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Over a period of 4-1/2 years, patients having model cast dentures that had been inserted in the dental office were checked and submitted to follow-ups. It became evident that the socalled pre-prosthetical measures had been performed in a non-satisfying manner. In 69% of the patients, teeth had been extracted directly before inserting the model cast denture. As a result thereof, a majority of the dentures was sagging after a relatively short time and 70% of the dentures revealed non-occlusion in the final follow-up. 47% of the dentures had to be modified because of necessary tooth extractions, thereby reducing the original number of abutment teeth by 19%. About a third of the inserted model cast dentures showed gross deficiences, the percentage of socalled "collar" constructions was relatively high.
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PURPOSE: The purpose of this study was to examine changes in the masticatory function of complete denture wearers after relining the mandibular denture with a soft liner. MATERIALS AND METHODS: Conventional complete dentures were fabricated for 6 completely edentulous patients. One month after completing adjustments of the dentures, maximum biting force, masticatory performance, and electromyography of the masseter muscle during mastication were recorded. Chewing strokes, chewing time, muscular activity, and masticatory rhythm were calculated using the recorded electromyography. The mandibular dentures were then relined with a soft liner. One month after finishing adjustments of the relined dentures, the same tests were performed. These values were compared using a paired t test (alpha = 0.05). RESULTS: When using the soft liner, masticatory performance and maximum biting force were significantly greater (P = 0.019 and P = 0.023, respectively). In addition, the number of chewing strokes was significantly lower (P = 0.020), and chewing time was reduced (P = 0.010). A more stable masticatory rhythm was also found in the initial chewing stage. The muscular activity tended to decrease after the insertion of the lined denture, but no significant difference was found between before and after relining. CONCLUSION: It was shown that applying a soft lining material to the mandibular dentures of 6 edentulous patients improved masticatory function with no adverse effect on the muscular task.
PURPOSE: This article presents a critical review of the literature on the prosthodontic maintenance requirements of mandibular mucosa- and implant-supported overdentures. MATERIALS AND METHODS: A search of the literature produced 35 papers pertaining to prospective and retrospective studies. The relationship of these prosthodontic maintenance requirements to the axis of rotation treatment concept was examined. RESULTS: More often than not, 2 anterior mandibular implants either splinted (round or ovoid bars) or unsplinted (balls or magnets) have been used to evaluate this prosthodontic follow-up. Wide variation existed in the categories used for prosthodontic complications. Although principally related to alterations of overdenture contour and aspects of patrix and matrix maintenance, they also provide subjective information on relines and the rationale for avoiding overdenture fractures. These prosthodontic maintenance requirements undoubtedly have a direct impact on the time to retreatment of mandibular mucosa- and implant-supported overdentures. CONCLUSION: There appears to be a need for a more uniform, standardized categorization with criteria for determining prosthodontic success, in terms of maintenance requirements and complications, for mandibular mucosa- and implant-supported overdentures. Controlled prospective evaluations of exact prosthodontic maintenance requirements of mandibular overdentures using different systems are lacking and encouraged. There is also an absence of prospective studies on such maintenance requirements of mandibular overdentures using multiple round bars on 3 or 4 implants.
PURPOSE: A prospective study on mandibular implant-supported overdentures using more than 2 Brånemark implants splinted with multiple round bars evaluated a hypothesis that unnecessary prosthodontic maintenance would result from the contravention of accepted biomechanical principles. MATERIALS AND METHODS: A randomized prospective trial on 59 edentulous patients details prosthodontic maintenance and complications of 52 mandibular overdentures (11 unsplinted, 41 splinted) over a 3-year period. RESULTS: Prosthodontic maintenance was greater in the first year than in subsequent years, regardless of design. Comparison between the splinted designs with round bars revealed no statistically significant difference with either retentive clip activation or fractures. More than 70% of the retention clips in the 2-implant (single round bar) design needed activation, as compared to 44% of those with the 3-implant (double round bar) or 4-implant (triple round bar) design. Retention clip fracture occurred in 30% of patients with 3 or 4 implants and 16% of those with 2 implants. Relining the overdentures, regardless of design, revealed an excessive maintenance burden in 40% of overdentures. Remaking of overdentures was necessary in 21% of patients. CONCLUSION: Multiple round bars splinting 3 or 4 implants can still be a treatment concept in mandibular overdenture treatment. Results from prospective evaluation of this design indicate less prosthodontic maintenance of clip activation but more clip fractures than with 2 implants splinted with single round bars, although not at statistically significant levels.
