Removable Complete Dentures Research Articles

Clinical Performance of Removable Partial and Complete Dentures at a Speciality Dental Clinic, Hyderabad: A Retrospective Study

Clinical Performance of Removable Partial and Complete Dentures at a Speciality Dental Clinic, Hyderabad: A Retrospective Study

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.

Impact of implant-supported prostheses on nutritional status and oral health perception in edentulous patients

Improvement of nutritional status and perception of oral health are supposed to be different with complete conventional denture or implant-supported fixed or removable prostheses. Since no study has been conducted in Lebanon, the aim of our study was to assess the nutritional status and oral heath related quality of life (OHRQoL) in totally edentulous patients after treatment with complete denture or implant supported-prostheses. This was an observational clinical prospective study. A convenient sample of Lebanese people aged 60 years or more was selected between September 2013 and July 2015 from the Departments of removable and fixed prosthesis at Saint-Joseph University of Beirut. The treatment options included complete denture, implant-supported complete denture and implant-supported fixed prostheses. Nutritional status and OHRQoL were assessed with the Mini-Nutritional Assessment Index (MNA) and the Geriatric Oral Health Assessment Index (GOHAI) respectively at Baseline (first visit before treatment), 2-3 weeks after treatment (t1), 3 months (t2) and 6 months (t3) after treatment. Fifty-one participants (mean age: 69.39±7.164 years) were included. The results have shown an improvement over time in nutritional status and OHRQoL for all treatment groups. However, 2-3 weeks after treatment the number of participants at risk of malnutrition was higher with complete removable denture, intermediate with implant-supported complete denture and lower with implant-supported fixed prostheses (p-value=0.049). Moreover, the mean GOHAI score was significantly lower over time with complete removable denture compared to implant-supported prostheses (p-value <0.05). Our study has shown an enhancement in the quality of life and the nutritional status for implant supported-prostheses compared to conventional removable dentures. Therefore, it is fundamental that dentists communicate with their patients about implant treatment to understand their expectations, to explain the outcomes and achieve the desired clinical result.

Mental health of elderly and old people when using a complete dry dental prosthesis: myth or reality?

The study studied the ratio of 17 adults with complete loss of teeth and using complete removable acrylic dentures, to the disease, taking into account the degree of stability of dentures during chewing. To determine the type of patient's attitude toward the disease, a clinical test method was used to determine the type of attitude towards the disease, in which the clinical-psychological typology of patients' attitude to 'illness' was realized, which provides the possibility of determining one of the twelve types of response. It was found that when using complete removable dentures, regardless of age and sex, the types of attitude towards the disease were more often noted, with a marked disadaptive behavior with a predominantly intrapsychic orientation of the response to the disease, which was manifested by characteristic reactions such as irritable weakness, anxious, depressed, oppressed state. The use of the cream to fix the removable dental prostheses Corega allowed to improve the stability of complete removable dentures, to eliminate the pronounced phenomena of mental disadaptation, and to create realistic treatment settings for patients, to help restore social ties.

Electromyographic activity of masticatory muscles in elderly women - a pilot study.

ObjectivesTo evaluate the effect of age and chosen factors related to aging such as dentition, muscle strength, and nutrition on masticatory muscles electromyographic activity during chewing in healthy elderly women.BackgroundWith longer lifespan there is a need for maintaining optimal quality of life and health in older age. Skeletal muscle strength deteriorates in older age. This deterioration is also observed within masticatory muscles.MethodsA total of 30 women, aged 68–92 years, were included in the study: 10 individuals had natural functional dentition, 10 were missing posterior teeth in the upper and lower jaw reconstructed with removable partial dentures, and 10 were edontoulous, using complete removable dentures. Surface electromyography was performed to evaluate masticatory muscles activity. Afterwards, measurement of masseter thickness with ultrasound imaging was performed, body mass index and body cell mass index were calculated, and isometric handgrip strength was measured.ResultsIsometric maximal voluntary contraction decreased in active masseters with increasing age and in active and passive temporalis muscles with increasing age and increasing body mass index. In active masseter, mean electromyographic activity during the sequence (time from the start of chewing till the end when the test food became ready to swallow) decreased with increasing age and during the cycle (single bite time) decreased with increasing age and increasing body mass index. In active and passive temporalis muscles, mean electromyographic activity during the sequence and the cycle decreased with increasing age, increasing body mass index, and loss of natural dentition. Individuals with natural dentition had significantly higher mean muscle activity during sequence and cycle in active temporalis muscles than those wearing full dentures and higher maximal activity during cycle in individuals with active and passive temporalis muscles than in complete denture wearers.ConclusionDecrease in electromyographic activity of masticatory muscles in elderly women is related to age, deterioration of dental status, and body mass index.

