Accelerated rehabilitation of an edentulous patient with an implant retained dental prosthesis: a case report

This case report details the successful rehabilitation of an edentulous patient using a complete upper prosthesis and a lower implant retained overdenture. The provision of care was split between a specialist centre and a primary care setting. This approach reduced inconvenience to the patient. Modern surgical and prosthodontic techniques also reduced the total delivery time. After initial consultation a new set of complete dentures was prescribed with changes in design to the originals. The patient was also planned for placement of two mandibular implants to stabilise and retain the mandibular denture. The first line of treatment involved provision of a new set of dentures constructed by the patient's general dental practitioner. Dental implants were then placed in a specialist centre and the patient returned to the dental practice for attachment of the lower denture to the dental implants. The benefits and success of mandibular implant retained dentures are well documented. With delivery of the overdenture, the patient reported increased satisfaction with his prostheses which allowed him to eat a greater range of foods and enabled him to feel confident when speaking and socialising.     

Complete denture hygiene and nocturnal wearing habits among patients attending the Prosthodontic Department in a Dental University in Brazil

Gerodontology 2010; doi: 10.1111/j.1741‐2358.2010.00369.x Complete denture hygiene and nocturnal wearing habits among patients attending the Prosthodontic Department in a Dental University in Brazil Objective: The aim of this study was to evaluate the overnight wearing and cleaning habits of complete denture wearers. Background: Successful complete denture treatment can be achieved when the patients are motivated and aware of appropriate denture wear and hygiene. Materials and methods: A sample of 224 complete denture wearers (162 women) aged 37–89 years was studied. Inclusion criteria comprised edentulous subjects who had received their new complete dentures between 2000 and 2005 in the Dental Clinic of the Araçatuba and Araraquara Dental School, São Paulo State University. Ethical approval was sought and granted. Subjects were interviewed using questions related to overnight denture wearing and denture cleaning habits. Possible statistical relationships among some of items were analysed by the chi‐square test at 5% significance level. Results: Of the patients, 55.8% removed their dentures during the overnight period and 88% did this every day. Among them, 66.4% removed both dentures. Most of the patients used brushing with toothpaste (105 patients – 46.87%) as a cleaning method. More than a half of the subjects (63.4%) showed biofilm and calculus on their dentures. Conclusion: The patients need instructions and motivation concerning denture hygienic and denture removal overnight.     

Should edentulous patients be constrained to removable complete dentures? The use of dental implants to improve the quality of life for edentulous patients

doi:10.1111/j.1741‐2358.2009.00294.x
Should edentulous patients be constrained to removable complete dentures? The use of dental implants to improve the quality of life for edentulous patients Background: Nowadays, there is some speculation among dental educators that the need for complete dentures will significantly decrease in the future and that training in their provision should be removed from the dental curriculum. Objective: To sensitise the reader to the functional shortcomings of complete denture therapy in the edentulous patient and present restorative options including implants to improve edentulous quality of life in these patients. Methods: Information retrieval followed a systematic approach using PubMed. English articles published from 1964 to 2008, in which the masticatory performance of patients with implant‐supported dentures was assessed by objective methods and compared with performance with conventional dentures, were included. Results: National epidemiological survey data suggested that the adult population in need of one or two complete dentures will increase from 35.4 million adults in 2000 to 37.9 million adults in 2020. Clinical studies have showed that the ratings of general satisfaction were significantly better in the patients treated with implant overdentures post‐delivery compared with the complete denture users. In addition, the implant group gave significantly higher ratings on comfort, stability and ability to chew. Furthermore, patients who received mandibular implant overdentures had significantly fewer oral health‐related quality of life problems than did the conventional group. Conclusion: Implant‐supported dentures including either complete overdentures or a hybrid prosthesis significantly improve the quality of life for edentulous patients compared with conventional removable complete dentures. Therefore, the contemporary dental practitioner should consider other options as well as conventional removable complete dentures to restore edentulous patients.     