The aim of the present study was to evaluate clasp-retained removable partial dentures (RPDs) made in the Public Dental Health Service (PDHS) in Orebro County in 1989. Records from all 25 PDHS clinics concerning RPDs from 1989 were collected after eight years and available information was registered. The entire material consisted of 447 RPDs (both attachment-retained and clasp-retained RPDs) in 387 patients. Of the 316 clasp-retained RPDs that were traceable, 208 were followed from 1989 to 1997. In most instances, information on diagnoses, alternative treatments and design of the RPDs was lacking. One hundred and thirty-two (42%) of the 316 clasp-retained RPDs were judged to still be in use in 1997 while 75 were not in use. The main reason for ceased use was dislike by the patient. There were 108 clasp-retained RPDs that were not possible to follow from 1989 to 1997 because there were no notes regarding follow-ups in the records. The most common technical complications noted in the records during the observation period were clasp fractures and loosened artificial teeth.
The aim of present study is to assess the effect of complete denture relining on the electromyogram of masticatory muscles. The electromyography and the computer-EMG system were used for collecting and processing bilateral masseter and anterior temporal muscles activities before and after denture relining. The results showed that the mean myoelectric potentials of the masticatory muscles was increased during chewing and maximal biting when the dentures were relined. The conclusion was that the level of the masticatory muscle activity was increased when a clinically acceptable occlusal vertical dimension was obtained by using relining method.
PURPOSE: The aim of this study was to evaluate clinical usefulness and durability of continuous glass-fiber reinforcement in repair of acrylic resin removable dentures. MATERIALS AND METHODS: Fractured removable dentures without reinforcement, with conventional metal-wire reinforcement, or with mesh reinforcement were collected from two dental schools in Finland. The total number of dentures was 51 and the number of patients was 48. During the repair, the dentures were reinforced with a polymer-preimpregnated E-glass fiber at the region of the fracture. The fibers were used as partial fiber reinforcement, i.e., only the weakest part of the denture was reinforced. Follow-up time varied from 4 months to 4.1 years. After the follow-up period, possible fractures and discoloring were visually inspected. Possible irritation of oral mucosa by glass fibers and the general shape of the denture were also evaluated. RESULTS: In 88% of the cases, there was no need for adjustment at the region of partial fiber reinforcement, and the clinical condition of the dentures was good. Glass fibers did not irritate the oral mucosa. In the case of refracture or hairline fracture, positioning of the partial fiber reinforcement was incorrect or the reinforcement had been used incorrectly (the wetting of the reinforcement with denture base resin was inadequate). CONCLUSION: Polymer-preimpregnated partial fiber reinforcement seems to be useful in eliminating fractures of acrylic resin removable dentures. However, this study emphasizes the importance of correct positioning and accurate laboratory technique when partial fiber reinforcement is used.
PURPOSE: This article proposes a classification protocol for reporting the outcome of implant overdentures. MATERIALS AND METHODS: Review of the literature pertaining to postinsertion prosthodontic procedures for maxillary and mandibular implant overdentures revealed a wide range in the terminology used and methods of reporting outcome, usually as a result of the use of varying designs among different implant systems. A need for comparative evaluation of the prosthodontic success of implant overdentures was identified. RESULTS: An existing classification protocol for implant-fixed prostheses containing six objectively defined fields was modified for implant overdentures. This new protocol, which also uses the descriptive fields of success, survival, unknown, dead, and retreatment (repair or failure), provides a method whereby postinsertion prosthodontic procedures and subsequent time to retreatment can be quantified regardless of design, method of attachment, or implant system. A ratio method for identifying prosthodontic treatment cost effectiveness of implant overdentures is included. CONCLUSION: This protocol could assist clinicians in their choices of implant overdenture therapy by providing accurate comparisons of varying implant overdenture systems and designs, and by identifying prosthodontic treatment cost effectiveness.
