Article

Will there be a need for complete dentures in the United States in 2020?

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Abstract

Currently, there is much speculation among dental educators that the need for complete dentures will decline markedly in the future and that complete denture training should be removed from the dental curriculum. Estimates based on national epidemiologic survey data indicate that edentulism has declined by 10% every decade and that only 90% of edentulous adults obtain and wear complete dentures. However, when the number of adults in each specific age group is multiplied by the percentage who need a complete maxillary or mandibular denture, the results suggest that the adult population in need of 1 or 2 complete dentures will increase from 33.6 million adults in 1991 to 37.9 million adults in 2020. The 10% decline in edentulism experienced each decade for the past 30 years will be more than offset by the 79% increase in the adult population older than 55 years. The clinical implications of these findings are twofold: First, practicing dentists will find that a sizable minority of the patient population will continue to need complete denture services; and second, if training in complete denture prostheses is eliminated from the dental education curriculum, millions of patients will be forced to seek denture services from alternative providers.

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... Recent developments in dental materials has brought about considerable improvement in preventive dental care over the past years [1]. However, studies have shown that there will still remain a need for removable prosthetic treatment as a result of extended life expectancy and population growth globally [2,3]. ...
... In recent years, the focus has shifted to implant retained prosthesis for missing teeth replacement [6]. The expense, complex surgical procedure and risks related to implant retained prosthesis is the reason that conventional removable denture is a treatment modality that is being used worldwide for replacing missing teeth [1]. ...
Article
Objective: To explore current trends in removable partial prosthodontics teaching in undergraduate dental colleges of Sindh, Pakistan. Study Design: Descriptive Cross-sectional. Place and Duration of the Study: Department of prosthodontics in dental colleges of Sindh in September 2019. Methodology: A descriptive cross-sectional study was done in which a questionnaire was sent by email to head of Prosthodontics department of 16 dental institutes of Sindh, Pakistan. The survey included different questions regarding current trends in removable partial prosthodontics education in undergraduate dental colleges. Results: Out of sixteen questionnaires, fourteen were completely filled and returned. Majority (69.2%) of the institutes teach fabrication of removable partial dentures (RPDs) in third year of dental college. Students of only one dental college fabricate 10-12 RPDs in their clinical rotation. All dental colleges teach acrylic RPD construction in their preclinical years. Faculty in 12 (85.7%) dental colleges always give clinical demonstrations to students before their clinical rotations. Eleven out of the fourteen colleges teach cast partial dentures (CPDs) theoretically, but no CPDs are fabricated by the students during their clinical rotation. About 70% dental schools do not have in-house facility to fabricate cast partial dentures. Conclusion: This study describes current trends of removable prosthodontics teaching in undergraduate colleges of Sindh. A large majority of undergraduate dental students are not fabricating the minimum number of partial dentures as per PMC requirement. Although theoretically cast partial dentures are taught in lectures but students do not construct them in their undergraduate years. Efforts should therefore be made to improve teaching practices and clinical skills of undergraduates, for them to be able to treat partially dentate patients after graduation.
... removable partial dentures (RPDs) are the treatment of choice for most individuals. Oral rehabilitation with a removable partial denture (RPD), when well indicated, plays a direct role in reestablishing the oral and systemic health of partially edentulous patients [1][2][3][4]. ...
... Tooth losses caused by trauma, periodontal disease or caries interfere with the quality of life of patients. Dental prostheses aim at partial or total rehabilitation to restore the esthetics and function, reestablishing the physical and psychological wellbeing of patients, since tooth loss causes functional damage, impairing the masticatory capacity, negatively influencing the speech and esthetics (1,(5)(6)(7)(8). ...
... Elderly people have many health problems, among which tooth loss has become an issue of concern in the Vietnamese elderly. Although the prevalence of complete tooth loss has declined over the last decade, edentulism remains a major disease worldwide, especially among older adults (2). According to Nguyen Thuy Nga and Truong Manh Dung (2017), the overall rate of tooth loss in elderly people in Hanoi in 2017 was very high (80.7%) ...
Article
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Background: The loss of teeth in elderly people reduces their chewing ability and leads to a decrease in food intake, including meat. In Vietnam, meat is a common source of protein; most people maintain the habit of buying meat in large pieces from traditional markets and then slicing it at home with a knife. However, the thickness of meat sliced by hand is usually 3-5mm; the slices are large and irregular so they are difficult for the elderly to chew. In Japan, which has the highest proportion of elderly and the longest healthy life expectancy in the world, people generally use pre-sliced meat instead of block meat. By using a meat slicer, we can get pieces of meat of the same size, with a thickness of only 1.5mm (depending on the adjustment to the slicer). Purpose: To examine the effect of using thinly sliced meat compared with meat sliced by hand on time of chewing and the number of chews and food intake in older adults who have lost teeth. Methods: We conducted an intervention study following a cross-over design on 38 elderly subjects. After evaluating sensory characteritics and recording the time and number of chews between 2 samples of meat (thinly sliced meat and hand-cut meat), they were randomly divided into groups A and B; each group had 19 subjects. We provided subjects all the foods that they ate with either diet, using thinly sliced meat or hand-cut meat (cooked in the same way and with the same quantity) for 1 week. After a week washout, the diet was reversed. The subjects did not eat anything apart from the diets that they were served. The diets were weighed before and after eating and then the amount of food consumed was calculated. Results: The thinly sliced meat took less overall time for chewing and and fewer chews than the hand-cut met (same quantity). To chew 3g of thinly sliced meat, subjects took 53 ± 22 times and 47 ± 23 seconds while to chew the same quantity of hand-cut meat needed 73 ± 35 times and 65 ± 33 seconds, both (p < 0.05). When subjects consumed the Thinly sliced meat diet, energy, protein, lipid intakes were higher than with the Hand-cut meat diet in both moderate dentition subjects (21-27 teeth) and poor dentition subjects (20 teeth or less), and the differences were statistically significant (p<0.05). The average scores of the sensory test for thinly sliced meat samples were higher than for sliced by hand samples in terms of taste, tenderness, and overall acceptability (p<0.05). Conclusions: Thinly sliced meat was easier to chew and favored over meat sliced by hand in the elderly who have lost teeth.
... Depression has been reported to predispose to oral diseases due to biological disturbances and a lack of motivation. [10] Likewise, oral diseases have also been found to impair self-esteem, OHRQoL, and thereby, affecting the psychological well-being of individuals. [11] Edentulous persons aged less than 55 and those who lost all their teeth before 55 years of age reported more depressive symptoms than those who were elder to them. ...
Article
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Background: Edentulism affects the chewing ability of a person and can engender nutritional deficiencies which can affect the overall quality of life and depression. Aim: Our aim was to evaluate the association between perceived chewing ability, oral health-related quality of life (OHRQoL) and depressive symptoms among completely edentulous patients with and without dentures. Settings and design: Institutional study and cross-sectional design. Methods: A cross-sectional study among 207 completely edentulous persons was conducted in South India. The subjects completed a self-administered questionnaire on demographics, Beck's depression inventory, oral health impact profile-edentulous (OHIP-EDENT), age when edentate, chewing ability, and denture satisfaction. Further, denture status was clinically evaluated. Statistical analysis: Data were summarised and analysed using the Chi-square test and multivariate logistic regression. P < 0.05 was considered significant. Results: Persons not using complete dentures (odds ratio [OR] =3.5, P < 0.05), who reported impaired chewing ability (OR = 4.6, P < 0.05), those who became edentate before 55 years (OR = 4.6, P < 0.05) and with poor denture status (OR = 6.2, P < 0.05) were more likely to report depressive symptoms. Lesser impact in relation to OHRQoL was found to be protective against depression among completely edentulous (OR = 0.24, P < 0.05). Conclusion: Depressive symptoms were associated with impaired chewing ability, higher impacts on OHIP-EDENT, and edentulous persons not using complete dentures. High priority must be given to enhance awareness towards oral rehabilitation among completely edentulous to reduce the chance of depression occurring due to impaired chewing ability and poor OHRQoL.
... Tooth loss, an irreversible measure of poor oral health, is a condition found among older individuals and is an increasing public health concern. Researchers have projected that by the 2020s, the number of denture wearers will steadily increase due to population aging and declining access to dental care (Douglass et al., 2002). Understanding the distinct health risks that individuals with tooth loss face is crucial to improving health outcomes on the aggregate level. ...
