Use of lingual frenum in determining the original vertical position of mandibular anterior teeth.

STATEMENT OF PROBLEM: There is no accurate method for determining the correct vertical dimension of occlusion in edentulous patients. Preextraction diagnostic casts may facilitate determination of vertical dimension of occlusion. In the maxilla, the incisive papilla is a stable anatomic landmark and can be used as a guide to determine the vertical relation of the edentulous patient. Unfortunately, the mandible is devoid of such a stable anatomic landmark. PURPOSE: This study evaluated the reliability of measurement of the distance between the anterior attachment of the lingual frenum and the incisal edges of the mandibular incisors, on casts, to be used as a preextraction record for determining the vertical position of the mandibular incisors in complete denture patients. MATERIAL AND METHODS: Eighteen dentate subjects (9 men, 9 women; 21-28 years; mean age 23 years) were selected. Four mandibular casts were made from irreversible hydrocolloid impression material in plastic stock trays for each subject. All subjects were instructed to elevate the tongue while the impressions were made. The vertical distance between the anterior attachment of the lingual frenum and incisal edges of mandibular central incisors was measured on the casts. Means and standard deviations of the 4 measurements were calculated and statistically analyzed. RESULTS: The mean standard deviation of the distance between the anterior attachment of the lingual frenum and incisal edges of mandibular central incisors among the subjects was 0.1326 mm (coefficient of variation 1.292%). The distance between the anterior attachment of the lingual frenum and incisal edges of mandibular incisors was relatively stable when the frenum was recorded during function. CONCLUSION: The distance between the anterior attachment of the lingual frenum and incisal edges of the mandibular central incisors can be used on preextraction diagnostic casts as a preextraction record for determining the original vertical position of the mandibular anterior teeth.     

Reliability of Different Facial Measurements for Determination of Vertical Dimension of Occlusion in Edentulous Using Accepted Facial Dimensions Recorded from Dentulous Subjects

The study was undertaken to evaluate the reliability of different facial measurements for determination of vertical dimension of occlusion in edentulous subjects using accepted facial dimensions recorded from dentulous subjects. The hypothesis was that facial measurements can be used to obtain the vertical dimension of occlusion for edentulous patients where no pre-extraction records exist. A total of 180 subjects were selected in the age groups of 50–60 years, consisting of 75 dentate male and 75 dentate female subjects for whom different facial measurements were recorded including vertical dimension of occlusion and rest, and 15 edentulous male and 15 edentulous female subjects for whom all the facial measurements were recorded including the vertical dimension of rest and occlusion following construction of upper and lower complete dentures. The left outer canthus of eye to angle of mouth distance and the right Ear–Eye distance were found to be as valuable adjuncts in the determination of occlusal vertical dimension. The Glabella–Subnasion distance, the Pupil–Stomion distance, the Pupil–Rima Oris distance and the distance between the two Angles of the Mouth did not have a significant role in the determination of the occlusal vertical dimension. The vertical dimension can be determined with reasonable accuracy by utilizing other facial measurements for patients for whom no pre-extraction records exist.     

The Incisive Papilla: A Significant Landmark in Prosthodontics

Several investigators have studied the horizontal relationship between incisive papilla and maxillary central incisor and measured the papilla incisor distance in dentate subjects to extrapolate this distance as a guide to place maxillary central incisors in complete dentures. Based on this premise, incisive papilla is recognized as an important landmark in complete denture construction. Papilla incisor measurements were made either from the middle or posterior border of the papilla and certain ethnic and national norms have been recommended to set the central incisors in complete dentures. This study was done on Dravidian dentate subjects to relate incisive papilla to central incisors and canines and also to ascertain its shape. During its transition to the edentulous state, incisive papilla changes its shape consequent to remodeling of the alveolar bone, palatal mucosa and interdental papilla following extraction of central incisor teeth. It was found that the papilla in dentate is not always round but seen in several forms. In some it was a double papilla and in a few it was rudimentary. The center of the papilla also changes from its dentulous to edentulous state. The posterior border is a relatively stable landmark since it undergoes least change after extraction of anterior teeth.     

