Clinical long-term study of complete denture wearers

Investigation of Morphological Changes of the Soft Tissue in the Aesthetic Zone: A 3D Virtual Analysis after Conventional Tooth Extraction and Benex® Extraction

BACKGROUND

Postoperative resorption of hard and soft tissues occurs as a consequence of tooth extraction. The Benex®-Control extractor allows minimally invasive extraction of the tooth without causing pronounced iatrogenic trauma. The aim of this study was to verify whether the resorption of the tissues after extraction can be reduced by using the Benex® system compared to the conventional extraction method.

METHODS

Postoperative intraoral scans were superimposed after surgery (t0), after 7 days (t1), after 14 days (t2), after 30 days (t3), after 60 days (t4), and after 90 days (t5) within the two groups (study n = 14, control n = 16), and defined regions of interest (ROIs) (1-8) and volume changes were analyzed. In addition, the influence of gingival thickness and the thickness of the labial cortical plate was investigated.

RESULTS

The greatest decrease in volume was observed in both groups in ROI3, although there was no significant difference observed between the groups. In the presence of an adjacent tooth, there was less volume loss in the affected ROIs (1, 2 and 7, 8). The thickness of the gingiva and the bony lamella did not significantly influence the change in volume.

CONCLUSIONS

Due to the small cohort, the results are limited, and the hypothesis is rejected.

Association of Salivary Cortisol With Anxiety in Type 2 Diabetes Mellitus Patients Before and After Complete Denture Rehabilitation: An In-Vivo Analysis

Background Complete edentulism negatively impacts emotional, physical, social, and psychological well-being, leading to a decline in quality of life and heightened stress and anxiety. Stressful situations associated with edentulism can elevate cortisol levels, potentially increasing the risk of diabetes. Rehabilitation with complete dentures needs careful evaluation for its impact on general health, considering stress points and systemic effects. This study aimed to assess salivary cortisol levels in type 2 diabetes mellitus patients before and after complete denture rehabilitation, highlighting the intricate relationship between diabetes, cortisol, and the stress response. Methods This is a cross-sectional study centered on individuals with diabetes who were completely edentulous and undergoing evaluation by the outpatient prosthodontic department. Glycated hemoglobin, anxiety levels, and the fabrication of complete dentures were all accomplished with the participants' consent. Patients underwent evaluations before and one month after receiving complete denture rehabilitation. Results An absolute correlation between salivary cortisol levels and anxiety may be established because anxiety levels dramatically decreased during complete denture rehabilitation. Conclusion By learning how the patient's general health is related to their new set of complete dentures and how to correlate that information with dental rehabilitation, professionals can help patients better adapt to their new set of dentures.

Unveiling the Realm of Denture Fabrication: Revitalizing Aesthetics and Optimizing Efficiency for Geriatric Patients

Disfigurement of the face has a significant impact not only on the appearance and function but also on the psychological well-being of an individual. Due to tooth loss, various psychological problems can occur. Dentures can help patients regain a sense of normalcy and also boost their confidence to live in society. Complete denture restores phonetics, esthetics, and mastication. A 63-year-old male patient reported to the Department of Prosthodontics with the chief complaint of total loss of teeth and wanted to get treated for the same. The purpose of this article is to describe changes in impression techniques, dental material, methodologies in teeth setting, and novel approaches to enhance the esthetics to optimize the results in a final complete denture. To reestablish the patient's masticatory, apparatus steps of complete denture fabrication were revisited accompanied by the modern application of innovative techniques with the base of historical concept.

Patient Satisfaction and Oral Health-related Quality of Life (ohrqol) of Edentulous People after Mandibular Denture Relining With a Soft-liner Material: A Pilot Study

Background:

Oral health-related quality of life indicators have been effectively used to assess the influence of a range of dental treatments and interventions on patient satisfaction and acceptance.

Objectives:

The purpose of this study was to evaluate the impact of the relining of mandibular dentures with a soft-liner material, using the Oral Health Assessment Index (OHIP-14).

Methods:

Forty-two full denture wearers were selected from patients who attended 9 private prosthetic clinics in New South Wales, Australia. All participants had their lower dentures relined with a soft-liner material, according to the manufacturer’s instructions. Oral health-related quality of life was evaluated before and 1 month after relining using the Oral Health Assessment Index questionnaire. A simple descriptive quantitative analysis of the survey results was undertaken, including a comparison of median scores using the Wilcoxon paired test and binomial probability test.

Results:

In all the outcome variables measured, there was a noticeable positive effect from the denture relining. Specifically, mandibular denture relining with a silicon-based soft-liner material has a positive impact on patient satisfaction and oral health-related quality of life (OHRQoL) of edentulous patients.

Conclusion:

Patient satisfaction and oral health-related quality of life (OHRQoL) of edentulous patients can be significantly improved by the use of soft-liner materials.

Assessment of Salivary Malondialdehyde and Superoxide Dismutase Levels in Completely Edentulous Patients: An In Vivo Study

Introduction

Residual ridge resorption (RRR) is a chronic inflammatory process; the free radicals formed may lead to tissue damage in the form of bone resorption mediating through many pathways and processes. We aimed to study the correlation between levels of malondialdehyde (MDA) and superoxide dismutase (SOD) enzyme and residual ridge resorptive status levels in completely edentulous patients.

