A clinical investigation of the relationship between the quality of conventional complete dentures and the patients’ quality of life

Objective

The purpose of this study was to determine whether there is a correlation between the clinical quality of conventional complete dentures and patient quality of life.

Materials and methods

This study included a random sample of 32 completely edentulous patients (15 males and 17 females) who were treated with conventional complete dentures. Using a validated questionnaire, three investigators evaluated the dentures independently on the basis of seven clinical parameters: esthetics (lip support and lower lip line), retention and stability of the maxillary and the mandibular dentures, and occlusion. Patients completed the validated Oral Health Impact Profile-20 (OHIP-20) questionnaire. Correlations were determined by using the point-biserial correlation coefficient.

Results

Clinicians rated the overall clinical quality of the dentures satisfactory in 80.3% of patients. The mean (±standard deviation) total OHIP-20 score was 56.3 ± 15.9 out of a possible 120 maximum. A statistically significant negative correlation was found between the stability of the maxillary and mandibular dentures and the total OHIP-20 score (p = 0.009 and 0.0023, respectively). A negative correlation between the total OHIP-20 score and the retention of the mandibular denture approached significance (p = 0.092). Esthetics, retention of the maxillary denture, and occlusion were not correlated with patient quality of life (p > 0.169).

Conclusion

Stability of the maxillary and mandibular dentures is the denture quality parameter that can most significantly affect patient quality of life.     

Effect of three investing materials on tooth movement during flasking procedure for complete denture construction

Problem statement

Tooth movement has been shown to occur during and after the processing of complete dentures. An understanding of this phenomenon may permit one to construct functional complete dentures that require less occlusal adjustment in the articulator and in the patient’s mouth.

Purpose

The purpose of this study was to examine the effects of three different investing methods on tooth movement occurring during the processing of simulated maxillary complete dentures.

Material and methods

Forty-five similar maxillary dentures were made using heat-polymerized acrylic resin, and assigned randomly to three experimental groups (n = 15 each) according to investing method: plaster–plaster–plaster (P–P–P), plaster–stone–stone (P-S-S), and plaster–mix (P–M). Specimens in all experimental groups were compression molded with denture base resin. Transverse interincisor (I–I) and intermolar (M–M) distances, and anteroposterior incisor–molar (LI–LM and RI–RM) distances, were measured with digital calipers at the wax denture stage (pre-polymerization) and after denture decasting (post-polymerization). Analysis of variance and Tukey’s test were used to compare the results.

Results

M–M, LI–LM, and RI–RM movement was significantly greater in the P–P–P group than in the P–S–S and P–M groups; no significant difference in I–I movement was observed among groups. Transverse movement along M–M and I–I was significantly greater than anteroposterior movement in the P–P–P group; no significant difference among measurements was observed in the other two groups.

Conclusion

The study results indicate that the use of dental stone or a 50:50 mixture of plaster and stone for investing of dentures is an important factor in efforts to control the magnitude of tooth movement.     

The effectiveness of chemical denture cleansers and ultrasonic device in biofilm removal from complete dentures

Adequate denture hygiene can prevent and treat infection in edentulous patients. They are usually elderly and have difficulty for brushing their teeth.

Objective

This study evaluated the efficacy of complete denture biofilm removal using chemical (alkaline peroxide-effervescent tablets), mechanical (ultrasonic) and combined (association of the effervescent and ultrasonic) methods.

Material and Methods

Eighty complete denture wearers participated in the experiment for 21 days. They were distributed into 4 groups (n=20): (1) Brushing with water (Control); (2) Effervescent tablets (Corega Tabs); (3) Ultrasonic device (Ultrasonic Cleaner, model 2840 D); (4) Association of effervescent tablets and ultrasonic device. All groups brushed their dentures with a specific brush (Bitufo) and water, 3 times a day, before applying their treatments. Denture biofilm was collected at baseline and after 21 days. To quantify the biofilm, the internal surfaces of the maxillary complete dentures were stained and photographed at 45º. The photographs were processed and the areas (total internal surface stained with biofilm) quantified (Image Tool 2.02). The percentage of the biofilm was calculated by the ratio between the biofilm area multiplied by 100 and the total area of the internal surface of the maxillary complete denture.

