A randomised trial of a simplified method for complete denture fabrication: patient perception and quality

Complete denture fabrication involves a series of complex technical procedures. Nevertheless, simplified methods may be as effective as conventional ones albeit the lesser use of time and resources, without disadvantage for the patient. This study compared a simplified method for complete denture fabrication to a conventional protocol in terms of oral health‐related quality of life (OHRQoL), patient satisfaction and denture quality. Forty‐two edentulous patients requesting treatment with complete dentures were randomly allocated into two study groups. Group S received dentures fabricated by a simplified method and Group C received conventionally fabricated dentures. Before interventions and after three and 6 months following insertion, OHRQoL and patient satisfaction were analysed by specific instruments. A prosthodontist assessed denture quality 3 months after delivery. Groups presented no difference for OHRQoL, denture quality and general satisfaction. Differences regarding patient satisfaction with some aspects of the dentures were found after 3 months (S > C), but were insignificant at 6 months. It was concluded that the simplified method is able to produce dentures of a quality comparable to those produced by the conventional method, influencing OHRQoL and patient satisfaction similarly.     

Part‐Digitizing System of Impression and Interocclusal Record for Complete Denture Fabrication

Few studies have reported the application of digital technology to removable dentures, particularly for the process of impression and interocclusal recording for complete denture fabrication. This article describes a part‐digitizing system of impression and interocclusal records for complete denture fabrication. The denture foundation area in an edentulous mouth, including the border areas and residual ridge, is outlined by tracing the surfaces with a 3‐D pen‐type digitizer. Specialized trays for final impressions and interocclusal records were generated using computer‐aided design and manufactured using the digital data. Final impression and interocclusal records were carried out using these specialized trays. The computer‐aided method using preliminary digital impressions and specialized trays would be feasible for clinical use for complete denture fabrication.     

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目的比较硅橡胶闭口式印模法和开口式印模法在无牙颌义齿修复中的临床疗效。方法收集2008年3月至2011年9月福建医科大学附属第一医院口腔科收治的无牙颌修复患者30例,按初诊时间顺序随机分为闭口式印模组和对照组,分别使用闭口式和开口式印模法制作全口义齿,3个月后复查其吸附力和压痛修改情况。结果用闭口式印模法制作的全口义齿,吸附力好于开口式印模法,其压痛修改次数也明显减少。结论对于无牙颌全口义齿的制作,硅橡胶闭口式印模法优于开口式印模法。     

What is the evidence base for the efficacies of different complete denture impression procedures? A critical review

ObjectivesMany procedures used in prosthodontics, including the materials and methods used for complete denture impressions, lack support of good evidence. The aims were to systematically, and critically, review the literature on complete denture impression materials and methods to identify an impression procedure that can be considered expedient for achieving a satisfactory clinical outcome for complete denture wearers.Data and sourcesMEDLINE/PubMed and the Cochrane Library were searched for studies on impression procedures used in the clinical fabrication of complete dentures. The search focused on best available evidence with respect to clinical outcome.Study selectionPubMed listed 1201 titles for the combination terms of complete denture and impression. Five relevant randomized controlled trials were identified. No review of complete denture impressions was found in the Cochrane Library.ResultsTwo-step procedures for complete denture impressions dominate all textbooks, teaching and specialist practice, despite an absence of convincing evidence of its superiority. No controlled studies supporting the use of border moulding, post-dam, and functional and mucostatic impressions, were identified. Two studies showed that a one-step method using alginate in a stock tray offers a similar clinical result to more complicated, expensive and time-consuming two-step material and technique combinations.ConclusionsThere was no support for the frequent textbook statement that the two-step procedure is necessary and superior to the one-step method. While some special clinical situations may benefit from other combinations of materials and techniques, the results suggest that the simple and inexpensive one-step procedure can serve the needs of the majority of edentulous patients.Clinical significanceIn spite of the fact that two-step procedures for complete denture impressions dominate textbooks, teaching and specialist practice, the results of this review suggest that a simple and inexpensive one-step procedure can serve the needs of the majority of edentulous patients.     