Methods

This study included 45 patients aged 40-65 yrs who were completely edentulous. The mean levels of MDA and SOD were evaluated and correlated with different classes of bone resorption, period of edentulism, the effect of denture wearing, age and gender.

Results

The mean value of MDA levels in completely edentulous patients was 2.6 ± 1.23 and that for SOD was 1.8 ± 0.47. There was no statistically significant difference in MDA levels whereas SOD levels showed statistical significance between all four classes (p<0.05). MDA levels showed statistically significantly higher levels in patients with an edentulism period of one year or less and non-denture wearers. There was no statistically significant difference in MDA and SOD levels in relation to age and gender.

Conclusion

Within the limitations of the study, there may be higher antioxidant activity in patients with more resorption. The present study correlates with other studies on RRR done using radiographs and other clinical parameters implicating that MDA and SOD may be used as biomarkers of RRR.

Hard tissue dimensional changes following implant removal due to peri-implantitis: A retrospective study

BACKGROUND

The current evidence regarding the alterations experienced by the alveolar ridge (hard tissue changes) after implant removal due to peri-implantitis is limited.

PURPOSE

To assess the hard tissue dimensional changes following implant removal due to peri-implantitis.

MATERIAL AND METHODS

Clinical records were examined to identify patients with implants that had to be removed due to a hopeless prognosis secondary to peri-implantitis due to expendability of peri-implantitis implants for functional reasons. Patients with preoperative and postoperative cone-beam computed tomography (CBCT) scans were included. Patient-related, implant-related, and surgery-related factors were assessed based on the clinical records. Linear measurements were made to evaluate the influence of bone plate thickness (BPT), ridge width (RW), and ridge height (RH) at various levels upon the outcome of implant removal. A descriptive statistical analysis of the quantitative and qualitative variables was performed. Correlations of the variables with the primary outcome (dimensional changes) were tested using univariate and multivariate analyses (multinomial random intercept mixed model linear regressions).

RESULTS

A total of 26 patients (n_implants = 79) met the eligibility criteria. The mean decrease in RW at 1 and 3 mm below the crest was 11.3% and 4.4%, respectively (P < 0.001). Buccal and lingual RH was significantly reduced by 2.2% and 6.3%, respectively (P < 0.001). Few patient-related, implant-related, and surgery-related factors appeared to have an impact upon the hard tissue dimensional changes. Bone regeneration simultaneous to implant removal minimized the dimensional changes of the ridge both vertically (5% lesser buccal RH reduction) and horizontally (12% lesser RW reduction) when compared with spontaneous healing. The use of a reverse-torque removal kit seemed to be critical in limiting the dimensional changes of the ridge.

CONCLUSIONS

Minimal hard tissue changes can be expected following implant removal due to peri-implantitis. Simultaneous bone regeneration procedures and the use of a removal kit may considerably reduce the impact upon the dimensional changes (NCT04534361).

Retention and wear of resin matrix attachments for implant overdentures

OBJECTIVES

The aim of the present laboratory study was to investigate the retentive properties and the wear of three different resin matrix attachments for implant overdentures as well as to assess the effects of implant angulation.

METHODS AND MATERIALS

Three attachment systems with either polyetheretherketone inserts (PEEK; Novaloc, Straumann, Basel, Switzerland), polyetherketoneketone inserts (PEKK; CM Loc, Cendres + Métaux, Biel, Switzerland) or nylon inserts (Locator R-Tx, Zest Dental Solutions, Escondido, California, USA) were evaluated. The patrices were connected to their implant analogues and fixed in a resin cast at implant angulations of 0° and 15°. The corresponding matrices with inserts were fixed in a stylized unilaterally removable dental prothesis. To simulate masticatory forces 30,000 insertion and removal cycles with an eccentric load of 100 N at a distance of 12 mm were performed in a chewing simulator. The retention forces were measured. The wear patterns were examined using a scanning electron microscope (SEM). The statistical analysis was performed using a one-way ANOVA followed by a Games-Howell test and a Friedman test.

RESULTS

All attachment systems revealed a significant decrease in retention after testing, except PEEK 0°/0° and PEEK 15°/15°. PEEK and PEKK attachment systems showed significantly higher retentive forces than the nylon attachment system between 5000 and 30,000 cycles. The implant angulation did not significantly influence the retention behavior for any of the three attachment systems. Patrices showed no signs of wear, whereas the matrix inserts displayed signs of deformation.

CONCLUSION

Within the limitations of the present study, attachments with PEEK and PEKK inserts combined with titanium patrices are favorable for long-term use, both for orthogonal and tilted implants. All three attachment systems showed a high variability of the retentive forces at baseline and for subsequent cycles. This should be taken into consideration for clinical use.

Longevity of complete dentures: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Patients and clinicians are aware of the efficacy and benefits of complete dentures, but evidence regarding their longevity is limited.

PURPOSE

The purpose of this systematic review was to examine the literature describing the longevity of complete dentures and to review variations in longevity by denture type and duration of follow-up.

MATERIAL AND METHODS

Four electronic databases were searched by using key terms: MEDLINE, CINAHL (EBSCO), Dentistry and Oral Sciences Databases, and The Cochrane Library. Studies meeting the inclusion criteria were reviewed according to an established protocol and data extracted. Reference lists of identified studies were examined. Risk of bias was assessed by using the AXIS tool. Weighted means and weighted standard deviations were calculated. Pooled complete denture failure proportions were estimated by using random effects models based on the DerSimonian and Laird method.

