Prevalence of temporomandibular disorder signs in patients with complete versus partial dentures

Objectives: To determine the prevalence of signs of a temporomandibular disorder (TMD) in completely edentulous patients wearing upper and lower complete dentures (CD) and to compare this to the prevalence of signs in partially edentulous patients wearing upper and lower clasp-retained acrylic removable partial dentures (RPD). Materials and methods: A questionnaire and a clinical examination were used to assess 200 patients. One hundred of these were complete denture wearers being treated for the provision of replacement CD. The other 100 patients were partially edentulous patients, who had RPD replacing upper and lower partially missing teeth and their supporting structures. Results: It was shown that there was a statistically significant difference between the two groups regarding the presence of temporomandibular signs. Partially edentulous patients wearing upper and lower RPD had a significantly higher prevalence of TMD signs than edentulous patients wearing CD (36% compared to 17%). They also exhibited significantly (P<0.04) more signs of joint tenderness (18%) on clinical examination compared to (5%) only in the CD-wearing patients. Tenderness upon palpation in the periauricular region was the most common site reported in both groups. Conclusions: The partially edentulous patients (wearing RPD) exhibited more TMD signs when compared with the CD-wearing patients. Significantly, more partially edentulous patients had joint tenderness (P<0.04) than did CD-wearing patients. The masseter muscle most commonly demonstrated muscle tenderness.     

Mastication and jaw motion of partially edentulous patients are affected by different implant‐based prostheses

The main goal of prosthetic treatment is to restore masticatory function. However, insufficient evidence supports the recommendation of one specific prosthetic intervention for partially edentulous patients. Function after the use of three different prostheses by the same partially edentulous subject. Mastication was assessed in 12 subjects (mean age 62·6 ± 7·8 years) after they had used removable partial dentures (RPDs), implant‐supported partial dentures (IRPDs) and implant‐fixed partial dentures (IFPDs). Masticatory ability (MA) was estimated by visual analogue scale questionnaire, while the mandibular chewing motion was evaluated by kinesiographic device, representing an objective measurement of masticatory function. Data were analysed by repeated‐measures anova followed by Tukey–Kramer (P < 0·05). MA improved after IRPD and IFPD use (P < 0·05). Opening, closing and total cycle time duration were reduced after both IRPD and IFPD use (P < 0·05), irrespectively the implant prosthesis type. IFPDs and IRPDs restore the masticatory function of partially edentulous patients better than RPDs.     

Veterans Administration Cooperative Dental Implant Study--comparisons between fixed partial dentures supported by blade-vent implants and removable partial dentures. Part IV: Comparisons of patient satisfaction between two treatment modalities.

This study compares treatment assessments made by two groups of patients with Kennedy class I or class II mandibular edentulous conditions, who received either a removable partial denture (RPD) (N = 115) or one or two fixed partial dentures (FPDs), each supported distally by a blade implant (N = 113). Two questionnaires were administered, one at 16 weeks after the implant or RPD insertion and at the 6-month interval and the other at 18, 36, and 60 months. Marked functional improvements were perceived by a large majority of patients in both groups after the insertion of prosthesis. At 6 months, a higher percent of patients with RPDs than those with FPDs found it easy to clean their RPDs and experienced chewing discomfort, restriction of food choices, feeling of insecurity with their RPDs, and difficulty with their pronunciation. The exclusion of assessments by 25 RPD patients, whose treatment was judged to be a failure functionally, made the mean differences between the two treatments statistically significant (p less than 0.05) only for ease of cleaning in favor of the RPD and fewer restrictions of food choices in favor of the FPD group. At 60 months, significant differences between the percents of patients with the most favorable responses occurred for perceptions of eating enjoyment, food particles seldom getting under the removable partial denture, and improvement in social life in favor of the FPD treatment and for the ease of cleaning the removable partial denture in favor of the RPD treatment. The results seem to support superiority of the FPD in terms of patient satisfaction, but not enough to favor this type of prosthesis over the RPD without consideration of other pertinent factors.     

