Creating complete dentures that are stable in function

Many edentulous people can experience difficulty in carrying out functional activities when wearing complete dentures. This may be due to a number of factors, one of which is the ability to control the dentures effectively during mastication and speech. For this reason, it is critical when constructing complete dentures to incorporate features in their design which will aid stability in function. Usually, the challenges are greater in constructing a prosthesis to replace the missing mandibular teeth. It is recognized that the use of osseointegrated implants offers considerable advantages for people who have to wear complete dentures, and the contribution of implantology to the provision of stable complete dentures will be explored. However, many people will not have the opportunity to experience the benefits of this approach. Furthermore, for people who need to wear conventional dentures, age and other factors may impact on their ability to control the prostheses effectively during oral function. In this paper, the ways in which design features may impact on the stability of complete dentures will be discussed. Clinical Relevance: This paper considers how complete dentures can be designed and constructed so that they are stable in oral function, and can be worn comfortably without causing damage to the intra-oral tissues.     

A Pilot Study to Evaluate Different Palate Materials for Maxillary Complete Dentures with Xerostomic Patients

PURPOSE: The hypothesis tested in this pilot study was that materials used for the palatal region of a maxillary denture affect the comfort of the maxillary denture in xerostomic patients. MATERIALS AND METHODS: Xerostomic complete denture wearers were selected to test three different maxillary dentures that were made with different palatal materials. Each denture was worn for a period of 2 weeks. The Kapur Index was used to measure retention. The Oral Health Index Profile (OHIP) was used to determine the patient's perception of each denture after the 2-week period. At the end of the study, the patients were asked to select which of the three dentures they would like as their primary denture. RESULTS: All participants chose the metal-palate dentures, and 4 of 5 selected the titanium-palate denture as their primary denture. Statistical analysis of the OHIP demonstrated that the metal-palate dentures were perceived as being more comfortable than the acrylic-resin dentures. CONCLUSION: This pilot study suggests that for xerostomic patients who have worn complete dentures, their selection of a metal-palate denture as their primary prosthesis strongly suggests that these dentures have properties that make them more comfortable to the patient than acrylic dentures. Subjective patient measurements supported this conclusion that the metal-palate dentures were preferable, while the evaluation method available to the clinician failed to discriminate among the prostheses.     

Direct and indirect fiber-reinforced fixed partial dentures: case reports.

Direct and indirect fiber-reinforced resin composite fixed partial dentures are a new way to produce minimally invasive, esthetic, and cost-effective metal-free tooth replacements. These treatment alternatives have a number of indications, for example, chairside tooth replacements, long-term provisional fixed partial dentures, economically feasible tooth replacements for patients who cannot afford more traditional treatment regimens, and tooth replacements for medically compromised patients who are unable to withstand the physical stress associated with fabrication of traditional fixed prostheses. This article presents four typical cases in which fiber-reinforced fixed partial dentures seemed to be the preferable treatment modality.     

Denture adhesives: their effects on denture retention and stability

Denture adhesives have been used by denture wearers for many years. A number of studies have been conducted to assess the effectiveness of these adhesives.This article describes a technique whereby the effectiveness of the adhesives was determined with the dentures in function through the use of the kinesiograph. The results indicated that denture adhesives improved the retention and stability of dentures, more so for ill-fitting than well-fitting dentures.     

An assessment of attitudes to, and extent of, the practice of denture marking in South Australia