RESULTS

The search yielded 21 607 unique abstracts, of which 273 met the inclusion criteria. Assessment of the full-text articles reduced this number to 42. Of these, 24 studies were rated as having low risk of bias and 18 as very low. The weighted mean ±standard deviation longevity of maxillary complete dentures was 10.3 ±3.8 years, of mandibular dentures was 8.6 ±2.6 years, and of both maxillary and mandibular dentures was 10.8 ±4.7 years. The pooled failure proportion for complete dentures observed for 2 years or less was 0.05 (95% confidence interval [CI]: 0.00-0.10), 5 to 6 years was 0.12 (95% CI: 0.08-0.16), and 10 years or more was 0.41 (95% CI: 0.28-0.53).

CONCLUSIONS

Complete dentures, fabricated primarily in university settings, were found to have a weighted mean ±standard deviation longevity of 10.1 ±4.0 years. The failure rate of these prostheses increased with denture age, and the longevity of maxillary dentures was greater than that of mandibular dentures.

Management of Edentulous Patients

Edentulism, defined as the complete loss of all dentition, is a worldwide phenomenon. Edentulism occurs because of biologic disease processes, such as dental caries, periodontal diseases, trauma, and oral cancer. Edentulism is accompanied by several comorbidities that can significantly influence an individual. Although the rate of edentulism is declining, the number of edentulous patients continues to rise because of the increase in population. The management of edentulous patient has been addressed since the early days of dentistry. This article describes complete dentures and their maintenance, and advanced technology in complete dentures, and in implant-retained and implant-supported prosthesis.

Horizontal ridge augmentation with guided bone regeneration using particulate xenogenic bone substitutes with or without autogenous block grafts: A randomized controlled trial

BACKGROUND

To evaluate dimensional bone alterations following horizontal ridge augmentation using guided bone regeneration (GBR) with or without autogenous block graft (ABG) for the rehabilitation of atrophic jaws with dental implants.

MATERIALS AND METHODS

Forty-two patients, with 42 severe horizontal bone atrophy sites in the maxilla or mandible were randomly assigned to two groups: ABG or GBR. The ABG group received a combination of ABG with particulate xenograft, covered by a collagen membrane, while the GBR group received particulate xenograft alone, covered by a collagen membrane. After 6-9 months of healing, implants were inserted. All implants were definitively restored 6 months after implant placement. Radiographic examination (cone-beam computed tomograms) was performed immediately after bone grafting procedure (T0), at 6 months (T6), and at 18 months (T18), to evaluate the amount of horizontal bone width (HBW) gain. Patient demographic information, amount of ridge width augmentation, implant survival, complications, and contributing factors were gathered and analyzed.

RESULTS

Thirty-nine patients completed the study. Both groups developed enough bone ridge width for implant placement. A total of 65 implants were placed. Implant survival rate was 100% in both groups at T18. Mean increases in HBW amounted to 5.6 ± 1.35 mm in GBR sites and 4.8 ± 0.79 mm in ABG sites at T18. There was no statistically significant difference in HBW gain obtained in the GBR group when compared to the ABG group at 6 months (P = 0.26) or 18 months (P = 0.26). However, the ABG group had a statistically significant higher prevalence of sensory disturbances (P = 0.02) and hematomas (P = 0.002) compared to the GBR group.

CONCLUSION

These findings indicated that either GBR with or without ABG is an effective approach in augmenting resorbed horizontal deficient ridges prior to implant placement. However, more complications may be seen with the use of ABG related to the donor sites.

Multicenter Retrospective Analysis of Implant Overdentures Delivered with Different Design and Attachment Systems: Results Between One and 17 Years of Follow-Up

PURPOSE

To analyze implant and prosthetic survival rates, complications, patient satisfaction, and biological parameters of patients rehabilitated with implant overdentures (IOV) on splinted and nonsplinted implants and different attachment systems, in function for one to 17 years.

METHODS

This retrospective study evaluated data collected from patients rehabilitated with implant overdentures between January 2001 and December 2016 in nine different centers. Outcome measures were implant and prosthetic success rates, mechanical complications, marginal bone loss (MBL), oral health impact profile (OHIP), bleeding on probing, and plaque index.

RESULTS

A total of 581 implants were installed in 194 patients. Patients were followed for a mean period of 60.6 months (range 6⁻206). Eighty-nine patients received 296 low profile attachment (OT Equator), 62 patients received 124 ball attachments, and 43 patients received 107 Locator attachments. In eighty-three patients the implants were splinted with computer aided design/computer aided manufacturing (CAD/CAM) or casted bar. At the last follow-up, 10 implants failed in eight patients. Statistical significance was found for failed prostheses (P = 0.0723) and complications (P = 0.0165), with better values for splinted implants. No statistically significant differences were found in proportion of implant and prosthetic failure (P > 0.05). At a five-year follow-up, proportion of complications (P = 0.0289) and failed prostheses (P = 0.0069) were statistically higher for IOV on Locator attachments. No difference was founded in MBL at one- and two-year follow-up between different attachment systems (P > 0.05). Statistically significant improvement in all the OHIP categories was reported in all the patients, after one year of function.