A study to compare the oral health impact profile and satisfaction before and after having replacement complete dentures constructed by either the copy or the conventional technique

Aims: To assess the oral health impact profile (OHIP) on edentulous subjects who needed to have their dentures replaced either by a copy technique or a conventional technique, and to determine whether any change in the subjects’ assessment of their original and replacement dentures impacted on oral health related quality of life parameters. Background: The OHIP is an instrument used to measure subjects’ perceptions of the social impact of oral disorders on their well being. Changes in the OHIP may occur when subjects need to have their complete dentures replaced. Furthermore, it is possible that the method by which the dentures are constructed may impact on this. Methods: A total of 65 edentulous subjects were studied. Thirty‐three subjects had their dentures constructed by a copy technique and 32 by a conventional technique. Subjects completed the OHIP‐14 questionnaires before and after being provided with a set of replacement complete dentures. They also assessed specific features of the upper and lower dentures. Responses were recorded on a Likert scale. Results: For many subjects, the responses in the before treatment questionnaires were at the lower end of the Likert scale, indicating that there were no major impacts on oral health related quality of life parameters. There were no major differences between the copy denture subjects and the conventional denture subjects in relation to the change in OHIP scores before and after treatment. Generally subjects expressed improved satisfaction with the new lower denture. However, for the copy denture group there were significant improvements for all seven assessments compared with only five out of seven assessments for subjects in the conventional group. Conclusion: For these groups of edentulous subjects, although they may need dentures to be replaced after a period of wear, this does not necessarily have significant impacts on oral health related quality of life parameters. It seems likely that this is the main reason why the provision of new dentures by either a copying or conventional technique did not result in major changes to the OHIP.     

A comparison of patient satisfaction between treatment with conventional complete dentures and overdentures in the elderly: a literature review

doi:10.1111/j.1741‐2358.2009.00299.x
A comparison of patient satisfaction between treatment with conventional complete dentures and overdentures in the elderly: a literature review Background: It has been stated that mandibular overdentures are more satisfactory than conventional dentures, but problems relating to the use of retrospective ratings, lack of control group and sequential provision of treatment may compromise the findings. Objective: To establish a comparison between treatment with conventional complete dentures and implant‐retained overdentures in elderly patients by conducting a literature review. Materials and methods: A search of English language peer‐review literature was completed using Medline up to 2008 focusing on evidence‐based research. Randomised clinical trials (RCTs) and longitudinal prospective studies were favoured in the review, using a general hierarchical classification. Articles that did not focus exclusively on the comparison of patient satisfaction between complete dentures and overdentures were excluded from further evaluation. The last search was conducted in February 2008. Key terms included quality of life, patient satisfaction, edentulism, complete denture and overdenture. Results: Among the 90 articles found in the initial search, 27 met the inclusion criteria. This included 18 RCTs and eight prospective and one cohort study. Most of the articles stated superiority of the mandibular implant‐retained overdenture therapy over the conventional complete denture regarding patient satisfaction and quality of life. Conclusion: Even with implant treatment presenting higher patient satisfaction and improvement of quality of life, it was not possible to establish a direct comparison between the studies due to differences in adopted methodologies.     

下颌种植覆盖义齿的生物力学研究进展

口腔生物力学是用生物力学的概念和方法,研究口腔医学中的有关基础性科学问题、解决口腔医学中的临床实际问题、发展口腔临床技术的一门学科。在口腔正畸学、修复学、种植学及口腔颌面外科学等领域存在着大量的生物力学问题,生物力学已成为口腔医学的基础科学之一。传统全口义齿修复常常会出现固位稳定差、咀嚼效率低、患者有疼痛感、适应时间长等情况,很大程度上不能满足患者的修复要求。种植覆盖义齿对于下颌牙槽嵴严重吸收的患者,效果尤为明显。种植覆盖义齿是义齿与种植体之间以不同的附着体作为连接,形成患者可以自行摘戴的种植体支持的覆盖义齿修复。下颌种植覆盖义齿因其能有效地提高下半口义齿的固位性和稳定性、显著提高了患者的咀嚼效率,目前已成为修复下颌牙槽骨严重吸收的无牙颌患者的有效修复方法。本文针对下颌种植覆盖义齿的生物力学研究进展作一综述。     

