Denture Quality Research Articles

The impact of self-perceived masticatory function on nutrition and gastrointestinal complaints in the elderly.

Impaired masticatory function is generally considered to be a contributing factor in the development of malnutrition (1, 2). Furthermore, the exclusion of essential and high-fibre foods from the subjects' diets, due to chewing problems, may induce gastrointestinal disorders (3-5). The impact of masticatory function on malnutrition and gastrointestinal symptoms was evaluated. This prospective cross-sectional study was conducted in four nursing homes in Berlin, Germany. 119 residents (mean 86, ± 8.0 years, 62-102) took part in the study. Dental status, denture quality, prosthetic condition as well as masticatory ability and gastrointestinal symptoms were evaluated by clinical examination or interview. Nutritional state was determined according to Mini Nutritional Assessment (MNA). The mean Body Mass Index was 24.4, ±4.9 kg/m² (17% < 20 kg/m²). The mean MNA was 22.5, ±4.3, 51.3% below normal. 54.5% of the dentures were poorly fitting. No significant relationships were found between the MNA and dental parameters except loose fit of dentures. However, there was significantly more food avoidance among the subjects with stated chewing problems, discomfort with dentures or ill-fitting dentures and there were significantly more digestive complaints among this group. Impairments of masticatory function may lead to food avoidance and to a higher incidence of digestive complaints.

Knowledge and attitude of elderly persons towards dental implants

Despite their unrivalled place in restorative treatment, dental implants are still scarcely used in elderly patients. The aim of this survey was therefore to identify potential barriers for accepting an implant treatment. Participants were recruited from a geriatric hospital, two long-term-care facilities and a private clinic. The final study sample comprised 92 persons, 61 women and 31 men with an average age of 81.2 ± 8.0 years. In a semi-structured interview, the participants' knowledge of implants and attitude towards a hypothetical treatment with dental implants were evaluated. Twenty-seven participants had never heard of dental implants, and another 13 participants could not describe them. The strongest apprehensions against implants were cost, lack of perceived necessity and old age. Univariate and multiple linear regression analysis identified being women, type and quality of denture, having little knowledge on implants and being hospitalised as the risk factors for refusing implants. However, old age as such was not associated with a negative attitude. The acceptance of dental implants in the elderly population might be increased by providing further information and promoting oral health in general. Regardless of the age, dental implants should be placed when patients are still in good health and live independently.

Effectiveness of Tele-guided Interceptive Prosthodontic treatment in rural India: A comparative pilot study

Loss of teeth and resultant resorption of the residual ridges is a major oral health problem in India. The resorption leads to irreversible loss of bone volume of the jaws and seriously undermines retention and stability of future dentures. Loss of masticatory efficiency causes nutritional deficiencies and affects quality of life. However, construction of over-dentures (dentures anchored to modified teeth or roots), a sophisticated procedure requiring skills of several dental specialists, can arrest the resorption and provide retentive dentures. Dental specialists in India are, however, concentrated in urban areas leaving the rural populace under-serviced. The aim of our study was to find out whether newly graduated dentists, under remote guidance from specialists, can fabricate over-dentures that are functional and improve the oral health related quality of life.Two groups of subjects were treated with over-dentures. Group 1 consisted of subjects attending a rural dental health clinic (site1) and group 2 at a university teaching hospital (site 2). Two dental graduates at each site carried out treatments. Operators at site 1 were guided remotely over a telemedicine link, cell phones, and emails while those at site 2 were guided directly. Functional assessment of dentures was carried out at the end of the treatment period to determine the technical quality of dentures. Subjective evaluation was carried out by subjects completing the Oral Health Impact Profile (OHIP-EDENT) questionnaire for edentulous subjects before and after treatment.No statistically significant difference was seen between the functional assessment scores of dentures from the two sites (p=0.08) at 95% confidence interval. Both groups also experienced significant improvement in all domains of OHIP - EDENT.Remotely supervised newly graduated general dentists can provide over-dentures of sufficient quality to rural population. This strategy has the potential to improve access to care and elevate the level of dentistry available to rural population when referral to specialists in not feasible. The results of the study provide pointers for dental public health policy makers and administrators in developing nations on how to leverage Information and Communication Technology infrastructure to enhance access to care in rural areas.

