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The influence of the accuracy of the intermaxillary relations on the use of complete dentures: a clinical evaluation.

The aim of this study was to investigate possible associations between the accuracy of intermaxillary relations and complete denture usage 3 months and 3 years after their insertion. A total of 600 patients were provided with new complete dentures. Willis gauge and Woelfel's method were used to assess the quality of the existing complete dentures and the use of these dentures. Three years after insertion the remaining 250 patients took part in a follow-up examination. Three months post-insertion, significant relationships were found between adequate interocclusal rest space or quality of registration of centric relation and daily wearing of complete dentures and between quality of registration of centric relation and use of dentures for eating. Three years after insertion the adaptation to denture wearing was generally satisfactory. However, no significant relationship was observed between the accuracy of intermaxillary relations and complete denture usage.

Adult↗

[On the viscoelastic properties of the palatal mucosa analyzed for the displacement of maxillary complete denture].

The condition of palatal mucosa caused by wearing a maxillary complete denture closely resembles a closed hydrostatic system. To clarify the viscoelastic properties of the palatal mucosa under such a condition, we measured as a function of the degree of denture displacement during biting movements. For this work, we developed three dimensional movement-measuring equipment. The following results were obtained: 1. The displacement of the maxillary complete denture during biting movements (loading and unloading of occlusal forces) could be approximated by an empirical formula of exponential function. This formula expressed the delayed elasticity characteristics of the viscoelasticity of the palatal mucosa. 2. Observation of the denture's displacement revealed that the movement of the palatal mucosa after occlusal forces are unloaded could be regarded as creep according to a Voigtian two-element model. 3. Denture displacement differed between occlusal force loading and unloading: dentures took longer to return to the original position during occlusal force unloading. 4. This time delay, indicating the degree of delayed elasticity of the palatal mucosa, was substantially shorter than the reported value based on local compression tests. Our study clearly shows that when a maxillary complete denture is worn, movement of the palatal mucosa approximates a closed system, and differs from localized open systems.

Biomechanical Phenomena↗

Oral health-related quality of life in patients treated with fixed, removable, and complete dentures 1 month and 6 to 12 months after treatment.

PURPOSE: This study described oral health-related quality of life (OHRQoL) before and after treatment in patients with fixed, removable, and complete dentures. MATERIALS AND METHODS: OHRQoL was measured using the German version of the Oral Health Impact Profile (OHIP-G) in a convenience sample of 107 prosthodontic patients at baseline and 1 and 6 to 12 months after treatment. The sum of OHIP-G item responses (OHIP-G49, range 0 to 196) characterized OHRQoL impairment in 42 patients treated with fixed prosthodontics, 31 patients treated with removable dentures, and 34 patients treated with complete dentures. OHIP-G49 medians were compared with the OHRQoL level in a general population sample (n = 2,026). A multivariable binomial regression analysis, controlling for the effects of baseline OHRQoL and follow-up wave, was used to compare the level of impaired OHRQoL in different prosthodontic treatment groups at follow-ups. RESULTS: OHRQoL improved in 96% of the subjects. OHIP-G49 medians reached the level of OHRQoL in the general population 1 month after treatment (fixed prosthodontics patients 6 OHIP-G units; general population subjects 5 units; removable denture patients 23 units, 15 units in general population subjects; complete denture patients 13 units, 23 units in general population subjects). OHIP-G49 medians were below population norms 6 to 12 months after treatment. In patients treated with removable/complete dentures, the expected posttreatment OHIP-G49 problem rate was 1.9 times the problem rate in patients treated with fixed prosthodontics, holding baseline OHIP-G49 and follow-up wave constant. CONCLUSION: OHRQoL changed substantially comparing pretreatment scores with 1 and 6 to 12 months of follow-up in patients treated with fixed, removable, and complete dentures.

Adult↗

Complete denture education in U.S. dental schools.

