Maintaining occlusal stability by selecting the most appropriate occlusal scheme in complete removable prosthesis

The accuracy of anatomic landmarks on the occlusal plane: a comparative study between conventional and 3D image method

BACKGROUND

To establish the occlusal plane, the conventional methods for facial analysis to gain accurate alignment of the occlusal plane are inadequate, while 3D technologies are an ideal diagnostic tool. The aims of this research are to compare the difference accuracy of anatomic landmarks on the occlusal plane and ala-tragus line between the conventional clinical method and 3D image method in both non-orthodontic and orthodontic treatment volunteers.

METHODS

A total of 44 volunteers (22 non-orthodontic and 22 orthodontic treatment volunteers) with normal occlusion were selected. All volunteers received 2 operative methods for occlusal plane determination. In conventional method, the occlusal plane was defined by the fox plane line. The ala-tragus line was defined by the radio-opaque markers. In the 3D image method, the volunteers were recorded intraoral images, 3D facial images and CBCT images. A 3D virtual picture was created using EXOCAD® software. The occlusal plane was generated by the incisal and occlusal surfaces of the teeth. Both methods, the angles and distances between the occlusal plane and ala-tragus line were measured and compared statistically on both sides of each volunteer.

RESULTS

Both volunteers' group, the mean angles and distances between the occlusal plane-ala tragus line in the conventional method were reported to be significantly greater than the 3D method (P < 0.05). The percentage difference of angles in conventional method were reported to be significantly higher by 13.61-21.58% (p < 0.05) compared to the 3D method. The percentage difference of distances in the conventional method were reported to be significantly greater than the 3D method by 4.73-7.51% (p < 0.05).

CONCLUSIONS

Within the limitation of the study, it can be concluded that both conventional and digital methods for establishing the occlusal plane are not parallel to the occlusal plane. The occlusal plane and ala-tragus line in the conventional method and the 3D method were significantly different in terms of angles and distances in both non-orthodontic and orthodontic treatment volunteers. However, the deviation angle of both methods is approximately 13-20 degrees, which is clinically acceptable for occlusal plane establishment. The accuracy of both methods is still within the using in clinical implementation.

Analysis of Oral Health-Related Quality of Life in Elderly Romanian Edentulous Patients: Implant-Supported Versus Conventional Complete Dentures

Background/Objectives: The integration of quality of life (QoL) assessments into dental health evaluations acknowledges the profound impact of oral health on overall well-being. This study aims to compare the impact of implant-supported complete dentures versus conventional complete dentures on oral health-related quality of life (OHRQoL) in elderly Romanian edentulous patients. Methods: This longitudinal study involved 93 initially recruited edentulous patients, with 52 completing the study over an 18-month period. Data collection utilized the OHIP-5 questionnaire, assessing the OHRQoL at baseline with conventional dentures and three months post-implant-supported denture placement. Ethical approval was secured from the Faculty of Medicine and Pharmacy University of Oradea, adhering to the Helsinki Declaration principles. A statistical analysis was conducted using SPSS version 25 and included non-parametric tests for score comparisons and Fisher's exact test for categorical data. Results: The comparative analysis of the questionnaire responses revealed significant improvements in all five OHRQoL dimensions post-treatment with implant-supported dentures. For instance, the proportion of patients reporting "never" experiencing difficulty chewing any foods increased from 1.9% at baseline to 57.7% post-treatment. Similarly, those reporting "never" experiencing painful aching rose from 3.8% to 76.9%. There was also a notable reduction in discomfort regarding the appearance of mouth, dentures, or jaws from 3.8% reporting "never" at baseline to 75% post-treatment. The improvements in sense of taste and difficulty in performing usual activities saw comparable increases. Conclusions: The findings support the hypothesis that implant-supported complete dentures significantly enhance OHRQoL among elderly edentulous patients compared to conventional dentures, with improvements noted in mastication ability, pain reduction, aesthetics, taste perception, and activity performance. These results underscore the value of prosthetic interventions in dental care to substantially improve patients' OHRQoL.

