Comparison of treatment outcomes and time efficiency between a digital complete denture and conventional complete denture: A pilot study

BackgroundThe authors of this study aimed to compare the treatment outcomes and time efficiency between digital and conventional complete denture restorations and propose suggestions for clinical use.MethodsThe authors used digital (functionally suitable digital complete denture [FSD]) and conventional complete denture restorations to make 2 dentures each for 10 edentulous patients. All the operations of both techniques before denture delivery were completed in the first 4 visits, and then 2 dentures were delivered successively for the patients. The clinical and laboratory times were recorded to evaluate the time efficiency; treatment outcomes were evaluated via scoring the denture satisfaction of the dentist and patients in a double-blind manner.ResultsThe satisfaction scores of FSDs (7.6-9.6 [dentist's scores], 8.4-10 [patients' scores]) were higher than those of conventional dentures (7.2-9.7 [dentist's score], 7.4-9.8 [patients' scores]), but there were no significant differences. The clinical and laboratory operation times of the FSD group were less than those of the conventional group, saving an average of 28.0 minutes and 64.3 minutes in the clinic and laboratory, respectively.ConclusionsFSD technology can improve the efficiency of clinical and laboratory operations and shorten the manufacturing cycle of dentures. The occlusion stability of FSDs was statistically better than that of traditional dentures, but there was no statistical difference in other clinical indicators.Practical ImplicationsFSD technology is low cost and easy to operate and has several applications. Compared with conventional complete denture restoration technology, FSDs can save time and have a comparable clinical effect.This clinical trial was registered at the Chinese Clinical Trial Registry. The registration number is ChiCTR1900021722.     

Time and methods used for complete denture construction in dental students and general dental practitioners in Great Britain in 1972.

A survey was conducted to assess whether there were any differences in the clinical methods employed in constructing full dentures by dentists and final year dental students.Students at twelve British dental schools and dentists who graduated between 1956 and 1970 were surveyed. Students took about $\text{4}\text{1}\text{2}$ hours spaced over 5–6 visits whilst dentists took 68·4 minutes over 4 appointments to complete a set of dentures. Over 90 per cent of dentists did a preliminary examination, one impression, adjustment of bite, try-in and final fit for 90 per cent or more of their full denture cases. Only 47·8 per cent generally took preliminary impressions and 30·4 per cent usually did border moulding. Facebows and gothic arch tracings were not frequently carried out by dentists. A small number of dentists appeared to allow their technicians to do procedures in the mouth. Students generally did all steps in denture construction and had to do the laboratory work in at least one case. They had to complete 3 cases at one dental school and as many as 20 at another.Twenty-two per cent of dentists said that of all their undergraduate subjects, they were best prepared in full denture construction by their dental undergraduate course; less than 5 per cent of students had that opinion. The majority of dentists and students would like the same amount of instruction in full dentures (75 per cent of dentists and 70 per cent of students); only 6·6 per cent of dentists wanted less teaching in the subject.There were differences between the time taken and number of stages employed by students and practitioners. If teachers are convinced of the usefulness of the procedures that they teach they should teach them with greater conviction.     

Rehabilitation for a scleroderma patient with severe microstomia using digital and conventional methods

BackgroundMicrostomia is a principal clinical symptom in patients with scleroderma. It is characterized by an abnormally small mouth opening, which makes traditional prosthetic rehabilitation difficult.MethodsFirst, the primary impression and jaw relation record were acquired using an intraoral scanning technique and the primary diagnostic dentures were fabricated using 3-dimensional printing (3DP). The definitive impression and jaw relation were obtained and digitally scanned. The second diagnostic denture was also made to confirm the esthetic and occlusal effects. Next, the adjusted dentition parts were scanned and milled from a cross-linked polymethyl methacrylate disk. In addition, the titanium alloy frameworks were also fabricated using 3DP. With flasking, the milled dentition parts were inserted and the definitive dentures were finally fabricated and delivered to the patient.ResultsThe authors constructed the definitive removable partial dentures successfully using the digital methods of intraoral scanning, computer-aided design, and 3DP.Conclusions and Practical ImplicationsThese digital methods provide an alternative option for prosthetic rehabilitation in scleroderma patients with severe microstomia.     