PURPOSE: In 2001, a survey of U.S. dental schools was conducted to determine curricular content, teaching philosophies, and techniques used in clinical complete denture programs. MATERIALS AND METHODS: The questionnaire was mailed to the chairperson of the prosthodontic/restorative department of 54 U.S. dental schools. Of these, 44 schools returned the completed survey, resulting in a response rate of 82%. The mean, median, and range of responses were computed where applicable. RESULTS: Results from this survey show that a large majority of schools are using similar materials in clinical complete denture treatment: irreversible hydrocolloid for preliminary impression (87%); light-cured composite resin for record base fabrication (70%); a semiadjustable articulator (98%); and semianatomic posterior tooth form used exclusively or in combination with other tooth forms (75%). In addition, a large majority of schools are using similar techniques in clinical complete denture treatment: use of a protrusive record (80%); use of extra-oral measurements, speech, and esthetics for establishing the occlusal vertical dimension (59%); use of the conventional compression molding method for processing complete dentures (82%); occlusal equilibration and face-bow preservation (75%); and the clinical remount procedure (91%). A quality control program is present for cases sent to and returned from the laboratory in 73% and 84% of responding schools, respectively. CONCLUSIONS: Clinical complete denture predoctoral programs vary from school to school, yet a large percentage of schools agree on many topics. Only 55% of schools reported incorporating new educational materials such as the use of dental implants and treatment of patients with implant-retained overdentures at the predoctoral level. Sixteen percent are allowing students to graduate without a set number of required complete dentures as has traditionally been the case. Sixteen percent are using newer techniques such as injection molding and microwave processing technique in addition to the conventional processing technique.

Curriculum↗

The future of teaching of complete denture construction to undergraduates in the UK: is a replacement denture technique the answer?

Due to changes in the amount of curriculum time available for teaching complete denture construction to undergraduate students, course content requires reconsideration and possible modification. The idea that a replica complete denture technique may offer some advantages is explored. A review of the relevant literature fails to support many of the claimed benefits of this technique such as relative ease of adaptation by the elderly to new dentures. This article suggests that the replica denture technique should be considered as no more than an alternative method of making dentures. The relative demerits of the technique are discussed. A modification of the replica block technique to include important aspects of conventional complete denture courses is described. It is suggested that, because less clinical time is required, it may be a suitable way of introducing students to complete denture construction and educating them to a level which would encourage some to take further postgraduate study and would allow all graduates to treat routine cases or diagnose, treatment plan and refer to clinical dental technicians.

Adaptation, Psychological↗

[Specifics of mastication with complete dentures].

INTRODUCTION: Mastication is a process characterized by alternating phases of physiological inactivity, food intake, initial food crumbling, mouthful formation and deglutition. Although there is a so called human type of mastication, this process is individual for variety of reasons. Mastication is not an innate characteristic and it must be learned, but once it is learned, it gets a reflexive function, demanding maximal involvement of the highest nervous system centers. DISCUSSION: Specificities of mastication in complete denture wearers are caused by specificities connected to changes of the oral cavity due to teeth loss, technical features of complete dentures and quality of their manufacture. Loss of teeth causes loss of periodontal receptors consequently damaging the source of information which, as long as teeth are present, travels from the oral cavity towards the central nervous system and regulates the masticatory muscles activity. As one of the consequences of periodontal receptors' loss, interocclusal perception decreases, because the number of receptors within the masticatory mucosa is negligible. Another problem is that loss of teeth causes loss of the occlusal surface. Occlusal surface is considered to be the only reference coordinate of the zero intermaxillary separation with precise spatial representation within the someostatic field cortex. Permanent loss of antagonistic contact causes disappearance of the memory pattern of the occlusal surface. Therefore completely edentulous mouths are characterized by disintegration of the free interocclusal space. Masticatory forces' value directly depends on the: size of muscles creating the forces, their position in the mandibula, shape of the edentulous alveolar ridge, type of chewing, the relationship between the height of the branch, length of the mandibular body, gonial angle, mandibular angle in relation to the anterior cranial base and posterior facial height and the degree of intermaxillary separation. Bite forces in complete denture wearers are significantly decreased in relation to persons with natural teeth. There is a fundamental difference in the distribution of the functional energy in complete denture wearers and subjects with intact teeth. Persons with natural teeth tend to generate energy through bolus, whereas in complete denture wearers most of the chewing energy is distributed outside bolus, directly through the denture base on the supporting tissues. RESULTS: As the result of this specific dynamics stress of supporting tissues often occurs with consequential mucosal inflammation and rapid alveolar bone resorption. Reduction of masticatory efficacy in denture wearers may be caused by irregular activity of masticatory musculature or is the consequence of irregular flow of energy during mastication. In comparison with young examinees with healthy teeth, authors have registered that complete denture wearers need about seven times more masticatory movements to achieve equal number of sample parts. CONCLUSION: It has been documented by experience and also scientifically proved, that the satisfaction of complete denture wearers is not often proportional with objective functional denture values. Comparison of subjective parameters with objective test results reveals that the percentage of complete denture wearers who consider their dentures to be good, although they objectively are not such, is significantly higher than the percentage of those who complain about their dentures, although they are functionally proper. Our study comprised patients (average age of 69) who wore complete dentures longer than five years.