Comparisons of tactile thresholds between implant-supported fixed partial dentures and removable partial dentures.

This study compared the tactile sensitivity of splinted abutment and denture teeth of 16 fixed partial dentures (FPD) supported by blade implants and 16 removable partial dentures (RPD) in patients with Kennedy Class I and Class II edentulous conditions. No significant differences were noted between the tactile thresholds of the natural abutment teeth and artificial teeth in the FPD and RPD groups. The splinted abutment teeth required 45.4 g, or 5.4 to 5.8 times higher occlusal loads than did those needed for the comparable nonsplinted teeth, to detect the stimulus. A further increase of 54% in thresholds with the FPD and over 100% with the placement of the RPD indicated the superiority of the RPD in terms of load distribution as a result of the cross-arch splinting and mucosal support. Moderate positive correlations (r = 0.37 to 0.46; P < .05) between tactile thresholds and masticatory performance were found, signifying that reduced tactile perception was not responsible for the incomplete restoration of the masticatory function with RPDs or FPDs but might be contributing to increased masticatory performance within both treatment groups.     

Maxillary Rehabilitation Using Fixed and Removable Partial Dentures with Attachments: A Clinical Report

Despite requiring dental crown preparation and possible root canal treatment, besides the difficulty of clinical and laboratory repairs, and financial burden, the association between fixed (FPD) and removable partial dentures (RPD) by means of attachments is an important alternative for oral rehabilitation, particularly when the use of dental implants and FPDs is limited or not indicated. Among the advantages of attachment‐retained RPDs are the improvements in esthetics and biomechanics, as well as correction of the buccal arrangement of anterior teeth in Kennedy Class III partially edentulous arches. This article describes the treatment sequence and technique for the use of attachments in therapy combining FPD/RPD.     

Veterans Administration Cooperative Dental Implant Study--comparisons between fixed partial dentures supported by blade-vent implants and removable partial dentures. Part III: Comparisons of masticatory scores between two treatment modalities

Five Veterans Administration Medical Centers participated in a study to determine the comparative influence of fixed partial dentures (FDPs) supported by endosteal blade implants and removable partial dentures (RPDs) on masticatory performance. The study design, methodology, and success rates have been described in Parts I and II. A total of 232 patients received comprehensive dental care, including RPDs for 118 patients and FPDs for 114. Three standardized masticatory tests were made with peanuts and carrots before treatment. These tests were repeated at 16 weeks following RPD or implant insertion and thereafter at 6, 18, 36, and 60 months. At entry, there were no significant differences in performance scores and chewing time and strokes taken to reach the swallowing threshold between the RPD and FPD groups (p greater than 0.05). After treatment completion, FPDs and RPDs significantly improved the masticatory ability of patients with Kennedy class I or class II edentulous conditions (p less than 0.001). The improvements in performance scores for both test foods were slightly better in the RPD group than in the FPD group, although none of the 30 mean differences was significant (p greater than 0.05). After the baseline period to 60 months, only slight changes in performance scores were observed for both groups. RPDs and FPDs were comparable in improving the chewing efficiency of patients with Kennedy class I and class II partially edentulous conditions.     

The Effect of Removable Partial Dentures on Alveolar Bone Resorption: A Retrospective Study with Cone‐Beam Computed Tomography

Purpose: The aim of this study was to compare vertical and horizontal mandibular alveolar bone resorption by measuring bone morphological variation in Kennedy Class II removable partial denture (RPD) wearers and non‐wearers using cone‐beam computed tomography (CBCT). Materials and Methods: In total, 124 sites in the CBCT scans of 62 (29 RPD non‐wearers, 33 RPD wearers) Kennedy Class II patients were analyzed retrospectively. Three‐dimensional representations of the mandible with superimposed cross‐sectional slices were developed with the CBCT scans to evaluate the mandibular alveolar height and width by measuring distances between the mandibular canal, mylohyoid ridge, alveolar crest, and lower border of the mandible in four regions (eight sites) of Kennedy Class II non‐wearers and wearers of RPDs. Results: Mandibular alveolar bone height and width were significantly lower in edentulous sites when compared with dentate sites in both Kennedy Class II non‐wearers and wearers of RPDs (p < 0.05). Additionally, mean vertical and horizontal mandibular bone resorption was significantly higher in RPD wearers than in non‐wearers (p < 0.05). Conclusions: Vertical and horizontal alveolar bone resorption was found to be higher in the RPD wearing patients when comparing the dentate and edentulous sites.     