Denture marking or labelling is not a new concept in either prosthetic or forensic dentistry and its routine practice has been urged by forensic odontologists internationally for many years. In the general community it is often recommended for institutionalized persons to prevent confusion of ownership of dentures. In Australia, the Nursing Home Standards require that dentures of residents be 'discreetly labelled' and marking of all dentures is recommended by the Australian Dental Association. In some countries the marking of dentures is regulated by legislation, but elsewhere there seems to be a reluctance to effect this practice.
Various methods which have been proposed include the insertion of an identifying label during the fabrication of the dentures with the utilization of a number of materials and coding systems. This study reports the results of a survey undertaken to determine the extent of the practice of denture marking in South Australia, the methods in use, and the attitudes of dentists, dental technicians and institutions to it.
The results indicated that 24.5 per cent of all practitioners providing removable prostheses to their patients include an identifying label as part of the service on some occasions. This included 19.9 per cent of general dental practitioners, 25 per cent of specialist prosthodontists, 57.1 per cent of practitioners with training in forensic odontology, and 43.5 per cent of clinical dental technicians.
No practitioner labelled dentures routinely. Reasons cited for not labelling dentures included cost, lack of awareness of standards and recommendations and a belief that it was of little importance.     

Complete denture treatments for a cerebral palsy patient by using a treatment denture. A case report

This article describes the prosthodontic treatment for a patient with cerebral palsy, in which complete dentures were successfully stabilized using treatment dentures. A 69-year-old edentulous male with no medical complications or mental retardation presented to our clinic. Opening movement of the jaw was possible, but a conspicuous mandibular shift towards the right was observed. He had never received any prosthodontic treatment. Initially, treatment dentures with flat tables were fabricated to rectify his erratic mandibular movements. During the first 3 weeks, the treatment dentures functioned poorly. Eventually, the patient could make tapping movement to some degree and have a meal with less effort. Indentation marks from the cusps of the opposing maxillary denture could be clearly seen on the flat tables. After six weeks, as he did not complain of any pain, definitive dentures were fabricated. When flat table treatment dentures are used, it is considered that the mucosa provides information regarding the vertical stop and bite force. In addition, it is speculated that there is an increase in the response from masseter muscle. In the present case, flat tables were effective for rehabilitation of the mandibular movement.     

An assessment of attitudes to,and extent of,the practice of denture marking in South Australia

Denture marking or labelling is not a new concept in either prosthetic or forensic dentistry and its routine practice has been urged by forensic odontologists internationally for many years. In the general community it is often recommended for institutionalized persons to prevent confusion of ownership of dentures. In Australia, the Nursing Home Standards require that dentures of residents be ‘discreetly labelled’ and marking of all dentures is recommended by the Australian Dental Association. In some countries the marking of dentures is regulated by legislation, but elsewhere there seems to be a reluctance to effect this practice. Various methods which have been proposed include the insertion of an identifying label during the fabrication of the dentures with the utilization of a number of materials and coding systems. This study reports the results of a survey undertaken to determine the extent of the practice of denture marking in South Australia, the methods in use, and the attitudes of dentists, dental technicians and institutions to it. The results indicated that 24.5 per cent of all practitioners providing removable prostheses to their patients include an identifying label as part of the service on some occasions. This included 19.9 per cent of general dental practitioners, 25 per cent of specialist prosthodontists, 57.1 per cent of practitioners with training in forensic odontology, and 43.5 per cent of clinical dental technicians. No practitioner labelled dentures routinely. Reasons cited for not labelling dentures included cost, lack of awareness of standards and recommendations and a belief that it was of little importance.     

Halitosis manifestation and prevention means for patients with fixed teeth dentures

The objective of this research is to analyse the causal relationship between construction of fixed bridge dentures and the intensity of halitosis manifestations, as well as to establish basic hygiene requirements for construction of fixed dentures which would completely exclude retention of food particles and avoid bad breath. 48 patients (36 men and 12 women), who use fixed dentures for 2-10 years, have been involved in this research. 26 patients wore fixed bridge dentures made of punched tooth crowns, the other 22 patients wore cast fixed dentures. The obtained measurements of halitosis magnitude point to the close connection between bad breath and the construction of fixed dentures. Fixed dentures with tooth crown laps, saddle intermediate parts, as well as denture constructions, which impede complex of mouth hygiene measures, cause bad breath. In this research, the condition of patients' teeth, periodontium, and oral cavity hygiene have been evaluated as satisfactory; the tongue is not perceptibly coated, and patients etiologically have not experienced problems caused by respiratorial or gastrointestinal diseases. The examined patients have not complained of xerostomia problems. In conclusion, it should be admitted that fixed dentures, which make difficult or even completely impede the complex of oral cavity hygiene measures, intensify the development of halitosis.     