Denture, Complete↗

Influence of mandibular residual ridge shape on masticatory efficiency in complete denture wearers.

PURPOSE: The purpose of this study was to investigate the influence of mandibular residual ridge shape on masticatory efficiency in complete denture wearers. MATERIALS AND METHODS: Twenty-eight complete denture wearers (mean age 75.6 years, SD 4.8) who received their complete denture treatment by one of the authors and had no troubles in daily use were selected. The mandibular residual ridge was evaluated by using a replica of the ridge obtained with heavy-body silicone impression material. The basal area of the replica was measured by a digitizer. The volume and the height of the replica were calculated. Masticatory efficiency in each subject was measured by the sieving method. RESULTS: There was a significant correlation between the masticatory efficiency and basal area, volume, and height of the residual ridge. The basal area showed the strongest correlation. CONCLUSION: The basal area of the denture foundation greatly influenced the masticatory efficiency, suggesting that the masticatory efficiency in complete denture wearers was limited by their own residual ridges and that clinicians should inform their patients about the limitation of the recovery of masticatory ability before the beginning of denture treatment.

Aged↗

Changes in dental attitude and behavior among Dutch adults wearing complete dentures.

In 1992 a follow-up on the Dutch National Dental Survey of 1986 (DNDS) was performed. The main objective was to detect and analyze changes in oral self care, dental attendance, and oral health status. This paper will focus on the DNDS adults wearing complete dentures. Changes over a 6-yr period will be presented of: dental attendance, denture satisfaction and wearing of the complete dentures, and denture treatments. A postal questionnaire was used: 232 persons (64%) participated in the study. Analysis of Variance (ANOVA) was used to study the effect of dental and social variables on observed changes since 1986. Risk ratios (RR) were computed to clarify the actual effects of these variables. With respect to dental attendance, a shift towards visits for denture check-ups was found, thought to reflect the respondents' concern for their complete dentures (RR = 1.6). A small shift towards more visits because of denture problems was found. This was attributed to denture treatments that had taken place between 1986 and 1992 (RR = 2.8). With respect to changes in denture satisfaction, no influence of denture treatments could be noted, but a relation was found with a variable indicating the imperfection of the complete dentures as felt by the respondents (RR = 2.8). In 31% of the respondents some denture treatment had been performed since 1986. No objective dental criteria of complete dentures and denture bearing areas had influenced these denture treatment decisions, but only respondents' subjective criteria (RR = 1.9-2.9).

Adult↗

Studies of changes in occlusion after the insertion of complete dentures. Part I.

The present study aims to investigate changes in the occlusion of complete dentures after their insertion. A total of 85 edentulous patients were provided with new complete dentures. Their individual hinge axes were determined using mechanical axiography and the upper finished dentures were transferred by facebows to Dentatus articulators. The lower dentures were mounted according to an intraoral central bearing point (CBP) registration and equilibrated in terminal hinge position. An articulator specially modified for measurements in the condylar area was used. The differences between the positions of the condylar balls with CBP registration and those after equilibrating the occlusion were determined. On average, 19 days after insertion, 71 patients took part in a follow-up examination. As in the first session, the terminal hinge position was registered with the CBP method using the apex of the Gothic arch. Thus, the positions of the condylar balls immediately after the new registration could be compared with those in equilibrated intercuspation 3 weeks earlier. The differences were found to be 0.5 +/- 0.4 mm (0-2.9 mm) in the three axes (sagittal, coronal and horizontal). They are thought to result from settling into the denture bearing tissues and also from neuromuscular adjustment of the masticatory system. Compulsory remounting of complete dentures after insertion is therefore recommended.

Adaptation, Physiological↗

[3D finite element analysis in consideration of the slide on residual ridge and the rigidity of mandibular complete denture].

