Muscle-formed complete mandibular dentures

A systematic review of patient-oriented outcomes following complete denture treatment: a comparison between the neutral zone technique and conventional approach

OBJECTIVES

To determine the patient-oriented outcomes after complete denture (CD) treatment using neutral zone (NZ) techniques compared with those of conventional dentures.

MATERIALS AND METHODS

Electronic and hand searches were conducted up to December 2023 based on PICOS criteria. Population (P) was patients with complete edentulism on maxillary and mandibular arches and were either or not wearing CDs. Intervention (I) focused on the fabrication of mandibular and/or maxillary CD using NZ techniques. Comparators (C) included other CD fabrication approaches, such as conventional and simplified techniques, and the use of old or existing CDs. Outcomes (O) were patient-oriented treatment outcomes. Study design (S) included human studies.

RESULTS

Eleven human experimental studies were included. NZ dentures demonstrated better patient-reported outcomes, by providing greater comfort, enhancing denture stability and retention, reducing food traps underneath the denture, as well as improving appearance, chewing efficiency and speech. Objective findings varied, with most studies showing equivalent outcomes for NZ and conventional dentures. However, one study indicated superior, and another demonstrated worse outcomes for NZ dentures.

CONCLUSIONS

NZ dentures generally improve patient-reported outcomes more than conventional dentures. However, their impact on objective outcomes compared with a conventional denture remains uncertain.

Morphological comparison of artificial teeth position utilising denture space in glossectomy patients

OBJECTIVE

This study aimed to compare the denture space of edentulous glossectomy patients with that of a control group from the perspective of artificial teeth positioning by using three-dimensional techniques.

BACKGROUND

It is known that the shape of the denture space may be affected by tongue resection or reconstruction. However, the details of artificial teeth positioning in these patients remain unclear.

MATERIALS AND METHODS

Six edentulous glossectomy patients aged 73-83 years and six normal participants aged 74-85 years participated in the study. Piezography was used to elucidate the characteristics of the denture space. For visualisation, piezographic records were scanned using cone beam computed tomography and the data were converted into stereolithographic format. Three-dimensional images of piezographic records were then constructed. Bucco-lingual widths of the mandibular occlusal surface were reproduced, and the camber line of the occlusal surface was set so as to simulate the position of the artificial teeth. The maximum chord of the occlusal surface on the left and right sides was recorded and measured. The discrepancy and ratio of the larger chord to the smaller chord between the right and left sides was calculated and subjected to statistical analyses using the Mann-Whitney U test.

RESULTS

There were significant differences in discrepancy and ratio between the left and right in the control group and the glossectomy patients (P ˂ .01). The glossectomy patients showed a greater discrepancy and ratio than the control group.

CONCLUSIONS

The simulated artificial teeth positions on the occlusal surface between the right and left side were asymmetric in glossectomy patients.

Neutral zone or conventional mandibular complete dentures: a randomised crossover trial comparing oral health-related quality of life

There is widespread consensus that the neutral zone (NZ) concept contributes to improved stability for mandibular complete dentures (CDs). However, little is known about its impact on oral health-related quality of life (OHRQoL) of edentulous patients compared to conventionally (CV) manufactured dentures. In this prospective crossover trial, performed at the Oral Health Centre of the University of the Western Cape, CV and NZ mandibular dentures were made for each patient. Scores from the 20-item oral health impact profile (OHIP-20) for both types of dentures were compared with pre-treatment scores using paired t-tests. Treatment effect size (ES) was established. Associations of OHIP-20 scores and several patient variables (age, gender, period of edentulousness, quality of the denture-bearing tissue, denture dimensions, preference) were performed using the generalised linear model. Significance was set at P = 0·05. Records of thirty-five participants were included in the study (mean age of 62·3 years, range 47-85 years). There were highly significant differences between pre-treatment and both post-treatment OHIP-20 scores with t = 6·470 for CV and t = 6·713 for NZ. Treatment ES was large for both types of dentures (>0·8). Difference of ES between NZ and CV dentures was small (ES < 0·2). None of the patient variables showed significant associations with OHIP-20 scores of the two types of dentures, except for preference and NZ OHIP-20 scores. For this group of patients, both treatment methods improved OHRQoL significantly and patient-related factors did not influence impact on OHRQoL differently for both interventions.

Customized Cheek Plumper with Friction Lock Attachment for a Completely Edentulous Patient to Enhance Esthetics: A Clinical Report

Prosthetic rehabilitation of a completely edentulous patient should never be restricted to the replacement of missing teeth. The ultimate aim of complete denture treatment should be restoration of the full range of oral functions and esthetics. Slumped cheeks are always a concern for esthetically demanding complete denture patients. This article describes a simple, scientific, cost-effective technique to improve facial esthetics in a completely edentulous patient with the help of a cheek plumper. The technique used here implements the concept of neutral zone to precisely determine the amount of space available for the cheek plumper. The simple friction lock attachments that retained the cheek plumpers on the prosthesis were also fabricated after determining the space available in the appropriate areas. Thus an effort was made to keep the cheek plumpers unobtrusive yet effective to ensure complete integration of the prosthesis into the stomatognathic system.

Managing the Unstable Mandibular Complete Denture – Tooth Placement and the Polished Surface

Constructing satisfactory conventional mandibular complete dentures is often challenging in comparison to the upper counterpart partially due to differences in the anatomy of the denture-bearing area. This problem is exaggerated in the atrophic mandible, where supporting structures are frequently ill-defined and suboptimal in quality. Implant-retained prostheses offer well recognized benefits but are not always a feasible options, so conventional methods must be relied upon. The importance of impression quality and registration has been reviewed previously. This article aims to discuss the influence of tooth placement, the polished surfaces and the neutral zone on the success of lower dentures. Clinical relevance: This article highlights the importance that polished surface contouring and tooth prescription can have on the outcome of lower dentures. Techniques for assessing and recording the neutral zone are explained, along with alternative occlusal schemes.

Prosthodontic management of postsurgical soft tissue deformities associated with marginal mandibulectomy. Part I: Loss of the vestibule

1. Marginal mandibulectomy patients with a postoperative obliteration of the vestibule were treated prosthodontically in accordance with the "denture space" concept. 2. All patients presented displayed adequate form and function with the prostheses during a period ranging from 2 to 6 years without being subjected to preprosthetic surgery. 3. The most important factor when considering prosthesis stability is the interrelationship between form and function of the orofacial structures rather than the mechanical factors of maximal bone coverage by the prosthesis.