PURPOSE: The aim of this study was to evaluate the prosthetic complications with implant-supported overdentures in the maxilla. MATERIALS AND METHODS: Forty-one patients (mean age 61 years) were consecutively admitted for treatment from 1991 to 1998. A total of 173 ITI implants were placed. Four to six implants either connected with a bar (34 overdentures) or with single anchors (seven overdentures) supported the denture, and only a few parties had fewer than four implants. The overdentures had a horseshoe design and were reinforced by a cast-metal framework. The mean observation time was 3.2 years. Oral hygiene and periimplant parameters were regularly assessed, and records were kept of prosthetic maintenance service. All prosthetic complications encountered were classified related to (1) implant components and anchorage devices, (2) mechanical and structural failures of dentures, or (3) denture-related adjustments. RESULTS: Three implants did not osseointegrate, and five implants were lost after loading. Thus, the overall survival rate of the implants was 95.5%. Altogether, 85 prosthetic complications were encountered. The most frequent finding was retightening of the bar screw and adjustments of the bar retainers. Repair of dentures was not frequent and was mostly related to broken teeth. No fracture of dentures was observed. Renewal of dentures occurred twice, once after loss of all implants in one patient. Thirty-nine overdentures had been continuously worn; thus, the overall denture stability was 95%. Mucosal irritation and need for occlusal adjustment were the most frequent findings in the first year. Over time, a decrease of complications was observed. CONCLUSION: Planned maxillary overdentures supported by implants are a successful treatment modality on a short-term basis.
Modern prosthodontic therapy must continue to address the inevitable consequence of tooth loss--that is, alveolar process atrophy. The use of removable partial dentures (RPDs) to treat partial edentia must rely, in part, on support from the ever-deteriorating edentulous ridges. Extension-base RPDs are particularly affected as the tissue-base relationship changes over time after extraction of the natural teeth. This article reviews the concept of observed changes in the residual edentulous alveolar ridge and conventional procedures used to compensate for this bone loss. Finally, a practical procedure is presented which uses convenient and accurate materials that can be readily incorporated into the modern dental practice.
The atrophic edentulous ridge represents one of the greatest challenges faced in general practice. An estimated 20 million adults in the U.S. are edentulous in at least one arch and a significant number of these patients experience problems with their prostheses from alveolar bone loss. Many of these patients, for various reasons, are not candidates for endosseous dental implants. Alveolar ridge augmentation is a viable option in many of these cases; however, this procedure has been unpredictable because of particle migration. Presented here is a method of ridge augmentation with dense hydroxylapatite beads linked in a resorbable suture matrix to prevent particle migration during healing. This technique may be performed with minimally invasive surgery, providing long-term prosthetic support.
PURPOSE: This prospective study evaluated the prosthodontic maintenance requirements during the first year of service of mandibular overdentures supported by two unsplinted implants using three different implant systems. MATERIALS AND METHODS: Seventy-two patients randomly allocated to three equal groups were each provided with a conventional complete maxillary denture and a mandibular overdenture supported by two unsplinted implants. A different implant system was used for each group (Steri-Oss, ITI, or Southern Implants), and their prosthodontic maintenance requirements were compared, primarily for the patrix and matrix. Additional maintenance categories recorded included any type of overdenture fracture, reline or remake of the overdenture, and maintenance of the maxillary denture. RESULTS: Sixty-eight percent of the patients, regardless of implant system, required prosthodontic maintenance in the first year, most commonly for the matrices. The Southern Implants matrices required less maintenance than those of Steri-Oss or ITI (P < .05). Additional overdenture maintenance was required by 28% of patients, irrespective of implant system. When all categories of prosthodontic maintenance were combined, there were no differences between implant groups. Evaluation of overall prosthodontic success using six-field tables revealed statistically significant differences between the three implant systems, with more ITI and Steri-Oss patients than Southern Implants patients requiring overdenture retreatment (repair). CONCLUSION: During the first year of service, the matrix maintenance requirements of Southern Implants were significantly lower than those of the ITI or Steri-Oss groups; this was reflected in the number of retreatment (repair) categories recorded. Although the three systems did not differ significantly for overall prosthodontic maintenance, both the Steri-Oss and the ITI titanium matrices showed problems of clinical significance.
