A procedure for making a bruxism device in the office.

Microtrauma to the temporomandibular joint, the masticatory muscles, and the dentition can be significant in mandibular parafunctional activity such as nocturnal clenching and bruxing. Intraoral therapy can be useful in helping to reduce the deleterious effects of this activity. This article presents an in-office procedure for a device to reduce a delay in starting treatment and the time needed for adjustment of the device in the mouth.     

A Viable Treatment Alternative in Distal Extension Cases: A Case Report

Dentures requiring support from teeth, the mucosa and the underlying alveolar ridges are subjected to many forces that adversely effect the abutment teeth and the residual ridges during functional and parafunctional activity. A number of designs of the framework and the direct retainers were used to improve the comfort and acceptance of the patient wearing a removable partial denture. Attachment retained removable partial denture is one of the viable treatment alternative through which significant number of patients could be benefited. In this particular case of distal extension, attachment retained removable partial denture was chosen as a treatment modality. This article provides an overview and a simplified approach to this treatment through a case report and the criteria followed for selection of the particular attachments for treating the patient.

     

Muscle physiology during functional activities and parafunctional habits

Many of the signs and symptoms of muscle pathosis and fatigue are better treated when the underlying cellular and biochemical mechanisms of muscle function are appreciated. The basic structural and functional components of muscle tissue and the biochemical cellular activity of muscle contraction have been described. The muscle physiology of the functional activities of chewing and swallowing have been compared to the muscle physiology of the parafunctional habits of clenching and bruxing.     

The pre prosthetic management of the edentulous patient.

The problems to be solved are those largely caused by prolonged wearing of old, inadequate dentures where faulty occlusion, ill-fitting bases, poor denture hygiene, parafunctional habits combine to produce denture stomatitis and papillary hyperplasia. A programme is set out to deal with these problems and to adjust abnormal frenum and muscle attachment.     

Masticatory muscle activity assessment and reliability of a portable electromyographic instrument

STATEMENT OF PROBLEM: Masticatory muscle hyperactivity is thought to produce muscle pain and tension headaches and can cause excessive wear or breakage of restorative dental materials used in the treatment of prosthodontic patients. The quantification and identification of this type of activity is an important consideration in the preoperative diagnosis and treatment planning phase of prosthodontic care. PURPOSE: This study investigated the quantification process in complete denture/overdenture patients with natural mandibular tooth abutments and explored the reliability of instrumentation used to assess this parafunctional activity. MATERIAL AND METHODS: The nocturnal EMG activity in asymptomatic complete denture/overdenture subjects was assessed with and without prostheses worn during sleep. Because of the large variance within and between subjects, the investigators evaluated the reliability of the 3 instruments used to test nocturnal EMG activity in the sample. RESULTS: Electromyographic activity data of denture/overdenture subjects revealed no differences between prostheses worn versus not worn during sleep but demonstrated a very large variance factor. Further investigation of the instrumentation demonstrated a consistent in vitro as well as in vivo reliability in controlled laboratory studies. CONCLUSION: The portable EMG instrumentation used in this study revealed a large, uncontrollable variance factor within and between subjects that greatly complicated the diagnosis of parafunctional activity in prosthodontic patients.     

Effect of treatment with fixed and removable dental prostheses. An oral health-related quality of life study

The aim of the study was to evaluate patient-reported effects of treatment with fixed dental prostheses (FDP) and removable dental prostheses (RDP) and relate the change in Oral Health Related Quality of Life (OHRQoL) to the type of treatment and objective dental variables of aesthetics and mastication. Additionally, the purpose of the study was to identify aspects of impairment and improvement that the treatments caused. Fixed dental prostheses treatment was performed in 200 patients and RDP treatment in 107 patients. Gender, age, region of replacement, and number of teeth present and replaced were obtained. The participants completed the Oral Health Impact Profile 49 (OHIP-49) before and after treatment. A control group with no need for dental treatment also completed the OHIP-49. All participants had a significant improvement in OHRQoL. The improvement was higher for the RDP group than the FDP group. Removable dental prostheses that replaced only masticatory teeth did not improve the OHRQoL significantly. The improvement in OHRQoL for both the FDP and RDP groups was not at the level of the control group. Higher age was associated with lower improvement in OHRQoL. Higher age, being a woman and having teeth replaced in the aesthetic zone were associated with deterioration in OHRQoL. Both RDP treatment and FDP treatment were associated with a reduction in the problems most frequently reported before treatment. Treatment with RDP was associated with new problems caused by the RDP. Fixed dental prostheses and RDP treatments improved OHRQoL and reduced the number of problems. The RDP participants improved more than the FDP participants.     