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.

Reported case: Interprofessional approach on the oral rehabilitation of a patient using removable complete dentures

Reported case: Interprofessional approach on the oral rehabilitation of a patient using removable complete dentures

Consensus statements and clinical recommendations on treatment indications, surgical procedures, prosthetic protocols and complications following All-On-4 standard treatment. 9th Mozo-Grau Ticare Conference in Quintanilla, Spain.

ObjectivesThe present consensus report critically evaluates the scientific evidence based on a comprehensive systematic review of the All-On-4 treatment concept, focusing primarily on the treatment indications, surgical procedures and prosthetic protocols, and secondarily on the mechanical and biological complications involved.Material and MethodsA systematic review was made in advance of the meeting. Consensus statements, treatment guidelines and recommendations for future research were based on within-group as well as plenary debates and discussions of the systematic review.ResultsThe main indication of All-On-4 standard care is an atrophic maxilla or mandible, with or without remnant hopeless tooth. in ASA I or II patients. This surgical-prosthetic protocol seems efficient, safe and effective in the case of Cawood & Howell class IV, V and VI. It is necessary for the implant to have had an insertion torque of over 35 Ncm for immediate loading. The provisional prosthesis should provide rigidity, being non-flexible in order to avoid micro-movements, and should be strong enough to not fracture. Balanced occlusion without interferences is required, ensuring very gentle dynamic movements. The design of the definitive prosthesis must be cleanable and biomechanically adjusted to the implant position and individual characteristics of each patient. A non-concave acrylic base resting over soft tissue is recommended, facilitating hygiene. Regarding occlusion, a group guide should be made, taking into account whether the antagonist is not a removable complete denture. In that case, bi-balanced occlusion should be assessed. Prosthetic complications occur as a result of fractures of the provisional acrylic prostheses. These problems in turn can be resolved by repair through relining or fixing. The most frequent biological complication is the loss of at least one implant, while the second most frequent complication is the development of peri-implantitis and mucositis.ConclusionsIn the treatment of atrophy for full-arch implant supported restorations it is considered that four implants suffice for immediate loading and the final prosthesis, even when there is available bone between the mental foramina or maxillary sinuses. The weakness of the quality of the available evidence indicates that further studies are needed, involving an appropriate design and with adequate follow-up in All-On-4 standard care to confirm the present results mainly in relation to survival rates and complications. Key words:Atrophic jaw, All-on-4, immediate implant loading, edentulous mandible, edentulous maxilla, tilted implant, implant failure, dental implants.

Medication-Related Osteonecrosis of the Jaws (MRONJ) Induced by Incompatible Complete Removable Denture: A Case Report

Multiple myeloma is a malignant, hematological neoplasia affected plasma cells. It causes anemia, leads to increased susceptibility to infections by compromising immune response and severe pain is raised as a result of osteolytic lesions. For medical therapy of this condition, bisphosphonates (BPs) can be prescribed. Despite its great benefits in Multiple Myeloma (MM), in particular intravenous administration of BPs can lead to Medication-related osteonecrosis of the jaws (MRONJ). A 61-year-old female patient refers to our department for complaint of difficulty on usage of her prosthesis. In medical history, it was learned that her chemotherapy for multiple myeloma has been continued for 5 years and skull radiographs showed characteristic punched-out lytic lesions. With clinical and radiological examinations, this condition diagnosed as Stage II MRONJ. The aim of this study is to report the case of MRONJ within the reason of incompatible prosthesis by this way to be directive about preventive management.

