Correlation between patient satisfaction with complete dentures and denture quality,oral condition,and flow rate of submandibular/sublingual salivary glands

PURPOSE: The purpose of this study was to examine the correlation between patient satisfaction with complete dentures and parameters of denture quality, oral condition, and flow rate of the submandibular and sublingual salivary glands. MATERIALS AND METHODS: The parameters were evaluated on 50 denture wearers using semiquantitative scales and a recently described submandibular/sublingual saliva collector. RESULTS: Most patients had a medication-induced reduced salivary flow rate (mean 0.024 mL/min/gland; SD 0.040). Submandibular/sublingual salivary flow rate correlated statistically with six denture satisfaction parameters: maxillary denture retention and comfort, mandibular denture retention and comfort, abilities of chewing, and speech. Residual alveolar ridge resilience, maxillary ridge shape, and denture quality did not significantly correlate with denture satisfaction. Characteristics of musculature correlated significantly only with subjective maxillary denture retention, and mandibular ridge shape correlated with comfort. CONCLUSION: Submandibular/sublingual salivary flow rate is an important factor in denture satisfaction. The retention of the maxillary denture was correlated to the oral musculature characteristics, and the mandibular denture comfort was correlated to the mandibular ridge shape. Denture satisfaction was not affected by other anatomic or denture quality-related parameters.     

Randomized clinical trial comparing the efficacy of mandibular implant-supported overdentures and conventional dentures in diabetic patients. Part III: comparisons of patient satisfaction.

STATEMENT OF PROBLEM: There is insufficient evidence to indicate the functional superiority of mandibular implant-supported overdentures to justify their use in edentulous patients. PURPOSE: This study compared the benefits perceived by patients who received a new maxillary denture and a mandibular conventional denture (CD) and an implant-supported overdenture (IOD). METHOD: New maxillary and mandibular dentures were delivered to 89 diabetic denture wearers with clinically acceptable metabolic control who treated their diabetes either with insulin (IT) or without insulin (NIT). Of the 89 patients, 37 received maxillary and mandibular CDs and 52 received a maxillary CD and an IOD. Two questionnaires with categorical responses were used; the first contained 13 questions to ascertain a patient's absolute assessments of original dentures at entry and study dentures at 6- and 24-months after treatment completion; the second questionnaire had 11 questions that assessed the relative change perceived by patients with study dentures. Of the 78 patients who completed the posttreatment (PT) assessments at 6 months, 68 patients provided longitudinal data for questionnaire I and cross-sectional data for questionnaire II. In addition, 46 patients (18 CD and 28 IOD) also provided PT assessments at 24 months. RESULTS: Both mean scores and percentage distributions of longitudinal data for questionnaire I showed perceptual improvements with both types of study dentures. Improvements were higher in the IOD than in the CD group. Mean scores failed to show any significant differences between the 2 treatment groups. The only significant difference was found in the change in percentage distributions for perceptual chewing ability in favor of the IOD group. Even this advantage was lost at 24 months. With the comparative questionnaire, a higher percentage of patients in the IOD group than in the CD group perceived improvements with study dentures from their original dentures in chewing ability, chewing comfort, and denture security. However, mean differences were statistically significant in favor of the IOD group only for chewing ability and less difficulty to chew hard foods. CONCLUSION: The mandibular implant-supported overdenture offers same advantage in terms of perceived chewing function over the conventional denture.     

Does the Presence of Anterior Mandibular Teeth Increase the Incidence of Denture Stomatitis?

Purpose : To compare the frequency of denture stomatitis (DS) under maxillary complete dentures (CDs) in patients with opposing mandibular distal extension removable partial dentures (RPDs) and CDs. Materials and Methods : Participants included 365 maxillary CD wearers (241 women, mean age 70.5 ± 13.2 years; 124 men, mean age 71.5 ± 10.4 years) from 7 rest homes in Istanbul. A total of 268 had mandibular CDs; 97 had mandibular distal extension RPDs. Two independent, calibrated examiners performed oral examinations. Presence of maxillary denture‐related stomatitis and the effect of risk factors on DS were evaluated and recorded. Results : The frequency of palatal DS (Newton I‐III) was 45.1% (n = 121) in the mandibular CD group and 49.5% (n = 48) in the mandibular distal extension RPD group, a statistically insignificant difference (p= 0.4). Factors significantly associated with palatal DS were maxillary denture age (p= 0.02), reduced occlusal vertical dimension (p= 0.04), and nocturnal denture wear (p= 0.03). Conclusion : In this study, DS beneath maxillary CDs did not differ between mandibular distal extension RPD and CD wearers. The presence of mandibular anterior teeth did not influence the occurrence of palatal DS.     

