Removable Prosthodontic Treatment Research Articles

A Cross-sectional Study of Self-confidence Differences in Removable Prosthodontic Treatment among Undergraduate Students of a Saudi Dental School

Background: Removable denture treatments remain an option for the edentulous population in terms of oral rehabilitation. In dentistry schools, improving students' self-confidence in performing prosthodontic procedures should be paramount. Objectives: The aim of this study was to examine students' self-confidence perceptions in performing removable partial dentures (RPDs) and complete dentures (CDs) treatments and to draw attention to the steps in which they felt most and least prepared to do so without close supervision. Methods: This cross-sectional study was conducted at one dental school in Saudi Arabia at the end of the 2022-2023 academic year. A total of (n=96) undergraduate students in their clinical years, 5th and 6th cohorts, were included in this study. These students were requested to participate in a closed questionnaire consisting of 38 items that focused on self-reported confidence and the perceived quality of their education. A non-parametric test, the Mann-Whitney U-test, was used to compare between groups. The data were analyzed using IBM SPSS Statistics (V.28.0). Results: A response rate of 95.8% was achieved. Over the course of their studies, students' sense of confidence grew. Also, males were more confident than females in performing all clinical procedures. Overall, students were satisfied with their prosthodontic education, except for pre-clinical sessions and learning materials. Increasing their clinical experience would be most advantageous for boosting their confidence levels. Conclusion: The study revealed where students were most and least confident in carrying out removable prosthodontics. Students require supervision during their internship year because they reported average confidence in removable prosthodontic procedures. The results also point to the need for more research into the confidence gaps between males and females. The pre-clinical curriculum necessitates updating and more didactic teaching.

Comparative Analysis of Levels of Salivary Lysozyme before and after Removable Prosthodontic Treatment among Partially Edentulous Patients: An Observational Study

Comparative Analysis of Levels of Salivary Lysozyme before and after Removable Prosthodontic Treatment among Partially Edentulous Patients: An Observational Study

Perception of confidence among dental interns when performing removable prosthodontic treatment

Introduction: Removable prosthodontics constitutes the majority of the prosthodontic curriculum at an undergraduate level and it is expected that the students will be able to perform these procedures independently. However, in recent years, it has been observed that the majority of the removable prosthodontic treatment have been referred to consultants or at times even delegated to the technicians. One of the major reasons behind this trend may be the result of an individual graduate's internal perception of their ability or lack of confidence in their ability to perform these procedures.
 Materials and Methods: A cross-sectional study was conducted among dental interns in People’s Dental College and Hospital, affiliated to Tribhuvan University, Kathmandu, Nepal after the ethical approval from PDCH-IRC. A self-designed validated questionnaire related to the experience of individual interns and level of confidence pertaining to clinical procedures related to removable prosthesis fabrication was distributed by the authors to the interns. The data were analyzed using SPSS software (version 21); descriptive statistics and Fisher’s exact test was applied.
 Results: Overall most of the interns (77.8%; n=28) were confident in removable prosthodontics and they were equally confident while performing both complete and partial denture prostheses. Male interns were significantly more confident (p<0.5) in performing complete denture prostheses while the clinical experience did not have a significant effect on the confidence level. The interns were confident in performing most of the procedures related to complete and partial denture prostheses (median=3).
 Conclusions: The interns at People’s Dental College and Hospital were confident in removable prosthodontics. The few procedures where our interns lacked have been identified and efforts will be made to overcome these shortcomings.

Laser-Milled Microslits Improve the Bonding Strength of Acrylic Resin to Zirconia Ceramics.