EFFECT OF POLYMER PROSTHETIC CONSTRUCTION TREATED WITH GLOW-DISCHARGE PLASMA ON ORAL MUCOSA (CLINICAL CASE)

Prosthetic material should induce minimal pathological reaction when in contact with the oral mucosa, especially during oral rehabilitation of patients with tumors of the oral mucosa. The article presents monitoring of a patient after surgery for cancer of the buccal mucosa at the stage of orthopedic rehabilitation. Treatment plan proposed complex oral rehabilitation. A maxillary complete removable denture was manufactured as well as metalloceramic and partial mandibular dentures. Plasma chemical modification of the removable dentures was planned after correction of the prosthetics and primary adaptation. Removable dentures were applied at the maxilla and mandibula. Per our recommendations, the patient was examined weekly for a month and monthly for 6 months. No new tumors or pathological elements were observed. Conclusions. Changes in critical surface tension of the removable dentures made of acrylic plastic improve their biological characteristics as demonstrated by positive clinical dynamics. Prosthetic constructions with hydrophilic surface are recommended in complex clinical cases when patients with tumors of the oral mucosa require dentures.

Preventive and conservative prosthodontic treatment using overdenture and Richmond crown

Prosthodontic treatment aims to restore the chewing function (rehabilitation) and to prevent tooth decay and bone resorption (preventive and conservative). As an example, treatment by overdenture and Richmond crown. Overdenture is a partial or complete removable denture covered and supported by one or more teeth, the tooth roots and/or dental implants. Richmond crown is fixed denture by post and crown system, in which the post part goes into the root canal and its crown covers the entire of original tooth crown surface. By retaining the original teeth and/or roots, it could improve the stability and retention of the denture, and defend proprioseptic of teeth and vertical dimensions. To provide information about preventive prosthodontic treatment and prevention by using overdenture and Richmond crown. Case Report: A 50 year old woman only has 44 teeth on the mandible which is indicated for the overdenture construction and loss teeth 13, 14, 17 and 27 on the maxilla with deep caries in teeth 22 which is indicated for a removable partial denture (RPDs) construction by Richmond crown gear 22. On an early stage study, printing models is done. Then treatment of the root canal on teeth 22 and 44, followed by root canal preparation, core construction (cast post) and Richmond crown on tooth 22 and bareroot preparation on tooth 44 for overdenture construction. The procedure followed by printing, recording bite to insertion. Choosing treatment either overdenture or Richmond crown is very important because it could mantain remain original teeth, thus it can help to improve the retention and stabilization.

Theoretical Considerations and a Mathematical Model for the Analysis of the Biomechanical Response of Human Keratinized Oral Mucosa.

Removable complete and partial dentures are supported by the residual alveolar ridges consisting of mucosa, submucosa, periosteum, and bone. An understanding of the biomechanical behavior of the oral mucosa is essential in order to improve the denture-bearing foundations for complete and partially edentulous patients. The purpose of this paper was to examine the biomechanical behavior of the soft tissues supporting a removable denture and develop a model for that reason. Keratinized oral mucosa blocks with their underlying bone were harvested from the maxillary palatal area adjacent to the edentulous ridges of a cadaver. The compressive response of the oral mucosa was tested by using atomic force microscopy. The specimens were first scanned in order their topography to be obtained. The mechanical properties of the specimens were tested using a single crystal silicon pyramidal tip, which traversed toward the keratinized oral mucosa specimens. Loading-unloading cycles were registered and four mathematical models were tested using MATLAB to note which one approximates the force-displacement curve as close as possible: a. spherical, b. conical, c. third order polynomial, d. Murphy (fourth order polynomial, non-linear Hertzian based). The third order polynomial model showed the best accuracy in representing the force-displacement data of the tested specimens. A model was developed in order to analyze the biomechanical behavior of the human oral keratinized mucosa and obtain information about its mechanical properties.

The Role of New Removable Complete Dentures in Stimulated Salivary Flow and Taste Perception.

To evaluate the effect of replacement of inadequate complete dentures on salivary flow and taste perception in geriatric patients. Thirty-three patients, 13 males and 20 females, with a mean age of 64.4 years were submitted to stimulated and unstimulated salivary flow rate and salivary pH measurements, and sense of taste evaluation. Tests were performed 3 months before complete denture substitution and 3 weeks after denture insertion. The mean for unstimulated saliva (USS) was 2.1 ml before and 2.7 ml after replacement (p = 0.003). The mean volume of stimulated saliva was 6.3 ml before and 8.2 ml after replacement (p = 0.004). The pH mean of USS was 7.8 ± 0.44 before and 8.02 ± 0.41 after replacement (p = 0.005). No statistically significant difference was determined in the sense of taste before and 3 weeks after complete denture replacement. The replacement of inadequate complete dentures increases saliva flow; however, it does not improve taste perception.