A Comparative Analysis of the Effect of Various Denture Adhesives Available in Market on the Retentive Ability of the Maxillary Denture: An In Vivo Study

"Every human being has a divine right to enjoy the health to its fullest." Oral and Dental health is not an exception to this dictum. The speciality of Prosthodontics has emerged as a science to provide replacement of missing dentition for its form and functions along with associated structures. Any successful complete denture treatment combines exemplary technique, effective patient rapport, patient education, and familiarity with all possible management options in order to provide maximum satisfaction to patient. There are some forcing situations where providing desirable (optimal) retention may be a problem. In such types of patients use of denture adhesives is recommended for enhancing the quality of retention. The use of denture adhesive provides comfort and additional confidence not only by increasing the adhesive and cohesive but also eliminating voids between the denture base and the basal seat. This study is undertaken to evaluate the enhancement of retentive quality of complete denture with the use of denture adhesives available in Indian markets for the use by denture wearers.

Denture quality has a minimal effect on health-related quality of life in patients with removable dentures

The present study examined the association of denture quality and health-related quality of life (HRQoL) in patients with removable dentures. In a study of 171 consecutive patients with removable partial dentures or complete dentures (mean age: 68·0 ± 9·3 years) at a university-based prosthodontic clinic, dentists rated two aspects of denture quality (stability and aesthetics) using a 100-mm visual analog scale (VAS). HRQoL was evaluated using the mental and physical component summary (MCS and PCS) scores of the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36). Oral health-related quality of life (OHRQoL) was evaluated using the Oral Health Impact Profile-Japanese version (OHIP-J). The associations among denture quality, OHRQoL, and HRQoL were examined by linear regression models. Bivariable linear regression analyses revealed that denture stability was significantly associated with the SF-36 MCS [regression coefficient = 0·52 for a 10-unit increase in denture stability on a 0-100 VAS, 95% confidence interval (CI): 0·03-1·00, P = 0·04], but not with the PCS (0·11, 95% CI: -0·49 to 0·70). Denture aesthetics was not related to the PCS or the MCS (0·22, 95% CI: -0·44 to 0·88 or 0·07, 95%CI: -0·47 to 0·62). When OHIP-J was added to the regression model, this variable was substantially and significantly associated with the MCS and PCS summary scores; in addition, the regression coefficient for denture quality decreased in magnitude and was statistically nonsignificant in all analyses. The quality of removable dentures had a minimal effect on HRQoL in patients with removable dentures, and this association was mediated by OHRQoL.

Comparative evaluation of two techniques in achieving balanced occlusion in complete dentures

Background: This study was undertaken to evaluate new technique, which claims to reduce treatment time while retaining the quality of treatment. The aim of this study was to compare complete dentures made by two techniques: with the use of face bow and without the use of face bow. Methods: Twenty edentulous subjects were selected and each one received two pairs of complete dentures. Dentures were made from duplicated casts and each one followed different techniques. One technique used face-bow. Teeth were set using individualized wax rims as guides. In other technique an articulator was used, which avoids face-bow and teeth were set by the cast-analysis method. The number of occlusal contacts in centric relation and excursive movements were registered, in addition to this the opinion of patients regarding denture bearing during oral functions were taken. Result: Both groups had dentures with balanced occlusion, but the technique that avoids face-bow presented better results in regard to time taken, esthetics, comfort and stability. Balanced occlusion was provided even without face-bow and could be an alternative to obtain adequate complete dentures with a better prognosis. Conclusion: For achieving better quality of denture in the form of esthetics, phonetics and function in short duration of time; a new technique was used to establish balanced occlusion in complete denture prostheses.