Randomized controlled clinical trial for verifying the effect of silicone-based resilient denture liner on the masticatory function of complete denture wearers

PURPOSE: The purpose of this study was to investigate whether application of permanent silicone-based resilient denture liner (SR) to mandibular complete dentures significantly improves patients' masticatory ability compared to conventional heat-activated acrylic resin (AR). MATERIALS AND METHODS: Twenty-eight edentulous patients were randomly placed into 1 of 2 crossover groups (AR-SR/SR-AR) by using a random permuted block within strata method. The AR-SR group received AR denture treatments followed by SR denture treatments. The SR-AR group received treatments in the reverse sequence. The outcomes were classified by matiscatory performance, mandibular movement, electromyographic activity, and maximum occlusal force. RESULTS: No significant differences were observed in any of the baseline characteristic measurements between groups. SR denture wearers exhibited significantly higher masticatory performance than AR denture wearers. SR denture wearers exhibited a longer early-stage occluding period than AR denture wearers. There were no differences in electromyographic activity between the AR and SR groups. There were no significant differences in maximum occlusal force between the AR and SR groups. CONCLUSION: This study showed that the application of SR to mandibular complete dentures resulted in significant improvements to the patients' masticatory ability compared to AR.     

Structural equation modeling of the impact of mandibular ridge form and denture quality on oral health-related quality of life in complete denture wearers

PurposeTo examine the effect of mandibular ridge form and denture quality on oral health-related quality of life (OHRQoL) in complete denture wearers by using structural equation modeling (SEM) analysis of data before and after new complete denture insertion.MethodsFour hundred thirty-two edentulous patients who visited the Dental Hospital of Tokyo Medical and Dental University for new complete dentures were recruited. An intervention study design was conducted, including complete denture fabrication with SEM analysis. Mandibular ridge form, mandibular denture stability, accuracy of jaw relation record, and the Oral Health Impact Profile for edentulous subjects (OHIP-EDENT-J) total score before and after new complete denture insertion were used in the hypothesized model.ResultsTwo hundred and thirty-seven participants completed the research. SEM analysis demonstrated adequate model fit. Path coefficients of mandibular ridge form to OHIP-EDENT-J before and after insertion, and mandibular denture stability to OHIP-EDENT-J before insertion, were significant.ConclusionsThis study demonstrated that mandibular denture stability and mandibular ridge form are important to ensure successful complete denture therapy.     

Vertical dimension measurements

Changes in the vertical dimension of mandibular rest position for 50 subjects wearing complete dentures were measured on cephalometric radiographs between lead markers attached to the face and between skeletal landmarks. Measurements between the landmarks were compared on radiographs made without (edentulous) and with (edentoprosthetic) the dentures in the mouth. The findings support the following statements. The facial structures tended to mask the positional changes of the mandible. The rest position of the edentulous mandible tended to vary within the time frame of the cephalometric examination. The range of measurements of the skeletal rest position appeared greater with greater denture age and experience of the subjects. The rest position of the edentoprosthetic mandible (with dentures in the mouth) was more frequently constant when measured skeletally than when measured facially and more frequently constant than the edentulous mandibular rest position. The edentulous mandibular rest position of most subjects was increased upon insertion of dentures. The rest position was decreased for the remainder of the subjects. As a group, those subjects whose mandibular rest position decreased (up-shifted) with insertion of dentures had older dentures and more years of denture-wearing experience than subjects whose mandibular rest position increased (down-shifted) with insertion of dentures. The edentulous mandibular rest position does not seem particularly suitable for determination of the vertical dimension of occlusion and appears somewhat less suitable when facial measurements are used.     

