Oral rehabilitation of severely worn dentition using an overlay for immediate re-establishment of occlusal vertical dimension

The aim of this study was to describe the treatment used in an elderly patient presenting with bruxism and dental erosion, with good gingival health and bone support, but with decreased occlusal vertical dimension (OVD). The oral rehabilitation of elderly patients presenting with bruxism in association with tooth erosion has been a great challenge for dentists. The loss of OVD, the presence of occlusal instability and the absence of an effective anterior guide due excessive dental wear, can damage stomatognathic system (SS) biology, the function and the aesthetics. In the first treatment stage, an overlay removable partial denture (ORPD) was fabricated for the immediate re-establishment of function and aesthetics. After a 2-month follow up, with the patient presenting no symptoms, a second rehabilitation stage was accomplished, with fixed and removable prostheses. Oral rehabilitation with an ORPD was able to re-establish the SS biology, but a correct diagnosis and treatment plan are essential for success. The ORPD is a non-invasive and reversible restoring modality for general dentists that allow the re-establishment of the patient's immediate aesthetics and function at low cost.     

Biometric ratio in estimating widths of maxillary anterior teeth derived after correlating anthropometric measurements with dental measurements

doi: 10.1111/j.1741‐2358.2012.00648.x Biometric ratio in estimating widths of maxillary anterior teeth derived after correlating anthropometric measurements with dental measurements Objective: To correlate dental measurements i.e. combined mesiodistal width of six maxillary anterior teeth with facial measurements i.e. inner canthal distance, interpupillary distance and intercommissural width and acquire a biometric ratio to serve as a preliminary guide in selection of the maxillary anterior teeth. Background: In the absence of pre‐extraction records, the resultant denture can lead to patient dissatisfaction towards the aesthetic appeal of their dentures. The maxillary anterior teeth play a pivotal role in denture aesthetics. Various techniques and biometric ratios have been described in literature for selection of the maxillary anteriors. This study derives a biometric ratio for the same, obtained after correlating anthropometric measurements with dental measurements. Materials and methods: Two standardized digital photographs of the face were generated; one, when the facial muscles were relaxed and the other, when the subject was smiling; thereby, revealing the maxillary anterior teeth upto the canine tip. Inner canthal distance, interpupillary distance, intercommissural distance, distance between the tips of the maxillary canines and distance between the distal surfaces of the canines were measured. On the cast, the distance between tips of maxillary canines and distance between distal surfaces of maxillary canines were noted. The data was analysed using Spearman’s rank correlation coefficient. Results: A high correlation was found between the intercommissural measurement with distance between the tips of the canines on the photograph and between the tips of the canines on the cast with the interpupillary distance, giving a biometric ratio of 1:1.35 and 1:1.41 respectively. The least correlation was between the inner canthal distance and the tips of the canines measured on the photograph. Conclusions: Extra oral anthropometric measurements of the interpupillary distances and the intercommissural distances with the help of standardised photographs can help us determine the combined widths of the anterior teeth accurately, thus aiding their selection in the absence of pre‐extraction records.     

Direct restorative treatment of anterior weared teeth after re‐establishment of occlusal vertical dimension: a case report

doi: 10.1111/j.1741‐2358.2012.00630.x Direct restorative treatment of anterior weared teeth after re‐establishment of occlusal vertical dimension: a case report Objective: The loss of posterior teeth resulting in a lack of stability may lead to excessive mandibular load on some points of occlusion of the remaining teeth, causing wear. The rehabilitation of these cases must be carefully planned and the treatment requires a period of adaptation with a new vertical dimension. Background: This case report describes the treatment of a patient with a loss of almost all posterior inferior teeth and a consequential loss of occlusal vertical dimension and accentuated wear of anterior elements. Materials and methods: Provisional removable partial dentures were manufactured and the patient used them for a period of adaptation prior to restoration of the anterior teeth. After the patient’s adaptation with the new occlusal dimension, anterior restorations were made using a mycrohibrid resin composite with different color aspects for an optimal stratification. Results: The restorations achieved an aesthetic configuration with ideal function as the final result and the occlusion showed a satisfactory stability for a provisional removable partial dentures. Conclusion: This article presents an anterior direct rehabilitation approach not only as an alternative option, but also as viable and less expensive treatment option with an optimally aesthetic and functional result.     