IMMUNOLOGICAL AND MICROBIOLOGICAL STATUS OF THE ORAL CAVITY IN ELDERLY PATIENTS USING REMOVABLE LAMINAR DENTURES

Aim - analysis of immunological and microbiological indicators of oral cavity in elderly patients who use complete and partial removable dentures. Materials and methods. 42 patients with combinations of complete and partial absence of teeth were involved in the research. The group included 27 women and 15 men, whose age varied from 60 to 74 years. All patients used complete and partial removable dentures. Results. The results show marked abnormality of microbiocenosis of the oral mucosa in patients engaged in the research. Conclusion. The results of the microbiological research of the oral mucosa in elderly patients who use removable dentures demonstrate significant dysbiotic changes in the resident and transient oral microflora both in quantitative and qualitative indicators.

Why do edentulous adults with intellectual disabilities not wear dentures? Wave 2 of the IDS TILDA cohort study

PurposeOlder adults with intellectual disabilities (ID) are often edentulous. When total tooth loss occurs, they are very unlikely to wear complete removable dentures (CRDs) to restore oral function in Ireland. The reasons for this are unclear, though opinion holds that this is because dentists do not offer prosthodontic treatment to this group. In this study we ask edentulous older adults with ID why they do not wear dentures. MethodsCross-sectional survey data from Wave 2 of the Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA) was examined to study reported denture wear among edentulous older adults with ID. ResultsOut of 692 participants, 186 were edentulous (26.9%), of whom 57 (30.6%) wore CRDs and 129 (69.3%) did not. Twelve of this 129 had dentures but did not wear them. Of the 117 respondents who reported that they did not have dentures, 99 (valid %=92.5%) did not want dentures, while only 8 did. No respondents in this study reported that they were denied denture therapy. Rather, they simply did not want dentures. Clinicians should understand that extra steps may be needed to ensure that consent is truly informed when patients opt for, or decline, complete denture therapy. ConclusionWhile there is a high normative need for prosthodontic rehabilitation, expressed need is low. Extra steps may be necessary to ensure optimal outcomes for people with ID.

Stabilization of mandibular complete dentures by four mini implants: Impact on masticatory function

ObjectivesThe frequent instability of mandibular removable complete dentures causes an alteration of mastication. An innovative therapeutic strategy involves placing four symphyseal mini implants. This study aimed at assessing the development of masticatory parameters and the impact on quality of life in subjects that underwent this procedure. MethodsEleven edentulous subjects (mean age 72±11 years) with unstable mandibular complete dentures were followed-up before (T0) and two − three months after (T1) mini implant setting. Physiological parameters (number of cycles, duration of sequence and frequency of mastication) during the mastication of food models and the bolus median particle size (d50) of carrot were evaluated at each time. Quality of life was assessed at T0 and T1 using the Global Oral Health Assessment Index (GOHAI). Parametric tests were used to test relationships between mastication, quality of life variations and mini implant setting, and to compare each parameter mean value at times T0 and T1. ResultsMore subjects were able to chew carrot after setting the mini implants (8 subjects compared to 4 at T0). This improvement was accompanied by changes in kinematic parameters when chewing carrots, soft and hard model food, and by an improvement of their quality of life. However, the particle size values observed in the bolus remained higher than for normal dentate subjects (9.2±2.8mm). ConclusionsThese results indicated that the placement of mini implants as retentive elements for mandibular full dentures had a positive impact on patients’ masticatory function and quality of life. Clinical significanceThe placement of mini implants has a positive impact on the masticatory function and oral health quality of life. The results suggest that this alternative procedure can be used as a treatment option for patients unable to receive conventional implants.

Custom fabrication of try-in wax complete denture

Purpose The use of removable complete dentures is a selectable restorative procedure for edentulous patients. To improve the fabrication quality and efficiency of removable complete dentures, this paper aims to introduce a new method to fabricate customized wax complete dentures with additive manufacturing. This process uses complementary digital technologies, and allows faster and better manufacture of complete dentures. Design/methodology/approach In the study, a dental scanner was used to obtain surface data from edentulous casts and rims made by the dentist. A parameterized three-dimensional graphic database of artificial teeth was pre-established. Specialized computer-aided design software was used to set up the artificial dentition and design the esthetic gingiva and base plate. A selective laser sintering machine was used to transfer the data from stereolithography files into a wax base plate with location holes for each artificial tooth. Findings Under this method, a set of wax base plates with 28 location holes available for the placement of the artificial teeth were designed and fabricated within 6 h. The try-in wax dentures fitted the patient’s mouth well, besides occlusion relationships. Then, the occlusion relationships can be adjusted manually to achieve a balanced centric occlusion. Originality/value This method can be used to design and fabricate wax try-in removable complete dentures semi-automatically and rapidly; however, the algorithm for the occlusion contact design needs to be improved.