Heightened aesthetic considerations in modern dentistry have generated increased interest in metal-free “zirconia-supported dentures.” The lifespan of the denture is largely determined by the strength of adhesion between zirconia and the acrylic resin. Thus, the effect on shear bond strength (SBS) was investigated by using an acrylic resin on two types of zirconia ceramics with differently sized microslits. Micromechanical reticular retention was created on the zirconia surface as the novel treatment (microslits (MS)), and air-abrasion was used as the control (CON). All samples were primed prior to acrylic resin polymerization. After the resin was cured, the SBS was tested. The obtained data were analyzed by using multivariate analysis of variance(α = 0.05). After the SBS test, the interface failure modes were observed by scanning electron microscopy. The MS exhibited significantly higher bond strength after thermal cycles (p < 0.05) than the CON. Nevertheless, statistically comparisons resulted in no significant effect of the differently sized microslits on SBS (p > 0.05). Additionally, MS (before thermal cycles: 34.8 ± 3.6 to 35.7 ± 4.0 MPa; after thermal cycles: 26.9 ± 3.1 to 32.6 ± 3.3 MPa) demonstrated greater SBS and bonding durability than that of CON (before thermal cycles: 17.3 ± 4.7 to 17.9 ± 5.8 MPa; after thermal cycles: 1.0 ± 0.3 to 1.7 ± 1.1 MPa), confirming that the micromechanical retention with laser-milled microslits was effective at enhancing the bonding strength and durability of the acrylic resin and zirconia. Polycrystalline zirconia-based ceramics are a newly accessible material for improving removable prosthodontic treatment, as the bond strength with acrylic resin can be greatly enhanced by laser milling.

A comparison of cost and cost-effectiveness analysis of two- implant-retained overdentures versus other removable prosthodontic treatment options for edentulous mandible: A systematic review.

Aim:The aim of this study was to examine systematically the data published on the cost and cost-effectiveness of mandibular two-implant-retained overdentures compared to other removable prosthodontic treatment options for edentulous mandible.Settings and Design:It is a systematic review which analyses the available data from the prospective and retrospective studies and randomized clinical trials to find out costs and cost effectiveness of different removable treatment modalities for completely edentulous mandible. The study protocol was decided according to PRISMA guidelines.Materials and Methods:The search was limited to English literature only and included an electronic search through PubMed Central, Cochrane Central Register of Controlled Trials, and complemented by hand-searching. All clinical trials published up to August 2019 were included (without any starting limit). Two independent investigators extracted the data and assessed the studies.Statistical Analysis Used:No meta-analysis was conducted because of the high heterogeneity of data.Results:Out of the initial 509 records, only nine studies were included. The risks of bias of individual studies were assessed. Six studies presented data on cost and cost analysis only. The rest three articles provided data on cost-effectiveness. The overall costs of implant overdentures were higher than the conventional complete dentures. However, implant overdentures were more cost-effective when compared to conventional complete dentures. Single-implant overdentures are also less expensive than two-implant overdentures. Overdentures supported by two or four mini-implants were also reported as more cost-effective than conventional two-implant-supported overdentures.Conclusions:Two-implant-retained overdentures are more expensive but cost-effective than the conventional complete dentures. Two- or four-mini-implant-retained overdentures are less expensive than two-implant-retained overdentures, but there is a lack of long-term data on aftercare cost and survival rate of mini-implants. Single-implant overdentures are also less expensive than the two-implant-retained overdentures. The differences of the aftercare costs of different attachment systems for implant overdentures were not significant. There is a need of further studies on comparative cost-effectiveness of different types of implant overdentures.

Geriatric patients’ psychological status relative to the removable prosthodontic treatment

Geriatric patients’ psychological status relative to the removable prosthodontic treatment

Iatrogenic Damage to the Periodontium Caused by Removable Prosthodontic Treatment Procedures: An Overview.

As the number of aged people in the world is growing, the need to provide patients with tooth alternate through removable partial dentures is equally growing. There are adversarial effects that should be kept in mind which might disturb the remaining teeth; specially, the abutments and the supporting tissues. These effects might spread to the muscles of mastication and also to the supporting periodontal tissues. Thus, we should plan removable partial dentures (RPDs) without mutilation to the adjacent teeth or the underlying tissues.

Development of a new chewing function questionnaire for assessment of a self‐perceived chewing function