Implant Overdentures: Dental Students’ Performance in Fabrication, Denture Quality, and Patient Satisfaction

The purpose of this study was to evaluate dental students' performance when fabricating a mandibular two-implant overdenture (OD) as compared to conventional dentures (CD) and to determine if these prostheses were successful. Twenty students and twenty patients were divided into two groups: complete denture group (CDG) and maxillary denture and two-implant OD group (ODG). Students' progress was evaluated at each appointment as they were given a clinical assessment score (CAS), which varied from 1 (unacceptable, needs to repeat procedure) to 4 (acceptable, no errors). The success of the prosthesis was evaluated by the patients using a visual analog scale (VAS) and an expert (a prosthodontist) using a denture quality assessment (DQA) form. Performance for both groups was not statistically different across all eight appointments (CDG 3.16 versus ODG 3.25; p=0.46). Patients with ODs reported greater stability with their dentures (p=0.048) and greater ability to chew than patients with CDs (p=0.03). There were no differences between the groups in terms of expert appraisal (ODG 71.1 versus CDG 67.5; p=0.59). The performance of dental students when fabricating a two-implant OD is thus not different from that of a CD. Students can successfully fabricate a two-implant OD as perceived by both patients and prosthodontists.

Expectations and final evaluation of complete dentures by patients, dentist and dental technician

There is a poor association between the dentist's evaluation of denture quality and patients' satisfaction with their dentures. Possible differences between dental professionals and patients' expectations might help explain differences in outcome evaluations. This study compared scores given by a dentist, a dental technician and patients for their expectations before and their final evaluation after complete dentures treatment. Twenty completely edentulous patients, a prosthodontist and a dental technician provided scores for the expected aesthetic and functional results of their dentures based on a visual analogue scale at baseline. Post-treatment completion ratings were given after adjustments, by dentist and patients. The dental technician provided post-treatment completion ratings after completing the dentures. The patients had higher expectations than the dental technician and the dentist perceived for both aesthetic and function (P < 0.001). The patients also presented higher post-treatment completion ratings than the dental professionals perceived for final aesthetics (P = 0.016, Kendall's W = 0.207) and function (P = 0.002, Kendall's W = 0.303). Only the dentist presented a statistically significant difference between expectations (lower) and final (higher) outcomes for aesthetics (P = 0.017) and function (P = 0.003). There was no correlation between expectations and post-treatment completion ratings according to the patients' age. There was also no correlation between the patients' gender and expectation scores. Patients presented higher expectations regarding their dentures than dental professionals. The dentist believed that dentures would bring fewer benefits than patients did, but his perception of denture benefits post-treatment was significantly higher than his expectations.

The Current and Future Treatment of Edentulism

The purpose of this review and summary is to focus the clinician's attention on existing potential limitations regarding the management of edentulism. The current published data and opinions concerning the need for treating edentulism, the quality of dentures, related morbidity, and alternative or related therapeutics (e.g., dental implants) suggest there are opportunities for improvement in the treatment of the edentulous population. This may be achieved by adopting a broader therapeutic strategy focused not solely on technical aspects of an oral prosthesis. Instead, a wider array of clinical features of the edentulous patient should be addressed. A contemporary strategy may include concerns for prevention of tooth loss, evaluation of residual alveolar ridge resorption, and related issues of denture function, continual evaluation of oral mucosal health, compassionate management of maladaptive patients, a rationale for timely replacement of dentures, and continued development of dental implant therapies. The importance of therapeutic technical quality can be underscored, but should not overwhelm the broader concerns for assuring the overall health and well-being of the edentulous population.