新疆罗布泊小河墓地居民的口腔健康与饮食

小河墓地是新疆罗布泊地区一处重要的早期青铜时代墓地。本文主要对该墓地出土颅骨所附牙齿的磨耗程度及牙结石沉积状况进行了观察、量化统计和分析,同时也对该人群其他的口腔疾病如根尖脓肿、颞下颌关节病变、生前牙齿脱落等做了简单的统计,以期从古病理学的角度获取当时居民的口腔健康、食物类型和饮食习惯等信息。本研究发现:1)小河人群的牙齿磨耗程度远远高于对比组的古代居民,其上腭圆枕及颞下颌关节炎出现率较高,存在牙齿崩裂现象,且其前后部牙齿磨耗差异不大。这一方面说明其食物加工技术比较落后,食物粗糙坚硬;另一方面小河居民的经济生活方式和食物构成都比较复杂,不同的食物对前部和后部牙齿磨耗的程度造成了不同的影响;此外,小河人群风沙肆虐的生活环境也对其严重牙齿磨耗的形成产生了一定影响。2)小河人群异常严重的牙结石沉积归功于其高蛋白质和碳水化合物的饮食,以及生活用水的水质。3)统计分析发现两性存在上、下颌犬齿的磨耗差异,而这一情况可能暗示了在家庭手工业方面存在男女分工的现象。     

Endodontic considerations in the elderly

Tooth retention has increased significantly in older adults, and dentists are now challenged by the need to preserve critical teeth. There will be a need to consider endodontic therapy, and this paper describes how successful endodontics can be provided for elderly patients. Strategic treatment planning is essential, and preservation of key teeth will facilitate satisfactory oral function for elderly patients. These teeth may be important in achieving and maintaining an intact anterior dental arch, for removable partial denture retention or preservation of alveolar bone. In some cases, this can only be achieved if endodontic procedures are undertaken. When infection of a root canal is present, there is no reason why good quality endodontic therapy should not work in a healthy elderly patient. Elimination of infection can be challenging in narrow root canals, and a systematic approach for improving access into and negotiating these canals is outlined.     

The satisfaction with the removable partial denture therapy in the Croatian adult population

Little is known about the outcomes of treatment and patient's satisfaction with removable partial dentures in adult Croatian population. Therefore patient's satisfaction with their partial dentures in relation to some socio-economic variables was studied. Patient's satisfaction with denture retention, speech, aesthetics, comfort of wearing dentures, chewing ability was also studied in relation to different denture classification, construction, material, denture base shape (major connectors), denture support and the number of missing teeth. A total of 165 patients, 59 males and 105 females between 38 and 87 years took part in this study. A questionnaire, devised for a purpose of the study, was divided into three parts. In the first part, patients answered questions about age, gender, marital status, education, general health, socio-economic status, self-supporting life, period of tooth loss and number of previous denture experiences and in the second part, patients graded their partial dentures, depending on the level of satisfaction, by using a scale from 1 to 5. In the third part a dentist determined Kennedy classification and their modifications, denture material and denture support, denture base shape and the number of missing teeth and graded a denture construction. Influence of these factors on patient's satisfaction was analyzed. A majority of the examined patients were satisfied with the partial prosthesis, but a small amount of dissatisfaction existed. More then half of them scored all the examined parameters to the best score category. Considering chewing with lower partial dentures, women were more satisfied than men (p < 0.05). Patients with more missing teeth gave lower grades for the comfort of wearing dentures (p < 0.05). Patients of higher education gave lower grades (p < 0.05) for the aesthetics. Patients were not satisfied with speech if the dentist graded a construction of a lower partial denture low (p < 0.05). Dissatisfaction was related to mastication, aesthetics, number of missing teeth and ability of speech. These findings can aid a clinician in discussing a treatment plan and help a patient understand the risk of dissatisfaction in the presence of certain factors.     

Compressive strains and displacement in a partially dentate lower jaw rehabilitated with two different treatment modalities

