The patient's and the therapist's evaluation of complete denture therapy

A total of 222 patients were studied. In a questionnaire patients graded their complete dentures of different age and quality, depending on the level of satisfaction, using the modified analogue-visual scale from 1 to 5. The dentist assessed the same dentures, as well as the denture bearing area. The patients' assessments were surprisingly high, the grades were bigger than the therapist's (p < 0.05), but in disappointed patients the grades were smaller than the therapist's (p < 0.05). It seems that the dentist is more critical in assessments than the patient. No significant difference existed between chewing and denture stability and between stability and the comfort of wearing lower full denture (p > 0.05). Unstable denture aggravates chewing and causes pain and discomfort on the bearing area. It seems that subjective factors in patients, expectations of the denture or the number of previous dentures play a role in satisfaction, not only the quality of denture bearing area and the quality of a denture.     

Effects of denture maintenance on satisfaction levels of Taiwanese elderly using removable partial dentures: a pilot study

doi: 10.1111/j.1741‐2358.2011.00500.x
Effects of denture maintenance on satisfaction levels of Taiwanese elderly using removable partial dentures: a pilot study Objective: The aim of this study was to evaluate the correlation between patient satisfaction with removable partial dentures and denture maintenance by patients, including regular application of denture adhesives and cleansers. Background: The success of removable partial dentures depends on patient satisfaction with dentures and their regular denture maintenance. Materials and methods: Demographic information, the Oral Impacts on Daily Performance (OIDP) indicator and details of denture maintenance (including the use of denture cleansers and adhesives) were collected from 193 (41.5% men and 58.5% women) participants by using questionnaires. A dentist performed oral examinations to evaluate denture function according to the OIDP items photographically and recorded the number of remaining teeth and Kennedy’s classification. Results: Most participants were satisfied with their removable partial dentures and tended to have higher satisfaction levels than the dentist’s estimation. Further, those using denture adhesives and cleansers had higher satisfaction levels than those not using such denture maintenance. Conclusions: Appropriate education regarding denture use is important because regular denture maintenance by patients affects their degree of satisfaction with dentures, as well as the dentist’s skill and the patient’s oral condition. Dentists could use this information to predict the potential success of dentures.     

可摘局部义齿戴入后义齿区微生态的改变

可摘局部义齿是口腔活动修复中运用最久最为广泛的一种修复方式,其通过卡环的固位,基托的稳定,连接体的连接,可以使人工牙在患者缺牙间隙发挥相应的咀嚼功能。但是,可摘局部义齿作为一个外源性的异物戴入患者口内后,由于其理化性质与口腔正常环境差别极大,并且占据了口腔中的天然间隙,势必会导致口腔内环境的相应改变。口腔微生物依附于口腔内环境,与宿主共生。当口腔内环境变化时,口腔微生态也会产生相关的变化。研究可摘局部义齿戴入后口腔内微生态的变化可以使我们更好地评估可摘局部义齿的适应证,并指导我们新义齿的设计及开发方向。目前相关研究已相当充分,本文就可摘局部义齿戴入后,口腔微生态的变化作一简单综述。     

Tooth loss, the wearing of dentures and associated factors in Sri Lankan older individuals

Objective: To determine tooth loss, wearing of dentures and associated factors in older individuals from Sri Lanka. Design: A cross‐sectional survey where the data were collected by means of an oral examination and an interviewer administered questionnaire. Setting: Negambo within the Gampaha district of Sri Lanka. Subjects: A total of 630 subjects who were aged 60 years and above. Results: Only 11 subjects had all 32 teeth and 17% were edentulous. Age, gender and level of income were significantly associated with the number of missing teeth. Of those with missing teeth, 22% wore dentures. Only 16% of the non‐denture wearers perceived a need for dentures. Among the non‐denture wearers who perceived a need for dentures, a majority had cited ‘cost’ as the main barrier for obtaining dentures. Logistic regression analysis revealed that age, gender, levels of income and education and missing teeth were significant predictors of wearing of dentures. Conclusions: Knowledge of factors that influence tooth loss and wearing of dentures may have implications for oral health care planners in the provision and delivery of oral health services to the older individuals.     