Conventional Rehabilitation of Edentulous Patients: The Impact on Oral Health-Related Quality of Life and Patient Satisfaction

PURPOSE: This study examined patient satisfaction and oral health-related impacts on the quality of life of patients restored with complete conventional or duplicate dentures. MATERIALS AND METHODS: Forty patients (aged 55 to 85 years) were assigned to receive new complete maxillary and mandibular dentures using either a conventional or duplication technique according to clinical need. Patients rated their satisfaction with their dentures on 100-mm visual analogue scales before treatment and 1 month after delivery of their new dentures. Their oral health-related quality of life was determined by completion of an Oral Health-Related Impacts on Quality of Life questionnaire (OHIP-20) at the same time points. RESULTS: Both groups of patients had similar satisfaction and OHIP ratings at the beginning of the study and 1 month after delivery of their new dentures. The two groups were comparable with regard to age and gender. Statistically significant improvement in the OHIP domains of functional limitation and physical and psychological disability was seen in both groups. The conventional group also showed significant improvement with regard to handicap, whereas the duplicate denture group showed significant improvement in the patients' rating of pain and psychological discomfort. Patient satisfaction improved significantly in both groups across all variables except ease of cleaning and ability to speak. The duplication technique resulted in patients being less satisfied with the esthetics of their new dentures. CONCLUSION: In this study, the provision of new dentures either with a conventional technique or with a duplication technique resulted in an overall improvement in oral health-related quality of life and satisfaction. These improvements were statistically significant for some domains, which varied depending on the technique used for construction of the new dentures. Neither technique was seen to be superior, which may be a reflection of the patients' treatment expectations at the outset. Patients' reported satisfaction with their dentures and the impact that dentures have on their quality of life may not be useful measures for determining the most appropriate technique for providing new dentures.     

Oral health impact on daily performance in patients with implant-stabilized overdentures and patients with conventional complete dentures.

This cohort study (n = 83) investigated whether patients with implant-stabilized overdentures would demonstrate less impact on daily life, would have less difficulty in the mastication of different types of food, and would generally be more satisfied than patients with conventional complete dentures. The groups were comparable for gender, age of dentures, and duration of edentulism. The patients were interviewed using a questionnaire, which included the Oral Impacts on Daily Performances (OIDP) sociodental indicator. Patients with implant-stabilized overdentures were more satisfied with the comfort of their dentures, could eat a wide range of food items with less difficulty, and experienced less impact on daily life than patients with conventional complete dentures. The findings of this study support the need to consider implant-stabilized overdentures in the treatment of edentulous patients.     

Improvdent: Improving dentures for patient benefit. A crossover randomised clinical trial comparing impression materials for complete dentures

ABSTRACT: BACKGROUND: According to the UK Adult Dental Health Survey (2009) 15% of adults aged 65-74, 30% aged 75-84 and 47% aged >85 years are edentulous and require complete dentures. Patients' quality of life and nutrition status are affected by poor dentures. The quality of the dental impression is the most important issue for improving the fit and comfort of new dentures. There is paucity of RCT evidence for which impression material is best for complete dentures construction. This study aims to compare two impression materials for effectiveness and cost effectiveness. METHODS: IMPROVDENT is a double-blind crossover trial comparing the use of alginate and silicone, two commonly used denture impression materials, in terms of patient preference and cost-effectiveness. Eighty five edentulous patients will be recruited and provided with two sets of dentures, similar in all aspects except for the impression material used (alginate or silicone). Patients will try both sets of dentures for a two-week period, unadjusted, to become accustomed to the feel of the new dentures (habituation period). Patients will then wear each set of dentures for a period of 8 weeks (in random order) during which time the dentures will be adjusted for optimum comfort. Finally, patients will be given both sets of dentures for a further two weeks to wear whichever denture they prefer (confirmation period). Patients will be asked about quality of life and to rate dentures on function and comfort at the end of each trial period and asked which set they prefer at the end of the habituation period (unadjusted denture preference) and confirmation period (adjusted denture preference). A health economic evaluation will estimate incremental cost-effectiveness ratios of producing dentures from the two materials. A qualitative study will investigate the impact of dentures on behaviour and quality of life. Funding: IMPROVDENT is funded by NIHR RfPB (PB-PG-0408-16300). DISCUSSION: This trial aims to provide evidence on the costs and quality of dentures cast from two different commonly used impression materials; the intention is to significantly impact on the quality of denture production within NHS dentistry. Trial Registration ISRCTN Register: ISRCTN01528038 UKCRN Portfolio ID: 8305.     