Subjective values of different age groups in Japan regarding treatment for missing molars

Gerodontology 2010; doi: 10.1111/j.1741‐2358.2009.00357.x
Subjective values of different age groups in Japan regarding treatment for missing molars Objective: To determine how patients and dentists in Japan value the outcomes of different treatment options for missing molars. Materials and methods: Elderly removable‐denture wearers and dentate persons (senior group), preclinical dental students (young group), and prosthodontists were presented with five possible treatment options for missing lower bilateral first and second molars. The participants indicated on a visual analogue scale how they would value the treatment (utility value: UV), if they had received each of the treatments. Two‐way repeated measures anova was used for statistical analyses. Results: The UV for the shortened dental arch (SDA) without replacement was the lowest in every group. The young group rated the value of cantilever fixed partial dentures (FPD) and implants significantly higher than removable partial dentures (RPD), while the senior group rated the value of FPD and RPD significantly higher than implants. Those having experience with removable dentures were likely to place a higher value on the acrylic RPD. The prosthodontists rated the value of implants significantly higher than any other options. Conclusions: The participants in every group placed the lowest value on the outcome from the SDA in Japan. The denture wearers preferred the RPD, while prosthodontists preferred implants.     

The influence of mandibular implant-retained overdentures in masticatory efficiency

doi: 10.1111/j.1741‐2358.2011.00539.x The influence of mandibular implant‐retained overdentures in masticatory efficiency Objective: To evaluate the masticatory efficiency of patients rehabilitated with conventional dentures (CDs) or implant‐retained mandibular overdentures. Background: Despite the evident benefits of implants on mastication as assessed by subjective patient‐based outcomes, the extent of implant overdenture treatment effect on food comminution is not well established. Materials and methods: A randomised clinical trial was carried out with 29 completely edentulous patients divided into two groups. The first group was rehabilitated with a mandibular overdenture retained by two splinted implants with bar‐clip system, while the second group was rehabilitated with a mandibular CD. Both groups also were rehabilitated with maxillary CDs. Masticatory efficiency and patient satisfaction were assessed 3 months after denture insertion. Masticatory efficiency was evaluated through the colorimetric method with the beads as the artificial test‐food. Comparisons for masticatory efficiency and patient satisfaction were performed using Student’s t‐test (α = 0.05). Results: No significant statistical difference was found for masticatory efficiency (p = 0.198). Patient overall satisfaction was significantly higher for the mandibular overdenture (p < 0.001). In addition, mandibular overdenture patients were significantly more satisfied with chewing experience (p < 0.05) and retention of the lower denture (p < 0.005). Conclusion: The results of this study suggest that mandibular overdenture significantly improves chewing experience, although limited effect on masticatory efficiency has been observed.     

Clinical feasibility of mandibular implant overdenture retainers submitted to immediate load

Gerodontology 2010; doi: 10.1111/j.1741‐2358.2010.00374.x
Clinical feasibility of mandibular implant overdenture retainers submitted to immediate load Introduction: Millions of people around the world do not have access to the benefits of osseointegration. Treatments involving oral rehabilitation with overdentures have been widely used by specialists in the oral medicine field. This is an alternative therapy for retention and stability achievement in total prosthesis with conventional treatment, and two implants are enough to establish a satisfactory overdenture. Objective: The objectives of the study were to evaluate 16 patients of both sexes, with an average age of 47.4 ± 4 years, using electromyographic analysis of masseter and temporal muscles and analyse the increase of incisive and molar maximal bite force with their existing complete dentures and following mandibular implant overdenture therapy to assess the benefits of this treatment. Materials and methods: For these tests, the Myosystem‐BR1 electromyograph and the IDDK Kratos dynamometer were used. Statistical analysis was performed using the repeated measures test (SPSS 17.0). Results: A decrease in electromyographic activity during the rest, lateral and protrusion movements and increase of the maximal incisive and molar bite force after 15 months with a mandibular implant overdenture was observed. Conclusion: All the patients in this study reported a considerable improvement in the masticatory function and prostheses stability following treatment. It is possible to propose that the use of mandibular implants overdenture should become the selected treatment for totally edentulous patients to facilitate oral function and quality of life.     