Fabrication of complete dentures in three visits using existing prosthesis—a simplified technique for geriatric patients

Complete edentulism often limits patients’ ability to masticate and perform other oral functions, resulting in a reduction of oral‐health‐related quality of life. Although the two‐implant mandibular overdenture may be considered as a minimum standard of treatment of complete edentulism, patients often prefer conventional complete dentures due to cost and surgical procedures related to implant supported dentures. Many complete denture patients may have limited access to dental care due to socioeconomic or health issues, hence there is a need in simplification of complete denture fabrication. Researchers have proposed “simplified” techniques to fabricate complete dentures by eliminating two stage impression procedures facebow transfer, and articulator programming, with impressive initial results. However, long‐term clinical data of these techniques is unavailable. A novel technique for fabricating simplified complete dentures in three visits, using patient's existing dentures is presented here. Unlike previously described techniques on “simplified” dentures, this technique does not eliminate vital steps such as border‐molded impressions, facebow transfer, verification of centric relations during try‐in, programming of the articulator, and balancing procedures.     

精细印模法增强下颌全口义齿吸附作用的临床调查

目的:调查精细印模法增强下颌全口义齿吸附作用的临床效果.方法:对30名无牙颌下颌牙槽嵴条件较差患者用精细印模法和传统印模法取印模,并制作完成全口义齿.义齿戴入3个月后对下颌全口义齿固位功能、黏膜情况,舒适性、咀嚼功能、食物嵌塞等内容进行临床调查.结果:两种印模法完成的下颌全口义齿在舒适程度、黏膜情况、食物嵌塞方面无显著...     

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

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

具有组织终止带的下颌无牙颌印模技术初探

目的 初步确定并验证一种适用于下颌四类无牙颌的印模技术。方法 对20名四类无牙颌志愿者分别使用常规印模技术和具有组织终止带的印模技术取下颌印模,对比其将松软组织推开的能力以及相应暂基托的舒适度,随机选用其中一个模型完成总义齿制作,检查并记录总义齿初戴时的组织密合度及患者的复诊次数。结果 采用配对t检验显示：两组推开松软组织的能力间差异有统计学意义,舒适度评价差异无统计学意义;采用独立样本t检验显示：两组总义齿组织密合度间差异无统计学意义,复诊次数间差异有统计学意义。结论 具有组织终止带的下颌印模技术可以有效地推开松软组织,虽不能提高初戴的舒适性和基托的组织密合度,但是却有效地减少了患者的复诊次数。     

A Systematic Review of Impression Technique for Conventional Complete Denture

The importance of an in depth review of impression making for complete dentures lies in the assessment of the historical value of all the factors related to physical, biologic and behavioral areas and the time in which they were discussed and taught as well. This review documents the historical development of knowledge associated with scientific advancement from 1845 to the present year, i.e. 2009 related to impression procedures in conventional complete denture prosthesis. Search for articles was done through electronic media the Pubmed.     

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.     

Treatment of Edentulism: Optimizing Outcomes with Tissue Management and Impression Techniques

Significant numbers of patients throughout the world seek treatment for edentulism. The trend toward tissue-integrated prostheses has been a monumental step in restoring edentulous patients to function; however, this treatment can be out of reach for those who fail to qualify or those who do not have sufficient resources to afford it. In these cases, conventional dentures remain an important primary course of treatment. Attention to detail when diagnosing, treatment planning, and performing treatment for these patients is still a prime consideration for the best possible outcome. In particular, many experienced denture wearers are afflicted with chronically inflamed denture-bearing mucosa. Clinicians must recognize the need for tissue conditioning, choices of impression materials, and accepted fabrication techniques that can have favorable outcomes when matched with patients who are philosophical and realistic in their expectations. The purpose of this article is to review impression philosophies, associated materials, and methods of tissue conditioning. Retention and stability of the denture bases can be augmented by the routine use of denture adhesive, and indications for use of denture adhesive will be discussed.     