The masticatory handicap of wearing removable dentures in elderly men

Objective: This study aimed at describing the masticatory handicap of wearing removable dentures measured by some masticatory tests and the intake of hard and soft foods. Materials and methods: The subjects were participants in a comprehensive health examination of 67–68‐year‐old men living in Malmö, Sweden. Four hundred eighty‐three men took part in a clinical oral examination which recorded the number of teeth and removable dentures. One hundred and one had complete dentures in both jaws and 131 had removable partial dentures in different combinations. Masticatory tests used almonds to record the number of stokes to the first swallow, and two‐coloured chewing gums for recording bolus kneading and shaping. A nutritionist paid a home visit to assess dietary habits including the consumption of hard and soft foods. The data could be split into groups of different tooth and denture situations which were large enough to enable statistical analysis to be carried out. The results of a regression analysis of the group with different numbers of natural teeth (NT) and no removable dentures could be used as a reference for correlation with the masticatory capacity of removable denture wearers. Results: Number of strokes to the first swallow revealed no masticatory limitations of wearing removable dentures, while chewing gum colour‐mixing and shaping revealed more differentiated impairments equivalent to the function of five to 16 teeth in a remaining natural dentition. Hard food intake for the removable denture groups was comparable to 17–19 NT. Soft food intake was not influenced by denture wearing. In a ranking of oral conditions, those with more than 24 NT had the highest test values for all tests, and those with complete sets of dentures the lowest except for the number of strokes to the first swallow of an almond. Conclusion: Removable denture wearing can be regarded as a handicap when measured with objective masticatory tests using chewing gum and the intake of hard foods. The number of chewing strokes to the first swallow of an almond and the intake of soft foods is not affected by the wearing of removable dentures.     

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 patient's and the therapist's evaluation of bridges of different materials and age

The aim of this study was to find out patients' satisfaction with their bridges made of different materials (metal-ceramics, Au/resin, Ag-Pd/resin). One hundred and sixty four patients were examined at the Dental School, University of Zagreb, Croatia. They assessed their bridges--the overall quality, aesthetics, speech, chewing and the health of the gingiva by the scale from 1-5. The same categories were also assessed by a trained prosthodontist. The majority of the patients was really satisfied and gave the highest grades (quality, aesthetics, speech, etc.) and therefore the results were skewed and asymmetrical towards the biggest scores (biggest grades). The best gingival health was evaluated by the group of patients with ceramic crowns and bridges (p < 0.05) and the worst by the patients with Ag-Pd bridges. Speech was scored higher for the lateral than for the frontal bridges. Patients evaluated the health of the tissue surrounding their bridges, overall quality of fixed prosthodontic appliance and aesthetics with significantly higher scores than the prosthodontist (p < 0.01). The results point at a difference between the patient's and the therapist's evaluations and to the patient's insufficient care about the gingiva around the bridge abutments.     

下颌起排法全口排牙临床效果研究

目的:研究通过比较不同的排牙方式制作的全口义齿对咀嚼次数、咀嚼效率以及患者的主观感受的影响。方法:78例无牙颌患者按照牙槽嵴高度分为正常组和低平组,正常组有患者32例,低平组有患者46例,每组分别戴用上颌起排法和下颌起排法制作的全口义齿,比较咀嚼次数、咀嚼效率和满意度的差别。结果:在戴用上颌起排法制作的全口义齿时,正常组的咀嚼次数高于低平组,差异具有统计学意义(t=3.60,P0.05);戴用下颌起排法制作的全口义齿后,低平组的咀嚼次数高于采用上颌起排法的全口义齿,差异具有统计学意义(t=4.41,P0.05);在戴用上颌起排法制作的全口义齿中,正常组的咀嚼效率高于低平组,差异具有统计学意义(t=5.72,P0.05);而在戴用下颌起排法制作的全口义齿后,低平组的咀嚼效率高于采用上颌起排法的全口义齿,差异具有统计学意义(t=7.16,P0.05)。正常组认为使用下颌起排法制作全口义齿咀嚼能力、稳固感好于上颌起排法,差异均具有统计学意义(P0.05);低平组认为使用下颌起排法制作全口义齿咀嚼能力、稳固感和舒适感好于上颌起排法,差异均具有统计学意义(P0.05)。结论:对于牙槽嵴低平无牙颌患者使用下颌起排法制作的全口义齿,能够有效地增强咀嚼效率,提高义齿的稳定性。     

Accuracy of Perceived Treatment Needs Among Geriatric Denture Wearers1

Patient satisfaction with and accuracy in assessing condition of dentures and oral tissue were related to their clinical evaluation and several psychological factors in 50 denture wearers 60 years of age or older. Seventy percent of those examined wore clinically inadequate dentures and 34% had unsatisfactory oral tissue. Few respondents were dissatisfied when clinical examination revealed satisfactory conditions but 70% were satisfied with inadequate dentures and 50% with unsatisfactory oral tissue. Contrary t o expectation, accuracy was not found significantly related to clinical evaluation or to psychological factors. However, satisfaction with dentures was related to their clinical evaluation: dissatisfied respondents had technically superior dentures as compared with those satisfied. These findings suggest that psychological factors are not related to denture patient assessment of their oral condition and that dissatisfaction may be of benefit to their oral health. The high proportion of those unaware of denture inadequacies indicates the need for patient education directed toward over-, as well as under-, adapters.     