Comparison between balanced occlusion and canine guidance in complete denture wearers--a clinical, randomized trial.

OBJECTIVE: Two occlusal concepts exist for the setup of complete dentures: canine guidance and balanced occlusion. These two schemes were studied in a randomized clinical trial of 22 patients. METHOD AND MATERIALS: Subjective data were collected using a visual analog scale that described the patients' satisfaction with the esthetic appearance, the ability to chew, the ability to speak, and denture retention. Objective data were collected on the number of denture ulcers, the number of occlusal contacts, and denture retention during eccentric movements. Statistic evaluation was performed with the Friedman test. RESULTS: Patients assessed canine-guided dentures to be significantly more satisfying in esthetic appearance, mandibular denture retention, and chewing ability. The ability to speak and the retention of maxillary dentures were not influenced by the occlusal concept in the patients' opinion, whereas the examiners found that maxillary canine-guided dentures lost retention more frequently during eccentric movements than balanced dentures. The objective inspection of mandibular denture retention underscores the patients' assessment, showing that the mandibular canine-guided dentures are much more stable during laterotrusive and protrusive movements. CONCLUSION: Canine guidance can be used successfully in complete denture treatment as it provides better mandibular denture retention, esthetic appearance, and chewing ability.     

Comparing the efficacy of mandibular implant-retained overdentures and conventional dentures among middle-aged edentulous patients: satisfaction and functional assessment

PURPOSE: The aim of this randomized clinical trial was to compare the relative efficacy of mandibular overdentures retained by only two implants and a bar attachment with conventional dentures. MATERIALS AND METHODS: Edentulous adults, aged 35 to 65 years, were randomly assigned to two groups that received either a mandibular conventional denture (n = 48) or an overdenture supported by two endosseous implants with a connecting bar (n = 54). All subjects rated their general satisfaction and other features of their original dentures and their new prostheses (comfort, stability, ability to chew, speech, esthetics, and cleaning ability) on 100-mm visual analogue scales prior to treatment and 2 months postdelivery. Oral health-related quality of life was also evaluated pre- and posttreatment. RESULTS: Multiple regression analysis revealed that the mean general satisfaction was significantly higher in the overdenture group than in the conventional denture group (P = .0001). Age, gender, marital status, and income were not significantly associated with ratings of general satisfaction. Furthermore, the implant group gave significantly higher ratings on three additional measures of the prostheses (comfort, stability, and ease of chewing; P < .05). CONCLUSION: A mandibular two-implant overdenture opposed by a maxillary conventional denture is a more satisfactory treatment than conventional dentures for edentulous middle-aged adults.     

A structural equation model relating oral condition,denture quality,chewing ability,satisfaction, and oral health-related quality of life in complete denture wearers

ObjectivesTo investigate the relationship between mandibular ridge form, stability and retention of mandibular complete denture, accuracy of jaw relation recording, patients’ perception of chewing ability, satisfaction with dentures and oral health-related quality of life (OHRQoL) in complete denture wearers.MethodsA total of 183 edentulous patients, who visited the Dental Hospital of Tokyo Medical and Dental University for new complete dentures, were recruited. Oral examination was performed. Cawood and Howell's method was used to grade the mandibular ridge form. The stability and retention of the mandibular complete denture were assessed using Kapur method. Accuracy of jaw relation recording was evaluated using a newly developed jaw relation index. Patients’ perception of chewing ability was rated using a food intake questionnaire. Patients’ satisfaction with complete dentures was assessed on a 100-mm visual analogue scale. OHRQoL was measured using the Japanese version of the Oral Health Impact Profile for edentulous subjects. A structural equation model was constructed based on the hypothesis that oral condition and denture quality would be related to chewing ability, satisfaction and OHRQoL.ResultsSignificant relationships were found between mandibular ridge form, stability of mandibular complete denture, accuracy of jaw relation recording, perceived chewing ability, satisfaction and OHRQoL. Various fit indices were within acceptable limits.ConclusionsOral condition and denture quality were related to patients’ perception of chewing ability, satisfaction with dentures and OHRQoL in complete denture wearers.Clinical significanceA favourable oral condition and denture quality are important for successful complete denture therapy.     