Wear of resin denture teeth in partial removable dental prostheses

PurposeTo investigate occlusal wear of resin denture teeth in partial removable dental prostheses worn by partially edentulous patients.MethodsThirty patients with partial removable dental prostheses were included in the study. Thirty-two patients with complete dentures served as a reference group. Occlusal wear after two years was evaluated indirectly using gypsum casts and a three-dimensional laser-scanner device. Overall wear of complete occlusal surfaces and maximum wear of occlusal contact areas were measured. Patient and prosthesis data were analyzed using univariate and multiple linear mixed models.ResultsOverall wear of denture teeth in partial removable dental prostheses was 91 (SD 85) μm, and maximum wear of occlusal contact areas was 329 (SD 204) μm (means and standard deviations). Average and maximum wear values for teeth in complete dentures were both lower than those for teeth in partial removable dental prostheses. However, differences between wear of different types of denture did not reach statistical significance after adjustment for gender, type of tooth, dental status of the opposing jaw, and antagonist material. Statistical analysis revealed that wear was greater for denture teeth occluding with ceramic crowns and/or fixed partial dentures as antagonists.ConclusionsResin denture teeth in partial removable and complete dental prostheses are subjected to clinically important occlusal wear that might destabilize occlusion and cause further problems. Patient-related factors and dental status affect wear behavior and should be taken into consideration when treating patients with removable dentures.     

Effects of stabilization appliances on nocturnal parafunctional activities in patients with and without signs of temporomandibular disorders

This study was designed to investigate the short‐term effects of stabilization appliances on parafunctional oral motor behaviour (bruxing and clenching) during sleep in patients with and without signs of temporomandibular disorders (TMD). Results revealed that stabilization appliances do not stop nocturnal parafunctional activities in both groups of patients. Active wear facets on the guide ramps of appliances were created by bilateral mandibular excursions. The extension of these facets indicate that the mandible moves laterally far beyond the edge‐to‐edge contact relationship of the canines during eccentric bruxism. Results also indicate that, with the exception of temporomandibular joint (TMJ) clicks, stabilization appliance therapy is effective in eliminating the signs of TMD evaluated.     

Tensile bond strength of acrylic resin denture teeth to a microwave- or heat-processed denture base

STATEMENT OF PROBLEM: Fracture of acrylic resin prosthetic teeth from acrylic resin denture bases can be a problem for some patients. The optimal combination of acrylic resin denture tooth, denture base material, and processing method is not known. Purpose. The objective of this study was to compare the tensile bond strengths of heat- and microwave-polymerized acrylic resins among 4 types of acrylic resin denture teeth. MATERIAL AND METHODS: Heat-polymerized (Lucitone 199) and microwave-polymerized (Acron MC) acrylic resins were used. Four types of acrylic resin denture teeth (IPN, SLM, Vitapan, and SR-Orthotyp-PE) were milled to a fixed diameter according to ADA specification no. 15. Ten specimens of each tooth type were processed to each of the denture base materials according to the manufacturers' instructions. Ten additional resin control specimens without teeth also were fabricated. Specimens were thermocycled and tested for strength until fracture with a custom alignment device. Data were analyzed with analysis of variance and Duncan's multiple range test. A scanning electron microscope was used to identify adhesive and cohesive failures within debonded specimens. RESULTS: The mean force required to fracture the specimens ranged from 5.3 +/- 3.01 to 21.6 +/- 5.2 MPa for the microwave-polymerized base and 11.2 +/- 3.0 to 39.1 +/- 5.1 MPa for the heat-polymerized base. The most common failure was cohesive within the denture tooth. With each base material, Orthotyp and IPN teeth exhibited the highest bond strengths; SLM and Orthotyp bond strengths were similar. In general, heat-polymerized groups failed cohesively within the denture base resin or the tooth, and microwave-polymerized groups failed adhesively at either the ridge lap or occlusal surface of the denture tooth. CONCLUSION: Within the limitations of this study, the results suggest that the type of denture base material and denture tooth selected for use may influence the tensile bond strength of the tooth to the base. Selection of more compatible combinations of base and resin teeth may reduce the number of prosthesis fractures and resultant repairs.     