Occlusion and Its Role in the Long-Term Success of Dental Restorations: A Literature Review

Occlusion plays a fundamental role in the long-term success of dental restorations by influencing both their functional stability and durability. This review explores the occlusal considerations for various restorative modalities, including fixed and removable prostheses, implant-supported restorations, and adhesive restorations. Special attention is given to the biomechanical principles involved, such as force distribution, stress management, and the role of occlusion in temporomandibular joint health. Diagnostic tools, including traditional and digital techniques such as T-Scan and OccluSense, are discussed to highlight their relevance in detecting occlusal disharmony. Additionally, the review examines the effects of parafunctional habits on restoration longevity and the influence of occlusal trauma on prosthetic outcomes. Despite advances in materials and technology, achieving functional occlusion remains essential in minimizing complications and ensuring patient comfort. This review underscores the need for proper occlusal analysis during treatment planning to enhance clinical outcomes and extend the lifespan of dental restorations.

The Influence of Occlusion Type on Oral Health-Related Quality of Life in Patients with Complete Dentures-Lingualized vs. Bilaterally Balanced Occlusion

OBJECTIVE

This randomized, single-blind controlled study aimed to investigate the QoL and satisfaction of patients wearing complete dentures with lingualized (LO) and bilaterally balanced occlusion (BBO). Participants were stratified based on their prior experience with complete dentures.

METHODS

The study involved 131 complete denture wearers who were categorized into four groups: G1-first-time prosthesis wearers treated with LO (n = 33); G2-first-time prosthesis wearers treated with BBO (n = 31); G3-participants with prior prosthesis experience treated with LO (n = 34); G4-participants with prior prosthesis experience treated with BBO (n = 33). After wearing the prosthesis for one month, all participants completed the Oral Health Impact Profile (OHIP-14) questionnaire. A statistical analysis was conducted using the χ2 test, Kruskal-Wallis analysis and Mann-Whitney test, with significance determined at p < 0.05.

RESULTS

After dividing the respondents into two groups, a statistically significant difference was observed in the distribution of scores for three questions related to oral pain severity, anxiety, and difficulty relaxing. However, the distribution of scores for all other questions did not show a statistically significant difference between the groups studied (p < 0.05). The total OHIP-14 score was also not statistically different (z = 0.469; p = 0.639). However, when respondents were divided into four groups, the median score for first-time denture wearers was 3.9 points higher in respondents who received dentures with BBO compared to those with LO (p < 0.001). Furthermore, the median score for first-time denture wearers who received BBO was higher than for those in the second group who received BBO (p = 0.013).

CONCLUSION

Patients wearing complete dentures for the first time demonstrated significantly higher satisfaction with the LO scheme compared to the BBO scheme. In contrast, satisfaction levels between occlusal schemes did not significantly differ among patients with prior denture-wearing experience. Novice denture wearers reported heightened sensations of oral discomfort, anxiety, and difficulty relaxing regardless of the occlusal scheme compared to experienced wearers, likely due to the unrealistic expectations that first-time wearers often have about complete dentures.

Maxillomandibular relationship record methods for computer-engineered complete dentures: a scoping review

OBJECTIVES

The purpose of this scoping review was to identify different methods employed for recording the maxillomandibular relationship (MMR) for computer-aided designed and manufactured (CAD-CAM) complete dentures (CDs).

MATERIALS AND METHODS

This scoping review followed the PRISMA-ScR guidelines and was developed according to Arksey and O'Malley and The Joanna Briggs Institute protocol. The methods were registered on the Open Science Framework (< osf.io/rf4xm> ). The focus question was: "What are the different techniques for recording the maxillomandibular relationship in the digital workflow used in CECDs?" Two investigators searched 3 online databases [MEDLINE (PubMed), Scopus, and Science Direct] independently. The inclusion criteria were clinical studies and reviews that assessed techniques for recording MMR using digital workflow for manufacturing of CECDs. A descriptive analysis was performed considering the study design, manufacturing system, clinical steps, and tools for the determination of MMR, and the difficulty level of procedures.