Interim acrylic resin duplicate removable partial dentures

Certain dental procedures require patients to be without their removable partial dentures. This can be a great inconvenience and psychologically difficult for some patients. This procedure permits duplicating existing removable partial dentures so that patients will not have to be without prostheses.     

The use of computed tomography in the detection of radiolucent denture base material in the chest

With the introduction of acrylic resin denture base materials to the dental profession, radiolucency was recognized as a significant deficiency at an early stage. Continuous research into the production of a radiopaque material has been directed at including radiopaque glasses, salts or metals powders in an otherwise radiolucent polymer. However, the majority of new dentures are still made in radiolucent material which is notoriously difficult to locate by conventional radiography and reports continue to appear relating to the inhalation or ingestion of dentures (or fragments of them), occasionally leading to the death of the patient. Advances in radiographic techniques and equipment have seen the development of computed tomography (CT). This has proved invaluable as a diagnostic aid for disease and therapy but little attention appears to have been given to the use of this sophisticated technique in the detection of foreign bodies, in particular those of dental origin. This study investigates the use of CT in the detection of radiolucent denture base material. The results suggest that CT has substantial advantages over conventional radiography in the detection of this material and should be considered as a valuable diagnostic aid in those patients thought to have inhaled dentures or fragments of dentures.     

Periodontal conditions with removable complete and partial dentures in the adult population aged 30 years and over

The periodontal conditions of subjects with different combinations of removable dentures were studied in a representative sample of 8000 subjects, of which 90% were used for the experiment. The number of subjects with removable dentures was 1468. Subjects with removable partial dentures had significantly more pockets and deeper pockets than did those without dentures. The periodontal condition of subjects with a complete denture in the opposite jaw was significantly better than that in other subjects. This was true in both men and women. The results indicated the importance of prophylactic and maintenance care in subjects with removable partial dentures.     

Dental treatment and socioeconomic status in the period of 1981-1995

Between 1981 and 1995 the number of people in the Netherlands with a complete set of dentures fell by an average of 0.8 per cent per year. This means that the number of Dutch inhabitants with complete dentures dropped from 3.5 million in 1981 to 2.5 million in 1995. In general, relatively more people with a lower than with a higher socio-economic status have complete dentures. These socio-economic differences did not change in the period 1981-1995. In the same period, the number of consultations at which the dentist provided preventive treatment increased by 1 per cent per year. The results do not show any important differences in preventive aid between socio-economic groups. Changes in the reimbursement system for dental treatment, introduced on 1 January 1995, have led to a decrease of the number of dental consultations by people on a low income with non-private health insurance.     

Resin denture bases: review of accuracy and methods of polymerization

Traditional compression molding and heat-activation methods for polymerization of denture base resins have been widely used. Studies have shown that stresses introduced during processing can lead to the distortion of denture bases. Chemical-, microwave-, and light-energy activation, and various combinations (including polymerization under pressure) have been offered as alternative ways to make dentures. These methods have been attempts to improve the accuracy of fit of the dentures, but sometimes the goal has also been to provide a more convenient laboratory technique. This extensive review covers studies that have investigated the accuracy of acrylic and other types of resins for making dentures using the known range of fabrication methods.     