Changes in the mandibular angle in the dentulous and edentulous states

Statement of problem. Reliable measurement of individual gonial angles is difficult because of the superimposed images appearing on the lateral cephalograms. However, this disadvantage is not encountered in orthopantomography. Purpose. This study determined whether the mean measurements of the mandibular angles of a group of totally edentulous patients were greater than those of unilaterally and posteriorly partially edentulous patients. Changes in the gonial angle between denture wearers and nondenture wearers in each group were also compared. Material and methods. A total of 134 panelipse radiographs were used for measurements of mandibular angles. All radiographs used in this study were taken with the same panelipse machine by the same person. Of the 134 radiographs, 49 were of unilaterally and posteriorly partially edentulous adults and 85 were of totally edentulous adults. Results. No significant differences were found between the mandibular angles when comparing partially edentulous and totally edentulous subjects. Conclusion. Within the limits of this study, there was no significant difference between the dentulous and edentulous states. (J Prosthet Dent 1998;80:680-4.)     

Comparison of oral stereognosis in relation to age and the use of complete dentures

The purpose of this study was to examine the age-related difference in oral sensory function by testing oral stereognostic ability (OSA) and to determine the effect of wearing complete dentures on OSA. Subjects were 20 dentate and 30 edentulous elderly patients free from oral symptoms and pathologies, and 30 younger dentate students as controls. The OSA tests were conducted with test pieces of 12 shaped forms. The duration time for recognition was noted and the answers were recorded using a three-point scale. anova and paired t-tests were used to examine significant differences. P-values <0.05 were considered to be statistically significant. The OSA score in older dentate participants and complete denture wearers was significantly higher than in younger dentate subjects. However, no significant difference was found in the OSA score between older dentate participants and complete denture wearers. When older edentulous subjects removed the maxillary and mandible complete dentures, the OSA score was significantly lower and the response time significantly longer than with dentures. Within the limitations of this study, an age-related difference in oral sensory function, as measured by OSA tests, was found. However, oral sensory function was not significantly different between fully dentate persons and complete denture wearers in the elderly.     

Effect of complete denture wearing on deglutition time: a cine-magnetic resonance imaging study

Purpose of the study was to evaluate the effect of complete denture wearing on deglutition time (DT), hyoid bone and larynx movements in edentulous patients with real-time balanced turbo field echo cine-magnetic resonance imaging. Subjects were examined by cine-magnetic resonance imaging in supine position during swallowing water. Two sets of images for 23 edentulous (with/without wearing complete dentures) and one for 23 dentulous patients were obtained. Radiographic outputs representing three consecutive deglutition stages (oral, pharyngeal and oesophageal) were provided to perform measurements. Deglutition time significantly increased when edentulous patients wore their dentures (mean 0·75 s increased to 1·17 s), whereas dentulous patients' DT was about 0·91 s (P ≤ 0.05). The duration of deglutition is crucial because prolonged pharyngeal transit times increases the risk of aspiration. Within the limitations of the study, complete denture wearing could increase the shortened DT of the edentulous patients.     

Milk and vegetables in the diet of institutionalized elderly people in Finland

More than 95% of the institutionalized elderly subjects drank milk, and more than 50% ate raw vegetables one or more times a day. There were no statistical differences between the frequencies of men and women, and the mean frequency index for age groups 65 to 74, 75 to 84, and ≧ 85 years was the same for milk throughout. For vegetables, the mean value rose slightly toward the older age groups. More than half of the edentulous denture wearers and of the dentulous subjects ate raw vegetables every day, while only 38% of the edentulous without dentures did. The availability of vegetables alone is not enough; the intake of these vegetables must be actively encouraged.     

松软牙槽嵴无牙颌的全口义齿修复

目的 探讨松软牙槽嵴无牙颌的全口义齿修复要点.方法 选择松软牙槽嵴无牙颌患者31例.修复前询问患者义齿使用习惯,检查口腔及旧义齿情况,进行必要的修复前手术,择期重新修复.在修复后6个月、1年、2年后复查,根据病历记录检查患者口腔和义齿情况是否有改变.结果 义齿修复后的2年中,牙槽嵴的松软范围没有明显扩大,义齿使用效果良好.结论 伴有松软牙槽嵴的无牙颌全口义齿修复时,应该注重印模的准确性、前牙与牙槽嵴顶的位置、前牙的覆(牙合)与覆盖,指导患者正确使用义齿并定期复查,可取得良好治疗效果.     