CONCLUSIONS

Implant overdenture showed high implant and prosthetic survival rates, low complications, high patient satisfaction, and good biological parameters in the long-term follow-up. Splinting the implants may reduce number of mechanical complications. Locator attachments showed higher number of complications. Further studies are needed to confirm these preliminary results.

The Role of Autologous Platelet Concentrates in Alveolar Socket Preservation: A Systematic Review

Prevention of alveolar bone resorption after tooth extraction may be useful for implant rehabilitation of the edentulous site minimizing the future need for bone augmentation procedures. A number of studies have investigated the efficacy of autologous platelet concentrates for the preservation of the alveolar bone volume after tooth extraction. Although encouraging results have been published, the available data are still controversial. The aim of the present systematic review was to assess the effect of platelet concentrates on alveolar socket preservation after tooth extraction. A literature search was carried out up to September 2017 for prospective controlled trials in which a test group using exclusively a platelet concentrate was compared with a control group in which extraction sockets were left to heal spontaneously. Seven controlled clinical trials published between 2010 and 2016 were included. A total of 320 extractions (170 tests and 150 controls) in 190 patients was considered. A great heterogeneity was found in terms of study design, methodological aspects, and outcome evaluation. For this reason, a quantitative analysis followed by meta-analysis was not possible, and only a descriptive analysis on the role of platelet concentrates in alveolar socket preservation was carried out. There is growing evidence that platelet concentrates may be advantageously used in postextraction sites, mainly to improve soft tissue healing and to reduce postoperative symptoms. Data about their potential in preserving the alveolar bone volume are still scarce and controversial, although recently encouraging results have been presented using more reliable and accurate evaluation technologies, such as the computed tomography. Further, well-designed and methodologically standardized investigations are strongly demanded to reach a higher level of evidence on this topic.

Alveolar socket healing: what can we learn?

Tooth extraction induces a series of complex and integrated local changes within the investing hard and soft tissues. These local alterations arise in order to close the socket wound and to restore tissue homeostasis, and are referred to as '"socket healing". The aims of the present report were twofold: first, to describe the socket-healing process; and, second, to discuss what can be learned from the temporal sequence of healing events, in order to improve treatment outcomes. The socket-healing process may be divided into three sequential, and frequently overlapping, phases: inflammatory; proliferative; and modeling/remodeling. Several clinical and experimental studies have demonstrated that the socket-healing process promotes up to 50% reduction of the original ridge width, greater bone resorption at the buccal aspect than at the lingual/palatal counterpart and a larger amount of alveolar bone reduction in the molar region. In conclusion, tooth extraction, once a simple and straightforward surgical procedure, should be performed in the knowledge that ridge reduction will follow and that further clinical steps should be considered to compensate for this, when considering future options for tooth replacement.

Efficacy of bone substitute material in preserving volume when placing a maxillary immediate complete denture: study protocol for the PANORAMIX randomized controlled trial

BACKGROUND

Bone preservation is an essential issue in the context of last teeth extraction and complete edentulism. The intended treatment, whether a complete denture or an implant placement, is facilitated with a voluminous residual ridge. Bone resorption after multiple extractions has not been as well studied as the bone resorption that occurs after the extraction of a single tooth. Recent advances in bone substitute materials have revived this issue. The purpose of this study is to evaluate the interest in using bone substitute material to fill the socket after last teeth extraction in a maxillary immediate complete denture procedure compared with the conventional protocol without socket filling.

METHODS/DESIGN

A randomized, controlled, clinical trial was designed. The 34 participants eligible for maxillary immediate complete denture were divided into two groups. Complete dentures were prepared despite persistence of the last anterior teeth. The control group received a conventional treatment including denture placement immediately after extractions. In the experimental group, in addition to the immediate denture placement, a xenograft bone-substitute material (Bio-Oss Collagen®) was placed in the fresh sockets. The primary outcome of the study is to compare mean bone ridge height loss 1 year after maxillary immediate complete denture placement, with or without bone-substitute material, in incisor and canine sockets. The secondary outcomes are to compare the average bone ridge height and width loss for each extraction site. An original quantitative evaluation method using cone beam computed tomography was designed for reproducible measurements, with a radio-opaque denture duplicate. Two independent operators perform the radiologic measurements.

DISCUSSION

The immediate complete denture technique limits bone resorption in multiple extraction situations and thus allows better denture retention and better options for implant placement. To compare the benefit of using any bone socket-filling material, we proposed a quantitative evaluation protocol of resorption in the specific case of the last anterior maxillary teeth extraction with immediate denture placement.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02120053 . Registered on 18 April 2014.

A study of the emotional effects of tooth loss in an edentulous Gujarati population and its association with depression

Context:

To fully estimate the burden of illness due to edentulism and establish valid treatment outcomes measures in this regard, it is equally important to study its psychosocial repercussions.

Aims:

The aim was to conduct a study to explore the emotional reactions to tooth loss, screen for current depressive symptoms and test for association between the two; among an edentulous Gujarati population.

Settings and Design:

A total of 147 edentulous people visiting the Prosthodontics Department were surveyed.

Subjects and Methods:

A questionnaire (based on previous studies) to test the emotional reactions to tooth loss and Nine Item-Patient Health Questionnaire to test for depression were used.

Statistical Analysis Used:

The data were analyzed using the Chi-square (χ²) test with the help of SPSS v. 18.0 (IBM Corp., Armonk, NY, USA).