PURPOSE: The purpose of this study was to evaluate the professional time required for the prosthodontic maintenance events of mandibular implant overdentures during the first year of service using three different implant systems (ITI, Steri-Oss, or Southern). MATERIALS AND METHODS: Seventy-two mandibular implant overdenture patients were allocated to three equal groups, each treated with a different implant system. Data on prosthodontic maintenance events during the first year were categorized and analyzed according to professional time allocation per procedure. RESULTS: The total professional time required to perform all the maintenance events ranged between 29.0 and 34.0 hours and did not differ significantly among the three groups, although there were time differences for matrix activation and replacement. When combining the professional time for all maintenance events for the mandibular overdentures alone, or with the opposing maxillary complete dentures, there were no significant differences between groups. For maintenance of the maxillary dentures, there was an unexplained difference between the Southern group and ITI or Steri-Oss groups (P < .05). CONCLUSION: The prosthodontic maintenance for mandibular implant overdentures required on average 72 to 98 minutes of professional time per patient during the first year of service, depending on the system used.
STATEMENT OF PROBLEMS: Research-based assessments of the quality of removable partial dentures (RPDs), especially within a large patient population, are lacking. PURPOSE: This study evaluated the prevalence and quality of RPDs by use of the National Health and Nutrition Survey (NHANES III) data set. MATERIAL AND METHODS: Estimates of the health and nutritional status of the American population were obtained from the NHANES III data set (1988-1994). Calibrated dentists performed dental examinations on 17,884 adults. If the subject wore an RPD, its quality was assessed with 5 criteria: integrity, tooth wear, the presence of temporary reline material or adhesive, stability, and retention. In this study, the data on RPD defects were used to assess the prevalence of problems. The original population was divided into 4 subgroups: paired RPD data = subjects wearing both maxillary and mandibular RPDs (n = 600 prostheses, 300 maxillary and 300 mandibular); single RPD data = subjects with only one RPD (n = 1003 prostheses, 511 maxillary and 492 mandibular); maxillary versus mandibular RPD data = all subjects with all RPDs (n = 1603 prostheses, 811 maxillary and 792 mandibular); and pooled RPD data = all subjects with a single RPD plus subjects with 2 RPDs, counting only the RPD with the most defects (n = 1303 prostheses, 674 maxillary and 629 mandibular). The subjects were analyzed with descriptive statistics. The distribution of defects in the RPDs was examined for possible associations with chi(2) tests. The paired data for patients with both maxillary and mandibular RPDs were analyzed with Wilcoxon signed rank tests. The prevalence of RPDs as a function of patient age and the association between RPD defects and patient age were analyzed with chi(2) tests. The results were considered highly significant at P<.0001 and significant at P<.05. RESULTS: Of the 17,884 adults who underwent a dental examination, 1306 had RPDs. Three patients were excluded because their records were incomplete, leaving 1303 patients available for analysis. Most of the prostheses examined (65%) had at least 1 defect. Lack of stability was the most prevalent single defect. Distinctions in the type and prevalence of defects were observed between mandibular and maxillary RPDs. Mandibular RPDs had significantly more problems related to retention, whereas maxillary RPDs had significantly more problems related to the presence of reline material and to integrity defects. Tooth wear defects were significantly associated with patient age (P<.0001). Only one third of the RPDs were considered satisfactory according to NHANES III criteria. CONCLUSION: A review of the database used in this study indicated that, in spite of a decline in tooth loss, RPDs are still used in all age cohorts, including young adults. A large number of RPDs were found to have defects.