Immediate replacement complete dentures: pitfalls of ignoring traditional teaching and established practice

A thirty-year-old female had immediate replacement dentures made by a general practitioner and her teeth extracted and the dentures fitted under general anaesthetic by her local oral surgeon three months previously. Anterior and posterior teeth had been extracted and no attempt had been made to smooth or shape the ridges. Both dentures were constructed with gum fitted anterior teeth without labial flanges. This treatment differs from traditional immediate replacement complete denture teaching. Traditionally, when possible the posterior teeth would have been extracted first and then once there had been a period of healing the immediate replacement complete dentures would have been made replacing the remaining anterior teeth. A trans-septal alveolotomy would have been performed, which would reduce the labial undercut on the edentulous ridge so that the denture could have a labial flange which would enable a border seal to be established to enhance retention but would not displace the lip. Care would have been taken to ensure that the fit surface of the denture would reflect the change in ridge shape that would follow healing. The divergence of this treatment management from a traditional approach raises important questions. In the past oral surgeons were well versed in pre-prosthetic surgery. As demand for this type of treatment has declined, so has the opportunity for oral surgery trainees, who themselves may have limited experience in prosthetic dentistry, to learn the techniques involved. Teaching of this form of removable prosthetic dentistry has been reduced reflecting the reduced frequency of this presenting condition.     

Complete dentures in the Dutch population 1981-1992

In the period 1981-1992 the percentage of people with a full set of dentures dropped from 31.6 to 22.5 in the Netherlands (persons > or = 16 years). This is particularly due to the relatively strong decrease in the number of young people with full dentures. Regional differences are remarkable: in the northern provinces the percentage is relatively high; in the province of Utrecht it is relatively low. Recently regional differences appear to be (very) small among the young age groups. Many people with a full set of dentures use the same dentures for a long period: about 20% of them have had their current prostheses for 16-25 years, another 20% for over 25 years. Taking into account the total adult population, it appears that the socio-economic status (SES) negatively correlates with the probability of having a full set of dentures. This holds for all three SES indicators in the study: education, income and type of insurance. But among the young age groups this correlation is only valid for education.     

Overcoming the unstable mandibular complete denture: the neutral zone impression technique

This article describes a technique for improving the stability of mandibular complete dentures for patients who have a diminished mandibular neutral zone.The technique involves making an impression which is shaped by the patient's oral musculature, and which defines the shape and contour of the patient's neutral zone. A case report is presented in which the use of this technique is described. It is hoped that this article will increase the awareness of dental practitioners to the use of this technique. Clinical Relevance: The neutral zone impression technique is a useful technique when providing mandibular complete dentures. Its use can overcome some of the denture stability difficulties caused in some patients by a more powerful oral musculature, or in patients who have poor or altered neuromuscular control.     

Sectional dentures revisited

Sectional dentures are constructed in separate parts which join together intra-orally to create a single prosthesis. They are used to exploit undercuts around teeth, hard and soft tissues which require more than one path of insertion, and are usually of split pin or locking bolts design. By using two case studies, we aim to illustrate the provision of sectional dentures and to which situations their uses are best suited. A 30-year-old male was referred to the Department of Prosthetics at the Birmingham Dental Hospital for a replacement upper partial cobalt chrome denture of a Kennedy Class IV bounded saddle. The patient had a history of failed upper cobalt chrome removable partial dentures owing to loss of retention and poor stability over the previous 12 months. A 40-year-old female patient was referred by her GDP for restoration of a bounded saddle in the lower right quadrant with a history of intolerance to previous dentures. These two cases demonstrate the successful use of sectional dentures in the aesthetic zone. Although more technically demanding, they lie well within the scope of general practice and offer patients alternative solutions from dental implants and bridgework. These cases highlight the importance of the use of alternative prosthetic techniques which can be simple and achievable for all practitioners. Clinical Relevance: Sectional dentures are a treatment modality for the edentulous space where the presence of one or more undercuts prevents restoration by more conventional techniques. This paper highlights some of the situations in which sectional dentures can be employed and emphasizes their use in general practice.