Effect of complete and partial removable dentures on chewing movements

Partial or complete edentulism impairs mastication. However, it is unclear how the chewing cycle is affected by prosthetics. We evaluated the chewing movements of patients fitted with complete (CD) or removable partial denture (RPD). A total of 29 subjects were kinesiographically evaluated during chewing of peanuts and Optocal portions in a random sequence. The subjects were divided into two groups according to prosthesis type. Group RPD was composed of 14 partially edentulous patients using a lower distal extension RPD (mean age 61 ± 8 years), and group CD contained 15 completely edentulous patients using CD (mean age 65·9 ± 7·9 years) in both jaws. Opening, closing, occlusal and masticatory cycle times, movement angle (opening and closing), maximum velocity (opening and closing), total area and chewing cycle amplitudes were evaluated. The results were subjected to anova and Tukey's HSD test at a significance level of 5%. The RPD group exhibited shorter opening and closing phases and masticatory cycle time (P < 0·05). Maximum velocities were also higher in the RPD group, irrespective of the test material (P < 0·05). The area and amplitude of the chewing envelope was smaller in the CD group (P < 0·0001). The test material did not influence chewing cycles in any of the parameters evaluated (P > 0·05). RPD wearers use a faster chewing sequence with greater vertical and lateral jaw excursions compared with CD wearers.     

Veterans administration cooperative dental impant study—Comparisons between fixed partial dentures supported by blade-vent implants and removable partial dentures. Part II: Comparison of success rates and periodontal health between two treatment modalities

Five Veterans Administration centers have participated in a study to determine whether fixed partial dentures (FPDs) supported by blade implants offer an acceptable substitute for mandibular unilateral or bilateral distal-base extension removable partial dentures (RPDs). The study design and methodology have been described in Part I. A total of 232 patients received comprehensive dental care including RPDs for 118 patients and FPDs for 114. Prespecified criteria determined treatment failures. During the 60-month period, treatment failures occurred in 19 FPD patients and 30 RPD patients. Ten FPD failures occurred before and nine after the FPD insertion. Five RPD failures were caused by abutment tooth loss and 25 for not using the RPD while eating. Life table analysis showed 5-year success rates of 84.2% for the FPD and 74% for the RPD. The 17.9% higher FPD success rate in Kennedy class II patients was both statistically and clinically significant. Excluding the 10 early failures, the 5-year FPD success rate war 91.5%. Of the 170 attempted implants, 26 failed, including 12 before the FPD fabrication. Radiographic assessments by a panel of three judges showed no bone deterioration during baseline to 60 months in 29.6%, slight in 25.4%, moderate in 15.9>, marked in 27%, and severe deterioration in 2.1% of the implant posts.     

A Technique for Retrofitting a Metal Ceramic Crown to an Attachment‐Retained Removable Partial Denture: A Clinical Report

In dental applications, precision attachments have been used to retain removable partial dentures (RPDs) for several decades. Various types of extracoronal attachments are commonly used in combination with fixed partial dentures and RPDs to achieve retention and stability. Fracture of the framework, fracture of the roots or teeth, and irretrievable decrease of retention are common reasons for a failed attachment‐retained RPD. Another complication of metal ceramic crowns with precision attachment is decementation of the crowns. When fixed components of the attachment‐retained RPD fail, the traditional treatment approach requires remaking both the fixed and removable components of the attachment‐retained RPD. This technique describes retrofitting of a metal ceramic crown to a resilient attachment‐retained RPD.     