doi: 10.1111/j.1741‐2358.2011.00572.x Compressive strains and displacement in a partially dentate lower jaw rehabilitated with two different treatment modalities Background: Understanding of the biomechanical consequences of the stresses generated to the supporting bone during occlusal loading is significant for improving the design and clinical planning process in partial edentulism therapy. Objective: The aim of this study was to analyse the distribution of strain and displacement on the partially dentate lower jaw rehabilitated with an partial denture (RPD) and to compare it to the strain and displacement distribution on a partially dentate lower jaw rehabilitated with a cantilever fixed partial denture (FPD). Material and methods: The experimental models were a partially dentate mandible with full‐arch PFM crowns and RPD and a partially dentate mandible rehabilitated with a full‐arch cantilever FPD. Strains and displacement were measured using the Digital Image Correlation Method. Results: Displacement values of the first experimental model ranged from 0.31 to 0.54 mm with strains from 1.35 to 2.34%. Analysis of the second experimental model results showed displacement values from 0 to 0.34 mm, while strains were in the range of 0–1.40%. Conclusion: Higher displacements and strains of bone tissue were observed below the RPD, especially in the region of the distal abutment and distal portion of the free‐end saddle. Strains within bone and the bone‐denture contact area were mostly influenced by the teeth and denture vertical displacement.     

Biomechanical association of dental and temporomandibular pathology in a medieval Nubian population

An analysis of the relationship between oral pathology and degenerative change at the temporomandibular joint (TMJ) was undertaken on an archaeological sample of 122 adult crania from the Medieval site of Kulubnarti in Sudanese Nubia. The crania were sorted into 2 groups: those demonstrating clearly visible bony changes at the joint (TMJ+) and those without visible change (TMJ-). These groups were compared according to 1) age; 2) sex; 3) active dental pathologies (abscesses, caries, partial socket resorption); 4) tooth loss with complete socket resorption; and 5) dental attrition. No statistically significant association was evident between degenerative change at the TMJ and age, active dental pathologies, or dental attrition; however, sex differences and posterior tooth loss with complete socket resorption revealed a significant correspondence to degenerative TMJ changes. Both of these factors agree with the clinical literature and with biomechanical models (most notably that of Hylander) based upon modern populations. Furthermore, the results support the contention that paleopathological conditions can be analyzed from a clinical and functional biomechanical perspective.     

Zygomatic implant-retained fixed complete denture for an elderly patient

Dental rehabilitation of a completely edentulous geriatric patient has always been a challenge to the clinician, especially in treating those with higher expectations and demands. Treatment duration and the amount of residual alveolar bone available are often important considerations when planning for dental implant-based fixed treatment for these patients. With the introduction of zygomatic implants, a graftless alternative solution has emerged for deficient maxillary bone with provision for immediate loading. This article describes the treatment of a completely edentulous elderly patient using zygomatic implants in conjunction with conventional implants. The implants were immediately loaded using a definitive acrylic resin fixed denture reinforced with a cast metal framework, to provide function and aesthetics.     

Use of resin‐bonded extracoronal attachments with removable partial denture: case report

doi:10.1111/j.1741‐2358.2009.00298.x
Use of resin‐bonded extracoronal attachments with removable partial denture: case report Introduction: Resin‐bonded extracoronal attachments may be indicated for the abutment teeth of removable partial dentures, especially for anterior teeth when a cingulum rest must be provided. This type of treatment has a series of advantages such as minimal tooth reduction, supragingival margins, favourable stress distribution, and improved aesthetic appearance. Objective: To report a clinical case of oral rehabilitation using a combination of resin‐bonded extracoronal attachments joined by a Dolder bar with a removable partial denture. Case report: A 60‐year‐old male patient with only the canines in the maxillary arch was restored with a combination of resin‐bonded extracoronal attachments joined by a Dolder bar and a removable partial denture. Conclusion: Dentures with resin‐bonded extracoronal attachments can have a number of advantages over traditional clasp‐retained removable partial dentures.     

Relationships between age and dental attrition in Australian aboriginals

Tooth wear scores (ratios of exposed dentin to total crown area) were calculated from dental casts of Australian Aboriginal subjects of known age from three populations. Linear regression equations relating attrition scores to age were derived. The slope of the regression line reflects the rate of tooth wear, and the intercept is related to the timing of first exposure of dentin. Differences in morphology between anterior and posterior teeth are reflected in a linear relationship between attrition scores and age for anterior teeth but a logarithmic relationship for posterior teeth. Correlations between age and attrition range from less than 0.40 for third molars (where differences in the eruption and occlusion of the teeth resulted in different patterns of wear) to greater than 0.80 for the premolars and first molars. Because of the generally high correlations between age and attrition, it is possible to estimate age from the extent of tooth wear with confidence limits of the order of +/- 10 years.     