Tooth loss, denture wearing and associated factors among an elderly institutionalised Brazilian population

Objective: This cross‐sectional study assessed the prevalence and extent of tooth loss as well as denture wear and associated factors in institutionalised elderly in Brazil. Background: There is scarcity of research in Brazil concerning geriatric oral health issues. Material and methods: A sample of 335 individuals over 60 years of age, representative of the institutionalised elderly from Belo Horizonte, Brazil, were selected through a stratified sampling strategy. Data were collected from structured questionnaires, reviews of medical records and intra‐oral examinations. Results: Edentulousness was observed in 74.9% of the elderly and was related to age, years of study, income, length of institutionalisation, systemic diseases and mini‐mental score. Among the dentate subjects, 17.9% possessed 20 or more teeth. Approximately half the edentulous elderly (42.6%) and most of the partially dentate subjects (66.7%) did not wear dentures. The multivariate analysis showed that subjects that wear dentures were more likely to be female, possess higher incomes, be more functionally independent and married. Furthermore, the odds of wearing dentures among the elderly who had lost 13–32 teeth were 9.11 times higher than those who had lost up to 12 teeth. Conclusion: Tooth loss is highly prevalent in this institutionalised Brazilian population, and the prevalence of denture wear is low. The extent of tooth loss, income, functional status and marital status are important predictors for denture wear. The development of an oral health programme for these individuals should assist in their rehabilitation needs and promote in‐home care or safe transport for the elderly to a health care location.     

Implant supported dentures: an estimation of chewing efficiency

doi: 10.1111/j.1741‐2358.2009.00303.x
Implant supported dentures: an estimation of chewing efficiency Background: Treatment of edentulous patients is one of the most demanding tasks the dentist can meet in his everyday practice. Implant based methods help to improve functioning of dentures and life quality of so treated patients. Objectives: The aim of the study was to evaluate the chewing efficiency of patients treated with lower complete implant‐supported overdentures and the simultaneous evaluation of treatment results by patients. Materials and methods: For the investigation were chosen edentulous patients, treated with upper conventional complete dentures and lower complete overdentures supported on two implants. In this group of patients, were conducted investigations of chewing efficiency changes, based on the Optocal test and overdentures functioning evaluation made by patients in the survey. Results: The objective evaluation of the chewing efficiency indicated the decrease of this value in the five years of observations. Lower complete overdentures supported on implants significantly increased the comfort of chewing of edentulous patients. Conclusions: The results of the study let us to assess positively the result of the therapy using titanium implants and lower complete overdentures. The therapy described significantly increases the life comfort of the edentulous patients. Decreasing chewing efficiency indicated by the research result should be compensated with the dentures maintaining or the prostheses exchange after about five years of use.     