Effect of the Quality of Removable Prostheses on Patient Satisfaction

The objective of this study was to evaluate patient satisfaction with removable prostheses and its relationship with denture quality. Sixty-seven patients who received 119 new removable prostheses over a period of one year at the College of Dentistry, King Saud University, were recalled for an interview with regard to their satisfaction with their dentures and a clinical examination. Prosthetic quality was determined using the California Dental Association criteria. Results showed 75% and 66% of upper and lower dentures, respectively, were reported by patients as satisfactory. Of all the upper prostheses rated as being of acceptable quality, 94% were also reported by patients as satisfactory, but of those of unacceptable quality, only 52% were reported by patients as unsatisfactory. The corresponding figures for lower dentures were 91% and 71%, respectively. No significant associations were found between patient satisfaction and age, or denture experience. Although acceptable quality of removable prostheses usually resulted in patient satisfaction, the finding that some patients were satisfied with their prostheses despite unacceptable quality suggests other factors besides quality affect outcomes. Patient satisfaction with removable dentures cannot be fully predicted from only the quality standards of those dentures.

Evaluation of the use of and attitudes towards a face‐bow in complete denture fabrication: a pilot questionnaire investigation in Chinese prosthodontists

The aim of this study was to assess the use of and attitudes towards a face-bow among Chinese prosthodontists in complete denture fabrication. Thirty-six prosthodontists in two dental hospitals affiliated separately to two of the top four dental schools in China were included. A questionnaire was sent to them with 18 questions covering the following four aspects: (i) the education and experience background of the prosthodontists, (ii) their impression of the quality of the dentures, (iii) the use of and attitudes towards a face-bow in complete denture fabrication and (iv) their understanding of jaw relationship and occlusal adjustment in complete denture fabrication. Most (97%) experienced Chinese prosthodontists seldom used a face-bow in complete denture fabrication. Although they (92%) believed that more than 90% of their edentulous patients were satisfied with the complete dentures, 39% of them thought that not using a face-bow might lower the quality of complete dentures and 94% believed that there was a difference between the quality of dentures fabricated with an adjustable articulator and those made with a simple articulator. Among the 36 prosthodontists, 75% often and 8% occasionally did the occlusal adjustment when giving the newly made dentures to their patients. The great majority of prosthodontists in two of top four Chinese dental hospitals, who believed most of their patients satisfied with their complete dentures, seldom used a face-bow. Occlusal adjustment may be helpful to eliminate the possible errors caused by not using a face-bow.

Does Removable Partial Denture Quality Affect Individuals’ Oral Health?

The impact of oral disorders and interventions on individuals' perceived oral health and oral-health-related quality of life (OHRQoL) is being increasingly recognized as an important health component. This study examined the association between denture quality and OHRQoL in individuals wearing removable partial dentures (RPDs). The study participants were 245 consecutive patients (mean age: 63.3 +/- 8.7 yrs) at a university-based prosthodontic clinic who wore RPDs for more than one month. RPD quality and OHRQoL were determined by means of a 100-mm visual analog scale (VAS) and the 49-item Oral Health Impact Profile-Japanese version (OHIP-J49), respectively. Linear regression analysis between RPD quality and OHRQoL revealed that a 10-mm VAS increase in RPD quality rating was related to -2.8 OHIP-J49 units (95% confidence interval: -4.5 to -1.1, p = 0.001), which represents an improvement in OHRQoL. The results suggest that RPD quality influences individuals' OHRQoL to a clinically significant extent.

Age, gender, dentures and oral mucosal disorders

The numbers of participants over 75 years of age in previous studies of oral health have not been sufficient to permit a full investigation of the influence of age on the mouth. In this study a disproportionate stratified random sample of 255 independent elders was selected from a list of urban voters to provide similar numbers of men and women in three age groups. The subjects were interviewed and examined, and nearly half of them had mucosal disorders. There was a significant (P < 0.05) association between mucosal lesions and the use of dentures and tobacco, whereas stomatitis, denture-related hyperplasia and angular cheilitis in particular were associated significantly with men and with the use of defective dentures. Logistic regression revealed that neither age alone nor the quality of dentures predispose to mucosal lesions, but that the odds of finding stomatitis, denture-related hyperplasia and angular cheilitis in particular increased about three-fold in denture-users, and almost doubled in men.

