale of 1 to 10 was 9.3. Satisfaction derived from specific categories was 8.54, with factors such as mastication and daily use without pain being the less satisfactory. The lower dentures were the least accepted in factors such as mastication and free use of pain. By applying the correlation coefficient, high and positive relationship was found related to mastication. Logistic regression found that patients older than 56, who do not exercise and drink alcohol, are more likely to generate lower levels of satisfaction. Conclusions: The percentage of overall satisfaction of patients rehabilitated with dentures was above 85%. Less satisfactory qualities were mastication and daily use without the presence of pain.

Determination of the Rate of Need for Relining Complete Dentures in Patients Referring to a Department of Prosthodontics

Introduction: Complete edentulous patients are an important part of prosthodontics department referrals. After a while of prosthetic use, complications such as loosening, tissue irritation, and inefficiency in chewing or change the appearance, cause the need of reline. The purpose of present study is evaluation of complete prosthesis relining needs in patients referring to removable prosthodontics department of Tabriz dentistry faculty in 2014. Materials & Methods: This retrospective study was conducted on 96 patients that referred to removable prosthetic department in dental faculty of Tabriz by questionnaire and clinical examination. Data were analyzed in SPSS21 software. In this study, P value less than 0.05 was considered statistically significant. Results: 61.5 % of patients were men and mostly were in 51-60 years old group. 83.3% had U-shaped ridge and 16.7% had V-shaped ridge. 5.2% of patients only in upper denture and 11.5% of them only in lower denture were required to reline. Also 8.3% of patients in both upper and lower denture were needed reline.75% didn't need to denture reline. Needs to reline were more in U-shaped ridge. Conclusions: Finally, the results of statistical analysis show that there was a significant relationship between need of reline and the residual ridge but there was not a significant relationship between need of reline and gender and also the time of the prosthesis is going to delivery. Keywords: Complete edentulous; Relining; Prosthesis;

The effects of clinical wear on the incidence of temporomandibular disorders among patients with complete dentures

Abstract Objective This study evaluates the effect of clinical wear on the incidence of temporomandibular disorders in patients with complete dentures. Methods A randomized clinical trial was conducted on two groups; group 1 (30 patients) received complete upper and lower dentures with teeth made of heat-cured acrylic resin, and group 2 (29 patients) received complete upper and lower dentures with teeth fabricated of porcelain. The occurrence and clinical examination of temporomandibular disorders were evaluated using Helkimo anamnestic dysfunction index (Ai) and Helkimo clinical dysfunction index (Di), respectively. Clinical wear of denture teeth was estimated by the assessment of wear depth using the mean differences between tracing images of lingual cusps at each follow-up. The patients were followed up at 6, 12, 18 and 24 months for assessment of clinical wear and incidence of temporomandibular disorders. Results The acrylic resin group was subjected to significantly higher wear than the porcelain group at 12, 18 and 24 months of follow-up. The incidence of temporomandibular disorders was also significantly higher in the acrylic resin group than in the porcelain group at 18 and 24 months of follow-up. Conclusion There was higher incidence of temporomandibular disorders among patients who wore complete dentures with teeth made of acrylic resin than in patients who wore complete dentures with porcelain teeth.

Importance of stability and retention of double total prostheses: factors related to its use in the etiology of temporomandibular disorders

Objective: Evaluate the prevalence of Temporomandibular Disorder in patients with full double prosthesis. Material and Methods: The sample was composed of 40 volunteer patients, aged between 34 and 92 years, with upper and lower dentures, assisted at the Total Prosthodontics Clinic of the School of Dentistry at the Federal University of Juiz de Fora. Patients were evaluated by a single trained examiner and the diagnosis of TMD was established from the axis I of the RDC/TMD. Results: The prevalence of TMD in the sample was 42.5%, and most patients were female. Although there was no statistical significance between the time of use of the prosthesis and the presence of TMD was found, there was a correlation between time without use of prosthesis and the presence of disc displacement. Conclusion: According to the methodology applied and the results of this study, it can be concluded that there was a considerable prevalence of TMD in patients with double dentures, but there was no correlation between the use of full and DTM prosthesis.Keywords: Facial Pain; Temporomandibular Joint Dysfunction Syndrome; Complete Denture.

A Study on Reproduction of Adjustable Upper and Lower Dental Impression Tray by Using a CAD System

A Study on Reproduction of Adjustable Upper and Lower Dental Impression Tray by Using a CAD System

Implant – Supported Full Mouth Rehabilitation: A Guided Surgical and Prosthetic Protocol

Implant – Supported Full Mouth Rehabilitation: A Guided Surgical and Prosthetic Protocol