Article
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In this study, we examine the impact of a severe health condition—complete tooth loss—on educational gradients in adult mortality risk among racial/ethnic groups by nativity in the United States. We use the 1999–2014 National Health Interview Survey Linked Mortality File (NHIS-LMF) to estimate Cox proportional hazards models of the risk of death for non-Hispanic White, non-Hispanic Black, and other-Hispanic populations, considering both Mexican-origin and other-Hispanic adults (N = 373,041). We find that although White, Black, and other-Hispanic adults have significant education gradients in mortality risk, these gradients disappear for individuals who have experienced complete tooth loss. Both foreign-born and US-born Mexican adults show no significant relationship between education and mortality risk, regardless of tooth loss status. Our results indicate that policies that focus on preventing tooth loss may be more effective at reducing disparities than those that improve care for adults with existing tooth loss.
... As a result of the progression of dental diseases, patients lose a large number of teeth. The most intense tooth loss is observed in patients over 40 years of age, reaching maximum rates in the age group over 60 years of age and can lead edentulism [2,3]. Complete edentulous leads to leads to functional chewing apparatus, this negatively affects the functioning of the gastrointestinal tract and the general health [4]. ...
Article
Objectives: The purpose of this study was to comparative analysis of effectiveness of isolated use of intradermal injections of modified hyaluronic acid (Hyalorepair 04) and its combination with platelet-rich autologous plasma in edentulous patients with perioral wrinkles of the skin. Materials and Methods: A total of 56 patient’s presence of perioral wrinkles of the skin participate in the study after dental implant prosthodontics rehabilitations. They were randomly divided into 2 groups in accordance with the applied therapy method (29 isolated implementation of modified hyaluronic acid bio-repairing and 27 bio-repairing combined with autologic plasmotherapy). Treatment included implant-prosthetic rehabilitation followed by hyaluronic acid injections in order to correct cheek-zygomatic sulcus, nasolabial folds and marionette wrinkles. Preparations in an amount from 1 to 4 ml were injected into the face area, depending on the zones to be corrected at the request of the patients. Results: The complex treatment restored the aesthetic profile of the face and oral cavity and increased the effectiveness of the chewing function. On M03 and M05, 2/3 of patients had significant improvement as assessed by physician and patient according to GAIS. Most of the patients also showed significant improvement at visit M12. Conclusion: A multidisciplinary approach to the treatment of edentulous patients with perioral wrinkles increases the functional and aesthetic effect of the treatment. Implementation of combined of bioreparation and autologous plasmotherapy is significantly more effective comparatively to the isolated implementation of modified hyaluronic acid. Keywords: Facial Esthetic; Implant-Prosthetic Rehabilitation; Hyaluronic Acid
... As life expectancy of individuals increases worldwide, the demand for removable dental prostheses is increasing. 1,2 However, when complete dentures are manufactured conventionally for edentulous patients, who are primarily older adults, the required number of visits can be burdensome. 3 In addition, if the complete denture is lost or fractured, it is difficult to have it remade. ...
Article
Purpose: This study aimed to analyze the shear bond strength between the 3D-printed denture base and the chairside relining material, according to the surface treatment. Materials and methods: Cylindrical specimens were prepared using DENTCA Denture Base II. The experimental groups were divided into 6 (n = 10): no surface treatment (C), Tokuyama Rebase II Normal adhesive (A), sandblasting (P), sandblasting and adhesive (PA), sandblasting and silane (PS), and the Rocatec system (PPS). After bonding the chairside relining material to the center of the specimens in a cylindrical shape, they were stored in distilled water for 24 hours. Shear bond strength was measured using a universal testing machine, and failure mode was analyzed with a scanning electron microscope. Shear bond strength values were analyzed using one-way analysis of variance, and Tukey's honest significant difference test was used for post-hoc analysis (P < .05). Results: Group PPS exhibited significantly higher shear bond strength than all other groups. Groups P and PA displayed significantly higher bond strengths than the control group. There were no significant differences between groups PS and A compared to the control group. Regarding the failure mode, adhesive failure occurred primarily in groups C and A, and mixed failure mainly in groups P, PA, PS, and PPS. Conclusion: The shear bond strength between the 3D-printed denture base and the chairside relining material exhibited significant differences according to the surface treatment methods. It is believed that excellent adhesive strength will be obtained when the Rocatec system is applied to 3D-printed dentures in clinical practice.
... The need for complete dentures is set to rise from 53.8 million in 1991 to 61.0 million in 2020. 1 The American College of Prosthodontists, has provided facts and figures which validate the need of dentures even today and for days to come. 2 Acrylic resin/Polymethyl methacrylate (PMMA) is the most widely used denture base material till date and has undergone various modifications in order to enhance its physical and mechanical properties. Even after the modifications acrylic resin is far from an ideal material for dentures and requires more research and breakthroughs to provide a better material. ...
Article
Objective The present study aimed to evaluate and compare the flexural strength and impact strength of heat-cured acrylic/Polymethyl methacrylate (PMMA) denture base resin and 3D printed denture base resin. Methods 60 rectangular specimens were fabricated from conventional heat-cured acrylic and 3D-printed denture base resins. 15 specimens each of heat-cured acrylic and 3D printed denture base resin were tested for flexural strength and impact strength. The flexural strength was assessed using three point bend test while impact strength was assessed by Izod impact test. Results The mean flexural strength of heat-cured acrylic resin was 92.01 ± 12.14 MPa and 3D printed denture base resin was 69.78 ± 7.54 MPa. The mean impact strength of heat-cured acrylic resin was 1.67 ± 0.79 kJ/m² and 3D printed denture base resin was 1.15 ± 0.40 kJ/m².The differences in mean impact and flexural strength between heat-cured acrylic and 3D printed denture base resins were statistically significant. Conclusion Heat-cured acrylic denture base resin (DPI heat-cure) had greater flexural and impact strength than 3D printed denture base resin (Next Dent denture 3D+).
... This is in accordance with another study which showed the average age of complete denture patients in their study was 67.3 years [26]. Another study states an increase in patients older than 55 years wearing dentures [27]. In our study, the number of completely edentulous male patients (56.4%) outnumbered female patients (43.6%). ...
... Although the introduction of implants in dentistry has improved the quality of prosthetic care for edentulous patients, 1 the ongoing need for removable prosthetic rehabilitation will increase regardless of the higher self-perception and awareness among patients. 2 In 2020, Douglass et al 3 reported an increase in complete denture treatment needs among the adult population in the U.S. and speculated a shift from 33.6 million in 1991 to approximately 37.9 million by 2020. To meet the increasing demands, a variety of prosthetic measures must be considered to ensure successful rehabilitative care. ...
Article
Purpose: To evaluate the effect of cigarette smoke on the surface roughness and color stability of three different soft denture liners. Methods: Three commonly used commercially available, chair-side, long-term vinyl polysiloxane soft denture liners were used for this study [Sofreliner Tough (S) Soft, Silagum Comfort Soft Relining, and GC Reline Soft]. Thirty disk-shaped specimens of each material, with a diameter of 25 mm and thickness of 2 mm, were fabricated. Initial color and surface roughness readings were recorded. The specimens of each group were randomly divided into two groups (n= 15): the control group (C) and the study group (S). The control group specimens were stored in distilled water and the study group samples were exposed to cigarette smoke in a custom-made smoking chamber. Final color and surface roughness readings were recorded. A single operator performed all the measurements. The differences in color and surface roughness were calculated. Statistical analysis was performed using two-way ANOVA, post-hoc Tukey test, and paired t-test. For all the analyses, a P< 0.05 was regarded as statistically significant. Results: After exposure to smoke, all groups showed a significantly perceptible color change (ΔE > 3.7). The greatest color change was seen in the Silagum group (ΔE= 8.94 ± 0.42), followed by the Sofreliner group (ΔE= 7.85 ± 0.47), with the least change in the GC reline group (ΔE= 3.87 ± 0.46). The mean color change after smoke exposure showed a statistically significant difference among all three study groups. The highest change in surface roughness was observed in the Silagum group (ΔR= 0.687 ± 0.14) followed by the GC reline group (ΔR= 0.265 ± 0.12), with the least change in the Sofreliner group (ΔR= 0.238 ± 0.06). There was a statistically significant difference between each group before and after exposure to smoke. Exposure to cigarette smoke caused significant changes in the color and surface roughness of all three soft denture liners tested in this study. The extent of these changes varied for each material.