An investigation of factors influencing patients’ satisfaction with new complete dentures using structural equation modelling

Objective To investigate possible relationships between patient and clinical factors and patient satisfaction with new complete dentures. Methods Patients attending King's College London Dental Institute, Guy's Hospital, London, for new complete dentures were recruited. Relevant history was recorded and the edentulous mouth and existing dentures, where present, were examined at the beginning of treatment. The edentulous mouth, the previous and new dentures were re-examined at the first post-insertion visit. Three months after this visit, patients were sent a postal questionnaire to assess patient satisfaction. Data were analysed using structural equation modelling techniques. Results 723 patients were recruited. Significant relationships were found between quality of complete dentures, quality of residual alveolar, adaptability factors and patients’ satisfaction with complete dentures. Conclusions Quality of the mandibular residual alveolar ridges, retention and stability of the mandibular dentures, accuracy of reproduction of retruded jaw relationship and patient adaptability were powerful determinants of patients’ satisfaction with new complete dentures.

The influence of personality on patients’ satisfaction with existing and new complete dentures

Objective To investigate the influence of patient personality on satisfaction with and use of complete dentures. Methods Patients attending a dental school for replacement of existing complete dentures completed a Personality Questionnaire and quality of existing complete dentures was assessed. After the first post-insertion visit quality of new dentures was assessed. Patients’ satisfaction with the new dentures was elicited using a structured interview. Three months and 2 years after insertion of new dentures self completed denture satisfaction questionnaires were mailed to all participants. Results Three hundred and eight patients participated and 217 completed all stages of the study. Use of dentures was not associated with personality. In the old dentures patient rating of the three aspects of satisfaction with the mandibular denture, of appearance and general satisfaction were significantly associated with neuroticism. In the case of the new dentures at first review, no aspects of satisfaction rated by patients were significantly associated with personality. Significant negative associations between Neuroticism and all aspects of satisfaction with new dentures were found at 3 months. At 2 years after the dentures were placed significant negative associations between Neuroticism and all aspects of satisfaction with new dentures except rating of appearance and maxillary denture chewing ability were found. Conclusions Neurotic patients were significantly less satisfied with complete dentures. Personality traits did not influence patients’ use of dentures.

Feasibility of oral health‐related quality of life assessment in prosthodontic patients using abbreviated Oral Health Impact Profile questionnaires

To report about the feasibility of oral health-related quality of life assessment using two short forms of the Oral Health Impact Profile - OHIP-J14 and OHIP-J5 - in prosthodontic patients. Using the item pool of the Japanese version of the OHIP, two short forms based on a 14-item English-language version and a 5-item German-language questionnaire were derived. To test construct validity, the associations between summary scores of two short versions and self-reported oral health and self-reported denture quality have been investigated. Responsiveness was tested in 30 patients treated for their removable partial denture. Test-retest reliability using a time interval of 2 weeks and internal consistency were also tested. Associations between the two short form summary scores and self-reported oral health and denture quality supported construct validity of the instruments. Acceptable reliability for OHIP-J14 and OHIP-J5 was indicated by intra-class correlation coefficients of 0.73 and 0.75 (test-retest reliability) and CRONBACH'S alpha of 0.94 and 0.81 (internal consistency) respectively. Responsiveness was sufficient for OHIP-J14 and OHIP-J5 indicated by 'medium' effect sizes (0.50 and 0.57 respectively). In addition to sufficient discriminative psychometric properties, the ability to measure change of perceived oral health make OHIP-J14 and OHIP-J5 suitable for outcomes research.

Japanese version of the Oral Health Impact Profile (OHIP‐J)