Bonding acrylic teeth to acrylic resin denture bases: a review

Partial or complete dentures are more commonly constructed for the elderly group of the population. Teeth debonding from the dentures can be frustrating to the patients as well as the dentist. Research has been carried out and is continuing to study the issue of bonding acrylic teeth to the denture base resin. The present review takes into account the majority of research papers published in the last five decades for determining the bond strength. Selection of more compatible combinations of denture base resins and acrylic teeth may reduce the number of prosthesis fractures and the resultant repairs.     

Variables affecting denture satisfaction in Israeli elderly:a one year follow-up

The purpose of this study was to investigate patient satisfaction with complete dentures after one year of use and several potential mitigating factors in Israeli elderly. Eighty–four patients who were 54 years of age or older and who were rehabilitated with complete dentures were recalled for examination 12-15 months later; 84.5% (n=70) were interviewed and reexamined by calibrated examiners who judged all prostheses to be clinically acceptable. The mean age of participants was 71.90 years and two-thirds were females. Over 73 % reported that they wore their dentures “always.” Nearly 79% indicated that they were pleased with their denture appearance. Difficulties were reported by 28.2%, while 46.5% reported difficulties with chewing. Chewing problems were significantly related to swallowing problems (P<.001); food enjoyment “as much now as you did five years ago” (P<.001); difficulties speaking (P<.00105) and “having sores under your dentures” (P<.00101) which affected 28.2% of the survey group. Married elderly expressed higher satisfaction with denture comfort as compared to “single” patients, and patients suffering from any systemic chronic diseases were more dissatisfied with appearance. A summary satisfaction scale of 7 items was constructed (Cronbach alpha reliability 0.6834) and logistic regression performed to identify key model variables for overall satisfaction. Stat sign findings included: 1) immigration year; 2) neurological or psychological disorder; and 3) age. The model correctly classified 92.75%. Findings suggest that a variety of factors may influence denture satisfaction. Gathering detailed information by means of a questionnaire before new denture fabrication may be an important tool for the dentist in predicting and consequently enhancing patient satisfaction with complete dentures.     

Cast titanium overlay denture for a geriatric patient with a reduced vertical dimension

An older patient reporting to the dental surgery for his/her dental treatment is becoming a common occurrence. Improved oral hygiene has meant that teeth are retained for a longer time, along with the potential problems of attrition, decreased vertical dimension, temporomandibular joint discomfort/strain, and poor aesthetics. The case in question is that of a 65-year-old male patient who had severe attrition in the lower arch, temporomandibular joint pain and reduced vertical dimension. The maxillary arch had previously been restored with a fixed partial prosthesis. For restoration of the lower teeth, a removable cast titanium overlay denture was fabricated incorporating an increased vertical dimension. Porcelain facings were placed to restore the aesthetics of the anterior teeth. The titanium was cast in a semi-automatic electric arc, pressure type casting machine. A titanium overlay denture with porcelain facing on the anterior teeth may provide a means of restoring a patient's concerns regarding aesthetics and function.     

Elderly complete denture wearers: a social approach to tooth loss

doi: 10.1111/j.1741‐2358.2011.00550.x Elderly complete denture wearers: a social approach to tooth loss Objectives: To correlate emotional reactions to tooth loss with denture satisfaction attributes in elderly complete denture wearers. Background: Total tooth loss is a serious life event, and poor oral health has an impact on daily life. Edentulism treated by rehabilitation with dentures can have a positive effect on patients’ self‐image and social behaviour. Methods: A group of 80 edentulous subjects undergoing routine prosthetic care in a Greek Department of Prosthetic Dentistry were interviewed using two structured questionnaires. The first questionnaire explored reactions to tooth loss, whereas the second measured their subjective experience of complete dentures. The responses to both questionnaires were compared using the statistical package spss v.17. Results: The results showed significant correlation between aspects of tooth loss experience and complete denture satisfaction. Despite the fact that a substantial proportion of patients were satisfied with their complete dentures, some patients experienced increased social and psychological problems related to their edentulousness and the wearing of complete dentures. The aesthetic and functional aspects of complete dentures affected both patients’ social behaviour and self‐confidence. Conclusions: Total tooth loss was not only reflected in patient’s social behaviour and self‐image, but it had a complex and multifaceted impact on satisfaction from complete dentures.     