To develop a new unidimensional questionnaire for patients' self-assessment of their chewing function (chewing function questionnaire: CFQ) and to test its psychometric properties. A focus group of 7 dentists and 15 prosthodontic patients generated a pool of 30 relevant items. A 5-point Likert scale (0-4) was used. A focus group reduced some redundant items, and 21 items remained for pilot testing after which additional four items were eliminated. Then, the 17-item questionnaire was tested on a larger sample (200 participants). Factor analysis was obtained to investigate the dimensionality of the questionnaire. Finally the 10 items remained, and the CFQ was unidimensional. To test the psychometric properties, the CFQ was administrated to 224 individuals: 100 patients were already removable denture wearers (RDWs), 24 patients needed a removable prosthodontic treatment, and 100 individuals had natural teeth (NT group). Discriminative validity was tested between the RDWs and the NT groups. Convergent validity and internal consistency were tested on 200 subjects. The internal consistency was assessed by calculating the Cronbach's alpha coefficient and the average interitem correlation. The test-retest reliability was tested on 60 subjects. Responsiveness was tested on 24 patients who received new removable prosthodontic treatment. The initial factor analysis revealed that the items had been grouped in three different dimensions. By eliminating items with complexities greater than one, additional six questions were eliminated. One more item with the lowest correlation was further eliminated. The final questionnaire included 10 items. Discriminative validity showed significant differences between the NT group and the RDWs, as predicted (P < 0.001). Convergent validity was confirmed by the Spearman's rank correlation. A significant positive association (P < 0.001) was found between the CFQ and one general question about chewing difficulties, as well as between the CFQ and five items from the OHIP49 related to chewing. The test-retest reliability showed high intraclass correlation and no significant differences between the two administrations of the CFQ (P > 0.05). The internal consistency showed satisfactory Cronbach's alpha values (0.916 for all subjects, 0.742 for the NT group, and 0.852 for the RDWs). Responsiveness was confirmed by a significant difference between the baseline and the follow-up score (P < 0.001) and a high effect size (0.95). The developed CFQ provides an assessment instrument of the hypothetical construct invoked to explain the chewing function. Psychometric properties are satisfactory demonstrating that the instrument is suitable for the assessment of a self-perceived chewing function.

Intercanthal distance of a Sudanese population sample as a reference for selection of maxillary anterior teeth size

Background: The choice of the size of artificial teeth takes an important place in the removable prosthodontic treatment. However, the standards or proportions commonly used as a guide have been developed mainly on Caucasian populations. Objectives: to investigate the relationship between intercanthal distance and the anterior maxillary teeth size in Sudanese population. Methods: This is a descriptive cross sectional study conducted in 114 subjects, (45 males - 69 females), from Khartoum and Juba Universities. The age range was from 18-46 years. The intercanthal distance (I.C.D) was the measurement taken between the median angles of the palpabral fissure. Maxillary intercanine distance was obtained by measuring a line from the tip of the canine on one side, to the canine on the other side. An electronic digital caliper (Narex – Czechoslovakia) was used for all measurements. Data were analyzed using Person chi–square test. Results: a significant correlation is found between intercanthal distance and maxillary intercanine distance in all subjects (P-value 0.015), and in females who had a (P-value of 0.006). Maxillary intercanine distance may be estimated by dividing I.C.D by factor 0.9. Conclusion: These results could be used as a helpful guide for selection of anterior teeth width in the Sudanese population.

Method for fabrication of a custom occlusal template

The curved metal occlusal template has been recommended as an aid to establishing the occlusal plane in both fixed and removable prosthodontic treatment.1–3 A common problem encountered when attempting to use this device is its lack of adaptability to short or asymmetrical anterior-posterior arch lengths. Because it is commonly made from stamped, heavy-gauge steel, even minor modification is difficult and time consuming. Additionally, alteration renders the template unsuitable for other treatment applications.

Incidence of tooth loss and prosthodontic dental care: effect on chewing difficulty onset, a component of oral health-related quality of life.

To quantify incidence of tooth loss, prosthodontic dental restoration, and chewing difficulty onset and the effect of tooth loss and prosthodontic restoration on chewing difficulty onset. A prospective cohort study of oral health and related behaviors with in-person interviews and clinical examinations conducted at baseline and 24 months. Telephone interviews were conducted every 6 months between these sessions. A community-based sample of four counties in north Florida. Eight hundred seventy-three persons who had at least one tooth and were aged 45 and older at baseline. Persons were queried regarding onset of chewing difficulty, an important component of oral health-related quality of life (OHRQoL). The chewing index of Leake, with minor revision, was the primary outcome of interest. Tooth loss was measured using direct clinical examination. Dental care use was reported during each interview. Approximately 22% of participants reported tooth loss during follow-up. Fixed prosthodontics (crowns and bridges) was the most common form of new prosthodontic treatment. People who reported tooth loss were 2.7 times more likely to report chewing difficulty onset than people without tooth loss (P<.001). Having fewer occluding pairs of teeth at baseline was significantly associated with an increased probability of chewing difficulty onset. People who received removable prosthodontic treatment were much less likely to report chewing difficulty onset than people who did not (P<.01). Incident tooth loss and removable prosthodontic restoration strongly predicted chewing difficulty, an important component of OHRQoL.