Results

The Kruskal-Wallis test was used for comparison among groups followed by the Dunn multiple-comparison test. All tests were performed respecting a significance level of 0.05. Significant difference was found among the treatments (KW=21.18; P<0.001), the mean ranks for the treatments and results for Dunn multiple comparison test were: Control (60.9); Chemical (37.2); Mechanical (35.2) and Combined (29.1).

Conclusion

The experimental methods were equally effective regarding the ability to remove biofilm and were superior to the control method (brushing with water). Immersion in alkaline peroxide and ultrasonic vibration can be used as auxiliary agents for cleaning complete dentures.     

Assessment of swallowing and masticatory performance in obturator wearers: a clinical study

PURPOSE

To assess function by identifying changes in swallowing and masticatory performance in maxillary obturator prosthesis wearers.

MATERIALS AND METHODS

Sixty subjects were recruited for the study, of which 20 were obturator wearers, 20 were completely dentulous and 20 had removable partial/complete dentures with similar Eichner''s Index. Swallowing ability was evaluated with and without obturator using the "Water Drinking Test"; Masticatory performance was evaluated with the Sieve test; and maximum occlusal force was recorded with the help of a digital bite sensor. The data was analyzed using the Statistical Package for Social Science version 15.0 with a confidence level at 95%.

RESULTS

Profile, behavior of drinking and time taken to drink were significantly improved (P<.001) in subjects after wearing obturator. Masticatory performance was not significantly different (P=.252) in obturator wearer when compared with dentulous or removable partial/complete denture wearer, but significantly (P<.001) high inter group difference in maximum occlusal force existed. Correlation between masticatory performance and maximum occlusal force was not significant (P=.124).

CONCLUSION

Swallowing ability was significantly improved after wearing obturator but masticatory performance was not significantly different from those having similar occlusal support zone in their dentition.     

In vivo efficacy of alkaline peroxide tablets and mouthwashes on Candida albicans in patients with denture stomatitis

Objective

Effective cleaning of dentures is important for the maintenance of good oral hygiene for denture stomatitis patients. The in vivo efficacy of three different brands of alkaline peroxide tablets (Polident, Efferdent, and Fittydent) and two mouthwashes (CloSYS II and Corsodyl) to eliminate Candida albicans on dentures was evaluated in this in vivo study.

Material and methods

Ninety denture wearers with clinical evidence of denture stomatitis were randomly divided into 5 test groups and 1 control group. Each group was further divided into three subgroups in which the dentures were subjected to 15-, 30-, and 60-min disinfection procedures. The dentures of each test group were treated with one of the cleaners, while those of the control group were treated with distilled water. Swab samples from the palatal surfaces (2 cm x 2 cm template delimited area) of the upper dentures were obtained before and after 15, 30, and 60 min periods of cleaner use and examined mycologically.

Results

The reduction in the number of colony-forming units (CFU) of C. albicans before, and after 15, 30, and 60 min of use of CloSYS II and Corsodyl was significantly greater than that of the control group (p<0.05). Moreover, there was no statistically significant difference (p>0.05) among Polident, Efferdent and the control group in any of the treatment periods. Dentures treated with Fittydent appeared to have a significantly greater reduction in the number of Candida spp. only after 60 min of treatment.

Conclusions

The results of this study showed that the use of mouthwashes significantly reduced the number of microorganisms on dentures.     

Usage of removable partial dentures in Saudi male patients after 1 year telephone interview

Objective

The success of removable partial dentures (RPDs) is partly dependent on patients’ acceptance and compliance in using them. The purpose of this study was to describe the usage of removable partial dentures (RPDs) by patients 1 year after insertion and to evaluate the factors that influence their denture usage.

Methods

Forty-seven patients who received 75 new RPDs at the undergraduate clinic of College of Dentistry, King Saud University, were contacted by telephone 1 year later for an interview. The questions covered denture usage, patient’s satisfaction and reasons for non-use.

Results

Results showed that 36% of patients discarded or occasionally used their RPDs. There was no significant association between denture usage and RPD experience, location or Kennedy classification. A significantly more RPD rejection was found when it was opposed by natural teeth or complete denture. The most quoted reason for RPD rejection was pain and discomfort.

Conclusion

Despite the short follow-up period, RPDs were poorly accepted by patients treated by undergraduate students.     