Influence of psychological factors on the acceptance of complete dentures

Objectives: To assess the influence of psychological factors on the acceptance of complete dentures in a population wearing dentures judged to be clinically satisfactory. Design: Subjects were asked to complete personality profiles and also to rate their dentures using a denture satisfaction questionnaire. Setting: The survey was conducted in the prosthetics clinic of a teaching hospital. Subjects: Patients were selected from those who had new complete dentures constructed in the department within the previous two years. Intervention and main outcome measures : The personality inventory was a self‐administered questionnaire comprising 240 items covering the five domains of personality. Denture satisfaction was scored on a nine item scale with four Likert type responses to each. Results: A group of 16% consistently complained about their dentures. Statistical analysis showed that personality factors especially Neuroticism had a significant relationship with denture satisfaction. Conclusion: Psychological factors significantly influence denture satisfaction and profiles may provide useful in predicting potential difficult denture wearers.     

The spectral analysis of syllables in patients using dentures

Changes in the oral cavity resulting from the loss of teeth and the ensuing reconstruction of a set of teeth by dentures (partial or complete) may cause changes in the speech and voice of the patient. The aim of the present investigation was to study the changes in speech and voice in patients suffering from teeth loss and the degree of speech improvement using dentures. Voice and speech parameters of a set of tested syllables were analysed in 10 patients at the 2nd Clinic of Stomatology. The analysis was carried out by means of an FFT, SoundForge 5.0 programme. Differently expressed acoustic changes in both consonants and vowels were ascertained in a percentage of the patients under examination. These concerned especially the sibilant ("s", "(see text)"), labiodental ("f", "v") and vibrating ("r", "(see text)") consonants. Changes in the FFT spectrum and air leakage in constrictive consonants were also found. In some patients the vowels, especially the closed ones ("i", "u"), may change their fundamental frequency and show noise admixture manifested as a blurred delimitation of the formants. A denture should, inter alia, render it possible for the patient to produce the same articulation to which he/she had been accustomed before the loss of teeth. For the construction of dentures the most important factors from a phonetic point of view appear to be the following: overbite, overjet, the height of the plate, the thickness of the palatal material, the incisor position, and the modelling of the ruga palatina on the hard palate. In case of wrong denture construction the acoustic changes may continue, resulting in the patient's stress load dependent upon sex, age, psychic condition and seriousness of the problem.     

Complete denture wearing and fractures among edentulous patients treated in university clinics

doi: 10.1111/j.1741‐2358.2011.00551.x
Complete denture wearing and fractures among edentulous patients treated in university clinics Objective: The prevalence of wearing and fracture of complete dentures was evaluated among edentulous patients treated in two dental schools in Brazil. Background: Acceptance and wearing of complete dentures are related to adaptive behaviour of edentulous patients. However, one reason that could interfere with the wearing dentures is their potential to fracture, which is still a common complication in denture rehabilitation practice. Material and methods: Two hundred and twenty‐four edentulous patients rehabilitated with complete dentures from 2000 to 2005 in Araçatuba and Araraquara Dental School, University of State of São Paulo, were assessed in 2006 and 2007 to answer a questionnaire about wearing and fracture of their dentures. Statistical analysis were performed using Epi Info software and chi‐squared test to compare maxillary and mandibular data (α = 0.05). Results: Almost 26% of the patients did not wear their dentures, and among the remainder, the majority wore the maxillary denture. About 30% of the dentures were fractured, with higher prevalence in the maxillary arch (p = 0.003). Conclusions: Discontinuation of wearing dentures was quite high, especially considering the treatment which was carried out in university clinics. Prevalence of fractures was also high, greater for the maxillary denture, and was one of the main reasons for non‐wearing of complete dentures.     