Veterans Administration Cooperative Dental Implant Study--comparisons between fixed partial dentures supported by blade-vent implants and removable partial dentures. Part II: Comparisons of success rates and periodontal health between two treatment modalities

Five Veterans Administration centers have participated in a study to determine whether fixed partial dentures (FPDs) supported by blade implants offer an acceptable substitute for mandibular unilateral or bilateral distal-base extension removable partial dentures (RPDs). The study design and methodology have been described in Part I. A total of 232 patients received comprehensive dental care including RPDs for 118 patients and FPDs for 114. Prespecified criteria determined treatment failures. During the 60-month period, treatment failures occurred in 19 FPD patients and 30 RPD patients. Ten FPD failures occurred before and nine after the FPD insertion. Five RPD failures were caused by abutment tooth loss and 25 for not using the RPD while eating. Life table analysis showed 5-year success rates of 84.2% for the FPD and 74% for the RPD. The 17.9% higher FPD success rate in Kennedy class II patients was both statistically and clinically significant. Excluding the 10 early failures, the 5-year FPD success rate was 91.5%. Of the 170 attempted implants, 26 failed, including 12 before the FPD fabrication. Radiographic assessments by a panel of three judges showed no bone deterioration during baseline to 60 months in 29.6%, slight in 25.4%, moderate in 15.9%, marked in 27%, and severe deterioration in 2.1% of the implant posts.     

Oral conditions and aptitude to receive implants in patients with removable partial denture: a cross-sectional study. Part II. Aptitude

summary The aim of this study was to evaluate the possibility of replacing removable partial denture (RPD) with fixed partial dentures on osseointegrated implants in a selective group of patients with partially edentulous lower jaws. Forty patients were evaluated to receive implants. Twenty-three patients showed a precarious oral hygiene, five patients refused the treatment (being satisfied with their RPD), six refused for economic reasons, three patients refused for fear and scepticism, one for long duration of therapy, and one was not treated because of a very marked atrophy of the alveolar crest. Finally, one patient was treated with implants. For these reasons, at the present time implants are not an appropriate treatment for introduction into large-scale public health programmes and RPD must still be considered a valid therapeutic procedure.     

A retrospective comparative ten-year study of cumulative survival rates of remaining teeth in large edentulism treated with implant-supported fixed partial dentures or removable partial dentures

PurposeThis study aimed to compare the survival rates of remaining teeth between implant-supported fixed dentures (IFDs) and removable partial dentures (RPDs) in patients with large edentulous cases. The second goal was to assess the risk factors for remaining tooth loss.Materials and methodsThe study subjects were selected among those who received prosthodontic treatment at Okayama University Dental Hospital for their edentulous space exceeding at least four continuous missing teeth. Twenty-one patients were included in the IFD group and 82 patients were included in the RPD group. Survival rates of remaining teeth were calculated in three subcategories: (1) whole remaining teeth, (2) adjacent teeth to intended edentulous space, and (3) opposing teeth to intended edentulous space.ResultsThe ten-year cumulative survival rate of the whole remaining teeth was significantly higher in the IFD group (40.0%) than in the RPD group (24.4%). On the other hand, there was no significant difference between two groups in the survival rate of teeth adjacent or opposing to intended edentulous space. A Cox proportional hazard analysis revealed that RPD restoration and gender (male) were the significant risk factors for remaining tooth loss (whole remaining teeth).ConclusionsThese results suggest that IFD treatment can reduce the incidence of remaining tooth loss in large edentulous cases.     

可摘局部义齿卡环疲劳性能测试方法及研究现状

牙列缺损是老年人的常见口腔疾病,会给患者的生活造成诸多不便,不仅影响患者的咀嚼、发音和口颌系统健康,也会对患者的心理健康和生活质量产生不同程度的负面影响.牙列缺损常见的修复方式有种植义齿、固定义齿和可摘局部义齿.目前,虽然选择种植义齿的患者日趋增多,然而仍有很多患者由于身体原因、经济原因等无法选择种植义齿修复.可摘局部...     