... In the present study, as dentures were made on intraoral scans of edentulous arches, their intaglio surfaces were the negative of residual ridges obtained without the additional steps, and potentially associated errors, of impression making, cast fabrication, and digitization; the measured deviations obtained in the present study were below the reported cutoff value 19 for clinical acceptability; as a result, both milling and 3Dprinting may be considered clinically acceptable. However, for clinical recommendations, a comprehensive evaluation of all advantages and disadvantages, including equipment and infrastructure costs, is required, with special attention given to accessibility and usability, especially in a global scenario where millions of people, even in developed countries, 27 are in need of removable prostheses. ...
Article
Statement of problem While the dimensional accuracy of the intaglio surface of a removable complete denture is key to its adaptation, comfort, and clinical performance, information on the ability of milling and 3D-printing workflows to accurately reproduce this surface is lacking. Purpose The purpose of this clinical study was to compare the trueness of the intaglio surface of milled and 3D-printed removable complete digital dentures. Material and methods Intraoral scans were obtained from 14 participants for a total of 20 edentulous arches. Ten maxillary and 10 mandibular denture bases were then designed and fabricated with a completely digital workflow, both with milling and 3D-printing. Fabricated dentures were digitized with the same intraoral scanner used to obtain intraoral digital scans of the edentulous arches. Standard tessellation language (STL) files of the printed and milled denture bases were used for 3D analysis and comparisons with the STL file of the corresponding designed denture base. Specifically, a reverse engineering software program was used to trim and extract intaglio surfaces, align them, and measure their global mean 3D distance. In order to evaluate the homogeneity of production accuracy of each manufacturing process, the intaglio surfaces were also divided into several regions of interest and the corresponding 3D distances measured. Within- and between-group differences and maxillary and mandibular dentures differences were assessed with parametric and nonparametric tests (α=.05). Results Milling showed a global better trueness of the entire intaglio surface (-0.002 mm) than 3D-printing (0.018 mm), both for the whole data set (P<.001) and for maxillary (P=.032) or mandibular (P=.049) denture base subgroups. Within each fabrication technology, maxillary (P<.11) and mandibular dentures (P=.2) showed no significant difference in trueness. Measured deviations were significantly different from zero for the 3D-printed dentures (P<.001), but not for the milled dentures (P=.487). Additionally, for milled dentures, no significant difference in trueness was found among the 11 regions of interest identified for the maxillary dentures (P=.085) and the 13 regions of interest for the mandibular dentures (P=.211). Conversely, 3D-printing showed significant variations in trueness among the same zones of interest, both in maxillary (P<.001) and mandibular (P=.004) dentures. Conclusions Within the limits of the manufacturing methodologies used for complete dentures, milling can provide a slightly better trueness of the intaglio surface than 3D-printing, with less variation across several zones of interest. However, given the magnitude of such differences, they may be reasonably considered to be of limited, if any, clinical significance.
... The demand for removable dentures in industrialized countries has been increasing because of the rapid growth of the elderly population [1]. There is an increasing need to perform multidimensional assessments including overall patient health and patient preferences in the clinical decision-making process. ...
Article
Purpose: To investigate the factors influencing patients’ willingness to replace removable dentures using structural equation modeling (SEM). Methods: A total of 153 patients who sought consultations for removable dentures self-evaluated denture quality using a visual analog scale (VAS); health-related quality of life using the 36-item Short-Form Health Survey; and oral health-related quality of life using the Oral Health Impact Profile. Dental clinicians evaluated denture quality using a VAS and by assessing the presence of defects. After being informed of various treatments, patients were asked whether they would prefer denture replacement. SEM was applied to analyze the relationships and interactive effects among the variables. Results: The final model showed high goodness-of-fit indices (chi-square/degree of freedom = 1.009, comparative fit index = 1.000, Tucker-Lewis index = 0.999, standardized root mean square residual = 0.421, and root mean square error of approximation = 0.008). SEM demonstrated that two latent constructs indirectly predicted patients’ willingness to replace dentures; the standardized total effects of good oral health and poor denture quality were −0.154 and 0.503, respectively. Conclusion: These findings provide a unified understanding of the shared decision-making process for denture replacement and highlight the pretreatment assessments that play a relevant role in patient treatment preferences.
... Nevertheless, epidemiological research showed that the proportional decrease of edentulism will not result in an actual decrease in the number of edentulous patients due to population growth. [2][3][4][5] The demand for rehabilitation of edentulous patients will remain real as less affluent members of society are particularly prone to tooth loss since they favor the least expensive (in monetary terms, certainly not biological) method for dental treatment. 6 Hence, treating edentulism in an inexpensive and effective way will remain important. ...
Article
Purpose: To compare patient-reported outcomes among balanced, lingualized, and monoplane occlusal schemes in relation to edentulous jaw classifications. Materials and methods: This randomized controlled trial was conducted in edentulous patients receiving new complete dentures using balanced, lingualized, or monoplane occlusal schemes. Demographic variables, bone ridge quantity, number of adjustments required after denture insertion, and satisfaction and quality of life (QoL) indices (ie, the Denture Satisfaction Questionnaire [DSQ] and General Oral Health Assessment Index [GOHAI], respectively) were assessed at 1, 2, 4, 8, 12, and 52 weeks. Within-group comparisons at different time points were carried out with Brunner-Langer nonparametric analysis. Furthermore, Kruskal-Wallis test was used to compare distributions of ordinal or continuous variables among the three occlusal scheme groups. Results: A total of 60 subjects (mean age: 68.1 ± 11.1 years; 56.7% men and 43.3% women) were analyzed. All three groups presented significant improvements in DSQ and GOHAI scores between denture insertion and the 1-year follow-up appointment (P < .001). There were no statistical differences in the distribution of demographic variables (eg, age, gender, years edentulous, and age of existing dentures) or of bone ridge classifications among the three groups. Similarly, there were no statistical differences in ridge classifications or in the DSQ and GOHAI values among the three groups for both the maxilla and mandible (P > .05) over the 52-week follow-up. On the other hand, the number of cases requiring denture adjustments was significantly lower in the lingualized scheme group, as compared to the two other groups (P = .034). Conclusion: Within the limitations of this study, the present findings suggest that the occlusal scheme for posterior teeth did not influence patient-reported subjective outcomes. However, the lingualized occlusal scheme required significantly fewer adjustments.
... Implant-supported fixed prostheses have been a successful treatment for completely edentulous patients [1][2][3] and have been used in conjunction with delayed or immediate loading protocols. 4,5 Longitudinal studies and systematic reviews have reported high implant survival rates for IFCDPs. ...
Article
Statement of problem Limited information is available on the association between prosthesis-associated risk factors and biologic complications for patients with implant fixed complete dental prostheses (IFCDPs). Purpose The purpose of this retrospective study was to assess the implant survival and biologic complications of IFCDPs up to 5 years of follow-up. Material and methods Patients who had received IFCDPs between August 1, 2009 and August 1, 2014 were identified through an electronic health record review. Those who consented to participate in the study attended a single-visit study appointment. Clinical and radiographic examinations, intraoral photographs, and peri-implant hard and soft tissues parameters were assessed. Only prostheses which could be removed during the study visit were included. Associations between biologic complications and prosthetic factors, such as time with prosthesis in place, prosthesis material, number of implants, cantilever length, and type of prosthesis retention, were assessed. Results A total of 37 participants (mean ±standard deviation age 62.35 ±10.39 years) with 43 IFCDPs were included. None of the implants had failed, leading to an implant survival of 100% at 5.1 ±2.21 years. Ten of the prostheses were metal-ceramic (Group MC) and 33 were metal-acrylic resin (Group MR). Minor complications were more frequent than major ones. Considering minor complications, peri-implant mucositis was found in 53% of the implant sites, more often in the maxilla (P=.001). The most common major biologic complication was peri-implantitis, which affected 4.0% of the implants, more often in the mandible (P=.025). Peri-implant soft tissue hypertrophy was present 2.79 times more often (95% CI: 1.35 – 5.76, P<.003) around implants supporting metal-acrylic resin prostheses than metal-ceramic ones, with the former type also showing significantly more plaque accumulation (P<.003). Conclusions Biologic complications such as soft tissue hypertrophy and plaque accumulation were more often associated with metal-acrylic resin prostheses. Peri-implant mucositis occurred more often under maxillary IFCDPs, while peri-implantitis appeared more common around mandibular implants.
... of tooth loss among the general population over the past 30 years [3]. The loss of natural teeth can affect the functional and psychosocial aspects of an individual [4]. ...