Comparing the efficacy of mandibular implant-retained overdentures and conventional dentures among elderly edentulous patients: satisfaction and quality of life

Objectives: The aim of this study was to compare the satisfaction and the quality of life in an elderly population using either mandibular conventional dentures or implant‐retained overdentures. Materials and methods: A total of 34 patients were divided into two groups: group I – complete dentures users; group II – users of upper complete dentures opposed by implant‐retained overdentures. The subjects were submitted to a questionnaire based on Oral Health Impact Profile and oral health related quality of life to evaluate their satisfaction levels and quality of life with their prostheses. Data were evaluated using a non‐parametric statistical analysis (Fischer test) with significant difference at α = 0.05. Results: There were no significant differences between the groups in relation to comfort, aesthetics, chewing ability, overall satisfaction, pain, functional, phonetic, social, and psychological limitations (p > 0.05). Comparing the stability of mandibular dentures, group II presented the better results (p < 0.05). Conclusion: Although the stability of the mandibular implant‐retained overdenture was enhanced compared to a conventional denture, the quality of life and satisfaction levels were similar for both the groups.     

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.     

Outcome of implant-supported overdenture treatment--a survey of 58 patients

Gerondontology 2012; doi: 10.1111/j.1741‐2358.2011.00524.x
Outcome of implant‐supported overdenture treatment – a survey of 58 patients Objective: The aim of this follow‐up study was to evaluate the long‐term outcome of implant‐supported or implant‐retained mandibular overdenture treatment. Material and methods: Altogether 112 patients treated with implant‐supported overdentures between 1985 and 2004 were invited to the follow‐up and 58 attended the clinical examination. The total amount of implants examined and still in use was 197. The average number of implants installed was three (range 2–4), and the mean length of the implants was 12 mm (range 8–21 mm). There were altogether 48 overdentures with a bar connection and 10 with a ball connection. Results: The most frequent prosthetic complications were technical: loosening of the retentive mechanism (39.7%) and breakage of the matrices (5.2%). The most common peri‐implant soft‐tissue findings were bleeding and slight hyperplasia. The implant‐supported overdentures of 19 patients (32.8%) had been renewed, while 39 patients (67.2%) still used their original overdentures, of which the oldest was 20 years old. Conclusion: The results of this long‐term follow‐up study show that the outcome of implant‐supported mandibular overdenture treatment was excellent. The patients were satisfied with the treatment, regardless of the attachment type used. Removable overdentures are more easy to clean and can be cleaned outside the patient’s mouth, whereas fixed‐implant full‐arch dentures in the edentulous mandible require much more time‐consuming hygiene. This kind of overdenture treatment is suitable also in the elderly, even though their ability to practice appropriate oral hygiene might be decreased.     

Clinical and microbiological efficacy of three different treatment methods in the management of denture stomatitis

Gerodontology 2010; doi: 10.1111/j.1741‐2358.2009.00354.x
Clinical and microbiological efficacy of three different treatment methods in the management of denture stomatitis Objective: This study evaluated. the effect of mouthrinses and tissue conditioner on the clinical findings and microbial flora of 60 patients with Newton’s type II denture stomatitis (N2DS) Background: Denture stomatitis is a common problem in complete denture wearers. Materials and methods: Sixty patients with N2DS were included in this study and divided into three groups. Two groups of patients were instructed to rinse their mouth with the designated mouthrinses DioxiDent and Corsodyl twice daily for 1 min and to soak their dentures overnight in these solutions for 15 days. For the third group, tissue conditioner was placed in each of 20 patients’ existing maxillary dentures. Patients were evaluated both clinically and microbiologically at baseline and after 15 days. Palatal swabs and smears were taken from each patient before and after treatment and these samples were examined mycologically. The difference between Candida colonisation before and after treatment and the differences between pre‐treatment and post‐treatment clinical findings were assessed. Results: DioxiDent and Corsodyl showed an improvement in palatal inflammation and a decrease in Candida colonisation compared to Visco‐gel. Conclusions: The effectiveness of topical chlorine dioxide and chlorhexidine gluconate in the management of N2DS was demonstrated.     