The impact of dietary advice on edentulous adults' denture satisfaction and oral health‐related quality of life 6 months after intervention

Objective: The aim of this study was to compare the impact of customised dietary advice on patients' satisfaction with their dentures and oral health‐related quality of life (OHRQoL) in patients wearing implant‐supported mandibular overdentures (IOD) or conventional dentures (CD). Materials and methods: In this prospective cohort study, 28 IOD (two implant‐retained mandibular overdenture) and 26 CD patients completed a denture satisfaction scale and the 20‐item oral health impact profile (OHIP‐20) before and 6 months following provision of customised dietary advice. Results: At 6 months following provision of individualised dietary advice, the IOD group showed significantly greater satisfaction than the conventional group for denture comfort (80.6, ± 15.6, vs. 68.7 ± 15.6 P=0.001), stability (75.8 ± 15.9 vs. 59.5 ± 30.4, P=0.002), and perceived chewing ability (79 ± 30.4 vs. 59.5 ± 30.4, P=0.027) ± when adjusted for baseline scores. Before delivery of the dietary advice there were no significant differences between groups for Satisfaction or OHIP scores. No difference in OHRQoL was seen between groups. Conclusions: The delivery of customised dietary advice to edentulous patients impacts differently on their satisfaction with denture comfort, stability and chewing ability depending on the nature of their prosthesis. This re‐evaluation of satisfaction occurs when edentulous patients challenge themselves to consume more fruits, vegetables and fibre‐rich foods. The IOD group reported an increased level of satisfaction and perceived chewing ability whereas it appeared that CD wearers may have had their awareness of the shortcomings of this sort of prosthesis reawakened. To cite this article:
Ellis JS, Elfeky AF, Moynihan PJ, Seal C, Hyland RM, Thomason M. The impact of dietary advice on edentulous adults' denture satisfaction and oral health‐related quality of life 6 months after intervention.
Clin. Oral Impl. Res. 21 , 2010; 386–391.
doi: 10.1111/j.1600‐0501.2009.01859.x     

A survey of treatment outcomes with removable partial dentures

The patient's satisfaction with removable partial denture (RPD) therapy has become an increasingly important factor in prosthetic treatment. This study examined patients' satisfaction with RPDs in relation to some socio-economic variables, patients' habits of wearing and cleaning RPDs, comfort of wearing RPDs and different RPDs characteristics. A questionnaire was devised for the purpose. Two hundred and five patients were required to assess satisfaction with RPDs. They graded RPDs, depending on the level of satisfaction, on scale ranging from 1 to 5. A dentist determined Kennedy classification, material and denture support, denture base shape, number of missing teeth and evaluated denture construction. Majority of the patients were satisfied with the prosthesis. The patients of a higher education level gave lower grades (P < 0.05) to aesthetics of maxillary RPDs. Almost half of the patients were wearing RPDs during the day. Most of the patients cleaned RPDs three times a day. A significant difference was found between the patients' grades for comfort of wearing mandibular RPDs and number of missing teeth and between hygiene of mandibular RPDs and habits of cleaning them. Majority of the patients treated with RPDs were satisfied with the prosthesis. Dissatisfaction was related to mastication, esthetics, number of missing teeth and maintenance of oral hygiene.     

Sex differences in denture satisfaction

OBJECTIVES: Males and females differ in their responses to many health conditions and treatments. The aim of this randomized clinical trial was to determine whether there are differences in the way that male and female edentulous elders rate their satisfaction with new mandibular implant overdentures (IODs) and conventional dentures (CDs), at 6 and 12 months following delivery. METHODS: Edentulous elders (n=256) were randomly assigned to receive maxillary conventional dentures and either mandibular overdentures supported by two implants with ball attachments or conventional dentures. Participants rated their general satisfaction, as well as other features of their dentures (comfort, stability, ability to chew, aesthetics, etc.) prior to treatment and 6 and 12 months after delivery. RESULTS: Ratings of satisfaction with IODs were significantly higher than with CDs. Six months after delivery, females in the CD group rated their general satisfaction and satisfaction with ability to chew and aesthetics significantly lower than did the males. The sex differences in the CD group remained at 12 months after delivery. However, males and females in the IOD group rated their general satisfaction and all six subcategories equally. CONCLUSIONS: Elderly females are less satisfied with conventional dentures than elderly males with regards to aesthetics and ability to chew, but equally satisfied with implant overdentures. At 6 and 12 months after delivery, elderly edentulous males and females wearing mandibular implant overdentures were significantly more satisfied than those wearing conventional dentures.     