Complication rates and patient satisfaction with removable dentures

PURPOSE

The purpose of this clinical study was to evaluate the frequency and type of prosthetic complications in relation to type and properties of removable dentures and to investigate the influence of these complications and several data about the existing dentures on patient satisfaction.

MATERIALS AND METHODS

Ninety nine patients (44 males and 55 females) wearing removable dentures have been included in the study. The complications of the patients were recorded; patient satisfaction was determined with a Visual Analog Scale (VAS) and the relationship of complications and patient satisfaction with several data about the dentures such as denture age, type of denture, centric relation and vertical dimension was investigated. Kruskal Wallis, Mann Whitney U and Chi square tests were used for statistical analyses. The results were evaluated statistically at a significance level of P<.05.

RESULTS

Need for addition of artificial teeth for dentures with correct centric relations was found to be significantly lower than dentures with wrong centric relations (P<.01). Loss of retention, ulcerations and high vertical dimension affected the VAS chewing ability scores negatively and ulcerations affected the VAS phonation scores negatively (P<.05).

CONCLUSION

Considering the results of this study, it can be concluded that loss of retention, ulcerations and high vertical dimension caused patient dissatisfaction. Additionally, dentures with wrong centric relations caused need for addition of artificial teeth.     

Inhibition of denture plaque deposition on complete dentures by 2-methacryloyloxyethyl phosphorylcholine polymer coating: A clinical study

Statement of problem

Denture plaque-associated infections are regarded as a source of serious dental and medical complications in the elderly population. Methods of managing this problem are needed.

Elastic modulus and flexural strength comparisons of high-impact and traditional denture base acrylic resins

Background

Fractures of acrylic resin dentures are a common occurrence in clinical dentistry. The denture may be fractured accidentally when dropped or while in service in the mouth due to flexural fatigue.

Objectives

The aim of this study was to compare the elastic modulus and the flexural strength between two heat-cured acrylic resins used in denture bases: a high-impact resin (Lucitone 199) and a traditional resin (Rodex).

Materials and methods

Rectangular strips of Lucitone 199 and Rodex (10 samples each) were fabricated and stored in artificial saliva at 37 °C for 2 weeks. The specimens were subjected to a three-point flexural test. The data were statistically analysed with Student’s t-test (p ⩽ .05).

Results

The high-impact acrylic resin had a lower elastic modulus (p = .000) and higher flexural strength (p = .001) compared to the traditional acrylic resin.

Conclusion

Within the limitations of this study, it can be concluded that the high-impact acrylic resin is a suitable denture base material for patients with clinical fracture of the acrylic denture.     

Relationship between retention forces and stress at the distal border in maxillary complete dentures: Measurement of retention forces and finite-element analysis in individual participants

Statement of problem

Although the retention force of maxillary complete dentures has been measured in numerous studies with different devices, the biomechanical mechanism associated with the generation of this retention force cannot be determined.

Clinical and antimicrobial efficacy of NitrAdine ™-based disinfecting cleaning tablets in complete denture wearers

Objective

This study evaluated the efficacy of NitrAdine^TM-based disinfecting cleaning tablets for complete denture, in terms of denture biofilm removal and antimicrobial action.

Material and methods

Forty complete denture wearers (14 men and 26 women) with a mean age of 62.3±9.0 years were randomly assigned to two groups and were instructed to clean their dentures according to two methods: brushing (control) - 3 times a day with denture brush and tap water following meals; brushing and immersion (experimental) - brushing the denture 3 times a day with denture brush and tap water following meals and immersion of the denture in NitrAdine^TM-based denture tablets (Medical Interporous^TM). Each method was used for 21 days. Denture biofilm was disclosed by a 1% neutral red solution and quantified by means of digital photos taken from the internal surface before and after the use of the product. Microbiological assessment was conducted to quantify Candida sp.

Results

An independent t-test revealed a significant lower biofilm percentage for the experimental group (4.7, 95% CI 2.4 to 7.9) in comparison with the control group (mean 37.5, 95% CI 28.2 to 48.1) (t38=7.996, p<0.001). A significant reduction of yeast colony forming units could be found after treatment with Medical Interporous^TM denture tablets as compared to the control group (Mann-Whitney test, Z=1.90; p<0.05).