Results:

Totally, 100 out of 147 edentulous people returned the questionnaire of which 58% experienced difficulties in accepting tooth loss and 37% felt unprepared for its effects. Those with difficulties accepting tooth loss had a greater effect on self esteem and social life, had more reservation about discussing tooth loss and was more likely to experience depression. Both groups were satisfied with dentures, had no problem meeting their friends or partners without dentures and leaving out dentures at night.

Conclusion:

About 58% of edentulous people had difficulties accepting tooth loss, which was unrelated to denture satisfaction. Respondents appeared to be restricted in social activities mainly due to functional limitations. Those with difficulties accepting tooth loss were more likely to experience depression.

Comparison of changes in retentive force of three stud attachments for implant overdentures

PURPOSE

The aim of this study was to compare the changes in retentive force of stud attachments for implant overdentures by in vitro 2-year-wear simulation.

MATERIALS AND METHODS

Three commercially available attachment systems were investigated: Kerator blue, O-ring red, and EZ lock. Two implant fixtures were embedded in parallel in each custom base mounting. Five pairs of each attachment system were tested. A universal testing machine was used to measure the retentive force during 2500 insertion and removal cycles. Surface changes on the components were evaluated by scanning electron microscopy (SEM). A Kruskal-Wallis test, followed by Pairwise comparison, was used to compare the retentive force between the groups, and to determine groups that were significantly different (α<.05).

RESULTS

A comparison of the initial retentive force revealed the highest value for Kerator, followed by the O-ring and EZ lock attachments. However, no significant difference was detected between Kerator and O-ring (P>.05). After 2500 insertion and removal cycles, the highest retention loss was recorded for O-ring, and no significant difference between Kerator and EZ lock (P>.05). Also, Kerator showed the highest retentive force, followed by EZ lock and O-ring, after 2500 cycles (P<.05). Based on SEM analysis, the polymeric components in O-ring and Kerator were observed to exhibit surface wear and deformation.

CONCLUSION

After 2500 insertion and removal cycles, all attachments exhibited significant loss in retention. Mechanism of retention loss can only be partially explained by surface changes.

Implant and root supported overdentures - a literature review and some data on bone loss in edentulous jaws

PURPOSE

To present a literature review on implant overdentures after a brief survey of bone loss after extraction of all teeth.

MATERIALS AND METHODS

Papers on alveolar bone loss and implant overdentures have been studied for a narrative review.

RESULTS

Bone loss of the alveolar process after tooth extraction occurs with great individual variation, impossible to predict at the time of extraction. The simplest way to prevent bone loss is to avoid extraction of all teeth. To keep a few teeth and use them or their roots for a tooth or root-supported overdenture substantially reduces bone loss. Jaws with implant-supported prostheses show less bone loss than jaws with conventional dentures. Mandibular 2-implant overdentures provide patients with better outcomes than do conventional dentures, regarding satisfaction, chewing ability and oral-health-related quality of life. There is no strong evidence for the superiority of one overdenture retention-system over the others regarding patient satisfaction, survival, peri-implant bone loss and relevant clinical factors. Mandibular single midline implant overdentures have shown promising results but long-term results are not yet available. For a maxillary overdenture 4 to 6 implants splinted with a bar provide high survival both for implants and overdenture.

CONCLUSION

In edentulous mandibles, 2-implant overdentures provide excellent long-term success and survival, including patient satisfaction and improved oral functions. To further reduce the costs a single midline implant overdenture can be a promising option. In the maxilla, overdentures supported on 4 to 6 implants splinted with a bar have demonstrated good functional results.

Ridge alterations following grafting of fresh extraction sockets in man. A randomized clinical trial

OBJECTIVE

To evaluate dimensional alterations of the alveolar ridge that occurred following tooth extraction at sites grafted with Bio-Oss(®) Collagen.

MATERIAL AND METHODS

Twenty-eight subjects with maxillary incisors, canines, and premolars scheduled for extraction were included. The tooth was carefully removed. The patients were randomly assigned to a test or a control group. In the test group patients, Bio-Oss(®) Collagen was placed in the fresh extraction socket while in the controls no grafting was performed. Radiographic examination (cone beam computed tomograms, CBCT) was performed immediately after tooth extraction and socket treatment. Four months later, a new CBCT was obtained. In the radiographs, (i) the distance (mm) between base of the alveolar process (apex) and the buccal and palatal crests was determined, (ii) the outer profile of alveolar process of the experimental sites was outlined, and the cross section of the area (mm(2) ) determined.

RESULTS

After 4 months of healing, the buccal and to a less extent also the palatal bone plate had become markedly reduced in height. The placement of a biomaterial in the socket failed to prevent resorption of the buccal and palatal bone walls. The cross-sectional area of the control ridge was reduced about 25% and of the test ridge with 3%.

CONCLUSION

The placement of a xenograft in fresh extraction sockets markedly counteracted the reduction in the hard tissue component of the edentulous sites.

Rehabilitation of reabsorbed maxillae with implants in buttresses in patients with combination syndrome

PURPOSE

To assess the success and marginal bone loss, after 1 year of loading, of implants placed in anatomic buttresses of atrophic maxillae to rehabilitate patients with combination syndrome.