影响全口义齿期望值与满意度的因素分析

目的分析影响全口义齿修复前期望值与修复后满意度的相关因素,为口腔修复医师提供一定的参考价值。方法收集临床全口义齿修复患者68例,修复前进行患者的年龄、性别、拔牙时间、拔牙目的、教育程度、有无佩戴活动义齿经验、对义齿了解程度等因素以及患者在外观、语音、咀嚼、固位稳定、舒适度等方面的期望值问卷,并在佩戴义齿1个月、3个月以及1年后进行满意度问卷,运用SPSS 13.0统计软件,采用单因素方差及t-检验方法进行统计学分析。结果 1）女性对咀嚼和舒适度的期望值高于男性,而男性对外观和发音的满意度更高;2）〈55岁组对各方面的期望值偏低,56~65岁组的期望值和满意度均最高,〉66岁组的满意度偏低;3）拔牙时间〉3年组对外观和咀嚼的期望值高于其它两组,但各组的满意度总体无显著差异;4）主动拔牙组对咀嚼的期望值高于被动拔牙组,但后者的各方面满意度高于前者;5）无活动义齿佩戴经验组对外观、咀嚼、固位稳定、舒适度的期望值高于有经验组,但后者对固位稳定的满意度更高;6）文化程度初级及以下组对外观、发音、咀嚼、固位稳定的期望值高于高级及以上组,但后者对咀嚼的满意度更高;7）义齿不了解组对各方面的期望值均显著高于了解组,但满意度中两组无明显差异;8）1个月时患者对语音、咀嚼、固位稳定和舒适度的满意度低于期望值,但3个月时满意度明显提高,到1年时,患者对发音、咀嚼、舒适度的满意度要高于3个月时的满意度。以上差异皆具有统计学意义（P〈0.01）。结论全口义齿的期望值和满意度与其个体因素密切相关,口腔修复医师需要在术前与患者进行良好的沟通,对特殊患者如女性、老年患者、过早缺失牙者、初戴者、文化程度低者、对义齿缺乏了解者等在义齿的功能和修复效果上应做更多的解释。     

The influence of some demographic and clinical variables on psychosomatic traits of patients requesting replacement removable partial dentures

SUMMARY The purpose of this study was to investigate the influence of some demographic and clinical variables on psychosomatic traits of the patients who visited the prosthodontic section of the Dental Hospital at Tokyo Medical and Dental University for replacement of their removable partial dentures (RPDs). Sixty‐six patients with 50 maxillary and 44 mandibular RPDs completed the psychological measurements concerning their dentures using visual analogue scales (VAS). Female patients rated significantly lower satisfaction with the comfort of their dentures than males. Younger patients expressed less satisfaction with the aesthetics of their dentures than the older patients. The period of wearing the present denture significantly correlated with psychological measures of pain, comfort, and general satisfaction, suggesting that this clinical variable may be an important factor. There was no significant correlation between the patients' general satisfaction with dentures and the retention/stability scores assessed by the examiner.     

"Prosthetic condition" and satisfaction with dentures

This study introduces the concept of 'prosthetic condition', combining the professionally assessed complete denture quality and quality of the residual alveolar ridge. In a group of 397 complete maxillary and mandibular denture wearers the prosthetic condition was assessed and the denture satisfaction recorded. The total prosthetic condition (maxillary and mandibular combined) was good in 225 (57%), moderate in 81 (20%), and poor in 91 (23%) subjects; the mandibular prosthetic condition was good in 155 (39%), moderate in 148 (38%), and poor in 94 (23%) subjects; 297 (75%) subjects were satisfied with their dentures. None of the criteria used for the prosthetic condition could explain the denture satisfaction. Furthermore, there was no significant correlation between prosthetic condition and denture satisfaction.     