Conclusion

The present findings suggest that NitrAdine^TM-based disinfecting cleaning tablets are efficient in removal of denture biofilm. In addition, a clear antimicrobial action was demonstrated. Therefore, they should be recommended as a routine denture maintenance method for the prevention of the development of microbial biofilm-induced denture stomatitis.     

Implant and root supported overdentures - a literature review and some data on bone loss in edentulous jaws

PURPOSE

To present a literature review on implant overdentures after a brief survey of bone loss after extraction of all teeth.

MATERIALS AND METHODS

Papers on alveolar bone loss and implant overdentures have been studied for a narrative review.

RESULTS

Bone loss of the alveolar process after tooth extraction occurs with great individual variation, impossible to predict at the time of extraction. The simplest way to prevent bone loss is to avoid extraction of all teeth. To keep a few teeth and use them or their roots for a tooth or root-supported overdenture substantially reduces bone loss. Jaws with implant-supported prostheses show less bone loss than jaws with conventional dentures. Mandibular 2-implant overdentures provide patients with better outcomes than do conventional dentures, regarding satisfaction, chewing ability and oral-health-related quality of life. There is no strong evidence for the superiority of one overdenture retention-system over the others regarding patient satisfaction, survival, peri-implant bone loss and relevant clinical factors. Mandibular single midline implant overdentures have shown promising results but long-term results are not yet available. For a maxillary overdenture 4 to 6 implants splinted with a bar provide high survival both for implants and overdenture.

CONCLUSION

In edentulous mandibles, 2-implant overdentures provide excellent long-term success and survival, including patient satisfaction and improved oral functions. To further reduce the costs a single midline implant overdenture can be a promising option. In the maxilla, overdentures supported on 4 to 6 implants splinted with a bar have demonstrated good functional results.     

Comparison of immediate complete denture, tooth and implant-supported overdenture on vertical dimension and muscle activity

PURPOSE

To compare the changes in the occlusal vertical dimension, activity of masseter muscles and biting force after insertion of immediate denture constructed with conventional, tooth-supported and Implant-supported immediate mandibular complete denture.

MATERIALS AND METHODS

Patients were selected and treatment was carried out with all the three different concepts i.e, immediate denture constructed with conventional (Group A), tooth-supported (Group B) and Implant-supported (Group C) immediate mandibular complete dentures. Parameters of evaluation and comparison were occlusal vertical dimension measured by radiograph (at three different time intervals), Masseter muscle electromyographic (EMG) measurement by EMG analysis (at three different positions of jaws) and bite force measured by force transducer (at two different time intervals). The obtained data were statistically analyzed by using ANOVA-F test at 5% level of significance. If the F test was significant, Least Significant Difference test was performed to test further significant differences between variables.

RESULTS

Comparison between mean differences in occlusal vertical dimension for tested groups showed that it was only statistically significant at 1 year after immediate dentures insertion. Comparison between mean differences in wavelet packet coefficients of the electromyographic signals of masseter muscles for tested groups was not significant at rest position, but significant at initial contact position and maximum voluntary clench position. Comparison between mean differences in maximum biting force for tested groups was not statistically significant at 5% level of significance.

CONCLUSION

Immediate complete overdentures whether tooth or implant supported prosthesis is recommended than totally mucosal supported prosthesis.     

An investigation into the effect of denture adhesives on incisal bite force of complete denture wearers using pressure transducers - a clinical study

PURPOSE

Study was conducted to determine and assess the effect of different type of denture adhesives on the incisal bite force of complete denture wearers until the dislodgement of upper denture, using pressure transducer.

MATERIALS AND METHODS

30 patients out of 100 were included in the study. Based on the Kapur''s method of scoring denture retention and stability, these patients were divided into 3 groups- Group A - Clinically good dentures; Group B - Clinically fair dentures; and Group C - Clinically poor dentures. A custom made occlusal force meter was constructed based on the load cell type of pressure transducers. Different adhesives (powder, paste and adhesive strips) were used in the study. Complete denture wearers were asked to bite on the load cell and the readings of incisal bite force were recorded. The readings of incisal bite force were subjected to statistical analysis using Repeated measures ANOVA followed by post-hoc bonferroni test.