PURPOSE: The motions and stress distributions of mandibular complete dentures during use were compared and investigated in terms of denture rigidity using 3D finite element method (FEM) stress analysis. METHODS: Four models for analysis of mandibular complete dentures with different elastic modulus (1. A resin base denture (C), 2. A resin base denture with reinforcement wire (R), 3. A metal base denture (M), 4. A metal plate denture consisting of a double structure (T)) and measured using 3D FEM. Modes were separated into two elastic bodies: the dentures and residual ridge. Analyses were executed under the same conditions total loads of 20 kgf and contact. RESULTS: 1. The total equivalent-potential strain of dentures was high beneath the load point for C and R (2.38 approximately 2.86 x 10(-3)epsilon at buccal-shelf of working side and 0.55 approximately 0.68 x 10(-3)epsilon at posterior residual ridge). The entire dentures barely distorted for M and T (0.98 approximately 1.17 x 10(-3)epsilon at buccal-shelf of working side and 0.21 approximately 0.25 x 10(-3)epsilon at posterior residual ridge). 2. In the main stress distribution of mucosa beneath denture bases, high loads were located beneath the loading point of dentures, at lingual distal areas of the working side in C and R. In M and T, increasing the rigidity of dentures reduced the stress beneath the loading point of dentures. Stress was distributed widely and evenly. CONCLUSIONS: When the rigidity of dentures is high, the strain of dentures decreases, the stress of the residual mucous membrane will evenly become distributed, and the distance of the balancing side from the denture border to the residual mucous membrane at the time of unilateral balanced position will decrease.

Dental Stress Analysis↗

Complete dentures: are they out of phase with current therapy?

Complete dentures are truly a full-mouth reconstruction that functions in a dynamic environment and provides the completely edentulous patient with function, esthetics, phonetics, facial support, and self-esteem. Solutions to six of the most frustrating problems of complete denture treatment are described. These solutions provide enhanced treatment possibilities and mutual satisfaction to both the patient and the practitioner.

Dental Articulators↗

The influence of psychologic factors on patient satisfaction with complete dentures.

This study investigated the relationship between satisfaction with complete dentures and some psychologic factors. New dentures were made for 130 patients who were investigated during their treatment. A neuroticism scale and the Health Locus of Control scale were used to investigate the patient's personality. The patient-dentist relationship was evaluated by asking patients their opinions about the treatment, and patient attitude toward dentures in general and their expectation toward the new dentures were evaluated by means of a questionnaire. No relationship was found between dissatisfaction and patient personality. A low relationship was found between dissatisfaction and the patient's opinion about the treatment, and a moderate relationship was found between dissatisfaction and the patient's attitude toward dentures. A patient's attitude toward dentures, measured by the questionnaire before new dentures were received, is a prospective tool for patient satisfaction with new dentures.

Adult↗

Some observations on the diagnosis and treatment of complete denture problems.

Diagnosis of problems in the wearing of complete dentures can only be made after taking a complete history of the difficulties encountered by the patient. This necessitates careful attention whilst the patient relates the various difficulties. The record of these statements should be scrutinized carefully and this will assist in making the correct diagnosis of the cause of the difficulties. Specific problems encountered by elderly patients are examined and some methods of overcoming them are presented.

Dental Occlusion↗

Correlation between patient satisfaction with complete dentures and denture quality, oral condition, and flow rate of submandibular/sublingual salivary glands.

PURPOSE: The purpose of this study was to examine the correlation between patient satisfaction with complete dentures and parameters of denture quality, oral condition, and flow rate of the submandibular and sublingual salivary glands. MATERIALS AND METHODS: The parameters were evaluated on 50 denture wearers using semiquantitative scales and a recently described submandibular/sublingual saliva collector. RESULTS: Most patients had a medication-induced reduced salivary flow rate (mean 0.024 mL/min/gland; SD 0.040). Submandibular/sublingual salivary flow rate correlated statistically with six denture satisfaction parameters: maxillary denture retention and comfort, mandibular denture retention and comfort, abilities of chewing, and speech. Residual alveolar ridge resilience, maxillary ridge shape, and denture quality did not significantly correlate with denture satisfaction. Characteristics of musculature correlated significantly only with subjective maxillary denture retention, and mandibular ridge shape correlated with comfort. CONCLUSION: Submandibular/sublingual salivary flow rate is an important factor in denture satisfaction. The retention of the maxillary denture was correlated to the oral musculature characteristics, and the mandibular denture comfort was correlated to the mandibular ridge shape. Denture satisfaction was not affected by other anatomic or denture quality-related parameters.

Aged↗

Comparison of the occlusal vertical dimension after processing complete dentures made with lingualized balanced occlusion and conventional balanced occlusion.