Preprosthetic laser assisted mandibular vestibuloplasty

A prosthetic treatment of the edentulous mandible can be very challenging. In cases with inadequate buccal depth, a necessary deepening of the oral vestibule can be achieved by surgically detaching the soft tissue attachments. A preprosthetic vestibuloplasty is usually done surgically by scalpel. With the permanent advancement of laser technology, a laser vestibuloplasty has become a preferred surgical procedure. The aim of this report was to present individuality of a mandible vestibuloplasty performed with Er. YAG laser. A 69-year-old patient was referred to the University Department of oral surgery after several previous unsuccessful attempts to stabilize his lower denture. The intraoral assessment revealed complete mandibular edentulism and a shallow vestibule with sufficient bone height in the anterior region. Since the patient's financial resources precluded dental implants, mandible anterior vestibuloplasty was planned to deepen the vestibule thus increasing the anatomic basis for prosthetic rehabilitation. The vestibuloplasty was performed with Er-Yag Laser (Fotona Fidelis III). The laser ablation started at the mucogingival junction. The soft tissue bands were ablated layer by layer till the desired vestibular depth was achieved. There was no need for suturing. No protective barrier was placed. The postoperative recovery was symptomless, without pain, oedema, or signs of infection. Four weeks after surgery, the healing process was completed and sufficient anterior vestibular depth was gained and maintained. Er.YAG laser assisted vestibuloplasty was a minimally invasive surgical procedure. The fast healing with minimal scarring resulted and a sufficient vestibular depth was gained.

THE EFFECT OF TWO PROTECTIVE OCCLUSAL SCHEMES OF IMMEDIATELY LOADED MINI-IMPLANT SUPPORTED MANDIBULAR OVERDENTURE ON MASSETER MUSCLE ACTIVITY AND RIDGE KERATINIZATION

background: Lingualized and monoplane occlusal (LO and MO) schemes are the most protective schemes regarding the prognosis of the immediately loaded mini-implants. The occlusal scheme in complete overdentures is a prime factor that affects masticatory efficiency that will subsequently determine the forces transmitted through the denture base to the denture foundation thus affecting ridge keratinization reaction as well as the degree of mini-implant osseo-integration . material and methods: Twenty completely edentulous male patients were divided into two equal groups. Complete upper and lower dentures were constructed for all patients with their artificial teeth set following the LO scheme for group I patients and the MO scheme for group II patients. Four mini-implants were installed interforaminally and immediately loaded in each patient. Electromyographic (EMG) records, keratinization index (KI) values and periotest values (PTVs) were collected at the time of denture delivery, one month and four months after denture delivery. results: Median EMG and KI values for LO and MO groups showed a significant increase after 1 and 4 months. Similarly, the median PTVs for LO group increased along the follow up periods showing a significant increase after 1 and 4 months. However, the median PTVs for MO group showed a perculating pattern showing a significant increase after 1 month followed by a significant decrease after 4 months of denture delivery. Changes in median KI values for MO group showed a significant difference than that for LO group after 1 and 4 months. Changes in median PTVs for LO group showed a significant difference than that for MO group after 4 months only. A significant inverse correlation was noticed between changes in EMG records and PTVs as well as between PTVs and KI values after 4 months of denture delivery

Demographics, social position, dental status and oral health-related quality of life in community-dwelling older adults.

PurposeTo identify demographic, socioeconomic and dental clinical predictors of oral health-related quality of life (OHRQoL) in elderly people.MethodsCross-sectional study involving 613 elderly people aged 65–74 years in Manaus, Brazil. Interviews and oral examinations were carried out to collect demographic characteristics (age and sex) and socioeconomic data (income and education), dental clinical measures (DMFT, need of upper and lower dentures) and OHRQoL (GOHAI questionnaire). Structural equation modelling was used to estimate direct and indirect pathways between the variables.ResultsBeing older predicted lower schooling but higher income. Higher income was linked to better dental status, which was linked to better OHRQoL. There were also indirect pathways. Age and education were linked to OHRQoL, mediated by clinical dental status. Income was associated with dental clinical status via education, and income predicted OHRQoL via education and clinical measures.ConclusionOur findings elucidate the complex pathways between individual, environmental factors and clinical factors that may determine OHRQoL and support the application of public health approaches to improve oral health in older people.

Neutral Zone- A Clinical Report

Edentulism from a long term results in high resorption of lower edentulous ridge which often pose a problem in stability of mandibular complete dentures. It is a challenge for a prosthodontist to rehabilitate those patients to near normal function, irrespective of the clinical picture. This paper presents neutral zone technique in a functional approach to overcome the problem of instability of lower dentures caused in patients by a more potential musculature.

Oral health self-perception evaluation using mandibular overdenture prosthesis in public health care

Objective: The aim of this study was to evaluate the impact on oral health in patients who used to have conventional lower denture and then started using a model of overdenture prosthesis for the purpose of its use in public health care. Methods: For this clinical trial study, 23 volunteers participated in the sample. To stabilize the prosthesis three implants were used and immediately loaded. Only one punch was needed for each implant to be installed, neither a flap nor suture was necessary. To evaluate the oral health self-perception the volunteers answered the OHIP-14 questionnaire twice, the first time before the treatment when they still used the conventional lower denture, and the second time within an average of 36 days after the use of the prosthesis stabilized by the implant/O-ring together. For statistical analysis, exploratory data analysis was initially performed and then the nonparametric Wilcoxon test was applied considering a significance level of 5%. Results: The average age of the sample was 57.6 years old (SD=9.0) with a minimum age of 43 and maximum of 74 years old. The results show a significant decrease in all domains after the treatment, functional limitation (p=0.0002), physical pain (p<0.0001), psychological discomfort (p=0.0002), physical disability (p< 0.0001), psychological disability (p=0.0008), social disability (p=0.0431) and handicap (p=0.0015). Conclusion: It was concluded that the model of overdenture prosthesis improved the volunteers oral health self-perception.