Article
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Alveolar ridge defect occurs due to complex extraction of tooth which leads to a certain amount of bone loss and it occurs due to injury, congenital defects, Denture wear, periodontitis and truama. Alveolar ridge defects were classified by Seibert's Classification which identified the ridge defect. Alveolar ridge defects can be classified as a loss of labial cortical or medullary bone or sometimes both. Thereby replacing the missing tooth and to restore good esthetics, phonetic, and mastication. To provide a proper treatment plan and treatment options can be assessed for successful outcomes. Hence, the purpose of this study was to assess the prevalence of alveolar ridge defect using the Seibert's classification in patients with fixed partial dentures. The retrospective study was conducted among patients with Fixed partial dentures. The data were reviewed of 86,000 patient records between 1 st June 2019 and March 30 st 2020 from which 407 subjects of fixed partial dentures were assessed for alveolar ridge defects using the seibert's classification. The Collected data was tabulated in the excel sheet which was imported to SPSS software Version 20 for statistical analysis. Out of 407 patients 226 (55.53 %) were more prevalent than females 186 (44.47%). Most commonly involved age group among 31-40 years (29.24%). Class III was the most commonly observed type of defect 49.14%, followed by class I 44.96% and Class II 5.90%. Sextant II (36.36%) was most commonly affected followed by Sextant VI (22.11%). Male patients were more commonly affected than the female patients, the most common age group was 31-40 years of age.
... Edentulisim is the state where patient does not possess any natural tooth [1]. Despite an expected decrease in the rates of edentulousness with age, still a large group of patients will require complete dentures [2]. Treating edentulous patients with complete denture is demanding task and its success depend upon proper retention, stability and support of prosthesis [3]. ...
... Edentulisim is the state where patient does not possess any natural tooth [1]. Despite an expected decrease in the rates of edentulousness with age, still a large group of patients will require complete dentures [2]. Treating edentulous patients with complete denture is demanding task and its success depend upon proper retention, stability and support of prosthesis [3]. ...
Article
Full-text available
79 examined for vibrating line clinically, assessed using phonation method. Subsequently, distance between vibrating line and fovea paltatinae was measured with uncalibrated compass in various contours of soft palate. Results: Out of 197 patient, the vibrating line was seen in130 (64%) anterior to fovea palatinae, whereas, 67 (34%) vibrating line was at the fovea palatinae. The mean distance of those anterior located vibrating line from fovea palatine was calculated as 2.13 (0.82) mm in Class, 2.07 (0.69) mm in Class II and 1.80 (0.82) mm in Class III soft palate contours. Statistical analysis showed no significant between gender, while statistically significant difference among age group and mean distance of anterior located vibrating line from fovea palatinae were found. Conclusions: The mean distance of vibrating line which is predominately found anterior to the fovea palatinae was 2.07 (0.77) mm.
... Demographic changes are working against this downward trend. Although projections differ, some institutes prognosticate that prosthetic needs will be, consequently, increased in the future [4], while others forecast that some aspects of prosthetic treatment will disappear [5]. The realities, as far as they are currently known, suggest that prosthetic treatment needs will continue to play an important role in the aging population. ...
Article
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To date, there is little evidence on centenarians’ dental and prosthetic status or their oral-health-related quality of life (OHRQoL). Therefore, the aim of this study was to assess possible associations between sociodemographic and oral health factors, including prosthetic needs in this special age group and their potential influence on OHRQoL. Persons born before 1920 were recruited from population registries in south-western Germany. Fifty-five centenarians participated and underwent a comprehensive oral examination. Cognitive capacity was evaluated using the short Mini-Mental State Examination (S-MMSE, max. 21 points). At an S-MMSE > 10, an analysis of OHRQoL by means of the Geriatric Oral Health Assessment Index (max. ADD-GOHAI score 60 points) was performed (n = 43). Bivariate statistics and a linear regression model were used after variable selection to analyze data. Centenarians presented with a mean (SD) of 22 (7.2) missing teeth. Complete (65.5%) or partial dentures (21.8%) in at least one jaw were most common. One-third of the dentures needed repair/replacement; 16% of the centenarians presented with denture sores. In 60% of cases, OHRQoL was rated unsatisfactory (ADD-GOHAI < 57). Trouble biting or chewing resulted in the lowest levels of OHRQoL. Fewer remaining teeth, reduced functional capacity and removable prostheses correlated with an impaired OHRQoL (rs = −0.36, p = 0.01; rs = −0.34, p = 0.01; rs = −0.29, p = 0.03, respectively). After variable selection, the final linear regression model included only the number of missing teeth, the associated ADD-GOHAI score decreasing by 0.3 points per missing tooth. In conclusion, tooth loss and removable prostheses in need of repair or replacement are highly prevalent in centenarians. These factors seem to modulate OHRQoL negatively, assumedly due to impaired chewing function. Larger confirmatory studies are needed to validate these first results.
... 27 On the other hand, another investigation by Douglass et al demonstrated that the increasing prevalence rates among the different communities were attributable to the increasing trends in population aging and related comorbidities that might significantly impact oral health. 28 Many factors in the literature have been reported in association with edentulism. Among these factors, age had been reported as a significant contributor to the development of edentulism among the various studies in the literature, both globally and at a national level across the Kingdom. ...
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The epidemiology of edentulism is different across the different communities and the prevalence rates are also significantly different and it can be affected by various factors. There have been many investigations that reported the prevalence rates of edentulism across the different countries globally. However, not many investigations were published in Saudi Arabia and the published ones also report different findings. In the present study, we have reviewed the current studies in the literature to investigate the prevalence of edentulism and associated factors in Saudi Arabia. Our results indicated that the reported rates were conflicting among the different reports across the Kingdom and some of these rates are lower than other rates that were reported in some countries but higher than others also. Therefore, further nationwide research was still needed to formulate better evidence and help draw adequate interventions for the most vulnerable groups. Age, gender, educational levels, regional residency, socioeconomic status, depression and diabetes have all been reported to be correlated with edentulism. The prevalence of the condition has been reported to be highest among older age groups, while evidence is contradicting about the difference between both genders. Therefore, targeting vulnerable populations with early interventions can reduce the incidence rates and enhance the quality of life among these populations.
... This is in accordance with another study which showed the average age of complete denture patients in their study was 67.3 years [10]. Another study states an increase in patients older than 55 years wearing dentures [16]. ...
... Epidemiological data indicate a continuous increase in the number of edentulous patients. It has been attributed to elongation of global average life expectancy [1][2][3]. Prosthetic rehabilitation of edentulous patients is difficult and requires knowledge and experience, both from dentists and dental technicians. Despite considerable advances in the field of prosthodontics, conventional complete dentures are still the most popular prosthetic restorations in edentulous patients [4]. ...
Article
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(1) In recent years, there has been a significant increase in the availability of denture adhesives for stabilizing removable dentures. The aim of the present study was to assess the cytotoxicity of three denture adhesives on human fibroblasts. (2) Methods: Three denture adhesives were analyzed. Fibroblast cultures were established for the study and control groups in order to assess the incidence of necrosis and to evaluate the microscopic intracellular alterations induced. Following incubation with (study groups) or without adhesives (control group), trypan blue dye exclusion assay was used to determine the number of viable and/or dead cells. Microscopic specimens were stained with haematoxylin and eosin, scanned, digitally processed and then analyzed by a histopathologist. (3) Results: All three denture adhesives analyzed demonstrated various toxic effects in vitro on human fibroblast: quantitative evaluation—45.87–61.13% reduction of cell viability (p = 0.0001) and slight to moderate cytotoxicity in qualitative evaluation. (4) Conclusions: Denture adhesive creams demonstrated a toxic effect on human fibroblasts in vitro in quantitative and qualitative evaluation. In vivo observations are needed to find out if denture adhesives present a cytotoxic effect in patients.
... (94) Use of CAD-CAM technology for fabricating complete dentures may overcome many of the above disadvantages. Indications for CAD-CAM dentures include individual patient care, education, research, and public health due to reasons such as: (1) continued growth of edentulous patients and increased demand for complete dentures in the United States; (95) (2) increased numbers of aging population in the United States; (96) (3) access to dental care issues around the world; (4) easier implementation in public health programs; (5) shortage of dental laboratory technicians in the United States; and (6) shortage of dentists and dental faculty in the United States. 2 Some of the expected advantages of CAD-CAM dentures are: (97) (1) reduced number of patient visits, which is especially beneficial to elderly patients; (2) superior strength and fit of dentures due to use of prepolymerized acrylic resin blocks for milling; (3) reduced potential for dentures to harbor microorganisms and minimize resultant infections; (4) reduced cost for the patient and the clinician in the long run; (5) easier reproducibility (creation of duplicate dentures) due to stored digital data; (6) improved potential for standardization in clinical research on complete dentures as well as implant-retained overdentures; and (7) better quality control. ...