An expedited technique for remaking a single complete denture for an edentulous patient

Traditional techniques for fabricating complete dentures commonly require 5 visits. Reduction of the number of visits and chair time for complete denture fabrication would be welcomed by dentists and patients. This article describes and illustrates clinical and laboratory procedures for fabricating a new denture for a patient with an existing complete denture. The procedure can be completed in 3 to 4 visits.     

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.     

A cross-over Randomised Controlled Trial of selective pressure impressions for lower complete dentures

Objectives

The objective of the research was to assess patient preference for a selective pressure impression technique for complete dentures by means of a Randomised Controlled Clinical Trial (RCT).

Methods

A literature review revealed no reported RCT's of selective pressure impressions for complete dentures. A cross-over, randomised, controlled, clinical trial was performed comparing selective pressure impressions with a placebo and an alternative method of re-distributing pressure. A sample size calculation yielded 65 patients. Sixty-nine patients, who had a superficial mental foramen on the lower denture bearing area, were recruited for the study. The primary outcome was the patients’ preference of the dentures provided. The hypothesis under investigation was that one of the dentures would be preferred by the patients.

Results

Sixty-six participants completed the trial, 33 (50%) preferred the denture from the selective pressure impression, 19 (29%) the denture with traditional pressure relief, and 14 (21%) the placebo control. 95% confidence intervals showed that the preference for the selective pressure impression was greater than that of the other two techniques. The null hypothesis was rejected.

Conclusions

The participants in this trial showed a preference for the denture constructed from the selective pressure impression technique, providing dentists with useful evidence for a clinical impression technique.     

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??Objective    To compare the clinical effect of modified silicone rubber impression technology with that of traditional alginate impression technology in complete denture. Methods    Twenty-three complete dentures by modified silicone impression technology and twenty-three complete dentures by traditional alginate impression technology were separately made. Sore spots were measured in situ respectively. Results    The number of sore spots in modified silicone impression technology dentures were less than those in traditional ones. Conclusion    Modified silicone impression technology can improve comfort of complete denture.     

全口义齿修复中改良硅橡胶印模法临床应用研究

目的    比较应用改良硅橡胶印模法与传统藻酸盐印模法制作全口义齿的临床效果。方法    选择2010年7月至2015年7月就诊于福建医科大学附属泉州第一医院口腔科要求制作全口义齿修复患者46例,随机分为2组,分别采用改良硅橡胶印模法和传统藻酸盐印模法制作全口义齿,于试戴1周后记录压痛点数量,比较其舒适度。结果    改良硅橡胶印模法制作的全口义齿压痛点数量较少（P < 0.05）。结论    改良硅橡胶印模法可增加全口义齿的舒适度。     

What is the evidence base for the efficacies of different complete denture impression procedures? A critical review

ObjectivesMany procedures used in prosthodontics, including the materials and methods used for complete denture impressions, lack support of good evidence. The aims were to systematically, and critically, review the literature on complete denture impression materials and methods to identify an impression procedure that can be considered expedient for achieving a satisfactory clinical outcome for complete denture wearers.Data and sourcesMEDLINE/PubMed and the Cochrane Library were searched for studies on impression procedures used in the clinical fabrication of complete dentures. The search focused on best available evidence with respect to clinical outcome.Study selectionPubMed listed 1201 titles for the combination terms of complete denture and impression. Five relevant randomized controlled trials were identified. No review of complete denture impressions was found in the Cochrane Library.ResultsTwo-step procedures for complete denture impressions dominate all textbooks, teaching and specialist practice, despite an absence of convincing evidence of its superiority. No controlled studies supporting the use of border moulding, post-dam, and functional and mucostatic impressions, were identified. Two studies showed that a one-step method using alginate in a stock tray offers a similar clinical result to more complicated, expensive and time-consuming two-step material and technique combinations.ConclusionsThere was no support for the frequent textbook statement that the two-step procedure is necessary and superior to the one-step method. While some special clinical situations may benefit from other combinations of materials and techniques, the results suggest that the simple and inexpensive one-step procedure can serve the needs of the majority of edentulous patients.Clinical significanceIn spite of the fact that two-step procedures for complete denture impressions dominate textbooks, teaching and specialist practice, the results of this review suggest that a simple and inexpensive one-step procedure can serve the needs of the majority of edentulous patients.     