Nocturnal electromyographic evaluation of masseter muscle activity in the complete denture patient

Nocturnal oral activity was evaluated in 12 complete denture wearers by means of EMG measurements of the masseter muscle. Patients who had worn dentures for at least 6 months were selected. EMG levels were compared when subjects slept with and without the dentures in the mouth. Three subjects appeared to have reduced EMG values when sleeping with the dentures. However, no overall group trends or significant differences were obtained. High variability in nightly EMG values could not be explained by a post hoc analysis of patient oral symptoms or denture characteristics. Efforts should be directed at improved methodology to study the specific mechanism of the effect of denture wearing on nocturnal muscle activity levels. Additional knowledge is needed on the occurrence and effects of parafunctional habits in the edentulous patients.     

Ceramic flask technique for duplicating a complete denture

The possibilities for use of the duplicate denture are many. The duplicate denture serves as an excellent custom tray for the final working impression. If it is acceptable on the existing denture, the vertical dimension of the duplicate denture can be directly transferred to the articulator. If not acceptable, the vertical dimension can be altered and checked intraorally by adding or removing acrylic resin on the occlusal surface of the teeth. Alterations in esthetics, phonetics, and occlusion can easily be achieved and tested by replacing the original teeth of the duplicate denture with stock acrylic resin teeth. Alterations to the duplicate denture with subsequent patient approval prior to construction of a new prosthesis eliminates many problems associated with new dentures.     

Severe vertical overlap: a modified method of treatment

Severe vertical overlap may predispose the patient to abnormal function, improper mastication, excessive stress, and functional problems such as bruxing, clenching, and craniomandibular disorders. This report describes the establishment of a new occlusal relationship by using the potential of posterior tooth eruption with the Hawley bite plane or the canine platform method. It was used in patients with a full complement of teeth or with some missing teeth. Patients treated by either the Hawley bite plane or the canine platform demonstrate a stable and long-lasting new occlusal relationship. The method described is efficient, inexpensive, and convenient to the patient.     

Use of the occlusalgraph in patients with parafunctional habits.

Dental patients with parafunctional habits (clenching and grinding of the teeth) may pose unique treatment problems for the dentist. Several patients suffering from such muscle hyperactivity disorders were studied longitudinally by use of the occlusalgraph method to preserve the photocclusal data recorded by each patient. This report suggests that the use of the described technique provides a quick and simple method of visualizing the problem and long-term monitoring of the treatment.     

A useful solution to a space problem--a striking plate

The natural dentition can be of fundamental importance to the prognosis of a partial denture when the teeth are within the same arch as the prosthesis. However, when the natural teeth oppose the edentulous area, a number of problems can present. One such problem can be the decrease of space for standard denture components. Solutions to this problem may involve increasing the vertical dimension or reducing the crown height of the opposing natural dentition. Both of these methods have significant disadvantages and this article describes an alternative solution using a 'striking plate' constructed in cobalt chromium.     

Fabrication of an occlusal splint

Occlusal splints used in the treatment of bruxism or occlusal-incisal attrition are not often completely successful in effecting a complete cure. Even if complete remission of nocturnal bruxing is never attained, the hard, smooth polymethyl methacrylate occlusal splint does an admirable job of fulfilling its other functions. It eliminates further nocturnal occlusal abrasion by keeping the patient's teeth apart and by preventing most of the effects of bruxing. The best way of accomplishing this is with a smooth, nonyielding splint andnot with the athletic mouth-guard type of appliance, the very resilience of which is likely to stimulate bruxing and clenching.     

The effect of removable partial dentures on periodontal health of abutment and non-abutment teeth