RESULTS

4779 articles were identified in the electronic search and 10 studies were included for data analysis. The review identified 4 commercially available CAD-CAM denture systems and 3 innovative methods suitable for abbreviating the number of appointments (2 to 4 visits). The trial denture is inherent to the procedure for the Baltic System and 3 innovative techniques. Three techniques (2 innovative and WholeYouNexteeth) demonstrated lower difficulty levels for performing the clinical procedures, regardless of the professional skills.

CONCLUSIONS

The commercially available and innovative techniques for the recording of MMR may provide predictability of the treatment. The techniques are effective, however, rely on the learning curve and the patient's clinical condition.

CLINICAL RELEVANCE

Recording of the maxillomandibular relationship is paramount for the manufacturing and functionality of complete dentures. Clinicians should be aware of the different tools and techniques described for registering the jaw relationship.

Occlusal Analysis in Natural Dentition: Systematic Review

This study aimed to evaluate the effectiveness of conventional occlusal analysis in contrast with digital occlusal analysis in natural dentition. Occlusal analysis allows the identification of normal and abnormal occlusal contact points that alter the craniomandibular cervical system. We searched for articles with keywords [[dental occlusion]], [[natural dentition]], [[occlusal adjustment]], [[Immediate Complete Anterior Guidance Development]] [[mastication]], [[bite force]], [[premature contact]], [[occlusal balance]] [[articulating paper]]], [[spray]], [[Occlusal contacts]], and [[bite strength]]. They were considered observational , odds ratio and case control studies. We found 189 items. After evaluating the abstracts and full texts of the articles, 10 papers met the inclusion criteria. It was found that occlusal analysis allows the identification of the relationship between poor occlusion and the sensitivity of the teeth due to occlusal trauma, which is also related to temporomandibular joint pain in dynamic occlusion. The contacts of greater strength were observed in nonfunctional cusps, 48%, without ruling out the functional cusps, 24%. Despite being the universal method of occlusal control to date, the use of joint paper, remains subjective compared to the digital occlusal control device. Posture is considered directly related to occlusal trauma and temporomandibular disorders; without proper occlusal analysis, a clear diagnosis of the patient's joint condition cannot be obtained. Digital occlusal analysis is more objective than traditional occlusal analysis.

Comparison of Canine-Guided Occlusion with Other Occlusal Schemes in Removable Complete Dentures: A Systematic Review

Choosing an adequate occlusion is challenging during the construction of artificial dentures, and critical for patient satisfaction. However, there is no conclusive evidence to support which occlusal design is more appropriate. The aim of this systematic review was to evaluate canine-guided occlusion in comparison to other occlusal schemes in removable complete denture wearers. The review was conducted according to the Preferred Reported Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. An extensive search was carried out on (PubMed (National Library of Medicine)), Scopus (Elsevier), Cochrane collaboration (Wiley), Science Direct (Elsevier) and Europe PMC (European Bioinformatics Institute). English and non-English studies were identified using keywords on canine-guided occlusion, denture occlusion, dental occlusion and artificial occlusal schemes. Out of 1759 articles searched, 18 were selected based on the inclusion criteria. The included studies were interpreted for the descriptive analysis for the calculation of occlusal schemes, occlusion assessment parameters, the outcome of the occlusal schemes and types of removable prosthesis used. The systematic analysis of occlusal schemes revealed that canine-guided occlusion is viable compared with other occlusal designs in terms of patient satisfaction, mastication, retention, esthetics, phonetics, oral-health-related quality of life and muscle activity. The type of occlusal scheme influences the complete denture patient’s’ masticatory efficiency, satisfaction, retention, phonetics and esthetics. Nevertheless, physical, physiological, mechanical and psychological factors play a vital role in the success of removable complete dentures. The canine-guided occlusal scheme is preferred because of its simplicity, less time consumption, good masticatory performance, ease of fabrication and modification into bilateral balanced occlusion if required. Further studies are required to reduce the controversies related to jaw relations, gnathology and occlusal schemes in complete dentures.