Functional impression and jaw registration: a single session procedure for the construction of complete dentures

The conventional fabrication of complete dentures involves two separate clinical sessions for functional impression making and jaw registration. The presented method combines both procedures in one session. The aim of this study was to survey the three-dimensional tooth positions in complete dentures with reference to the ridges to establish arbitrary guideline values that could be used for the manufacturing of tooth-position analogue plastic rims on functional impression trays. New complete dentures were fabricated by supervised undergraduate students in the conventional manner for 104 edentulous patients. The position of the maxillary teeth was surveyed in the horizontal plane using the Schmuth 'vizor-measuring plate'. The vertical dimension of occlusion, represented as the distance between opposing ridge areas of the dentures in maximum intercuspation, was measured at different sites by means of a Gutowski gauge. The tooth positions on the dentures varied widely, e.g. the horizontal distances between the incisive papilla and the maxillary incisors was 7.1 +/- 2.3 (3-14) mm. The vertical dimension of occlusion, which is most important in the jaw registration, varied equally with an anterior inter-alveolar distance between 12 and 33 (20.4 +/- 4.0) mm. Arbitrary moulding of the tooth position-analogue plastic rims does not seems to be an ideal method of pre-shaping functional impression trays, because the individual anatomical variation is considerable. Alternatively, the horizontal and vertical tooth positions of functionally and aesthetically pleasing dentures should be measured to pre-shape the rims of functional impression trays in the maxillary and the mandibular jaw. Such trays are a valuable tool for functional impressions and an immediate preliminary jaw registration in the fabrication of new complete dentures. This method allows a first try-in of the full set-up in the third clinical visit without loosing precision.     

Microstomia in a maxillectomy patient: A prosthetic challenge

The provision of a satisfactory denture in case of reduced stomal inlet has always been a trouble for the patient and a challenge to the prosthodontist. Fabrication of complete and removable partial denture prosthesis requires accurate diagnostic impression and diagnostic casts for the development of custom trays and final impression. The decreased mouth opening, technically called "Microstomia," poses problems in tray selection, impression making, jaw records and denture insertion. The causes for microstomia are numerous, one major cause being the after-effect of radiation therapy. Whatever the cause, the ability to make impressions and jaw records becomes taxing. A variety of impression techniques using modifications in the nature of the tray and impression materials are required. The present case report highlights an innovative and different aspect of impression making and fabrication of an obturator prosthesis for a microstomic patient who underwent maxillectomy.     

精细印模法增强下颌全口义齿吸附作用的临床调查

目的:调查精细印模法增强下颌全口义齿吸附作用的临床效果.方法:对30名无牙颌下颌牙槽嵴条件较差患者用精细印模法和传统印模法取印模,并制作完成全口义齿.义齿戴入3个月后对下颌全口义齿固位功能、黏膜情况,舒适性、咀嚼功能、食物嵌塞等内容进行临床调查.结果:两种印模法完成的下颌全口义齿在舒适程度、黏膜情况、食物嵌塞方面无显著...     