A structural equation model relating objective and subjective masticatory function and oral health‐related quality of life in patients with removable partial dentures

Summary The aim of this study was to investigate the relationships between objective masticatory function with respect to masticatory performance and food mixing ability, patients’ perception of chewing ability and oral health‐related quality of life (OHRQoL). Partially dentate patients with removable partial dentures (n = 131, mean age 67·1 year) participated in the study. Four tests were performed to evaluate objective and subjective masticatory function and OHRQoL. Masticatory performance and food mixing ability were assessed using peanuts or a two‐coloured wax cube as test items. Patients’ perception of chewing ability was rated using a food intake questionnaire. OHRQoL was measured using the Japanese version of the oral health impact profile. A structural equation model was constructed based on hypothesis in which objective masticatory function would be related to OHRQoL via perceived chewing ability as a mediator. Structural equation modelling analysis found a statistically significant medium effect of perceived chewing ability on OHRQoL and statistically significant medium or small effects of masticatory performance on perceived chewing ability and OHRQoL (P < 0·05); however, the effect of food mixing ability on perceived chewing ability or OHRQoL was not statistically significant (P > 0·05). A fit index indicated that the model fitted well to the data (Goodness‐of‐fit index = 0·99). These results suggest that perceived chewing ability is a critical factor for OHRQoL and that masticatory performance rather than food mixing ability is important for perceived chewing ability and OHRQoL in patients with removable partial dentures.     

CAD/CAM Constructed Poly(etheretherketone) (PEEK) Framework of Kennedy Class I Removable Partial Denture: A Clinical Report

The prevalence of partially edentulous adults that could be treated by removable partial dentures (RPDs) is estimated to be greater than 20% in some regions of the United States. Problems related to traditional materials for RPD construction have been documented. Advances in polymer‐based materials and digital fabrication strategies would allow increased biocompatibility, durability, and elasticity, as well as more esthetically pleasing and cost‐effective benefits. This article reports on poly(etheretherketone) RPD framework produced by digital and milling technology.     

Automatic,computer‐based speech assessment on edentulous patients with and without complete dentures – preliminary results

Summary Dental rehabilitation of edentulous patients with complete dentures includes not only aesthetics and mastication of food, but also speech quality. It was the aim of this study to introduce and validate a computer‐based speech recognition system (ASR) for automatic speech assessment in edentulous patients after dental rehabilitation with complete dentures. To examine the impact of dentures on speech production, the speech outcome of edentulous patients with and without complete dentures was compared. Twenty‐eight patients reading a standardized text were recorded twice – with and without their complete dentures in situ. A control group of 40 healthy subjects with natural dentition was recorded under the same conditions. Speech quality was evaluated by means of a polyphone‐based ASR according to the percentage of the word accuracy (WA). Speech acceptability assessment by expert listeners and the automatic rating of the WA by the ASR showed a high correlation (corr = 0·71). Word accuracy was significantly reduced in edentulous speakers (55·42 ± 13·1) compared to the control group’s WA (69·79 ± 10·6). On the other hand, wearing complete dentures significantly increased the WA of the edentulous patients (60·00 ± 15·6). Speech production quality is significantly reduced after complete loss of teeth. Reconstitution of speech production quality is an important part of dental rehabilitation and can be improved for edentulous patients by means of complete dentures. The ASR has proven to be a useful and easily applicable tool for automatic speech assessment in a standardized way.     