MATERIALS AND METHODS

A case series retrospective study of 22 patients with combination syndrome who were treated with implants in anatomic buttresses in the atrophic maxilla was performed. The inclusion criteria were Classes IV and V Cawood and Howell maxillary atrophy, rehabilitation with implants placed in anatomic buttresses, the presence of anterior remnant teeth in the mandible, and a minimum follow-up of 12 months after implant loading. The criteria of Buser et al were used to evaluate implant success, and marginal bone loss was measured on periapical radiographs. Statistical analysis was performed to relate implant success and marginal bone loss to gender, degree of maxillary atrophy, implant technique, and prosthesis type.

RESULTS

A total of 18 patients fulfilled the inclusion criteria. A total of 117 implants were placed; 32 were placed with the conventional technique in the alveolar ridges with enough height and width, 35 were positioned palatally, 30 were tilted in the frontomaxillary buttress, 10 were placed in the pterygomaxillary area, 6 were placed in the nasopalatine canal, and 4 were zygomatic implants. The follow-up ranged from 1 to 7 years after implant loading. Of the 117 implants, 7 failed, for an implant success rate of 94%. The mean marginal bone loss was 0.63 mm. A statistically significant relation was found between bone loss and implant placement technique and the level of maxillary atrophy, being greater in tilted implants and in Class V Cawood and Howell maxillary atrophy.

CONCLUSIONS

Implants in anatomic buttresses allow rehabilitation of atrophic maxillae in patients with combination syndrome. The implant success rate was high, and a mean marginal bone loss of 0.63 mm was recorded.

Biphasic alloplastic graft used to preserve the dimension of the edentulous ridge: an experimental study in the dog

BACKGROUND

Loss of teeth results in marked qualitative and quantitative alterations of the alveolar process at the edentulous site. It was observed that a graft comprised of bovine bone mineral placed in the fresh extraction socket delayed tissue modeling, but preserved the dimension of the ridge at edentulous sites.

OBJECTIVE

To analyze the influence of a biphasic synthetic graft on tissue modeling and remodeling during healing of extraction wounds.

MATERIAL AND METHODS

Five beagle dogs were used. Two premolars in the maxilla and two in the mandible were included. Full thickness flaps were elevated and the distal roots were removed. An alloplastic graft (BPCAP; α-TCP core coated with nanocrystalline biomimetic hydroxyapatite) embedded in porcine collagen was placed to fill the fresh extraction socket of the premolar sites. Flaps were replaced to cover the entrance of the extraction sockets during early healing. The extraction and grafting procedures were scheduled to allow for the study of 1, 2, and 3 months socket healing. The biopsies from the maxillary sites were decalcified, embedded in paraffin, and stained to allow the study of various aspects of hard tissue formation. The biopsies from the mandibular sites were processed for ground sectioning and used to evaluate alterations of ridge dimensions after 3 months of socket healing.

RESULTS AND CONCLUSION

It was documented that the biphasic alloplastic graft did not undergo marked resorption during tissue modeling and remodeling, but allowed large amounts of bone to form within the post-extraction site. Grafting the experimental sites with this biomaterial furthermore counteracted ridge resorption that otherwise occurs following tooth extraction.

Alveolar ridge augmentation for implant fixation: status review

This literature review was performed to illustrate and compare different alveolar ridge augmentation procedures before dental implant placement. The review was based on clinical and research studies listed in Pubmed. There is not enough evidence to support any single method as gold standard for any given condition, and choice seemed to be based on personal preferences. There is a lack of long-term survival data or success rates of grafting materials regarding donor and recipient sites. Although ridge splitting and distraction osteogenesis techniques eliminate donor site morbidity, circumvent the use of grafting materials, and reduce the operation time, some disadvantages and limitations should be considered. More studies are needed to compare the fate and characteristics of new bone obtained by these different procedures, as well as subsequent implant survival rates.

A survey of dentulous and edentulous patient preference among different denture esthetic concepts

STATEMENT OF PROBLEM

Most esthetic preference research and anatomical average analysis come from dentulous populations. If edentulous patients have a different preference, application of this data during denture construction is problematic.

PURPOSE

The aim of this survey was to compare dentulous and edentulous respondent preference among three different denture esthetic concepts.

MATERIAL AND METHODS

A questionnaire and test booklet of standardized full-face digital photographs were used. It included three arrangements during maximum smile for six subjects. Dentulous and edentulous respondents were asked questions about their preference among the three randomly ordered concept photographs for each of the six subjects. A total of 167 dentulous and 269 edentulous questionnaires were analyzed descriptively and with Chi-squared tests to compare the esthetic preference of the respondents.

RESULTS

There was no statistically significant difference overall between dentulous and edentulous preference. Respondent preference varied significantly depending upon subject set and gender. Preference data compared closely to previous research.

CONCLUSION

Within the limitations of this survey, dentulous and edentulous respondent preference among the three esthetic concepts was not significantly different. Questionnaire respondents continued to frequently prefer appearances that are far from the anatomical average.