A retrospective comparison of two definitive impression techniques and their associated postinsertion adjustments in complete denture prosthodontics

PURPOSE: To compare the number of postinsertion adjustment visits required by edentulous patients whose dentures were made from border-molded definitive impressions using modeling plastic impression compound (traditional technique) with patients whose dentures were made from border-molded definitive impressions using heavy-body vinyl polysiloxane impression material. MATERIALS AND METHODS: In this retrospective clinical study, 78 patients were treated with the traditional technique (custom impression trays border molded with gray modeling plastic impression compound) and 78 were treated with the modified technique (custom impression trays border molded with heavy-body vinyl polysiloxane impression material). In both techniques, definitive wash impressions were made with light-body vinyl polysiloxane impression material. Postinsertion visits were quantified for 1 year after the dentures were inserted. RESULTS: The average number of adjustment visits for patients treated with the traditional technique was 2.68. The average number of adjustment visits for patients treated with the modified technique was 2.68. The data were compared using Student t tests. There was no significant difference in the number of adjustments required for patients whose dentures were made with either technique (t = 0.000, p = 1.00). There was no significant difference in the number of post-insertion visits required by patients from either population. CONCLUSIONS: Within the limitations of this clinical study, border-molding custom denture impression trays with vinyl polysiloxane impression material provided similar results in terms of postinsertion visits for one year as compared to dentures made from impressions border molded with modeling plastic impression compound.     

Part‐Digitizing System of Impression and Interocclusal Record for Complete Denture Fabrication

Few studies have reported the application of digital technology to removable dentures, particularly for the process of impression and interocclusal recording for complete denture fabrication. This article describes a part‐digitizing system of impression and interocclusal records for complete denture fabrication. The denture foundation area in an edentulous mouth, including the border areas and residual ridge, is outlined by tracing the surfaces with a 3‐D pen‐type digitizer. Specialized trays for final impressions and interocclusal records were generated using computer‐aided design and manufactured using the digital data. Final impression and interocclusal records were carried out using these specialized trays. The computer‐aided method using preliminary digital impressions and specialized trays would be feasible for clinical use for complete denture fabrication.     

生物功能性修复系统应用于下颌低平牙槽嵴的修复效果初探

目的 比较生物功能性修复系统(Bio-functionnal Prothetic System,BPS)和传统方法对下颌低平牙槽嵴修复效果的影响.方法 选择10例口颌系统基本正常,下颌牙槽嵴重度吸收的无牙颌患者,分别采用BPS和传统方法进行全口义齿修复,随机选择戴用顺序,在修复后1、3、6个月后分别对义齿的固位力、咀嚼效能进行测定,并在戴用义齿1个月时进行满意度问卷调查.结果 在修复后1、3、6个月,BPS全口义齿的下颌义齿固位力高于传统全口义齿,差异具有统计学意义(P<0.05);2种全口义齿吸光度值作比较,在各个检测时期,BPS组吸光度值保持稳定,均高于传统全口义齿(P<0.05),传统全口义齿在3个月和6个月后吸光度值有所回升,与第1个月相比具有统计学意义,但仍低于同时期的BPS组(P<0.05);问卷调查显示,BPS组的主观满意度明显高于传统组;6个月后,10位患者均表示BPS全口义齿更舒适,不容易脱落.结论 采用BPS完成的义齿修复应用于下颌低平牙槽嵴的无牙颌患者时,能取得更好的修复效果.     

Comparison of patients' appreciation of 500 complete dentures and clinical assessment of quality

To compare patients' appreciation and clinical assessment of quality of complete dentures 500 patients attending a dental teaching hospital for provision of new complete dentures were recruited. In each case denture quality was assessed by an experienced prosthodontist using a validated classification of aspects of denture quality. Patients graded their appreciation of features of the dentures on a four point scale. Multiple correspondence analysis demonstrated close correspondence between dentist and patient appreciation of dentures when the dentures were rated as poor, but little or no correspondence when dentists or patients rated the dentures highly.     