Measurements of tooth wear among Australian Aborigines: I. Serial loss of the enamel crown

The dental casts made from Aboriginal children during the course of a longitudinal growth study in Central Australia provided material for analyzing tooth wear under known environmental conditions. The wear facets produced on the occlusal surfaces were clearly preserved on the dental stone casts and recorded the progress of enamel attrition from ages 6 to 18. These casts were photographed and traced by electronic planimetric methods that automatically recorded the location and size of wear facets on the first and second permanent molars. These areas of worn tooth surface were compared to the total tooth surface. The worn surface was regressed on age to calculate wear rates of each tooth. Discriminant analyses were also performed to determine the significance of dental attrition differences between the sexes at each age group. The total wear on each tooth was highly correlated with age as expected but females wore their teeth at a significantly higher rate than males. The mandibular molars wore more rapidly than maxillary teeth in both sexes. The discriminant analysis successfully grouped 91% of the cases according to age and sex. Pattern of wear, the location, and size of wear facets also differed between age groups and sex. The questions of why there is a difference between male and female wear or why there is greater wear on one arch or arch region have no ready answers. The differing rates and pattern of dental wear do suggest that arch shape and growth rates may be the answer though it has yet to be tested. However, the occlusal surface wear is useful for age estimation in a population and provides a record of shifting masticatory forces during growth.     

Prevalence of temporomandibular disorders in a population of complete denture wearers

doi: 10.1111/j.1741‐2358.2011.00574.x
Prevalence of temporomandibular disorders in a population of complete denture wearers Background: Complete tooth loss among the elderly is still frequent in developing countries and the incidence of temporomandibular disorders (TMD) is a common finding in complete denture wearers. Objectives: The aim of this study was to evaluate the prevalence of temporomandibular disorders (TMD) in a population of complete denture wearers. Materials and Methods: The data were collected by four examiners for the diagnosis of use and need for complete dentures followed by the World Health Organization standards and interviews for TMD signs and symptoms evaluation. Exploratory variables included demographic, socio‐economic status and TMD prevalence. Results: The prevalence of TMD among denture wearers was 55.12%. Chi‐squared test showed no statistical difference between subjects with or without TMD for gender, geographical location and skin colour (p < 0.05). The number of subjects with TMD increased as the period of complete denture wear increased, although no statistical difference between groups were found (p < 0.05). Conclusions: There is a need of educational programmes aiming at the importance of health care and periodical change of a complete denture, and strategies with a preventive approach to quality general dental care.     

Orthodontic treatment in an elderly patient with extraction of upper premolar

In the past few years, life expectancy of the world's population has gradually increased and as a result the number of elderly patients seeking orthodontic treatment is becoming higher. The objective of this work is to report a clinical case of orthodontic treatment of an elderly patient in which a dental extraction was performed to correct the relationship between upper and lower arches. The results favoured an improved dental arch relationship and promoted adequate aesthetics and function.     

On dental wear, dental work, and oral health in the type specimen (LB1) of Homo floresiensis

The claim that the lower left first mandibular molar of LB1, the type specimen of Homo floresiensis, displays endodontic work, and a filling is assessed by digital radiography and micro-CT scanning. The M(1) tooth crown is heavily worn and exhibits extensive dentine exposure that is stained white, but there is no trace of endodontic treatment or a dental filling in this Indonesian fossil dated to 17.1-19.0 kya. Dental calculus (commonly observed in foragers) is present on the teeth of LB1, but there are no observable caries. The pattern of dental attrition in the mandibles of both LB1/2 and LB6/1 (moderate to extensive flat wear across the entire arch) is consistent with that seen in Plio-Pleistocene Homo fossils and in modern hunter-gatherers, and is not typical of most agriculturalists. We conclude that the dental-work and farming hypotheses are falsified and therefore irrelevant to the debate over the taxonomy and phylogeny of H. floresiensis.     

Ageing and dental attrition in a medieval rural Danish population

The rate of attrition on the permanent molars may depend on culturally and economically determined conditions of living. In order to analyse the relation the probability of having entered the stages of attrition is analysed by means of logistic regression on age at death. It is shown that not all teeth continue to be worn at the same rate throughout life and that there is an association between advanced attrition and risk of dying. The rate of dental attrition does not differ much by sex but there are some indications that male teeth are worn quicker than female teeth. This greater rate of attrition might be due to greater consumption of food in males than in females. The stages of dental attrition give some information on the age at death but they are poor age indicators on their own.     