The effect of mandibular anterior teeth on the hypermobile tissue in the anterior part of the maxilla

The absence of posterior occlusal contacts may result in increased anterior occlusal contacts and forces between natural mandibular dentition and artificial maxillary dentition. The impact of natural mandibular anterior teeth on the development of hypermobile tissues in the anterior part of the edentulous maxillary alveolar ridge was investigated in this study. The study group consisted of 410 patients with maxillary complete dentures and various mandibular dentitions from seven rest homes in Istanbul. The data; including hypermobile tissue in the anterior part of the maxilla, occlusal relationship, nocturnal wear, denture age, and duration of the maxillary full edentulism period were recorded. A chi-square test was performed to analyze the effects of following data: Existence of mandibular anterior teeth, poor adaptation of the dentures, nocturnal wear, types of occlusal contacts, and gender, on the resorption of the anterior part of the maxilla. To examine the effects of the presence of anterior mandibular teeth and early maxillary edentulism on bone resorption in the anterior part of the maxilla, a logistic regression analysis was performed. The results reveal that patients with edentulous maxilla and natural mandibular anterior teeth are approximately twice more likely to show risk of hypermobile tissue in the anterior part of the maxilla than are full edentulous patients. Further, edentulous periods exceeding 30 years in maxilla seem to increase this risk approximately 4 times.

Patient satisfaction and dissatisfaction with mandibular two-implant overdentures using different attachment systems: 5-year outcomes

BACKGROUND

Different attachment systems for mandibular two-implant overdentures could influence levels of patient satisfaction. Positive consensus of the majority of patients being satisfied does not preclude the possibility of dissatisfaction for some.

PURPOSE

To evaluate patient satisfaction and dissatisfaction before and after 5 years of wearing mandibular two implant overdentures using different attachment systems ; to determine the prognostic relevance of pretreatment complete denture complaints to treatment outcomes.

MATERIALS AND METHODS

A total of 106 edentulous participants enrolled in a clinical trial completed a preliminary self-report inventory of their original complete denture complaints.New complete maxillary dentures and mandibular two-implant overdentures were provided to each participant using one of six different attachment systems. Patient satisfaction was determined at pretreatment; at baseline with mandibular two-implant overdenture insertion; and then annually for 5 years, using visual analogue and Likert-type scales.

RESULTS

Patient satisfaction with mandibular two-implant overdentures showed significant changes pre- to posttreatment(baseline) in all domains, but these were significant immediately and maintained without further significance for 5 years, other than pain with the overdenture. After 5 years, no significant differences were observed with all the attachment systems. Highly significant differences were found with some social and psychological aspects by the fifth year compared to baseline. Diagnostic and prognostic indicators from a pretreatment inventory identified 12 participants (13.5%) who were dissatisfied. These indicators revealed a maladaptive predisposition to mandibular two-implant overdentures.

CONCLUSIONS

The provision of mandibular two-implant overdentures will, in the majority of patients, significantly enhance levels of patient satisfaction for 5 years, as compared to complete mandibular dentures, regardless of the attachment system. Careful evaluation of pretreatment complaints with conventional dentures can possibly identify patient dissatisfaction with mandibular two-implant overdentures [corrected].

The potential benefits of dental implants on the oral health quality of life of people with Parkinson's disease

OBJECTIVE

To investigate how dental implants impact on the oral health quality of life of people with Parkinson's disease (PD).

BACKGROUND

PD is a progressive neurological disorder that can result in a number of oral health care challenges, including denture difficulties. Lack of evidence related to use of implants in PD prompted this study to investigate their use in this group of people.

MATERIALS AND METHODS

Nine people with PD were provided with either fixed or removable prostheses using Astra-Tech implants. Participants completed the socio-dental questionnaire, 'The Dental Impact on Daily Living Assessment' (DIDL) prior to implant surgery, and at 3 and 12 months after provision of the final prosthesis. DIDL comprises two components - the Oral Health Quality of Life Inventory (OH-QoL) and the Self-Reported Assessment of Oral Health and Functional Status (SROH).

RESULTS

Nine people (with an age range of 54-77 years) had implants placed. The implant success rate was 85 and 81% in the maxilla and mandible, respectively. The OH-QoL and SROH results (analysed using the one-way analysis of variance and pairwise multiple comparisons) demonstrated a significant improvement in the domains of eating and satisfaction with the prosthesis after 3 months, which was maintained at the twelve month review. The OH-QoL indicated a gradual improvement in oral well-being over the 12-month period.

CONCLUSION

The oral health quality of life of people with PD was improved by the use of dental implants, indicating this as a viable treatment option.

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

OBJECTIVES

To evaluate the pattern of maxillary complete denture movement during chewing for free-end removable partial dentures (RPD) wearers, compared to maxillary and mandibular complete denture wearers.

MATERIALS AND METHODS

Eighteen edentulous participants (group I) and 10 volunteers with bilateral posterior edentulous mandibles (group II) comprised the sample. Measures of mean denture movement and its variability were obtained by a kinesiographic instrument K6-I Diagnostic System, during the mastication of bread and a polysulphide block. Data were analysed using two-way ANOVA (alpha = 0.05).

RESULTS

Upper movement during chewing was significantly lower for group II, regardless of the test food. The test food did not influence the vertical or lateral position of the denture bases, but more anterior dislocation was found when polysulphide blocks were chewed. Group II presented lower intra-individual variability for the vertical axis. Vertical displacement was also more precise with bread as a test food.

CONCLUSION

It can be concluded that mandibular free-end RPD wearers show smaller and more precise movements than mandibular complete denture wearers.