Functional impression and jaw registration: a single session procedure for the construction of complete dentures

The conventional fabrication of complete dentures involves two separate clinical sessions for functional impression making and jaw registration. The presented method combines both procedures in one session. The aim of this study was to survey the three-dimensional tooth positions in complete dentures with reference to the ridges to establish arbitrary guideline values that could be used for the manufacturing of tooth-position analogue plastic rims on functional impression trays. New complete dentures were fabricated by supervised undergraduate students in the conventional manner for 104 edentulous patients. The position of the maxillary teeth was surveyed in the horizontal plane using the Schmuth 'vizor-measuring plate'. The vertical dimension of occlusion, represented as the distance between opposing ridge areas of the dentures in maximum intercuspation, was measured at different sites by means of a Gutowski gauge. The tooth positions on the dentures varied widely, e.g. the horizontal distances between the incisive papilla and the maxillary incisors was 7.1 +/- 2.3 (3-14) mm. The vertical dimension of occlusion, which is most important in the jaw registration, varied equally with an anterior inter-alveolar distance between 12 and 33 (20.4 +/- 4.0) mm. Arbitrary moulding of the tooth position-analogue plastic rims does not seems to be an ideal method of pre-shaping functional impression trays, because the individual anatomical variation is considerable. Alternatively, the horizontal and vertical tooth positions of functionally and aesthetically pleasing dentures should be measured to pre-shape the rims of functional impression trays in the maxillary and the mandibular jaw. Such trays are a valuable tool for functional impressions and an immediate preliminary jaw registration in the fabrication of new complete dentures. This method allows a first try-in of the full set-up in the third clinical visit without loosing precision.     

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目的 评价末端游离缺失患者使用不同印模材制取功能性印模过程中以及义齿修复后的临床疗效.方法 选择2011年2-9月在山西医科大学口腔医院修复科就诊的末端游离缺失患者40例,随机分为A组和B组(各20例),分别使用印模膏加藻酸盐印模材和硅橡胶(重体加轻体)制取印模,常规方法制作义齿,比较制取印模过程中以及义齿戴用3个月后患者的满意度.结果 制取印模过程中,患者对硅橡胶印模材的满意度高于印模膏加藻酸盐印模材(P＜0.05);义齿戴用3个月后,患者对印模膏加藻酸盐印模材组的满意度较硅橡胶印模材组高,差异均有统计学意义(P＜0.05).结论 可摘局部义齿修复末端游离缺失时,使用印模膏加藻酸盐印模材制取功能性印模其义齿修复效果好,但制取印模过程中患者感觉用硅橡胶印模材较舒适.由此可见,不同的印模材具有各自的优越性,要根据临床需要进行选择.     

Management of Compromised Ridges: A Case Report

Complete denture therapy is an age old form of dental treatment. Ridge atrophy poses a clinical challenge towards the fabrication of a successful prosthesis. Extreme resorption of the maxillary and mandibular denture bearing areas results in sunken appearance of cheeks, unstable and non retentive dentures with associated pain and discomfort. This article describes the step by step rehabilitation procedure of a patient with atrophic ridges using a hollow maxillary complete denture with cheek plumpers attached to it and the recording of neutral zone to ensure a stable mandibular denture.     

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??Objective    To compare the clinical effect of modified silicone rubber impression technology with that of traditional alginate impression technology in complete denture. Methods    Twenty-three complete dentures by modified silicone impression technology and twenty-three complete dentures by traditional alginate impression technology were separately made. Sore spots were measured in situ respectively. Results    The number of sore spots in modified silicone impression technology dentures were less than those in traditional ones. Conclusion    Modified silicone impression technology can improve comfort of complete denture.     