Impacts of wearing complete dentures on bolus transport during feeding in elderly edentulous

Prosthetic treatment with dentures is often required for the elderly who have reduced swallowing function. Therefore, it is important to understand the relationship between denture‐wearing and feeding function from the perspective of swallowing. To clarify changes in bolus transport during feeding in elderly edentulous patients with or without complete dentures. Subjects were 15 elderly edentulous volunteers who were treated with maxillary and mandibular complete dentures. The test food was 10 g of minced agar jelly containing barium sulphate with a particle diameter of 4·0–5·6 mm. Lateral videofluoroscopy was performed to assess the position of the leading edge of the bolus, the bolus volume in each area at swallow onset, bolus transit time and the mandibular position during pharyngeal swallowing. There were significant changes between the bolus transport with and without dentures. Without dentures, the leading edge of the bolus at swallow onset fell from the valleculae area to the hypopharynx, and the bolus volume in the hypopharynx increased. Bolus transit time increased in the oral cavity, valleculae and hypopharynx. The mandibular position shifted anterosuperior direction. The results arose owing to anatomical changes in the oral and pharyngeal structure and the following functional changes: poor food manipulation, poor bolus formation and delayed swallowing reflex. Removing dentures in elderly edentulous individuals influences bolus transport during feeding, resulting in the exacerbation of the reduced swallowing reserve capacity that accompanies ageing, and may increase the risk of dysphagia.     

Comparative Evaluation of Maxillary and Mandibular Anterior Teeth Width with the Length of Index and Little Finger

The size, color, morphology and arrangement of the anterior tooth are the various factors play an imperative role in achieving excellent esthetics in complete denture. Various modalities have been suggested for selecting the size of the anterior teeth like inter-alar distance, inter-canthal distance, bi-zygomatic width, intercanine width. There is no reliable method for selection of anterior teeth etc. To evaluate and compare the width of the maxillary and mandibular anterior teeth with the length of the index and little fingers. total of 50 people were taken for this study. They are grouped into four, Group I, 15–20 years; Group II, 20–30 years; Group III, 30–40 years; Group IV, 40–50 years. Irreversible hydrocolloid impressions of the maxilla and mandible were made and poured with dental stone. The widths of the maxillary and mandibular anterior teeth were measured with an adaptable ruler. The length of the index and little fingers were measured using a vernier caliper. There is significant correlation between the maxillary and mandibular anterior teeth with the index and little finger length. Conclusion: The maxillary anterior teeth width can be calculated with the formula (1.130 × index finger length − 11.972), mandibular anterior teeth width can be calculated with the formula (1.006 × little finger length − 2.231).     

The role of personality in the management of partial dentures

A sample of fifty-three partially dentate subjects who had had partial dentures provided in the last 3 years completed a personality questionnaire (Cattell's 16 PFQ). At the same time they completed a clinical questionnaire and were examined by two of the authors. The purpose of this was to assess the patients' satisfaction with their partial dentures. The results of the personality questionnaire showed that this group of partial denture wearers differed from the general population on only two factors. They were less intelligent and more self-sufficient. Interestingly they differed from a similar group of complete denture wearers on a further three factors. The partial denture group were more self-assured, self-sufficient and more relaxed. On the basis of the clinical questionnaire and examination, five partially dentate patients were found to be dissatisfied. Their personality scores were significantly more unstable than the satisfied group of partial denture wearers. Although based on a relatively small group, the results do suggest that personality may have a marked effect on the patients' adaption to partial dentures. When compared to a similar group of edentulous patients, marked differences were found, suggesting that the loss of the natural teeth in some individuals affects behaviour.     