Book
With the evolution and advancements in dental science, various new techniques and methods for the replacement of missing teeth have come into foray. Replacement of missing teeth with dental implants have now become the most sought-after treatment modality. Implant overdentures are increasingly used as a viable option to restore edentulous patients and mandibular overdenture has been advocated as a minimum standard of care for such patients, especially in developed nations. Compared with conventional removable dentures, the implant overdenture prostheses offers increased longevity, improved function, bone preservation, and better psychologic results. This book provides an overview on the various techniques and attachments that are available for implant supported overdentures.
... Despite the decrease in the percentage of edentulism over time, it is estimated that adults older than 65 needing complete dentures will increase from 33.6 million adults in 1991 to 37.9 million adults in 2020. 3 In order to maintain function, appearance or quality of life, need to replace teeth challenges oral health care providers in different ways, using removable or implant-supported prostheses, or in combination. It has been well-documented that prolonged use of complete denture can lead to the resorption in the remaining alveolar ridge. ...
Article
Purpose: Masticatory loading triggers active bone remodeling, altering alveolar bone mineral density (BMD). While dental implants are placed to bear masticatory loading, their influence on changing bone properties has not been fully investigated. Objective of this pilot study was to examine whether the dental implantation has an effect on BMD distribution of bone by comparing dentate, edentulous, and edentulous patients with implants. Materials and methods: Cone beam computed tomography (CBCT) images of 19 partially edentulous patients (Dent), 19 edentulous patients (Edent), and 16 edentulous patients who received implants in the mandible (Edent+Im), were obtained. CBCT images were also obtained from 5 patients within Edent+Im group, before implant placement and after implant loading. Basal cortical bone region of the mandible was digitally isolated. A histogram of gray levels proportional to BMD was obtained to assess mean, histogram standard deviation (HSD), fifth percentile of low and high values (Low5 and High5) of the BMD distribution. Multivariate analysis of variance and paired t-test were used to compare the BMD parameters among the 3 dental status groups and between pre- and post-implantation, respectively. Results: Edentulous patients with implants had significantly greater HSD and High5 values compared to edentulous patients (P < .013). All other comparisons were not significant (P > .097). Mean, HSD, and High5 values significantly increased after receiving implants (P < .022). Conclusion: The current findings suggested that receiving dental implants promoted oral bone mineralization for edentulous patients. The longitudinal investigation could provide valuable information on understanding the effects of implantation on the behavior of oral bone quality.
... The introduction of computer-aided design/computer-aided manufacturing led to a more accurate manufacturing of prosthetic frameworks, greater accuracy of dental restorations, and in particular, implant-supported prosthesis (Douglass et al., 2002). ...
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Objectives: Despite a large amount of materials and methods to make an implant-supported denture, nowadays there is no gold standard. Every solution has pros and cons that guide the clinician and the technician to choose the best solution for a single case. The aim of this study was to evaluate the mechanical characteristics of the fiber-reinforced composite superstructure made by using a novel three-dimensional (3D) printing technology able to create a reinforcing structure patient-specific, more reliable, structurally optimized, and faster than conventional methods. Materials and methods: To evaluate mechanical performances of 3D-printed fiberglass, mechanical characterization of 3D-printed material was performed. Before proceeding with the realization of the final prosthesis, five specimens were created on which the tensile test and volumetric fiber content measurement were performed. Then denture reinforcement 3D printing process began. Initially, the robot prints layers of fiber. Finally, the obtained 3D-printed reinforcement structure was finalized in the lab. Results: The prosthesis obtained through this process was lighter than a traditional prosthesis, there was a greater chemical adhesion between resin and 3D-printed reinforcement structure and a better result was obtained from an esthetic point of view. Conclusions: The outcomes we obtained endorse its performance both mechanical and esthetic. The entire process is automatic and does not require human operation thanks to specific software programming.
... Implants may be used for both single-and multiple-unit removable or fixed prosthetic dental restorations. This is an area of critical importance in dentistry due to the prevalence of edentulism in the population [2,3]. Partial and complete edentulism is known to have a negative impact on diet and nutritional intake as well as depression and self-rated health [4,5]. ...
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Titanium wear is a growing area of interest within dental implantology. This study aimed to investigate titanium and zirconium wear from dental implants at the time of insertion using X-ray-fluorescence spectrometry (XRF) and an in vitro protocol utilizing artificial bovine bone plates. Five groups were analyzed using XRF-spectrometry: groups 1–4 (titanium implants) and group 5 (zirconia implants). The implants were inserted into two bone blocks held together by a vice. The blocks were separated, and the insertion sites were analyzed for titanium (Ti) and zirconium (Zr). Statistical descriptive analyses of Ti and Zr concentrations in the coronal, middle and apical bone interface were performed. A comparative analysis confirmed differences between the implant’s surface stability and Ti accumulation within the insertion sites of the bone block. There was a direct relationship between implant length and the quantity of titanium found on the bone block. The data generally indicates greater quantities of titanium in the coronal thirds of the implants, and less in the apical thirds. The titanium and zirconium found in the bone samples where the group 5 implants were inserted was not of statistical significance when compared to control osteotomies. The results of this study confirm wear from metallic, but not ceramic, dental implants at the time of insertion.
... Advancements in dental prophylaxis; modern operative, prosthetic, and implant dentistry; and increasing patient demands have pushed dental total prosthetics to the margins of clinical and scientific interest for some time. However, given the demographic trends in industrialized countries, a growing number of edentulous patients must be expected in the future [1][2][3] . Therefore, complete denture treatment will continue to be an important therapeutic option for a sizeable percentage of patients. ...
Article
Aim: Milling-based, subtractive fabrication of digital complete dentures represents the computer-engineered manufacturing method of choice, but efficient additive manufacturing technologies might prove beneficial for the indication as well. The aim of this study is to evaluate the accuracy of surface adaptation of complete denture bases fabricated using subtractive, additive, and conventional manufacturing techniques. Materials and methods: A standardized edentulous maxillary model was digitally designed and milled. 12 duplicated plaster casts were scanned, and virtual denture bases were designed accordingly. Physical complete denture bases (n=12/technique) were manufactured applying different digital and conventional fabrication strategies. 1) CNC milling (MIL), 2) material jetting (MJ), 3) selective laser sintering (SLS), and 4) digital light processing technology (DLP). 12 denture bases produced by injection molding (INJ) served as control. The intaglio surfaces of the denture bases were digitized, superposed with the surface data of the casts using a best-fit algorithm, and accuracy of surface adaptation was assessed examining deviations. Statistical analysis was conducted using SPSS (p < 0.05). Results: Milling of denture bases led to significantly better surface adaptation compared to all other technologies (p < 0.001). The remaining fabrication methods, including conventional manufacturing of denture bases, revealed no considerable overall differences. Conclusions: All technologies investigated are adequate to produce complete denture bases regarding surface adaption, whereas milled denture bases present superior surface adaptation.
Article
To compare the outcomes of prosthodontic treatment for subjects wearing a complete maxillary denture opposing a root‐supported mandibular overdenture (RSO) or an implant‐supported mandibular overdenture (ISO). A literature search was performed in seven electronic databases: MEDLINE via PubMed interface, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, and AgeLine. The search terms were developed by the primary investigators and the health sciences librarian, who then started with PubMed and adapted the original search strategy for the other databases. Included articles were those that compared the outcomes for mandibular RSOs and those with ISOs, for persons wearing a maxillary complete denture. Seven articles were included in the review. There were limitations in this review because of small sample sizes, short study durations, and different methodologies. Also, no comparative studies were identified for clinically important outcomes, such as survival rates of abutments, prosthodontics/maintenance problems, and longitudinal cost of care. For prosthodontic complications, patient satisfaction, and ability to clean, no differences were reported. For oral tactile sensibility, RSOs presented significantly improved sensibility, whereas ISOs had higher maximum bite force capability, but the difference was not statistically significant, except when subjects had a cross‐bite or a lingualized occlusion. The results of this scoping review were not conclusive, except for maximum bite force, where ISOs seem to perform better than RSOs by the measured criteria. ISOs had higher survival rates than RSOs, and required less maintenance, but were more expensive. It was disappointing to find so few studies comparing these clinical treatment modalities, which suggests that either treatment may be clinically acceptable and depends upon a shared decision between patients and their dentists.