Treatment planning for replacing missing teeth in UK general dental practice: current trends

Summary The aim of this study was to examine the confidence, barriers and attitudes towards the replacement of missing teeth by general dental practitioners (GDPs). The perceived impact of the recently introduced National Health Service (NHS) contract on the provision of prosthodontic treatments was also considered. Pre‐piloted postal questionnaires were mailed to 500 GDPs in Wales. Open‐ and closed‐ended questions were utilised to establish confidence, adequacy of training and attitudes towards treatments for replacing missing teeth. Two hundred and seventeen completed questionnaires were received (response rate = 43·4%). Many respondents described themselves as ‘confident’ or ‘very confident’ in the provision of removable partial dentures (RPDs) (acrylic = 100%, metal based = 99·5%), cantilever resin‐bonded bridges (94·4%) and conventional bridgework (98·6%). GDPs were ‘not confident’ providing fixed‐fixed resin‐bonded bridges (21·1%) or implants (81·4%). Financial barriers were identified to the provision of prosthodontic treatments, including comments such as “the new [National Health Service] contract does limit the treatments available”. Privately funded patients were more likely to be offered a fixed bridge or implant replacement of a missing upper first molar, whereas non‐privately funded patients were more likely to be offered no treatment (P < 0·01). Most respondents reported confidence at providing more routine forms of prosthodontic care such as RPDs and bridges. It appears that funding arrangements may have an impact on treatments offered to replace missing teeth, particularly under the current NHS contract.     

Expectations and final evaluation of complete dentures by patients,dentist and dental technician

Summary There is a poor association between the dentist’s evaluation of denture quality and patients’ satisfaction with their dentures. Possible differences between dental professionals and patients’ expectations might help explain differences in outcome evaluations. This study compared scores given by a dentist, a dental technician and patients for their expectations before and their final evaluation after complete dentures treatment. Twenty completely edentulous patients, a prosthodontist and a dental technician provided scores for the expected aesthetic and functional results of their dentures based on a visual analogue scale at baseline. Post‐treatment completion ratings were given after adjustments, by dentist and patients. The dental technician provided post‐treatment completion ratings after completing the dentures. The patients had higher expectations than the dental technician and the dentist perceived for both aesthetic and function (P < 0·001). The patients also presented higher post‐treatment completion ratings than the dental professionals perceived for final aesthetics (P = 0·016, Kendall’s W = 0·207) and function (P = 0·002, Kendall’s W = 0·303). Only the dentist presented a statistically significant difference between expectations (lower) and final (higher) outcomes for aesthetics (P = 0·017) and function (P = 0·003). There was no correlation between expectations and post‐treatment completion ratings according to the patients’ age. There was also no correlation between the patients’ gender and expectation scores. Patients presented higher expectations regarding their dentures than dental professionals. The dentist believed that dentures would bring fewer benefits than patients did, but his perception of denture benefits post‐treatment was significantly higher than his expectations.     

Oral sugar clearance in elderly people with prosthodontic reconstructions.

The aim was to study oral sugar clearance in elderly individuals, around 70 yr of age, with various types of prosthodontic reconstructions. Salivary glucose concentration was measured under the tongue after chewing a glucose tablet in four groups of individuals with: 1) complete dentures (CD) (n = 19), 2) removable partial dentures (RPD) (n = 22), 3) fixed partial dentures (FPD) (n = 24), and 4) no dentures (controls) (n = 23). Salivary glucose clearance was also studied after a mouthrinse with 10% glucose in 18 of the 19 individuals with CD and in 13 of the 22 with RPD both with and without the dentures. Saliva samples for glucose analysis were taken, in this part of the experiment, at two separate locations: under the tongue and in the labial vestibule near the mandibular right first molar. After the tablet intake, the group with CD showed the highest initial salivary glucose concentration, the longest oral sugar clearance time and the largest area under the curve, followed by the group with RPD. FPD did not seem to influence the oral sugar clearance. After the glucose rinse, higher values for the various clearance variables were obtained in the vestibule than under the tongue and, to some extent, when the experiments were carried out with than without the dentures. Thus, the results from this study indicate that removable dentures, especially CD, contribute to less effective oral sugar clearance in elderly people and that the oral clearance seems to be more dependent on the site than on the presence or absence of removable dentures in the oral cavity.