无牙颌患者自然头位的研究

目的：了解无牙颌患者相对于有牙个体自然头位（natural head posture,NHP)的差异，以及义齿戴入即刻和戴用后短期NHP的变化。方法；分别选取20例无牙颌患者和22名有牙对照组个体，采用视线标记的头颅定位侧位片记录NHP。无牙颌患者拍摄义齿戴前、义齿戴入即刻和戴用3个月后3张X线片。有对照组拍摄一张X线片。选取6项角度测量值评价NHP，3项角度测量值和2项线距测量值评价下颌骨的位置。比较无牙颌患者义齿戴前与牙对照组上述指标的差异，以及义齿戴入即刻和戴用3个月后的变化。下颌骨垂向明显上移（P＜0．05）。义齿戴入即刻，颈椎曲度显著增高（P＜0．05）。义齿戴用3个月后，颅颈角显著减小（P＜0．05）。结论：无牙颌患者在义齿戴入即刻和戴入后短期，自然头位出现一定程度的改变；与不戴义齿的头位相比较，调整至一个新的更接近正常的平衡状态。     

Kinesiographic study of deglutition in dentate individuals and complete denture wearers

Swallowing is used as a clinical method in prosthodontics to determine and record jaw relationships. The aim of this study was to perform a quantitative evaluation, in naturally dentate subjects and complete denture wearers, of three measurements associated with the mandibular position during the act of swallowing water: 1. intermaxillary distance on vertical axis; 2. anteroposterior deviation; and 3. lateral deviation. Two groups were selected: Group I (GI) included 40 subjects with complete dentition (mean age 45.27 yrs) and Group II (GII) included 40 bimaxillary edentate subjects, complete denture wearers (mean age 63.92 yrs). A kinesiographic instrument was used for analysis. Three records were taken for each measurement and a mean value obtained. It was concluded that: 1. intermaxillary distance on vertical axis and horizontal deviation were similar for both groups; 2. there was a significant intermaxillary distance on the vertical axis; and 3. for anteroposterior and lateral axis, results showed moderate deviation in relation to maximal intercuspation (MI).     

Effects of tooth loss and denture wear on tongue‐tip motion in elderly dentulous and edentulous people

Summary The purpose of this study was to clarify quantitatively the differences in tongue‐tip motion among the dentulous elderly people and also among the elderly edentulous, both with and without their dentures and, to identify the influence of tooth loss and denture wear on tongue‐tip motion. Fourteen young dentulous people, 12 elderly dentulous people and 13 elderly edentulous people participated in this study. Subjects were asked to swallow a 10 mL barium sulfate solution three times. The elderly edentulous people were asked to swallow the solution while wearing dentures and with dentures removed. Functional swallowing was recorded on cine‐film with a digital subtraction angiography system. Lateral cinefluorography images were obtained from seated subjects. Using a cine‐projector, the movements of the tongue surface were traced as dots and lines frame by frame on a single tracing sheet within a definite period of time from the beginning of the oral phase to the end of the pharyngeal phase. With counting the number of ‘trajectories’ of tongue‐tip motion, tongue movements were classified as ‘stable’ and ‘hyperactive’ types. The results was that significantly more ‘hyperactive’ type subjects were found among the elderly edentulous who were not wearing dentures (12 of 13) compared with the dentulous young (1 of 14), the elderly dentulous (1 of 13) or the elderly edentulous wearing dentures (1 of 13) (P < 0.001). The tongue‐tip motion for the ‘hyperactive’ type was very complex and the tongue‐tip anchoring against the palate was always instable.     

Frequency and location of traumatic ulcerations following placement of complete dentures

PURPOSE: To determine the location of mucosal injuries that appear following placement of complete dentures, as well as the number of adjustments necessary to achieve patient comfort. The frequency of mucosal injuries in female and male patients and their connection with clinical anatomic features were also investigated. MATERIALS AND METHODS: Sixty-one completely edentulous healthy patients who wore dentures (47 women and 14 men) took part in the study; 122 newly fabricated complete maxillary and mandibular dentures were investigated. All patients were seen for a 1-week adjustment appointment. Areas where signs of denture-induced mucosal injuries appeared were marked on an anatomic illustration. The follow-up period was in 1-week increments as deemed necessary by the patient. Associations between variables were analyzed with analysis of variance. Results were recorded as mean + SD. Statistical significance was set at P < or = .05. RESULTS: Eighty-seven percent of the dentures required adjustment at week 1, 50% at week 2, and only 7% at week 3. No patients required a further visit. Most frequently injured maxillary areas were the vestibular sulcus (41%), maxillary tuberosity (21%), and hamular notch (12%). In the mandible, the most frequently injured areas were the retromylohyoid area (17%), lingual sulcus (14%), and vestibular sulcus (13%). Denture-induced irritations were detected in a higher ratio in the mandible (P < .001), especially in male denture wearers at the first adjustment (P < .05). Men had a higher ratio of lesions at the region of the maxillary vestibular sulcus between the labial and buccal frenum and at the mandibular vestibular sulcus of the buccal shelf region (P < .001). CONCLUSIONS: Denture-induced irritations appeared most often in the vestibular sulcus of the maxilla and mandible, indicating that it is necessary to evaluate the area of the facial seal of the prosthesis by applying a medium- or a heavy-pressure indicator paste to the borders, and to make adjustments at the delivery stage and subsequent adjustment appointments. Denture placement must not be the final patient-clinician encounter when treating with complete dentures. Denture adjustments are very important clinical phases of denture fabrication and essential in patient care.     