Do regular dental visits affect the oral health care provided to people with HIV?

Financial factors related to income and insurance coverage have been found to limit access to, and influence use of, oral health care services by people with human immunodeficiency virus, or HIV. The authors determined if visiting a dentist regularly affected the oral health services provided to people with HIV when financial barriers were eliminated as an impediment to access. They analyzed dental claims data for services submitted for payment to the Minnesota Access to Dental Care Program. The analyses focused on comparisons of dental utilization patterns among 273 people classified as regular patients, or RPs, and 222 people classified as nonregular patients, or NRPs. RPs were found to have been provided more diagnostic and preventive care, and less restorative, endodontic, periodontic, removable prosthodontic and oral surgical treatment than were NRPs. Although the mean submitted cost per patient visit was much higher for NRPs, total mean submitted costs per patient for RPs and NRPs were not significantly different. Even though NRPs underwent fewer procedures and had fewer clinic visits than did RPs, the procedures provided to NRPs were more complex and costly. As indicated by differences in the mix of dental care services provided to RPs vs. NRPs, continuity of primary oral health care for RPs led to a better oral health result at no increase in cost over that for NRPs. The study findings provide substantial evidence regarding the value of regular oral health care for people with HIV. This study reinforces the need for dentists to educate and encourage people with HIV to integrate regular oral health care into the ongoing maintenance of their overall health and well-being.

在宅高齢者に対する義歯補綴治療の効果

The purpose of the study was to verify the significance of prosthodontic treatment for the elderly patients by our university's dental treatment system at home. Thirty-four patients whose dental practice was based on removable prosthodontic treatment and performed by the staff of our department were given questionnaires on satisfaction with the treatment and denture insertion. The results were as follows:1. Seventy percent of the patients were in their seventies and eighties and almost half of them were edentulous.2. ADL scores of the patients were low and most patients needed care.3. The prevalence of cerebrovascular disease was fifty-six percent in the patients.4. Ninety-four percent of the chief complaints about dental satisfaction of the patients was masticatory disturbance due to wearing uncomfortable dentures.5. Forty-seven percent of the patients needed to have their dentures replaced.6. Almost all patients answered that they were satisfied with the prosthodontic treatments offered at home.From the results of this study, removable prosthodontic treatment is significant not only for the restoration of stomatognathic function and appearance but also for the improvement of quality of life for the home bound elderly.

The dental student as technician: an 18-year follow-up of clinical laboratory programs.

In 1977, a survey of American and Canadian dental schools was conducted by Weintraub to determine the delegation of laboratory procedures in preclinical and clinical complete and removable partial denture programs. This was performed in light of challenges raised to the value of requiring dental students, rather than laboratory technicians, to perform the various laboratory procedures involved in the fabrication of complete and removable partial dentures. Since 1977, the rate of edentulism has declined in the United States, and fewer edentulous patients have sought regular dental care. In addition, approximately 20% fewer curriculum hours have been spent in dental schools in removable prosthodontic instruction; a declining number of graduating dental students have felt comfortable with their level of knowledge of removable prosthodontics, especially complete dentures, and have performed fewer removable prosthodontic procedures in practice because of a perceived lack of treatment cost-effectiveness. The present study, an 18-year follow-up to the 1977 survey, was designed to determine if such trends toward a de-emphasis on removable prosthodontic treatment have affected the mechanisms of instruction in and the extent to which dental schools instruct students about removable-prosthodontics laboratory procedures. The 1995 survey was mailed to 53 American dental schools. Forty-six schools returned the completed survey, for a response rate of 87%. Results showed that the relative amount of material presented to students in clinical removable prosthodontics programs increased, primarily through the enhancement of laboratory technician support, both in-house and commercial, of student clinical removable prosthodontic laboratory procedures. The increase was greater than in preclinical removable prosthodontic programs, which were described in a companion article. The conflict between these outcomes and the call by the dental community, as well as that of the 1995 Institute of Medicine Study, for a reduced emphasis on teaching students about the technical details involved in removable prosthesis fabrication is recognized and explored.

An effective technique for denture border evaluation.

Proper extension and adjustment of denture borders is a critical component in successful removable prosthodontic treatment. Unfortunately, commonly marketed disclosing media may not provide appropriate viscosities for the accurate assessment of denture border extensions. This article provides a technique for the mixing, unit-dose packaging, and utilization of a disclosing medium that is extremely well-suited for denture border applications. The technique employs commonly available materials and compiles with current "unit-dose" guidelines.