全口义齿数字化技术分析

全口义齿是口腔修复中最为复杂的一类修复体,在完成过程中临床医生和技师都需要较多的临床操作步骤和较高的技术要求。随着全球社会的老龄化,无牙颌患者仍占据相对较高的数量。数字化技术如何在全口义齿全流程中发挥作用,成为口腔科研和临床应用的热点。笔者根据文献学习和自主研发数字化全口义齿的体会,谈谈对数字化全口义齿技术的认识和分析,并就患者就诊次数、医生端技术特点(初印模、终印模、颌位关系、试戴、初戴等)、技师端技术特点,以及数字化全口义齿的发展趋势进行讨论。     

Evaluation of the use of and attitudes towards a face-bow in complete denture fabrication: a pilot questionnaire investigation in Chinese prosthodontists

Summary  The aim of this study was to assess the use of and attitudes towards a face-bow among Chinese prosthodontists in complete denture fabrication. Thirty-six prosthodontists in two dental hospitals affiliated separately to two of the top four dental schools in China were included. A questionnaire was sent to them with 18 questions covering the following four aspects: (i) the education and experience background of the prosthodontists, (ii) their impression of the quality of the dentures, (iii) the use of and attitudes towards a face-bow in complete denture fabrication and (iv) their understanding of jaw relationship and occlusal adjustment in complete denture fabrication. Most (97%) experienced Chinese prosthodontists seldom used a face-bow in complete denture fabrication. Although they (92%) believed that more than 90% of their edentulous patients were satisfied with the complete dentures, 39% of them thought that not using a face-bow might lower the quality of complete dentures and 94% believed that there was a difference between the quality of dentures fabricated with an adjustable articulator and those made with a simple articulator. Among the 36 prosthodontists, 75% often and 8% occasionally did the occlusal adjustment when giving the newly made dentures to their patients. The great majority of prosthodontists in two of top four Chinese dental hospitals, who believed most of their patients satisfied with their complete dentures, seldom used a face-bow. Occlusal adjustment may be helpful to eliminate the possible errors caused by not using a face-bow.     

Fabrication of complete dentures in three visits using existing prosthesis—a simplified technique for geriatric patients

Complete edentulism often limits patients’ ability to masticate and perform other oral functions, resulting in a reduction of oral‐health‐related quality of life. Although the two‐implant mandibular overdenture may be considered as a minimum standard of treatment of complete edentulism, patients often prefer conventional complete dentures due to cost and surgical procedures related to implant supported dentures. Many complete denture patients may have limited access to dental care due to socioeconomic or health issues, hence there is a need in simplification of complete denture fabrication. Researchers have proposed “simplified” techniques to fabricate complete dentures by eliminating two stage impression procedures facebow transfer, and articulator programming, with impressive initial results. However, long‐term clinical data of these techniques is unavailable. A novel technique for fabricating simplified complete dentures in three visits, using patient's existing dentures is presented here. Unlike previously described techniques on “simplified” dentures, this technique does not eliminate vital steps such as border‐molded impressions, facebow transfer, verification of centric relations during try‐in, programming of the articulator, and balancing procedures.     

Do better qualified dentists make fewer hospital referrals?

OBJECTIVE: To assess the influence of further qualifications and length of clinical experience on the number of referrals of complete denture problems made by GDPs to secondary care. DESIGN: An audit was made of complete denture referrals to Sheffield Dental Hospital between January 1997 and June 1999. METHOD: All complete denture referrals (n=257), either single complete denture or 2 complete dentures, made by locally practising NHS registered dentists (n=211) to Sheffield Dental Hospital, were recorded, along with the year of qualification and any additional clinical qualifications of referring practitioner. RESULTS: Fewer referrals were made by better qualified dentists (p=0.003). Better qualified dentists also appeared willing to treat more difficult cases. In the absence of a further clinical qualification, length of clinical experience had no effect on the number of referrals made. CONCLUSIONS: Better qualified dentists make fewer complete denture referrals, emphasising the importance of continuing education in reducing referral rates and improving patient service.