Article
Purpose: To determine the survival rate, incidence of prosthetic complications and patient satisfaction of implant fixed complete dental prostheses (IFCDPs) after a mean observation period of 1.4 years. Materials and methods: Twenty-eight (28) eligible participants were recruited according to specific inclusion and exclusion criteria. The definitive metal-acrylic resin IFCDPs consisted of titanium bars veneered with acrylic resin and acrylic denture teeth. Prosthodontic complications, divided into major and minor, were monitored. Parameters such as gender, jaw location, bruxism, and occlusal scheme were evaluated. Moreover, a questionnaire was administered throughout the study to assess patient satisfaction. Poisson regression as well as repeated measures ANOVA were used for statistical analysis. Results: Fourteen (14) males and 14 females were enrolled and followed-up at 3, 6, and 12 months. All IFCDPs survived (100% survival rate). The most frequent minor complication was the loss of material used to close the screw access hole (20% out of total complications). The most frequent major complication was chipping of the acrylic denture teeth (77.14% out of total complications). Gender (P = 0.008) and bruxism (P = 0.030) were significant predictors for the total major complications (major wear and major chipping) while occlusal scheme was a significant predictor for major chipping events (P = 0.030). Conclusions: While IFCDPs demonstrated high prosthetic survival rates, they also exhibited a high number of chipping events of the acrylic veneering material, especially in males, bruxers, and individuals with canine guidance occlusion. However, the occurrence of these prosthetic complications did not negatively affect patient satisfaction. This article is protected by copyright. All rights reserved.
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Statement of problem. Dental publications worldwide have reported discrepancies between how removable partial dentures are taught at undergraduate level and how these clinical procedures are performed extramurally, particularly regarding rest seat preparation. Considerable gaps have already been documented between undergraduate teaching and actual implementation in dental practice. Purpose. The aims of this study are to evaluate the presence of mouth preparation (cingulum and/or occlusal rest seats) before fabrication of cast removable partial dentures and explore causes that may contribute to and result in discrepancies between what is taught at undergraduate level and what is later on practiced by qualified dentists. The tested null hypothesis was that there is no difference between the frequency of working casts with and without rest seat preparations evaluated by dental laboratories in our study. Material and Methods. 103 laboratories were identified through an internet search strategy. Each laboratory was subsequently telephoned to determine if they provided cast metal removable partial dentures. Only 36 laboratories were shortlisted and out of these only 24 agreed to take part in our study. Three establishments did not fulfil our inclusion criteria leaving an overall 21 dental laboratories to participate in this study. Laboratory staff were calibrated to inspect, detect, and record the presence or absence of cingulum and/or occlusal rest seats in working casts before fabrication of metal frameworks for removable partial dentures over a one-month period. All 21 calibrated laboratories were given a proforma spreadsheet to record the presence or absence of at least one rest seat preparation per model before fabrication of metal frameworks.Statistical analysis was performed with StataCorp softwareby using the binomial probability test of 1 sample. Results. A total of 1,512 working casts were inspected and 630 (41.70%)displayed rest seat preparations(P< 0.001). The remainder 58.30% of casts examined (882) had no rest seat preparations. Only two laboratories recorded over 80% of casts with rest seat preparations and eight laboratories recorded rest seat preparations in 20% of working casts, or less. Conclusions. Lack of rest seat preparation highlights a rather large proportion of dentists performing inadequate mouth preparation before removable partial denture fabrication. Interacting factors might include shortcomings in undergraduate curricular design for removable partial prosthodontics and a contemporary socioeconomic and cultural burden on the dental profession. These implications for dental education beg the question of how to implement and deliver curricular content emphasizing duty of care and ethics for future generations of competent dental practitioners. CLINICAL IMPLICATIONS The results from this study confirm a vast majority of dental practitioners do not perform suitable pre-prosthetic mouth preparation with regard to rest seats.This has a direct clinical impact on removable partial prostheses hindering successful oral rehabilitation, which is most likely to result in further damage to remaining hard and soft dental tissues.
Article
Statement of problem Complete-arch implant-supported zirconia prostheses appear to have less plaque accumulation than titanium prostheses, but a comparison of the materials and the possible influence on the adjacent soft tissue is lacking. Purpose The purpose of this clinical study was to compare the plaque accumulation and soft-tissue inflammation of complete-arch implant-supported fixed maxillary prostheses fabricated with either a titanium framework or monolithic zirconia. Material and methods Twenty participants with a complete-arch implant-supported fixed maxillary prosthesis were enrolled in the study. The participants were divided into 2 groups according to the prosthesis material, titanium (Ti) or zirconia (Zir). The prosthesis had to have been in function for at least 6 months, and participants were examined during at least 3 maintenance appointments at 3-month intervals. Clinical information collected in each appointment included standardized photographs to record the Plaque Area Index (PAI) of the intaglio surface of the prosthesis; clinical parameters including modified Plaque Index (mPI), modified Bleeding Index (mBI), implant mobility (MOB), probing depths ≥5 mm (PD), suppuration (SUP), keratinized tissue band ≥2 mm (KT), and an intraoral photograph of the maxillary arch without the prosthesis to evaluate the redness of the soft tissues. Results MOB was not present at any implant at any time point. SUP could not be analyzed because it was an infrequent finding. Both groups exhibited significant increases in mBI over time. No significant differences were observed for PD between the groups at any time point. Implants in the Ti group had significantly higher KT values than those in the Zir group; levels remained constant over time for both groups. Zirconia prostheses had slightly lower PAI levels than Ti prostheses. The PAI in the Zir group significantly decreased over time (P=.035); in the Ti group, they remained constant (P=.45). Higher PAI levels were correlated with increased levels of erythema; both groups had a significant decrease in erythema values over time (P=.04). Conclusions Zirconia complete-arch implant-supported fixed maxillary prostheses displayed a significant decrease in plaque accumulation in individuals who had received periodic maintenance and oral hygiene instructions. Ti prostheses had significantly higher plaque levels than zirconia prostheses at all time points, which was not reduced by maintenance and oral hygiene measures. The present study suggests that patients receiving zirconia prostheses respond well to plaque control measures, while plaque control for those with titanium prostheses may be more challenging.
Article
Statement of problem Sleeping without conventional complete dentures (CCDs) has been stated by some to induce negative effects on the cardiorespiratory functions of edentulous patients with obstructive sleep apnea (OSA), although others have reported the exact opposite. Therefore, a consensus on nocturnal CCD usage is lacking. Purpose The purpose of this clinical study was to assess the effects of nocturnal denture usage on cardiorespiratory stability by using pulse oximetry (PO). Materials and methods Thirty CCD wearers were enrolled in the study. The first nocturnal pulse oximetry (FNPO) recordings were made on 3 different nights while the participants were sleeping without dentures (WOD). Oxygen desaturation index (ODI) and other PO parameters of the participants, including total respiratory event (TRE), basal SpO2 (BSpO2), time≤88 (T88), average low SpO2 (ALSpO2), total pulse event (TPE), average pulse rate (APR), and heart rate variability index (HRVI), were processed and the obtained data were recorded as WOD condition values. According to the ODI scores, the OSA status of the participants was grouped as normal (ODI<5), mild (5<ODI<15), moderate (15<ODI<30), or severe (ODI>30). Complete dentures were fabricated by an experienced prosthodontist and a dental laboratory technician by following conventional procedures. At the end of the first month of the follow-up period, the second nocturnal PO recordings (SNPO) were made on 3 different nights while the participants slept wearing dentures (WID), and the data obtained were recorded as WID condition values. The comparison of mean PO values obtained from WOD and WID were analyzed with the Wilcoxon signed- rank test (α=.05). Results Significant differences were found between WOD and WID values in terms of TRE (P=.01), ODI (P=.001), ALSpO2 (P=.006), TPE (P=.001), and HRVI (P=.001) parameters. The significance of the improvements in the WID condition increased with the severity of OSA. Conclusions Improvements were observed in substantial cardiorespiratory parameters such as the ODI and HRVI of the participants wearing dentures nocturnally.