Form and patterning of anterior tooth wear among aboriginal human groups

Form and severity of dental attrition was assessed in aboriginal human groups including hunter-gatherers (Eskimos, Australians) and those with dependence to a varying degree on food production (Southwest U.S. and Ohio American Indians). Wear on anterior teeth was both relatively and absolutely greater in the hunter-gatherers, as indicated by comparisons of wear on anterior and posterior teeth which come into occlusion at roughly the same time. Distinct differences in form of anterior wear were also apparent: The hunter-gatherers exhibited steadily increasing incidences of labially rounded wear with greater functional age, while the food-producing groups showed little or no rounding but instead high frequencies of heavily cupped wear (especially in those with premature loss of posterior teeth). These differences were attributed to nonmasticatory utilization of the front teeth in hunter-gatherers and to employment of the anterior teeth in masticatory (grinding) activities necessitated by large-scale molar loss in food producers.     

Clinical studies on the appearance of natural anterior teeth in young and old adults

Objectives: To evaluate the typical appearance of natural anterior teeth in young and elderly people and to develop guidelines for the natural appearance of dentures. Design: Clinical examination and photography. Inclusion criteria were a dental state with natural anterior teeth and no more than two crowns. Subjects: A study group (SG) consisting of 64 patients ranging in age from 60 to 86 years (67.3 ± 5.8) and a control group (CG) composed of 64 dental students aged 21–33 years (25.8 ± 2.4). Setting: Dental schools of the Johannes‐Gutenberg‐University Mainz and the University of Leipzig. Results: Most participants were content with the appearance of their own natural teeth. With relaxed lips a mean of 1.5 (±0.19) mm of upper incisors and 1.6 (±0.19) mm of lower incisors were visible in the SG compared with 2.5 (±0.16) and 0.4 (±0.07) mm in the CG, respectively. The subjects in the SG showed a greater diversity in position of teeth in the anterior arch and this was more often with incisors than with canines. Features such as stains, cracks and defects were much more noticeable in the SG. An inter‐dental ‘black triangle’ seemed to be a typical feature of an aged dental appearance. Conclusion: The majority of people older than 60 years who still have their own natural anterior teeth would not wish for a change in appearance if they needed a prosthodontic reconstruction. Thus techniques for customisation should be promoted to obtain a natural appearance in dentures.     

Prevention of trauma to edentulous ridge from opposing natural teeth

doi: 10.1111/j.1741‐2358.2010.00397.x Prevention of trauma to edentulous ridge from opposing natural teeth Objective: To suggest a technique to prevent trauma of the edentulous ridge from opposing natural or restored teeth. Background: The prevalence of the condition where one edentulous arch opposes a natural or restored dentition is quite common. In most of cases, the maxillary arch is completely edentulous and either all teeth or only anterior teeth are present in the mandibular arch. These remaining teeth may continuously cause trauma to the opposing edentulous ridge during the night when a removable prosthesis is kept out of the mouth. Materials and methods: A thermoplastic acrylic resin mouthguard was fabricated on a cast of the remaining teeth dentition. Conclusion: This article presents a simple and inexpensive procedure to prevent self‐induced trauma of the edentulous ridge from opposing natural teeth by using a thermoplastic acrylic resin mouthguard.     

Accuracy and Reliability of a Novel Method for Fusion of Digital Dental Casts and Cone Beam Computed Tomography Scans

Several methods have been proposed to integrate digital models into Cone Beam Computed Tomography scans. Since all these methods have some drawbacks such as radiation exposure, soft tissue deformation and time-consuming digital handling processes, we propose a new method to integrate digital dental casts into Cone Beam Computed Tomography scans. Plaster casts of 10 patients were randomly selected and 5 titanium markers were glued to the upper and lower plaster cast. The plaster models were scanned, impressions were taken from the plaster models and the impressions were also scanned. Linear measurements were performed on all three models, to assess accuracy and reproducibility. Besides that, matching of the scanned plaster models and scanned impressions was done, to assess the accuracy of the matching procedure. Results show that all measurement errors are smaller than 0.2 mm, and that 81% is smaller than 0.1 mm. Matching of the scanned plaster casts and scanned impressions show a mean error between the two surfaces of the upper arch of 0.14 mm and for the lower arch of 0.18 mm. The time needed for reconstructing the CBCT scans to a digital patient, where the impressions are integrated into the CBCT scan of the patient takes about 15 minutes, with little variance between patients. In conclusion, we can state that this new method is a reliable method to integrate digital dental casts into CBCT scans. As far as radiation exposure, soft tissue deformation and digital handling processes are concerned, it is a significant improvement compared to the previously published methods.