Denture-related stomatitis: identification of aetiological and predisposing factors - a large cohort

The aim of this study was to identify and characterize aetiological and predisposing factors in denture-related stomatitis (DRS), by means of a case-control, transversal study, in a large cohort of 140 persons wearing removable maxillary polymethylamethacrylate prostheses. Data were obtained by (1) a questionnaire that included the identification of the subject, demographic and social data, medical history and behaviour; (2) intra-oral examination; (3) evaluation of the prosthesis; (4) microbiological examination; (5) yeast identification and analyses using Epi-info and the chi-square test. Results showed significant associations between DRS and yeasts, gender, age and alcohol consumption. We also found a significant relationship between the presence of yeasts and hyposalivation and decreased salivary pH. We found a highly significant difference between groups with and without DRS concerning the presence or absence of yeasts, regardless of the sample origin. Most cases of DRS showed the presence of Candida albicans. The results confirm a highly significant difference between groups with and without DRS concerning the presence or absence of yeasts.

Immediate Loading of Two Implants Supporting a Ball Attachment-Retained Mandibular Overdenture: A Prospective Clinical Study

BACKGROUND

A prospective clinical study was conducted to evaluate clinically and radiographically the performance of two implants immediately loaded supporting a ball attachment-retained mandibular overdenture.

MATERIALS AND METHODS

Seventeen completely edentulous patients were included in the study. Each patient received two implants inserted after a minimal flap reflection and no vestibular extension in order to reduce the postoperative swelling and facilitate immediate prosthesis connection. After implant placement, a mandibular complete denture was connected to the implants using ball attachments of appropriate height according to the depth of the peri-implant tissue. Patients were asked not to remove the denture for 1 week. No limitations to chewing function were given. At implant placement, the maximum value of insertion torque was recorded. Patients were examined at 1, 2, 4, 12, and 52 weeks postsurgery. At postoperative visit, occlusion was checked and the need for any prosthesis maintenance was recorded. The radiographic bone level (RBL) change was measured on periapical radiographs at baseline and 12 months after loading.

RESULTS

After 12 months of loading, no implant failure was reported and the survival rate was 100%. Average RBL change was 0.7 mm +/- 0.5 mm. Of the 17 cases, two had major prosthetic complications and five patients required minor extra maintenance appointments.

CONCLUSIONS

The immediate loading of two implants by means of ball attachment-retained mandibular complete denture may be a predictable treatment option. This clinical approach offers increased stability and comfort, while keeping a high implant success rate.

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

BACKGROUND

Complex procedures involving a facebow transfer and the use of lingualised teeth are deemed to have a positive influence on the chewing ability with complete dentures.

OBJECTIVES

To determine if patients' ratings of their ability to chew depend on the method of complete denture fabrication.

METHODS

Edentulous patients (n = 20) participated in a within-subject crossover trial. Each patient received two sets of new complete dentures. One pair was manufactured based on intraoral tracing of centric relation and facebow transfer; semi-anatomical teeth with lingualised occlusion denture (LOD) were chosen. The second pair was made using a simplified procedure without facebow transfer; jaw relations were recorded with wax occlusion rims, and anatomical teeth with a first premolar/canine-guidance (CGD) were selected. The dentures were delivered in randomised order, and each was worn for 3 months. Three months after delivery, patients' ratings of each new prosthesis were recorded on visual analogue scales for their ability to chew seven index foods. Repeated measurements analysis of variance was performed to investigate possible carry-over effects accounting for confounding by treatment period.

RESULTS

When comparing the two treatments, participants rated their ability to chew in general, to masticate carrots, hard sausage, steak and raw apple in particular, was significantly better with the CGD (anatomical teeth) than with the LOD (p < 0.05).

CONCLUSION

Comprehensive methods for the fabrication of complete dentures including semi-anatomical lingualised teeth and a full registration do not seem to influence the perceived chewing ability, when compared with more simple procedures. Chewing ability for tough foods appears to benefit from the use of anatomical teeth.

A Survey of Edentulous Patient Preference among Different Denture Esthetic Concepts

STATEMENT OF PROBLEM

Despite the fact that solutions to functional problems are available, successfully restoring the appearance of an edentulous patient remains a challenge.

PURPOSE

The aim of this survey was to determine if edentulous respondents could differentiate among three denture esthetic concepts and if there was an overall preference among the three.

MATERIALS AND METHODS

Six edentulous test subjects were selected based on age and smile criteria. One wax tooth arrangement was completed according to each of the three esthetic concepts for a total of three wax tooth arrangements per test subject. The three esthetic concepts followed were natural, supernormal, and denture look. Standardized full-face digital photographs were made of each arrangement (three) during maximum smile for each subject (six). These 18 photographs were included in a questionnaire. Respondents were asked questions about their preference among the three randomly ordered concept photographs for each of the six subjects. A total of 147 completed questionnaires were analyzed.

RESULTS

Ninety-six percent of respondents were able to differentiate among the three esthetic denture concepts. Natural tooth arrangements were preferred by 55% of the respondents, supernormal tooth arrangements were preferred by 19%, and the denture look arrangements were preferred by 26%.

CONCLUSION

Within the limitations of this survey, the questionnaire respondents differentiated between the three esthetic denture concepts. The tooth arrangement most closely resembling the anatomical average was selected by 55% of the respondents. Preference for a particular concept changed when responses to each test subject set were considered individually. Demographic factors do not significantly affect patient preference.

CLINICAL SIGNIFICANCE

Three esthetic concepts for complete denture construction have been differentiated. Questionnaire respondents preferred appearances that are far from the anatomical average 45% of the time.