义齿黏附剂和口腔湿润剂联合使用提高口干症患者全口义齿满意度的临床评价

目的：探讨义齿黏附剂和口腔湿润剂联合使用对牙槽嵴低平的口干症患者配戴全口义齿效果的影响。方法：选择10例牙槽嵴低平的无牙颌口干症患者,于义齿黏附剂使用前和使用后1个月及义齿黏附剂和口腔湿润剂联合使用后1个月、3个月及6个月对患者进行义齿满意度问卷调查, 采用SPSS17.0软件包对数据进行统计学分析。结果：义齿黏附剂与口腔湿润剂联合应用于全口义齿后6个月和使用口腔湿润剂前比较, 临床使用效果满意, 在总体满意度、咀嚼功能、舒适度以及下颌全口义齿固位效果等4个方面均显著提高)P<0.05) ; 而单独使用义齿黏附剂1个月后,患者配戴全口义齿的舒适度显著下降(P<0.05)。结论：对伴有口干症的牙槽嵴低平的无牙颌患者,联合应用义齿黏附剂和口腔湿润剂,可提高配戴全口义齿的满意度。     

The relationship between various parameters of complete denture quality and patients’ satisfaction

BackgroundPatients’ appreciation of their conventional complete dentures might be affected by the quality of the dentures.MethodsA random sample of 33 edentulous patients who were rehabilitated by means of conventional complete dentures participated in the study. Three independent investigators who underwent technique calibration evaluated the dentures on the basis of seven clinical criteria by using a validated examination form. The patients filled out a validated denture satisfaction scale. The author used Pearson product-moment correlation and analysis of covariance to identify possible correlations.ResultsThe study results showed that most patients were between “reasonably satisfied” and “very satisfied” with their dentures. The author found nominally higher satisfaction among those receiving both mandibular and maxillary dentures and significant positive correlations between the overall denture satisfaction score and the stability of the mandibular denture (P = .039) and retention of the mandibular denture (P = .005). In contrast, esthetic lip support and lower lip line, occlusion, and maxillary stability and retention were not correlated with participants’ overall satisfaction level (P > .064).ConclusionsThe results of this study show that a clinically stable mandibular denture was the most important determinant of patients’ satisfaction.Practical ImplicationsThe study findings highlight the most important denture quality parameters that can aid clinicians in meeting their patients’ expectations.     

A cross-over randomised clinical trial of eccentric occlusion in complete dentures

The objective of this study is to compare the effects of canine guidance (CG) and bilateral balanced occlusion (BBO) on denture satisfaction and kinesiographic parameters of complete denture wearers, by means of a cross-over trial. Fifty edentulous patients received new maxillary and mandibular complete dentures. After the intra-oral adjustments and adaptation period, 44 participants were enrolled in the trial and randomly received a sequence of occlusal schemes: BBO followed by CG, or CG followed by BBO. Outcomes were assessed after 30 days of each occlusal scheme. Participants answered a denture satisfaction questionnaire and a kinesiograph instrument recorded mandibular physiologic movements and pattern of maxillary denture movement during chewing. Wilcoxon test and paired sample t-test were used to compare satisfaction levels and kinesiographic data for each occlusal scheme, respectively (α=0.05). The results showed no differences between occlusal schemes on participant's satisfaction and in any of the kinesiographic parameters studied, except for the vertical intrusion of the maxillary complete denture during chewing, which was lower with CG. It can be concluded that the occlusal scheme did not influence on satisfaction and kinesiographic parameters evaluated, as long as volume and resilience of residual edentulous ridges of the participants were normal. Clinical Trial Registration Identifier: NC.T01420536.     

Occlusal contacts of edentulous patients with mandibular hybrid dentures opposing maxillary complete dentures.