The effect of osteoporosis on residual ridge resorption and masticatory performance in denture wearers

doi: 10.1111/j.1741‐2358.2011.00610.x The effect of osteoporosis on residual ridge resorption and masticatory performance in denture wearers Aim: To compare masticatory performance, masticatory efficiency and residual ridge resorption (RRR) in osteoporotic and non‐osteoporotic edentulous subjects after rehabilitation with complete dentures. Method: Thirty subjects fulfilling the inclusion criteria were enrolled from the patients visiting the Department of Prosthodontics for complete denture fabrication. Two groups consisting of control subjects (group I; N = 15) and osteoporotic subjects (group II; N = 15) were formed. Complete dentures satisfying certain criteria were fabricated for both groups. Masticatory performance and efficiency were measured 6 months after denture insertion. Areal measurements were taken on lateral cephalograms before and 6 months after denture fabrication. The data were then computed to analyse differences between groups I and II using SPSS statistical software version 15.0. Results: Six months after denture fabrication, the masticatory performance and efficiency were significantly higher (p < 0.001) for group I, with a significant decrease in maxillary and mandibular sagittal area seen in both groups. The rate of bone loss was more in group II compared with group I. Conclusion: Greater masticatory function was demonstrated by the non‐osteoporotic group, and the rate of RRR was more in the osteoporotic group compared with the normal group. In this pilot study, osteoporosis leads to greater RRR, decreased masticatory performance and efficiency in edentulous subjects 6 months after denture insertion. Screening for osteoporosis is suggested as a routine procedure for all edentulous subjects undergoing rehabilitation. Recall check‐ups for osteoporotic patients should be more frequent, and these patients may require more frequent denture remakes.     

Experimental studies of adaptation to complete dentures related to ageing

The assessment of a patient's capability to adapt to new dentures is still a challenge in the prosthetic treatment of geriatric patients. The aim of this study was to assess the relationship of age to manual motor ability as well as the mental concentration capacity in comparison to the oral motor ability and the capability to adapt to new dentures. Sixty complete denture wearers volunteered for the experiment. The results indicate, that the manual motor ability and the mental concentration capacity deteriorate with age, whereas the relationship of age to adaptation to new dentures and oral motor ability is less obvious. This may be due o t the patient's denture experience.     

Resonance frequency analysis of overdenture retainer implants with immediate loading

doi: 10.1111/j.1741‐2358.2011.00488.x
Resonance frequency analysis of overdenture retainer implants with immediate loading Objective: To evaluate 16 patients of both sexes with lower overdenture and upper complete dentures, by analysing the resonance frequency of the initial and late stability of implants used to retain the overdenture under immediate loading. Background: Oral rehabilitation treatment with complete dentures using implants has been increasingly more common among the specialists in the oral rehabilitation area. This is an alternative for obtaining retention and stability in treatments involving conventional complete dentures, where two implants are enough to retain the overdenture satisfactorily. Materials and methods: The Osstell? Mentor device was used for the analysis in the initial period (primary stability), 3 and 15 months after the installation of the lower overdenture (secondary stability). The statistical analysis was performed with the repeated measures model (p < 0.01). Results: The implant stability quotients were observed to increase after 15 months of the rehabilitating treatment. Conclusion: The use of overdentures over two lower implants should become the treatment of choice for individuals who have a fully edentulous mandible.     

Sensory detection of food odour in relation to dental status,gender and age

The aim of this study was to investigate to what extent declining odour perception can be ascribed to dental status and oral hygiene habits, taking into account gender and age. Apparently healthy adults (n=182), ranging from 53 to 93 years (mean age=68.4) were tested. Information about oral hygiene habits (brushing teeth and cleaning dentures) and dental status was obtained by questionnaires. A validated objective procedure was used to measure sensory detection thresholds for isoamylacetate by an ascending method of limits. A significant negative correlation of odour perception with age was shown by the edentulous subjects which might reflect their wider age spread with many subjects over age 75. The evaluation of odour perception as a function of dental status shows no significant difference in odour perception between persons partial denture wearers, with natural teeth only or complete dentures. However, a tendency for lower odour perception was observed among male partial denture wearers, especially those reporting less frequent oral hygiene, which justifies further more detailed study.