Application of digital technology in the prosthodontic management of a patient with myasthenia gravis: A clinical report

Application of digital technology in the treatment of a patient with myasthenia gravis and an excessively resorbed mandibular residual alveolar ridge is presented. The patient requested replacement of worn maxillary and mandibular prostheses. Treatment involved fabricating a new maxillary complete denture that was similar in appearance to the one being replaced and rebasing the existing and clinically acceptable mandibular fixed framework. The interim phase of treatment involved fabricating a mandibular milled prosthesis similar in morphology to the existing fixed complete denture with computer-aided design and computer-aided manufacturing technology. This facilitated conversion of an interim prosthesis by using an orientation device and eliminated the need for the patient to adapt to an interim removable complete denture.

Satisfaction and Fibromucosa Integrity in Patients Wearing Mandibular Kennedy Class I RPDs

Introduction: The association between the patient’s satisfaction and the occurrence of ulcers is important for treatment predictability. The aim of this study was to evaluate the satisfaction level, fibromucosa integrity and relation between these two factors in patients wearing mandibular Kennedy Class I removable partial dentures (RPD) and maxillary complete dentures at the Dental Department of Federal University of Rio Grande do Norte (UFRN). Materials and Methods: The satisfaction of 52 patients was evaluated based on a questionnaire about current prostheses, reasons for dissatisfaction, personal opinions about the prostheses, function and period 6 months to 1 year after insertion of denture wearing. The fibromucosa integrity was based on the occurrence of ulcers after 24 hours; 7, 15, 30 and 60 days, and 6 months. Results: A total of 90.4% of the patients (n=47) wore RPDs. Most of the patients (75%, n=39) reported satisfaction with RPDs; functional problems were the main reason for dissatisfaction (21.2%, n=11). The occurrence of ulcers decreased over time. The ulcers were usually located in the region of fornix. Patients were classified into Class III and IV according to the PDI classification. Fisher’s exact test was used to assess any association between satisfaction and fibromucosa integrity and no significant difference was found (p=0.275). Conclusions: The patients reported appropriate satisfaction with the Kennedy Class I RPDs after 6 months and 1 year. There was no association between patients’ satisfaction and fibromucosa integrity.

Fabrication and relining of dentures with permanent silicone soft liner: A novel way to increase retention in grossly resorbed ridge and minimize trauma of knife edge and severe undercuts ridges

The aim of this study is to suggest a technique to improve the retention of the prosthesis in grossly resorbed ridge and minimize the trauma of thin, atrophic knife edge ridge with severe undercuts. Significant numbers of patients seek treatment for edentulism throughout the world. In the current scenario, implant retained/supported prostheses have been considered a standard of care for rehabilitation of completely edentulous patients, but still this treatment modality is out of reach of many patients due to economic factor. In such patients, conventional removable complete dentures are considered for functional rehabilitation. However, in some of the patients with grossly resorbed ridges and knife edge ridges or ridges with severe undercuts, these prostheses have compromised retention and also continuously causes trauma to knife edge ridges and mucosa covering the undercuts during insertion and removal of the prosthesis thereby reducing the compliance of the patient. By incorporating, a layer of resilient permanent silicone soft liner on the tissue surface of a new or old denture is a novel way to reduce the trauma of thin and severe undercut ridges and also improve the retention of the prosthesis. This study described the successful functional rehabilitation of three completely edentulous patients with grossly resorbed, thin knife edge, and severe undercut mandibular ridges with permanent silicone soft liner. Permanent silicone soft liner act as a shock absorber, helps in equal dissipation of occlusal stresses, maintains an intimate contact with the underlying tissues and compressed during function thereby increasing retention and minimizing trauma by preventing a direct contact of hard denture base with compromised tissues.