Article
Statement of problem Comparative cost-analysis related to different manufacturing workflows for removable complete denture fabrication is seldom performed before the adoption of a new technology. Purpose The purpose of this study was to compare the clinical and laboratory costs of removable complete dentures fabricated with a conventional (workflow C), a partial digital (workflow M), and a complete digital (workflow D) workflow and to calculate the break-even points for the implementation of digital technologies in complete denture fabrication. Material and methods Clinical and laboratory costs for each of the investigated workflows and the manufacturing options related to denture base and denture teeth fabrication were collected from 10 private Italian dental laboratories and clinics. The selected variables included the clinical and laboratory manufacturing time needed to complete each workflow (opportunity cost); costs for materials, labor, packaging, and shipping; and capital and fixed costs for software and hardware, including maintenance fees. The effect of manufacturing workflows and their options on the outcomes of interest was investigated by using generalized estimated equations models (α=.05). Cost minimization and sensitivity analysis were also performed, and break-even points were calculated for the equipment capital costs related to the implementation of workflows M and D. Results From a laboratory standpoint, workflows M and D and related manufacturing options significantly (P<.001) reduced manufacturing time (5.90 to 6.95 hours and 6.30 to 7.35 hours, respectively), and therefore the opportunity cost of each denture compared with workflow C. Workflow M allowed variable costs savings between 81 and 169 USD, while workflow D allowed for an additional saving of 34 USD. The sensitivity analysis showed that the break-even point related to the capital investment for the equipment needed to implement workflows M and D could be reached, depending on the manufacturing options adopted, between 170 and 933 dentures for workflow M and between 73 and 534 dentures for workflow D. From a clinical standpoint, workflows C and M were almost identical. Conversely, workflow D, which included intraoral scanning, required 1 fewer appointment, saving 0.6 hours of chairside time and about 14 USD for materials compared with M. Conclusions Digital workflows (partial and complete digital workflows) were more efficient and cost-effective than the conventional method of fabricating removable complete dentures, with workflow D showing the lowest opportunity and variable costs and break-even point. Savings increased when stock denture teeth were replaced with milled denture teeth and still further with the adoption of 3-dimensionally (3D) printed denture teeth. Milling equipment and materials for denture base fabrication were more expensive than those for 3D-printing. Milling monobloc dentures reduced opportunity and labor costs but increased material cost.
Article
Objectives The challenge for general dental practitioners to provide maxillary implant overdenture treatment for their patients is complicated by multiple, diverse parameters, compared to mandibular implant overdentures. This topic review on maxillary implant overdentures, takes into consideration the specifications and challenges of different prosthodontic treatment options for clinicians in 2022. Data Sources A broad search of the published literature was performed using MEDLINE and PubMed to identify pertinent articles published in English from 1990 to 2021. From an original total of 1176 titles, 106 references were selected. They were reviewed and categorized with respect to seven factors related to the prosthodontic design. These were interarch restorative space, implant number, implant distribution and spread, overdenture base reinforcement, palatal coverage, selection of attachment system and splinted/unsplinted prosthodontic designs. They influence clinical and patient outcomes in terms of implant and prosthesis success, support, retention, prosthodontic maintenance and satisfaction. Conclusion Maxillary implant overdentures are a reliable treatment option for general dental practitioners, once competent with mandibular overdentures. The decision for adequate treatment for each individual patient is influenced by a diversity of parameters with clinicians needing to have a thorough knowledge and understanding of the anatomic obstacles, facial aesthetics, phonetics, and complete denture principles for essential pre-surgical and prosthodontic treatment planning. Currently there is no optimal number of implants, nor preferred attachment system, regardless of palatal coverage design. There are emerging trends of more evidence for use of reduced number of unsplinted implants simplifying procedures for general dental practice.
Chapter
Edentulous patients often object to almost every aspect of wearing complete dentures (CDs). Further, many dentists dislike dealing with CD patients for many reasons, including the fact that it can be almost impossible to provide a completely satisfactory solution for patient problems. The most important approaches to restoring the full arch case are implant overdentures and fixed implant bridges. The former are removable appliances which are both implant and tissue-borne prostheses which utilize an abutment and a denture attachment for the retention. They provide greater masticatory forces, improved incisal capacity, increased retention, improved taste and superior patient satisfaction. Fixed implant bridges or “crown and bridge restorations” are either a teeth-only replacement bridge, or a teeth and tissue replacement bridge or hybrid restoration. The advantages of fixed implant bridges include eliminating the need for removing the appliance, restoration of function and the use of biocompatible materials.
Article
Background: The present study was undertaken for assessing the pattern of oral prosthetic treatment and prevalence of dental diseases in edentulous patients in North Indian population. Materials and methods: A survey was carried out in North Indian population, and screening of the edentulous patients was done. Five hundred edentulous patients were enrolled. Complete oral and general examination was carried out. Pro forma was framed, and clinical details were recorded. Using mouth mirror and explorer, complete oral examination was carried out. Demographic profile was also evaluated. Prosthetic rehabilitation pattern of all the participants was also recorded. Results: Complete removable denture and removable partial denture were method of rehabilitation in 28% and 31% of the participants. Dental implant-supported complete denture was used in 8% of the patients, whereas dental implant-supported overdenture was used in 33% of the participants. Ulcerative lesions were present in 5% of the patients, whereas oral leukoplakia was present in 4% of the patients. Oral lichen planus and torus were present in 2% and 1% of the patients. Conclusion: Majority of the geriatric patients prefer having removable denture. Furthermore, due to nutritional deficiency associated with geriatric age, oral leukoplakia and ulcerative lesions are more common in them.
Article
p>El aumento de la edad de la población y el número relevante de pacientes edéntulos obligan a pensar su tratamiento como una necesidad actual y progresiva. El uso de implantes dentales deviene en alternativas de tratamiento de probada eficacia. Las sobredentaduras como nueva alternativa terapéutica están indicadas siempre en la mandíbula, mientras en el maxilar superior solo si existen piezas dentarias viables en el maxilar inferior. Se buscó literatura relacionada con el tema planteado, para desarrollar esta revisión narrativa, con el fin de estudiar las bases que indican las sobredentaduras implantoasistidas en el paciente desdentado total. La literatura científica internacional sugiere que el tratamiento de un desdentado total con prótesis completa convencional inferior no es actualmente el tratamiento más adecuado. Existe evidencia científica significativa que soporta la elección a priori de una sobredentadura inferior soportada por dos implantes, es vista como primera opción de tratamiento en un desdentado total.</p
Article
To assess the morphologic patterns of Incisive canal (IC), distance between the IC and buccal cortical plate in partially edentulous patients, distance between the maxillary central incisor (MCI) and IC in dentulous patients and measure length and width of IC on cone beam computed tomography (CBCT) scan for implant placement. A total of 104 CBCT scans consisting of 52 dentulous and 52 edentulous patients aged between 20 and 60 years were retrospectively reviewed from the archives’ of oral radiology unit. Kodak 9000C 3D unit was used for obtaining these scans. The morphology, location and dimensions of IC was analysed by two observers. The correlation of age and gender with all the variables was evaluated. The most common pattern found in this study was slanted straight SS (36.5%). A single canal was reported in 95.19% scans. The mean distance from buccal cortical plate to IC was 5.09 while that from MCI to IC was 2.33. The mean canal width of IC in partially edentulous scans was 2.96 while that in dentulous scans was 3.11. The mean canal length of IC was 10.1 in partially edentulous group while it was 10.68, in dentulous group. The study population is safe for implant placement in regards to the pattern and number of canals of IC and compromised with respect to the bone available anterior to the IC. The implantologists’ needs to be aware of these shortcomings while planning implant in the upper anterior region.
Article
The antimicrobial effects of denture adhesives containing novel surface pre-reacted glass-ionomer (S-PRG) fillers were assessed. We prepared denture adhesives containing S-PRG (particle sizes: 1 and 3 µm; quantities: 5, 7.5, and 10 wt%). We evaluated acid buffering capacity, ion release, and antimicrobial effects of denture adhesives with and without S-PRG. Significantly higher pH changes were observed in 1 µm S-PRG adhesives than in 3 µm S-PRG adhesives. Adhesives containing 7.5 and 10 wt% S-PRG exhibited significantly higher ion release than adhesives with 5 wt% S-PRG. The 1µm–10wt% S-PRG denture adhesive exhibited significantly lower colony-forming units on the denture adhesive contact surface than in the control group; additionally, it exhibited excellent acid buffering capacity, ion release properties, and antimicrobial effect against C. albicans, C. glabrata, S. mutans, and A. naeslundii. Longer contact periods resulted in significantly lower adhesion of Candida albicans to the denture base resin treated with denture adhesive.