STATEMENT OF PROBLEM: An increase in occlusal vertical dimension (OVD) may occur after processing complete dentures. Although many factors that generate this change are known, no information is available in the dental literature regarding the effect that the occlusal scheme may have on the change in OVD. PURPOSE: This in vitro study compared the increase in OVD, after processing, between complete dentures with teeth arranged in lingualized balanced occlusion and conventional balanced occlusion. MATERIAL AND METHODS: Thirty sets of complete dentures were evaluated as follows: 15 sets of complete dentures were arranged in conventional balanced occlusion (control) and 15 sets of complete dentures were arranged in lingualized balanced occlusion. All dentures were compression molded with a long polymerization cycle. The occlusal vertical dimension was measured with a micrometer (mm) before and after processing each set of dentures. Data were analyzed using an independent t test (alpha=.05). RESULTS: The mean increase in the OVD, after processing, was 0.87 +/- 0.21 mm for the control group and 0.90 +/- 0.27 mm for the experimental group. There was no significant difference between the groups. CONCLUSION: After processing, dentures set in lingualized balanced occlusion showed an increase in OVD similar to those set in conventional balanced occlusion. CLINICAL IMPLICATIONS: Although the 2 occlusal concepts resulted in similar increases in the OVD after processing, the lingualized balanced occlusion may result in easier occlusal adjustments, as the less complicated occlusal scheme uses a smaller number of centric occlusion contact points.

Acrylic Resins↗

Association between the accuracy of intermaxillary relations and complete denture usage.

STATEMENT OF PROBLEM: Previous studies have investigated possible associations between the accuracy of intermaxillary relations and complete denture usage with variable results. PURPOSE: This study investigated the association between the intermaxillary relations in new complete dentures and the use of these dentures for daily wear and eating. METHODS: A prospective study of patients (n = 523) attending Guy's Dental Hospital for complete dentures was undertaken. Patients were examined at the beginning of treatment and at the first post insertion visit. Rest vertical dimension and vertical dimension of occlusion were measured with a Willis gauge. Quality of registration of centric relation position was assessed and, 3 months later, a postal questionnaire was sent to investigate patients' use of dentures. Data were analyzed with Pearson's chi-squared test with exact nonparametric inference. RESULTS: Adequate interocclusal rest space was associated with daily wear of dentures (chi2 = 7.97, P =. 018). Quality of registration of centric relation was associated with daily wear (chi2 = 32.43, P <.001) and use of dentures for eating (chi2 = 20.23, P =.003). CONCLUSION: Positive associations were found between the accuracy of intermaxillary relations and complete denture usage.

Aged↗

Patient satisfaction with implant-retained mandibular overdentures. A comparison with new complete dentures not retained by implants--a multicentre randomized clinical trial.

OBJECTIVES: The aim of this study was to establish the treatment outcome of full denture treatment with or without implant support, in which the outcome assessment focuses on the patient's subjective evaluation ('denture-satisfaction'). DESIGN: A multicenter randomized clinical trial. SUBJECTS: Thirty-two men and 118 women (mean age 56 +/- 9, range 35-84 years) participated in the study. The mean height of the mandible was 13 +/- 2 mm, measured on a lateral cephalometric radiograph. The patients were randomly assigned to either a group treated with implant-retained mandibular overdentures and a new maxillary denture, or to a control group treated with a new set of complete dentures. MAIN OUTCOME MEASURES: Denture satisfaction was assessed using questionnaires focusing on denture-related complaints and 'a general satisfaction rate'. RESULTS: Based on the baseline data, from the 'denture complaints' questionnaire six interpretable factors could be extracted. One factor did not vary following treatment and was excluded from the outcome analysis. At the 1-year evaluation three out of five factors showed significantly better scores for the group treated with implants than for the control-group. The same was found for the general satisfaction rate. CONCLUSION: For patients with a severely resorbed mandible, overdentures retained by dental implants appear to provide a more satisfactory solution to their denture-related problems.

Adult↗

Mandibular bone resorption in patients treated with tissue-integrated prostheses and in complete-denture wearers.

Mandibular bone resorption was studied in patients treated with tissue-integrated prostheses (TIP) and in complete-denture wearers by distance and area measurements on cephalometric radiographs. The area measurements were performed by means of a computer. Two TIP groups with short and long periods (mean = 2.4 and 23.9 years) of edentulousness and wearing complete dentures before fixture installation were followed up over 7-8 years. Mandibular bone resorption was remarkably small behind the distally positioned fixtures in comparison with the corresponding region in complete-denture wearers. Patients with complete dentures showed a continuous resorption of the mandibular alveolar ridge over 21 years, even though there were great individual variations. The bone loss was most pronounced anteriorly and during the first 2 years after extraction of the residual teeth. It is concluded that treatment with tissue-integrated prostheses seems to reduce bone resorption in the mandible, probably owing to favorable load conditions and adequate stimulation of the bone.

Bone Resorption↗