The purpose of this study was to evaluate differences between the occlusal contacts of edentulous patients with mandibular implant-supported hybrid dentures opposing maxillary complete dentures and those of patients with conventional maxillary and mandibular complete dentures. Six parameters related to occlusion were measured in the 2 groups (n = 40 for each group) using pressure-sensitive film. The mean values generated by each test group for each parameter were compared using a t test. Pearson's correlation coefficients between occlusal force, age, and time in function were examined. Occlusal force and area in the implant denture wearers were larger than those in the conventional denture wearers. No significant difference was seen in occlusal force balance between the left and right sides. The center of occlusal load in the implant denture wearers was more anterior. The maxillary denture may become more unstable in implant denture wearers. It is suggested that the stability and retention of a maxillary denture be checked and the occlusion be adjusted more frequently in the hybrid denture wearer than in the conventional denture wearer.     

Clinical effects of acrylic resilient denture liners applied to mandibular complete dentures on the alveolar ridge

The purpose of this study was to investigate whether resilient denture liners has the potential to decrease problems affecting the alveolar ridge mucosa during the first adjustment session following the initial fitting of the denture. Interventions were complete denture treatment with permanent acrylic resilient denture liner dentures (RLD) in mandibles and conventional heat-activated acrylic resin dentures (ARD) in mandibles. Maxillary dentures were fabricated with conventional heat-activated ARD. Seventy-four subjects were randomly allocated to the RLD and ARD groups by random permuted blocks within the strata method after obtaining written informed consent. A randomized controlled parallel clinical trial with two hospital centres was conducted from April 2004 to July 2006. The problems were comprehensively evaluated by three outcomes with subjective and objective factors as follows: (i) numbers of sore spots, (ii) duration of wearing dentures and (iii) pain perception with 100 mm Visual Analog Scale. The numbers of sore spots in the mandibular support and border areas for the RLD group were significantly less than those for the ARD groups (P < 0.05). The RLD wearers were able to wear their dentures an additional day longer than the ARD wearers (P < 0.05). The maxillary and mandibular pain ratings for the RLD group were significantly lower than those for the ARD group (P < 0.05). Application of resilient denture liners to mandibular complete dentures provided edentulous patients with fewer problems affecting the alveolar during the first adjustment session following the initial fitting of the denture when compared with conventional denture treatments.     

Masticatory performance with mandibular implant-retained overdentures

It was investigated in a clinical trial whether the masticatory performance of complete-denture wearers depended on the support for their mandibular dentures by implants or mucosa. The trial involved the provision of a new maxillary denture and either a new conventional mandibular denture (mucosa-borne), a mandibular overdenture retained by two IMZ-implants (implant-mucosa-borne), or a mandibular overdenture on a transmandibular implant (TMI; mainly implant-borne). In comparison with mandibular implant-retained overdentures, subjects with conventional dentures needed 1.5 to 3.6 times more chewing strokes for an equivalent reduction in particle size. No differences in masticatory performance were found between subjects with IMZ-implants and those with TMI. This suggests that the increased stability of the mandibular denture with implants determines the wearer's masticatory performance, rather than the support by implants.     

含牛初乳凝胶提高口干症患者全口义齿满意度的临床评价

目的:探讨含牛初乳湿润凝胶对口干症患者配戴全口义齿效果的影响.方法:选择23例有口干症的全口义齿患者,于使用口腔湿润凝胶治疗前和治疗后1周、1个月、3个月让患者填写满意度问卷调查表,采用SPSS11.0软件包对数据进行分析.结果:湿润凝胶治疗后3个月和治疗前比较,治疗效果满意,在总体满意度、语音功能、咀嚼功能、舒适度以及下颌全口义齿同位效果等5个方面均有显著提高(P＜0.05);而上颌全口义齿固位效果未见明显差异(P＞0.05).治疗后1个月,总体满意率高于治疗后1周,治疗后3个月与治疗后1个月比较,则无显著差异.结论:伴有口干症的全口义齿患者,使用口腔湿润凝胶治疗,可以提高其对配戴全口义齿的满意度.     

Bite forces and functional loading levels in maxillary complete dentures

Using strain-gauged duplicate maxillary complete dentures, the maximum functional loading levels and bite forces were studied in a group of satisfied and dissatisfied complete denture wearers. The results indicate that, whereas complete denture wearers may have problems in chewing food efficiently, they may also exhibit areas of high local stress at the interface between their dentures and the supporting tissues. It was observed that patient acceptance of prosthetic treatment with complete dentures had no absolute relationship to the mechanical behavior of the denture and that functional deformation in dentures can only be studied satisfactorily in tests which include clinical experiments.