The objective of the study was to develop a Japanese version of the Oral Health Impact Profile (OHIP). The original 49 items were translated using a forward-backward method following accepted cultural adaptation guidelines. A de novo development of Japanese items was conducted to establish content validity. The associations between the OHIP summary score and self-reported oral health (n = 220) and self-reported denture quality (n = 155) were investigated for construct validity. The association between the OHIP summary score and six oral conditions (n = 227) were also tested. The responsiveness of the instrument was established by comparing the score before and after using newly fabricated removable partial dentures (n = 30). The test-retest reliability (n = 37) and internal consistency (n = 251) were also calculated. After the de novo development, five new items were added to the OHIP. The priori hypothesized associations between the OHIP score and oral health conditions were confirmed (P < 0.001). The change in the OHIP scores from 63.6 to 40.6 (P < 0.001) supports the responsiveness of the instrument. Intra-class correlation coefficients of 0.81 and Cronbach's alpha of 0.98 indicate high test-retest reliability and internal consistency of the instrument's summary score. Sufficient discriminative and evaluative psychometric properties of the currently developed Japanese version of the OHIP in typical target populations make the instrument suitable for assessing the oral health-related quality of life in cross-sectional as well as longitudinal studies.

Effect of recasting on the elastic modulus of metal-ceramic systems from nickel-chromium and cobalt-chromium alloys

Elastic modulus of metal-ceramic systems determines their flexural strenght and prevents damages on ceramics during mastication. Recycling of basic alloys is often a clinical practice, despite the possible effects on the quality of the future metal-ceramic dentures. This research was done to establish recasting effects of nickel-chromium and cobalt-chromium alloys on the elastic modulus of metal-ceramic systems in making fixed partial dentures. The research was performed as an experimental study. Six metal-ceramic samples of nickel-chromium alloy (Wiron 99) and cobalt-chromium alloy (Wirobond C) were made. Alloy residues were recycled through twelve casting generations with the addition of 50% of new alloy on the occasion of every recasting. Three- point bending test was used to determine elastic modulus, recommended by the standard ISO 9693:1999. Fracture load for damaging ceramic layer was recorded on the universal testing machine (Zwick, type 1464), with the speed of 0,05 mm/min. The results of this research revealed significant differences between elasticity modules of metal-ceramic samples in every examined recycle generation. Recasting had negative effect on the elastic modulus of the examined alloys. This research showed the slight linear reduction of elastic modulus up to the 6th generation of recycling. After the 6th recycling there was a sudden fall of elastic modulus. Recasting of nickel-chromium and cobalt-chromium alloys is not recommended because of the reduced elastic modulus of these alloys. Instead of reusing previously recasted alloys, the alloy residues should be returned to the manufacturer.

Clinical correlates of oral health‐related quality of life: evidence from a national sample of British older people

This study investigated the relationships between an oral health-related quality of life (OHRQoL) indicator and specific clinical dental measures, in a national representative sample of the British older population. A random subsample was drawn from the free-living sample of the National Diet and Nutrition Survey (people aged >or= 65 yr). This subsample consisted of 407 dentate and 346 edentate participants, who were clinically examined and interviewed. The OHRQoL was assessed through the Oral Impacts on Daily Performance (OIDP) indicator. After adjusting for age, gender, and education, dentate subjects with up to 8 occluding pairs of teeth were 2.66 [95% confidence interval (CI): 1.08, 6.51) times, and those with up to 2 anterior occluding pairs were 3.00 (95% CI: 1.55, 5.81) times, more likely to report oral impacts when compared with those having more occluding pairs of teeth. Edentate participants with inadequate denture adaptation were 1.92 (95% CI: 1.04, 3.53) times, and subjects with inadequate denture retention were 2.04 (95% CI: 1.13, 3.69) times, more likely to report oral impacts than the remaining edentate sample in each case. OHRQoL in older British people is significantly related to the number of occluding pairs of natural teeth among the dentate and denture quality among the edentate.

Facts and Fallacies: An Evidence Base for Complete Dentures

The rate of edentulism is falling but many edentulous people still need complete dentures. There is poor correlation between the quality of dentures and patient satisfaction. There is no evidence that a more complex fabrication technique including face-bow registration results in a better clinical outcome. Balanced occlusion/articulation is not necessary for successful complete denture function. Variations in materials and techniques appear to have only minor influence, if any, on the clinical end result. Psychosocial factors, especially a good relationship between dentist and patient, are more important than prosthodontic factors for a positive outcome. Creating a good relationship between the dentist and the patient is extremely important for a successful outcome of a complete denture treatment.