BACKGROUND: A removable partial denture (RPD) is a common treatment available for restoration of partially edentulous ridges. Longitudinal studies indicate that RPDs have been associated with increased gingivitis, periodontitis, and abutment mobility. METHODS: A total of 205 patients with RPDs participated in this study. There were 80 males and 125 females aged 38 to 89, with 123 maxillary and 138 mandibular RPDs. Patients were wearing existing RPDs for different periods ranging from 1 to 10 years. A two-part questionnaire was devised for this study. In the first part, patients answered questions on gender; age; smoking habits; denture age; denture wearing habits; mouth odor; and problems with food accumulating under the denture base, on the outside surface of the denture, and on the outside surface of remaining teeth after eating. The Kennedy classification, material, denture support, denture base shape, and number of teeth in contact, number of existing clasps, and occlusal rests were categorized. The quality of denture construction was also evaluated. In the second part of the questionnaire, baseline recordings of plaque (PI), gingival (GI), and calculus (CI) indexes were made, and Tarbet index (TI), as well as probing depth (PD), gingival recession (GR), and tooth mobility (TM) were measured, both on abutment and non-abutment teeth. RESULTS: Significant differences (P <0.01) were noted for PI, Cl, GI, PD, TM, and GR between abutment and non-abutment teeth, with abutment teeth showing more disease. CONCLUSIONS: RPD design plays an important role in the state of the periodontium. Appropriate design and good oral hygiene may decrease the appearance of periodontal disease.     

The Use of Light–Cured Acrylic Resin to Bond and Seal Castings Into Denture Teeth

In order to satisfy their personal perception of esthetics, some patients request that gold castings be incorporated into their denture teeth. The use of light-cured acrylic resin to bond and seal gold castings into denture teeth overcomes many of the problems traditionally associated with cementing castings to denture teeth or processing tooth-colored acrylic resin around castings.     

Influences on clinical wear of acrylic denture teeth: a pilot study

This study aimed to evaluate the effect of gender, antagonistic teeth, and type of denture on clinical wear of denture teeth. Wear measurements were made on gypsum replicas of 204 posterior denture teeth after 6 months using an optical 3-dimensional profilometer. Data were analyzed using univariate and mixed regression procedures. The mean wear of all denture teeth was -20.5 microm (+/- 14.6). Males demonstrated significantly higher wear than females. Interactions of the variables "gender" and "type of denture" and "antagonist material" and "type of denture" also showed significant influences on wear. The results indicate that some clinical parameters may affect wear of denture teeth.     

Prosthetic epidemiology

The need for an epidemiological method which focuses upon the problems of missing teeth, tooth spaces and prosthetic treatment is emphasized. From the prosthetic viewpoint the distinction between missing teeth and tooth spaces must be made and examples are given to show that up to 20 per cent of missing teeth do not give rise to tooth space. The presentation of the prosthetic parameters per tooth is recommended using the six alternatives: tooth present; tooth missing (open space); tooth missing (closed space); tooth replaced by pontic in fixed bridge, by removable partial denture, or by complete denture. In the presentation of the mean number of existing teeth, fixed bridge pontics should be included as they serve as natural teeth both aesthetically and functionally. Data on removable dentures, or edentulism without denture wearing, should be presented in such a way that comparisons at jaw level as well as at person level can be made. A system for this is described. The method may be used in industrialized countries where there is much prosthetic treatment as well as in developing countries with few health services. Comparisons will still be meaningful.     

An observational cohort study on shortened dental arches—clinical course during a period of 27–35 years

Objectives

The objective of this study was to investigate the clinical course of shortened dental arches (‘SDA group’) compared to SDAs plus removable denture prosthesis (‘SDA plus RDP group’) and complete dental arches (‘CDA group’, controls).

Materials and methods

Data (numbers of direct and indirect restorations, endodontic treatments, tooth loss and tooth replacements) were extracted from patient records of subjects attending the Nijmegen Dental School who previously participated in a cohort study on shortened dental arches with three to four posterior occluding pairs (POPs).

Results

Records of 35 % of the original cohort were retrievable. At the end of the follow-up (27.4?±?7.1 years), 20 out of 23 SDA subjects still had SDA with 3–4 POPs compared to 6 out of 13 for SDA plus RDP subjects (follow-up 32.6?±?7.3 years). Sixteen out of 23 CDA subjects still had CDA; none of them lost more than one POP (follow-up 35.0?±?5.6 years). SDA group lost 67 teeth: 16 were not replaced, 16 were replaced by FDP and 35 teeth (lost in three subjects) replaced by RDP. Mean number of treatments per year in SDA subjects differed not significantly compared to CDA subjects except for indirect restorations in the upper jaw.

Conclusion

Shortened dental arches can last for 27 years and over. Clinical course in SDA plus RDP is unfavourable, especially when RDP-related interventions are taken into account.

Clinical relevance

The shortened dental arch concept seems to be a relevant approach from a cost-effective point of view. Replacement of absent posterior teeth by free-end RDP cannot be recommended.