全口义齿修复中改良硅橡胶印模法临床应用研究

目的    比较应用改良硅橡胶印模法与传统藻酸盐印模法制作全口义齿的临床效果。方法    选择2010年7月至2015年7月就诊于福建医科大学附属泉州第一医院口腔科要求制作全口义齿修复患者46例,随机分为2组,分别采用改良硅橡胶印模法和传统藻酸盐印模法制作全口义齿,于试戴1周后记录压痛点数量,比较其舒适度。结果    改良硅橡胶印模法制作的全口义齿压痛点数量较少（P < 0.05）。结论    改良硅橡胶印模法可增加全口义齿的舒适度。     

Bilateral balanced occlusion compared to other occlusal schemes in complete dentures: A systematic review

No consensus has been reached regarding the best occlusal scheme for making complete dentures. Thus, the purpose of this systematic review was to compare bilateral balanced occlusion (BBO ) with other occlusal schemes (canine guidance, lingualised occlusion and zero degree) in complete dentures. The schemes were compared in terms of quality of life/satisfaction and masticatory performance. Two independent reviewers performed a comprehensive search of studies published in or before October 2017 using the PubMed/MEDLINE , Scopus and Cochrane Library databases. The search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA ) statement. The focused question was: “In conventional complete denture, is BBO better than lingualised occlusion, canine guidance and zero degree in terms of quality of life, patient satisfaction and masticatory performance/muscle activity?” Seventeen studies were selected for analysis. In total, there were 492 patients with a mean age of 64.78 years and a mean follow‐up duration of 2.96 months (range: 1‐6 months). All studies compared BBO with the other occlusal schemes. Eleven studies evaluated the influence of the occlusal scheme designs on quality of life and satisfaction, and 8 studies evaluated masticatory performance and muscle activity between BBO and the other occlusion schemes. The present systematic review indicated that BBO does not confer better quality of life/satisfaction or masticatory performance and muscle activity. Thus, lingualised occlusion can be considered a predictable occlusal scheme for complete dentures in terms of quality of life/satisfaction and masticatory performance, while canine guidance can be used to reduce muscular activity.     

全口义齿印模技术的进展介绍

采取印模是制作全口义齿的第一步,是成功修复全口义齿的关键。准确的全口印模要精确地反映无牙颌患者剩余牙槽嵴的解剖形态和周围组织生理功能活动范围,以便使义齿基托与口腔黏膜高度密合,获得良好的边缘封闭,从而取得全口义齿良好的固位,并能在功能运动时保持稳定。越来越多的研究表明,传统的印模方法已不能满足临床要求。近年来各种改良式印模方法层出不穷,如：开窗托盘印模法、动态压力式印模法、后缘截断框架式托盘印模法及中性区技术等,这些方法在取组织面、磨光面或黏膜转折处的印模上各有优势或侧重。针对不同的患者,应根据其剩余牙槽嵴条件、全身情况或修复需求等情况而选择相应的印模方法。本文就无牙颌取模技术的不同侧重角度、技术要点、适应证等方面作一综述。     

Mandibular complete denture versus single‐implant overdenture: a systematic review of patient‐reported outcomes

The single‐implant mandibular overdenture (SIMO) has been proposed as an alternative for edentulous patients who are poorly adapted to their dentures due to low retention and stability of the conventional mandibular complete denture (CD). However, there is a lack of evidence regarding the effectiveness of SIMO, which can be measured by examining patient perception of treatment effects. The aim of this systematic review was to assess the comparative results of CD and SIMO treatments using patient‐reported outcome measures. A literature search was carried out in PubMed, Scopus and Cochrane Central databases. The search included studies published up to July 2017. The focus question was: ‘Do single‐implant mandibular overdentures improve patient‐reported outcomes compared to conventional complete dentures in edentulous patients?’ Eligible studies were randomised clinical trials (RCT) and prospective studies. After initial screening for eligibility and full‐text analysis, 11 studies were included for data extraction and quality assessment (five parallel‐group RCTs, two crossover RCTs and four prospective studies). All studies reported marked improvement in satisfaction with the dentures and quality of life measures after SIMO treatment, irrespective of variations in implant treatment protocols and retention systems. Methodological considerations revealed a lack of evidence from RCTs on the comparative effectiveness of the two treatment strategies. Hence, although available evidence suggests considerable improvement in patient‐reported outcomes following the insertion of a single implant to retain a mandibular denture, further well‐designed comparative studies between SIMO and CD are required to improve the level of evidence and to support the indication of SIMO treatment in routine practice.