Chapter
The emotional and behavioural effects of tooth loss in edentulous patients encompass grief, lowered self‐confidence, altered self‐image, dislike of appearance, inability to discuss taboo subject, privacy, behaving in a way to keep tooth loss secret, altered behaviour when socialising and forming close relationships, sense of premature ageing, and lack of preparation. In the fully edentulous patient, it may be necessary to carry out an alveolectomy to attain sufficient restorative space, adjustment of opposing dentition or alternatively, opening of the occlusal vertical dimension (OVD) to create the desired space. In the edentulous mandible, the wearing of a fully removable prosthesis is considered to be extremely difficult with poor comfort and function. In the fully edentulous patient, because there is a loss of all occlusal contacts, prosthodontic management requires the subjective determination of the OVD. The prosthodontic rehabilitation of full arch cases may involve the use of a trans‐mucosal abutment called a 'multi‐unit abutment.
Article
Objectives This observational cross-sectional study aimed to evaluate and compare the oral health-related quality of life (OHRQoL) and clinical performance between dentate subjects and edentulous patients restored with conventional dentures or implant overdentures. Methods 85 edentulous patients were grouped as follows: Group-1 (CD): conventional denture wearers (n= 42), and Group-2 (IO): implant-retained overdenture wearers (n= 43). For the OHRQoL comparisons, a control group of subjects with a healthy natural dentition (Group-3, ND; n= 50) was included. Participants completed three validated questionnaires (OHIP-14sp, OHIP-20sp, and QoLIP-10). Socio-demographic data, prosthesis-related factors, clinical condition of the mouth, and patient subjective evaluations, were gathered. Descriptive and non-parametric probes were run (α= 0.05). Results The ND group was the most unsatisfied (OHIP-14sp; p≤ 0.001). The OHIP-20sp attributed significantly worse Psychological disability (p= 0.029) and Handicap (p= 0.027) to CD wearers when compared to IO wearers. The CD group showed the significantly highest need for relining (p= 0.041), and the lowest retention (p= 0.011). The OHIP-14sp disclosed a significantly worse OHRQoL for those volunteers who had a job (p= 0.003), a basic education instead of a secondary one (p= 0.022), and no partner (p= 0.006). Conclusions The overall OHRQoL was comparable for both prosthodontic groups, being modulated by socio-demographic and prosthesis-related features. Nonetheless, CD wearers presented prosthetic complications more frequently.
Article
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Objectives: To investigate the correlation between duration of edentulism and severity of obstructive sleep apnea in elderly edentulous patients. Material and methods: 1,017 patients aged 55-65 years, with a history of edentulism of 12-60 months were screened. Detailed history of tooth loss and period of edentulism was recorded for the 414 patients who tested positive for OSA (obstructive sleep apnea). Complete dentures were prepared for each patient and they were trained to use the dentures as a mandibular advancement device (MAD) during sleep at night. Apnea-hypopnea index (AHI) data at pre-treatment, six months and one-year post-treatment time intervals was recorded. A correlation between the period of untreated edentulism and severity of OSA and improvement post-treatment was derived in this study. Results: Mean duration of edentulism was 12.14±2.57 months and mean AHI was 16.62±13.24. For every three month increase in the duration of edentulism (after initial 6 months of total tooth loss), there was a statistically significant increase in severity of OSA. Patients who are edentulous for more than 15 months are increasingly vulnerable to OSA. Discussion: Severity of OSA in afflicted long-term edentulous patients was in direct relation to the period of untreated edentulism and regressed likewise with concomitant denture wear and mandibular advancement during sleep at night. Early prosthetic rehabilitation of edentulous patients is imperative to obviate morbidity of OSA.
Article
The purpose of this clinical report is to present a complete digital workflow for the fabrication of complete arch fixed zirconia implant restorations. An intraoral scanner was used to capture the implants’ position at the abutment level and also the patient's existing interim prostheses with the double digital scanning technique. A novel scan body and impression pin were utilized throughout the scanning process which allowed for the accurate and reproducible superimposition of the generated Standard Tesselation Language files. Prosthesis prototypes were digitally designed and fabricated, tried in, and verified intraorally. The definitive zirconia prostheses were then fabricated and delivered to the patient. This technique can be utilized in both arches overcoming the absence of stable intraoral landmarks for superimposition of STL files. This article is protected by copyright. All rights reserved
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Chapter
The main goal of modern removable prosthodontics is to restore the normal appearance, function, esthetics and speech in each completely edentulous patient. However, if all teeth are missing in a patient, it becomes very complicated to achieve it using traditional protocols. Therefore, implants were introduced into removable prosthodontics to ensure better retention and stability of the conventional dentures. In case of a large amount of bone missing in the jaw it is necessary to ensure the functioning of the dentures constructing various additional stabilizing and retentive prosthodontic solutions on the osseointegrated implants. Numerous types of attachment systems have been used recently for relating implant-retained overdentures to underlying implants: basically splinting (various bar shape designs) and non-splinting attachments (various ball type attachment, magnet attachment, telescopic coping systems). Indications for their use depend on the surgical and prosthodontic factors such as the number and position of the implants, the amount of free intermaxillary space and the type and size of the overdentures. Different indications, types of the overdentures and the attachment systems will be discussed in this chapter.
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For persons without all or some of their natural teeth in one or both arches, the use of a complete or partial denture and the quality of the denture used are important aspects of their oral health and functioning. This report of prosthodontic findings from the first three years of the 1988–94 National Health and Nutrition Examination Survey (NHANES III-Phase 1) provides estimates of denture use among the US civilian non-institutionalized population 18–74 years of age, as well as seminal information on the technical quality of dental prostheses nationwide. NHANES III-Phase 1 prosthodontic findings indicate that about one in five persons 18–74 years of age wears a removable prosthodontic appliance of some type. Overall, removable prosthodontic appliances are worn disproportionately more often by women than by men, and less frequently by whites than by blacks. Comparisons among race-ethnicity categories indicate that Mexican-Americans are less likely to use dentures than either of their non-Hispanic counterparts. Analyses of prosthodontic evaluation data indicate that approximately 60% of denture users have at least one problem with a denture. These findings from the oral component of NHANES III-Phase 1 provide clear indications that, despite increasing trends in tooth retention, dependence on removable prosthodontic appliances is still a reality of life for millions of Americans.
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Manual de datos estadísticos de Estados Unidos. Incluye datos demograficos, económicos e industriales por estados además de estadísticas del gobierno sobre las políticas del mismo. La presente edición incluye, también, un perfil de los distritos del congreso.
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While the overall prevalence of tooth loss and edentulism has been declining in the United States over the past several decades, important variations remain among subgroups of the population. Data from Phase 1 of the Third National Health and Nutrition Examination Survey (NHANES III) provide the most current estimates of the prevalence and distribution of tooth retention and tooth loss in the United States. Weighted analyses were conducted for all adults 18+ years of age (n=8,366) and for selected age, gender, and race-ethnicity groups. In 1988-91, 89.5% of the population was dentate, and 30.5% had retained all 28 teeth. The mean number of teeth retained was 21.1 for all adults and 23.5 for dentate persons. The most commonly retained teeth in the mouth were the six anterior teeth in the lower arch. Conversely, 10.5% of the population was edentulous. Partial edentulism was much more common in the upper arch than in the lower arch. The most commonly missing teeth were the first and second molars. Age was strongly related to every measure of tooth retention and tooth loss. Gender was not related to any of these measures, after adjustment for age. Race-ethnicity was consistently related to these measures, after adjustment for age and gender. In general, Mexican-Americans had the lowest and black non-Hispanics the highest rates of tooth loss. Future research needs to examine a wide range of potential correlates of tooth retention and tooth loss before we can understand the complex interplay among the personal, dental, and environmental factors influencing tooth retention and tooth loss in the United States.
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The purpose of this study was to collect information about the oral health of a representative group of elders in the New England states. This study provides the most current descriptive analysis of completely edentulous noninstitutionalized elders to date. In-home examinations and interviews were conducted for a representative sample of elders over 70 years of age. The oral examinations and interviews were conducted by calibrated dentists and trained interviewers, respectively. Of 1156 study participants, 424 (36.7%) were edentulous. Edentulous rates were similar for men and women and were negatively related to levels of education and income. Of the completely edentulous individuals, 89.9% had maxillary and mandibular complete dentures. Most of these dentures (83.2%) were worn during the day. More than one third of the respondents reported wearing one or both of their dentures while sleeping at night. For 77 of the completely edentulous individuals, examination revealed denture irritations, most of which were on the hard palate.