Tooth loss, denture wearing and oral health-related quality of life in elderly Chinese people

OBJECTIVES: To investigate the relationship between tooth loss, denture wearing and oral health-related quality of life (OHQoL) among community-dwelling elderly people in Hong Kong. METHODS: A questionnaire study of elderly people aged 60-80 years who were recruited at neighborhood social centres for the elderly. The Chinese version of the General Oral Health Assessment Index (GOHAI) was used and information about natural tooth number and denture wearing were obtained. RESULTS: 233 elderly subjects were recruited and interviewed. Around 20% of the partially dentate subjects had their last tooth loss within the previous year and a quarter within the last five years. Significantly fewer edentulous subjects had their last tooth loss within the previous year (3%) and within the last five years (12%, p < 0.001). Twenty two percent of the subjects had difficulty in accepting tooth loss. More edentulous subjects (69%) were satisfied with their dentures than partially dentate denture wearers (37%, p < 0.001). Edentulous elderly subjects had a higher mean GOHAI score (53.0) than partially dentate denture wearers (49.1, p < 0.001). Results from a multiple factor ANOVA revealed that elderly subjects who had loose teeth, difficulty in accepting tooth loss and were not satisfied with their removable dentures had a lower mean GOHAI score. CONCLUSIONS: In general, tooth loss and denture wearing did not have a major impact on OHQoL in elderly Chinese people. However, partially dentate denture wearers experienced a greater adverse impact on OHQoL than edentulous subjects most probably due to less satisfaction with their dentures and discomfort associated with loose teeth.     

Tooth spaces in and prosthetic treatment received by the middle-aged and the elderly in Hong Kong

Abstract The purpose of this study was to describe the state of the dentition of middle-aged and elderly Chinese in Hong Kong in terms of teeth present, tooth spaces, and prosthetic treatment received. In an oral health survey conducted in 1991 in Hong Kong, a sample of 372 35–44-yr-olds and 537 noninstitutionalized 65–74-yr-olds was interviewed and clinically examined. In all dentate subjects, each tooth was scored for the presence/absence of that tooth, a tooth space of 5.5 mm which had not been treated, or the presence of a denture or pontic replacing that tooth. Each denture was assessed according to a set of criteria. None of the 35–44-yr-olds were edentulous and the mean number of teeth present was 27.5. About 40% of the third molars and about 35% of the mandibular first molars were missing. For only 1% of the missing teeth had space closure resulted in missing teeth not being recorded as tooth spaces or treated tooth spaces. Overall, 72% of the 35–44-yr-olds had no prosthesis. 17% had a bridge or bridges, 12% had a denture or dentures, and 1% had both. Of the 65–74-yr-olds, 12% were edentulous, and the dentate subjects had a mean number of 17 teeth present. About 70% of the molars were missing. Overall, only 29% of the elderly had no prosthesis, 52% had a denture or dentures, 33% had a bridge or bridges, and 13% had both. Only 35% and 28%, respectively, of the middle-aged and elderly denture wearers had no complaint about their dentures. There were more assessed problems in the dentures of the elderly than in those of the younger adults, over one-third of the partial dentures and half of the mandibular complete dentures being unstable and unretentive.