Decreasing of residual alveolar ridge height in complete denture wearers. A five year follow up study

The resorption of the residual alveolar ridges is a chronic and continuous process of bone remodeling. The aim of this study was to analyse the rate of residual ridge resorption at different sites in the both jaws in complete denture wearers, through a five-year period of denture wearing. Residual ridge changes were measured on successive lateral cephalograms at 5 measurement points of the maxilla and the mandible. The first lateral radiograph was obtained at the delivery of complete dentures. The second lateral cephalogram was obtained after five years of denture wearing. Measurements were performed using a calibrated grid. The results of this study showed the existence of a significant alveolar ridge resorption at all five measurement points of the maxilla and the mandible. The observed variables, such as body mass index and the night time denture wearing had no significant influence on the rate of residual alveolar ridge resorption (p > 0.05). The duration of edentulousness had a significant influence on the rate of residual ridge resorption with significantly higher amounts of alveolar bone height decrease in those patients who had lost the last remaining teeth more recently.     

The oral health‐related quality of life in edentulous patients treated with Conventional complete dentures

Objective: To compare the oral health‐related quality of life (OHRQoL) between patients with both maxillary and mandibular complete denture and those with either the maxillary or the mandibular complete denture. Background: Satisfaction of denture wearers can be estimated using the OHRQoL questionnaires like the OHIP‐EDENT and the Geriatric Oral Health Assessment Index (GOHAI). Methods: Two questionnaires were used to compare the OHRQoL between edentulous patients who had conventional removable complete denture on both jaws and those who had on either one of the jaws. Result: The age of the participants ranged from 42 to 75 years, with the mean age of 58 ± 8.12 years. The mean OHIP‐EDENT scores were significantly high among those who wore conventional dentures in both jaws (54.12 ± 5.21), compared with the participants who only had denture either on upper or lower jaw (46.52 ± 7.35). It was noticed that the mean GOHAI score was significantly lower (p < 0.05) among participants who had conventional denture on both upper and lower jaw (28.25 ± 3.67), as compared to those who had conventional denture only on one arch (35.12 ± 2.11). Conclusion: Patients with complete dentures in both jaw (Group I) were less satisfied than patients with single complete denture (Group II). The result obtained in this study shows dissatisfaction with conventional dentures among edentulous patients.     

Maxillary complete denture movement during chewing in mandibular removable partial denture wearers

Objectives: To evaluate the pattern of maxillary complete denture movement during chewing for free‐end removable partial dentures (RPD) wearers, compared to maxillary and mandibular complete denture wearers. Materials and methods: Eighteen edentulous participants (group I) and 10 volunteers with bilateral posterior edentulous mandibles (group II) comprised the sample. Measures of mean denture movement and its variability were obtained by a kinesiographic instrument K6‐I Diagnostic System, during the mastication of bread and a polysulphide block. Data were analysed using two‐way anova (α = 0.05). Results: Upper movement during chewing was significantly lower for group II, regardless of the test food. The test food did not influence the vertical or lateral position of the denture bases, but more anterior dislocation was found when polysulphide blocks were chewed. Group II presented lower intra‐individual variability for the vertical axis. Vertical displacement was also more precise with bread as a test food. Conclusion: It can be concluded that mandibular free‐end RPD wearers show smaller and more precise movements than mandibular complete denture wearers.     

Patient ratings of chewing ability from a randomised crossover trial: lingualised vs. first premolar/canine-guided occlusion for complete dentures

Background: Complex procedures involving a facebow transfer and the use of lingualised teeth are deemed to have a positive influence on the chewing ability with complete dentures. Objectives: To determine if patients’ ratings of their ability to chew depend on the method of complete denture fabrication. Methods: Edentulous patients (n = 20) participated in a within‐subject crossover trial. Each patient received two sets of new complete dentures. One pair was manufactured based on intraoral tracing of centric relation and facebow transfer; semi‐anatomical teeth with lingualised occlusion denture (LOD) were chosen. The second pair was made using a simplified procedure without facebow transfer; jaw relations were recorded with wax occlusion rims, and anatomical teeth with a first premolar/canine‐guidance (CGD) were selected. The dentures were delivered in randomised order, and each was worn for 3 months. Three months after delivery, patients’ ratings of each new prosthesis were recorded on visual analogue scales for their ability to chew seven index foods. Repeated measurements analysis of variance was performed to investigate possible carry‐over effects accounting for confounding by treatment period. Results: When comparing the two treatments, participants rated their ability to chew in general, to masticate carrots, hard sausage, steak and raw apple in particular, was significantly better with the CGD (anatomical teeth) than with the LOD (p < 0.05). Conclusion: Comprehensive methods for the fabrication of complete dentures including semi‐anatomical lingualised teeth and a full registration do not seem to influence the perceived chewing ability, when compared with more simple procedures. Chewing ability for tough foods appears to benefit from the use of anatomical teeth.