RESULTS

The result suggests that denture adhesives improved the incisal bite force of complete denture wearers significantly The incisal bite force (in kg) in Group A without using adhesives, with powder adhesive, with paste adhesive and with adhesive strips was found to be 2.48 (± 0.16), 3.43 (± 0.11), 6.01 (± 0.11), 3.22 (± 0.09) respectively. The incisal bite force (in kg) in Group B without using adhesives, with powder adhesive, with paste adhesive and with adhesive strips was found to be 1.87 (± 0.18), 3.35 (± 0.14), 5.34 (± 0.18), 3.21 (± 0.12) respectively. The incisal bite force (in kg) in Group C without using adhesives, with powder adhesive, with paste adhesive and with adhesive strips was found to be 1.00 (± 0.17), 3.07 (± 0.14), 4.37 (± 0.26), 2.99 (± 0.14) respectively.

CONCLUSION

Within the limitations of the study, it was concluded that the use of denture adhesive was found to be significantly effective in improving the incisal bite force of complete dentures until the dislodgement of upper denture. Fittydent paste adhesive was found to be more effective than the powder and strips adhesives. The improvement in incisal bite force was found to be higher in Group C in comparison to that of Group A and Group B.     

Comparative evaluation of sodium hypochlorite and microwave disinfection on dimensional stability of denture bases

PURPOSE

To compare the effect of sodium hypochlorite and microwave disinfection on the dimensional stability of denture bases without and with relining.

MATERIALS AND METHODS

A brass die was prepared by simulating an edentulous maxillary arch. It was used to fabricate 1.5 mm and 3 mm of thickness denture bases (n = 40). The 1.5 mm of thickness-specimens (n = 20) were relined with 1.5 mm of autopolymerizing relining resin. Five holes were prepared over crest of ridge of brass die with intimately fitting stainless steel pins which were transferred to the intaglio surface of specimens during fabrication of denture bases. For calculation of dimensional changes in denture bases, differences between the baseline area before and after disinfection of the specimens were used. The denture bases without and with relining were divided into 2 groups (each n = 20). Data were analyzed using student paired ''t'' and unpaired ''t'' test.

RESULTS

Microwave disinfection produces significant shrinkage in both denture bases without relining (t = 17.16; P<.001) and with relining (t = 14.9; P<.001). Denture bases without relining showed more shrinkage when compared with relined denture bases after microwave disinfection (t = 6.09; P<.001). The changes in dimensional stability after sodium hypochlorite disinfection were not significant for both denture bases without relining (t = 2.19; P=.056) and denture bases with relining (t = 2.17; P=.058).

CONCLUSION

Microwave disinfection leads to increased shrinkage of denture bases without and with relining. Chemical disinfection with sodium hypochlorite seems to be a safer method of disinfection with regards to physical properties such as changes in dimensional stability.     

Stress analysis of a fixed implant-supported denture by the finite element method (FEM) when varying the number of teeth used as abutments

Objectives

In some clinical situations, dentists come across partially edentulous patients, and it might be necessary to connect teeth to implants. The aim of this study was to evaluate a metal-ceramic fixed tooth/implant-supported denture with a straight segment, located in the posterior region of the maxilla, when varying the number of teeth used as abutments.

Materials and Methods

A three-element fixed denture composed of one tooth and one implant (Model 1), and a four-element fixed denture composed of two teeth and one implant (Model 2) were modeled. A 100 N load was applied, distributed uniformly on the entire set, simulating functional mastication, for further analysis of the SEQV (Von Mises) principal stresses, which were compared with the flow limit of the materials.

Results

In a quantitative analysis, it may be observed that in the denture with one tooth, the maximum SEQV stress was 47.84 MPa, whereas for the denture with two teeth the maximum SEQV stress was 35.82 MPa, both located in the region between the pontic and the tooth.

Conclusion

Lower stresses were observed in the denture with an additional tooth. Based on the flow limit of the materials, porcelain showed values below the limit of functional mastication.     