The dental student as technician: an 18-year follow-up of preclinical laboratory programs.

In 1977, a survey of American and Canadian dental schools was conducted by Weintraub to determine the delegation of laboratory procedures in preclinical and clinical complete and removable partial denture programs. This was performed in light of challenges raised to the value of requiring dental students, rather than laboratory technicians, to perform the various laboratory procedures involved in the fabrication of complete and removable partial dentures. Since 1977, the rate of edentulism has declined in the United States, and fewer edentulous patients have sought regular dental care. In addition, approximately 20% fewer curriculum hours have been spent in dental schools in removable prosthodontic instruction; a declining number of graduating dental students have felt comfortable with their level of knowledge of removable prosthodontics, especially complete dentures, and have performed fewer removable prosthodontic procedures in practice because of a perceived lack of treatment cost-effectiveness. The present study, an 18-year follow-up to the 1977 survey, was designed to determine if such trends toward a deemphasis on removable prosthodontic treatment have affected the mechanisms of instruction in and the extent to which dental schools instruct students about removable prosthodontics laboratory procedures. The 1995 survey was mailed to 53 American dental schools. Forty-six schools returned the completed survey, for a response rate of 87%. Results showed that the proportion of schools with removable prosthodontic preclinical programs, especially those in removable partial dentures, increased, as did the relative amount of material presented to students in these programs. This was accomplished primarily through the enhancement of laboratory technician support, both in-house and commercial, of student preclinical removable prosthodontic laboratory procedures. The conflict between these outcomes and the call by the dental community, as well as that of the 1995 Institute of Medicine Study, for a reduced emphasis on teaching students about the technical details involved in removable prosthesis fabrication is recognized and explored.

Removable prosthodontics: a survey of practices and attitudes among South Australian dentists.

All dentists registered in South Australia were surveyed in July 1993 in relation to removable prosthodontics. The replies indicated that removable prosthodontics constituted a significant part of most dental practices. Most dentists felt that removable prosthodontics should be an essential part of the undergraduate curriculum. They felt that more expertise is now required to manage the treatment of the ageing population with either their first or replacement removable prostheses. The majority of dentists felt that their own undergraduate training had equipped them well to manage removable prosthodontic treatment for their patients; however, many helpful suggestions were made on areas that they thought required more emphasis.

Clinical Applications of a Polyphosphazene‐Based Resilient Denture Liner

The use of resilient denture liners provides an invaluable modality in removable prosthodontic treatment. Treatment of atrophic mandibles, preoperative and postoperative soft tissue management, and retention of removable prosthesis are a few applications of these materials. This article describes the clinical application of a polyphosphazene-based liner (Novus, Hygenic Corp, Dayton, OH) as a denture liner and retentive material in conventional and implant overdenture rehabilitation.

Prefabricated custom impression trays for the altered cast technique

Removable partial prosthodontic treatment requires multiple patient appointments with intermediate laboratory steps. A technique is described that allows the removable partial denture framework try-in and the impression for the altered cast to be efficiently completed in a single appointment. The method uses prefabricated custom impression trays that are readily attached to the framework after the try-in.

調音機能と補綴物との関係 ＩＩ‐１． 実験的口蓋床が発音前の内舌筋筋放電活動，舌運動および下顎運動に及ぼす経日的変化様相

As the first step of evaluating the kinematic function and the coordinative movement among articulatory organs, attention was focused on the palatal form in various factors related to the function of pronunciation on complete denture. After the experimental palatal plate was inserted into 13 natural dentitions in the age ranging from 21-24 years old, muscular discharge of intrinsic muscles, tongue movement and mandibular movement before pronunciation were recorded longitudinally. These data were comparatively evaluated with those before insertion of the experimental palatal plate, and the following conclusion were obtained. It has been made clear in this study that from the change of muscular discharge of intrinsic muscles, tongue movement and mandibular movement before pronunciation between before and after the insertion of the experimental palatal plate, correction aspect of the kinematic function and the coordinative movement among articulatory organs varied with point and method of articulation on each sound. And these facts suggested that it was necessary to diagnose and treat under consideration of the relation between the palatal form and articulatory function of tongue and mandible in removable prosthodontic treatment.