Influence of Occlusal Force on Electroencephalograms in Edentulous Patients

This study explored the effect of improved occlusal force resulting from complete denture treatment on electroencephalogram (EEG) findings to determine if such an outcome is a factor contributing to activation of synaptic/neuronal dysfunction in the brain. Twenty-three individuals with complete upper and lower dentures who visited the Department of Removable Prosthodontics at Tsurumi University Dental Hospital were included in this study. The Dental Prescale Occluzer FPD-705 system was used to perform an objective measurement of occlusal force before and after denture treatment. EEGs were recorded for 3 minutes in patients receiving complete dentures before and after denture treatment. Then, Dα values were calculated using a diagnosis method of neuronal dysfunction analysis to evaluate changes in synaptic/neuronal dysfunction of the brain. To investigate whether occlusal force affects Dα, Spearman's rank correlation coefficient (α = 0.05) was used to test the association between occlusal force (N) and Dα based on the rates of change in occlusal force and Dα calculated by dividing the measurement values after denture treatment by the measurement values before denture treatment. Medial occlusal force increased from 184.9 N before treatment to 277.2 N after treatment. A statistically significant increase in occlusal force (p < 0.05) was observed, with a total of 22 participants exhibiting increased occlusal force after denture treatment. The medial Dα value increased from 0.943 before treatment to 0.957 after treatment. A statistically significant increase in Dα (p < 0.05) was observed, and a total of 19 participants exhibited increased Dα values after denture treatment. The regression line was calculated as Y = 14.049X - 12.450. As occlusal force increased, Dα values increased as well. A significant positive correlation was observed between occlusal force and Dα (r = 0.498, p < 0.05). A positive correlation was observed between improved occlusal force attained via complete denture treatment and the activation of Dα. This finding reveals occlusal force as a denture treatment outcome that contributes to the activation of synaptic/neuronal dysfunction in the brain.

Sublingual crescent extension: A solution for loose lower denture

Mandibular complete dentures frequently lack retention and stability and offer less denture-supporting area than maxillary dentures. In case of severely resorbed ridges retention is highly compromised. Extending the anterior lingual flange of the lower denture sublingually makes it possible to achieve satisfactory retention in severely resorbed ridges. This clinical report describes a simpler method to achieve retention during impression making and thus help to maintain the retention and stability of lower dentures during the function.

An unsuspected foreign body: How we managed it

Ingestion or inhalation of foreign bodies can prove to be a diagnostic challenge. Unexplained throat pain and acute onset of dysphagia in an elderly patient should alert the clinician to the possibility of accidental foreign body ingestion. A patient presented with complaints of sudden onset of difficulty and pain in swallowing associated with ear pain, neck pain, and hypersalivation. The examination was within normal limits. It was on radiology that the suspicion of a foreign body was aroused. During esophagoscopy, an unsuspecting foreign body was discovered; a lower partial denture, swallowed unknowingly by the patient four days previously. Postoperatively the patient was stable. The case demonstrates how the clinician must have a high index of suspicion of foreign body ingestion, should a patient present with such symptoms. It also demonstrates the need for immediate and prompt intervention in order to prevent progression to fatal complications.

Sublingual Crescent Extension: A Solution for Loose Lower Denture-A Case Report

Mandibular complete dentures frequently lack retention and stability and offer less denture-supporting area than maxillary dentures. In case of severely resorbed ridges retention is highly compromised. Extending the anterior lingual flange of the lower denture sublingually makes it possible to achieve satisfactory retention in severely resorbed ridges. This clinical report describes a simpler method to achieve retention during impression making and thus help to maintain the retention and stability of lower dentures during function.

A revised technique for fabrication of hollow mandibular denture: A solution to severely resorbed residual ridge

Purpose: Prosthodontic rehabilitation of elderly patients with severely resorbed ridges is difficult due to compromised ridge height, increased inter-arch distance and altered insertion of associated jaw muscles. Planning dentures in such cases often require dentures that are lightweight to reduce the risk of further ridge resorption, which could otherwise complicate the situation. The purpose of the present technique is to fabricate a light weight lower denture by a revision of previously described technique in the literature. Materials and Methods: This article elucidates a simple technique for the fabrication of lightweight denture (hollow denture) in elderly patients with severely resorbed mandibular ridge. The minimum thickness of denture base acrylic resin for structural durability is ensured by a wax shim of 2 mm. The adequate hollow space indenture for optimal weight reduction is created by condensation silicone impression material. Conclusion: Condensation silicone putty material can be successfully used as a spacer for hollow dentures to combat severe ridge resorption.