EFFICACY OF BIOFILM DISCLOSING AGENT AND OF THREE BRUSHES IN THE CONTROL OF COMPLETE DENTURE CLEANSING

Objective:

This report evaluated the efficacy of three brushes and one biofilm disclosing agent in complete denture cleansing. Methods: Twenty-seven wearers of maxillary dentures were distributed into three groups and received different brushes: Oral B40, conventional toothbrush (Oral B); Denture, denture-specific brush (Condor); Johnson & Johnson, denture-specific brush (Johnson & Johnson). The 60-day experimental period was divided into two techniques: I - brushing (brush associated with a paste - Dentu Creme, Dentco) three times a day; II - brushing and daily application of 1% neutral red on the denture internal surface. Biofilm quantification was carried out weekly and the areas with dye biofilm were obtained by means of Image Tool 2.02 software.

Results:

Biofilm removal was more effective during Technique II (Wilcoxon test: p=0.01) for the three groups of brushes. When the brushes were compared in Technique I, the Kruskal Wallis test indicated statistical difference between Denture X Johnson & Johnson and Denture X Oral B40, in which the Denture was more efficient. For Technique II, there was no statistical difference between brushes (p>0.05).

Conclusion:

The disclosed application promoted more efficacy on biofilm removal, regardless of the brush used. Denture (Condor) was more efficient than the other brushes during Technique I.     

Randomized controlled clinical trial on satisfaction with resilient denture liners among edentulous patients

Purpose

The purpose of this study was to measure patients' satisfaction and their preference between mandibular dentures with permanent silicone-based resilient denture liner (SR) and conventional heat-activated acrylic resin (AR), both opposed by acrylic resin-based maxillary complete dentures.

Materials and Methods

Twenty-eight edentulous patients who had fulfilled selection criteria and provided informed consent were enrolled in this trial. Subjects were allocated randomly to either arm of cross-over groups (AR-SR/SR-AR), stratified by gender, using a random permuted block within the strata method. The AR-SR group received AR denture treatment followed by SR denture treatment. The SR-AR group received treatment in the reverse sequence. The primary outcome was patient satisfaction measured on 100-mm VAS, analyzed by two-way ANOVA and the Bonferroni multiple comparison as a post hoc test. The secondary outcome was patients' preference, evaluated by chi-square goodness-of-fit test. An intention-to-treat analysis was performed.

Results

Twenty-five subjects were enrolled in the analysis. There were no significant differences between AR and SR dentures 1, 2, and 3 months after the completion of control. Eighteen of 25 patients preferred SR dentures.

Conclusion

Although there were no significant differences in patient satisfaction ratings between the two types of dentures, a significant majority of patients preferred those with a resilient denture liner.—Reprinted with permission of Quintessence Publishing.     

Does a mandibular RDP and new maxillary CD improve masticatory efficiency and quality of life in patients with a mandibular Kennedy class I arch?

Objectives

To evaluate the change in masticatory efficiency and quality of life of patients treated with mandibular Kennedy class I removable partial dentures (RPDs) and maxillary complete dentures at the Department of Dentistry of the Federal University of Rio Grande do Norte.

Materials and methods

A total of 33 Kennedy class I patients were rehabilitated with maxillary complete dentures, and mandibular RPDs were selected for this non-randomized prospective intervention study. The patients had a mean age of 59.1 years. Masticatory efficiency was evaluated by colorimetric assay using fuchsin capsules. The measurements were conducted at baseline and 2 and 6 months after prosthesis insertion. Quality of life was evaluated using the Oral Health Impact Profile (OHIP-14) at baseline and 6 months after denture insertion. The Kolmogorov-Smirnov normality test was applied. Masticatory efficiency was evaluated by repeated measures ANOVA. Oral health-related quality of life was compared using the paired t test.

Results

There was no statistically significant difference in masticatory efficiency after denture insertion (p?=?0.101). Significant differences were found (p?=?0.010) for oral health-related quality of life. A significant improvement in psychological discomfort (p?<?0.01) and psychological disability (p?<?0.01) was observed. Mean difference value (95 % confidence interval) was 6.8 (3.8 to 9.7) points, reflecting a low impact of oral health on quality of life, considering the 0–56 range of variation of the OHIP-14 and a Cohen’s d of 1.13.

Conclusion

According to the results of the present study, rehabilitation with Kennedy class I RPDs and complete dentures did not influence masticatory efficiency but improved oral health-related quality of life.

Clinical relevance

The association between the patient’s quality of life and the masticatory efficiency is important for treatment predictability.