Influence of guidance concept in complete dentures on oral health related quality of life - Canine guidance vs. bilateral balanced occlusion

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.

Knowledge, attitudes, and practice related to tooth loss and dentures among patients with dental arch deficiencies

BACKGROUND

Tooth loss is a common problem that affects many people worldwide. Exploring knowledge, attitude, and practice (KAP) among patients can identify barriers and challenges in following recommended practices, providing valuable insights for dental healthcare providers, policymakers, and researchers. This study aimed to explore the KAP of patients with dental arch deficiencies regarding tooth loss and dentures.

METHODS

This web-based, cross-sectional study was conducted among patients with dental arch deficiencies using a self-designed questionnaire.

RESULT

3166 valid questionnaires were included. Participants' mean KAP scores were 6.84 ± 2.27 (possible range: 0 ~ 12), 39.4 ± 3.72 (possible range: 9 ~ 45), and 27.7 ± 4.36 (possible range: 8 ~ 40), respectively. Multivariable logistic regression analysis showed that knowledge (OR = 1.383), employed (OR = 1.805), family history (OR = 2.158), and treatment (OR = 1.683) were independently associated with attitude. Moreover, knowledge (OR = 1.239), attitude (OR = 1.250), female (OR = 0.619), age (OR = 0.967), college/bachelor (OR = 0.373), and master and above degree (OR = 0.418), employed (OR = 0.554) or student (OR = 0.434), with 10,001-20,000 Yuan household income per month (OR = 0.492), have been married (OR = 0.609), smoking (OR = 0.595), drinking (OR = 0.397), disease duration (OR = 0.972), with family history (OR = 1.676), and with treatment (OR = 3.492) were independently associated with practice (all P < 0.05).

CONCLUSION

Patients with dental arch deficiencies have insufficient knowledge, positive attitudes, and moderate practice toward tooth loss and dentures, which might be affected by multiple demographic factors.

Clinical performance of and patient satisfaction with conventional complete dentures with different occlusal schemes: A systematic review of systematic reviews

STATEMENT OF PROBLEM

The complete denture occlusal scheme may influence clinical performance and patient satisfaction. However, a consensus on which occlusal scheme should be used for complete denture users is lacking. As a result, many dentists choose the scheme based on their preferences and clinical experience.

PURPOSE

The purpose of this review was to assess the methodological quality and summarize the scientific evidence from secondary studies about the influence of occlusal schemes on the clinical performance of and patient satisfaction with complete dentures.

MATERIAL AND METHODS

Ten sources were surveyed according to the patient, intervention, comparison, outcome (PICO) strategy. Systematic reviews that evaluated the clinical performance and patient satisfaction (O) of rehabilitated edentulous patients with conventional complete dentures (P) under different occlusal schemes (I/C) were included. Methodological quality was assessed by using A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 tool by 2 authors independently. The effect of each occlusal scheme in comparison with others was summarized and classified as positive, neutral, negative, or inconclusive based on the conclusions of the systematic review concerning clinical performance and patient satisfaction outcomes.

RESULTS

The search led to the inclusion of 10 systematic reviews. Seven were classified as of critically low, 2 as low, and 1 as moderate methodological quality. The following occlusal designs were included and analyzed: bilateral balanced occlusion, lingualized occlusion, canine guidance, group function, and monoplane occlusion. Bilateral balanced occlusion and canine guidance obtained satisfactory results for both outcomes. Lingualized occlusion showed a trend toward better results than other occlusal schemes for normal and resorbed ridges. Group function presented mainly inconclusive results, and monoplane occlusion did not deliver satisfactory outcomes.

CONCLUSIONS

The present overview concluded that occlusal schemes might interfere with the clinical performance of and patient satisfaction with complete dentures. Lingualized, bilateral balanced, and canine guidance are preferred compared with monoplane occlusion, but lingualized occlusion tends to show better results in some reviews. However, the results should be carefully considered because of the low quality of the systematic reviews included.

HOW TO IDENTIFY SUBGROUPS IN LONGITUDINAL CLINICAL DATA: TREATMENT RESPONSE PATTERNS IN PATIENTS WITH A SHORTENED DENTAL ARCH

BACKGROUND

When dental patients seek care, treatments are not always successful,that is patients' oral health problems are not always eliminated or substantially reduced. Identifying these patients (treatment non-responders) is essential for clinical decision-making. Group-based trajectory modeling (GBTM) is rarely used in dentistry, but a promising statistical technique to identify non-responders in particular and clinical distinct patient groups in general in longitudinal data sets.

AIM

Using group-based trajectory modeling, this study aimed to demonstrate how to identify oral health-related quality of life (OHRQoL) treatment response patterns by the example of patients with a shortened dental arch (SDA).

METHODS

This paper is a secondary data analysis of a randomized controlled clinical trial. In this trial SDA patients received partial removable dental prostheses replacing missing teeth up to the first molars (N = 79) either or the dental arch ended with the second premolar that was present or replaced by a cantilever fixed dental prosthesis (N = 71). Up to ten follow-up examinations (1-2, 6, 12, 24, 36, 48, 60, 96, 120, and 180 months post-treatment) continued for 15 years. The outcome OHRQoL was assessed with the 49-item Oral Health Impact Profile (OHIP). Exploratory GBTM was performed to identify treatment response patterns.

RESULTS

Two response patterns could be identified - "responders" and "non-responders." Responders' OHRQoL improved substantially and stayed primarily stable over the 15 years. Non-responders' OHRQoL did not improve considerably over time or worsened. While the SDA treatments were not related to the 2 response patterns, higher levels of functional, pain-related, psychological impairment in particular, and severely impaired OHRQoL in general predicted a non-responding OHRQoL pattern after treatment. Supplementary, a 3 pattern approach has been evaluated.

CONCLUSIONS

Clustering patients according to certain longitudinal characteristics after treatment is generally important, but specifically identifying treatment in non-responders is central. With the increasing availability of OHRQoL data in clinical research and regular patient care, GBTM has become a powerful tool to investigate which dental treatment works for which patients.

The effect of clinical interventions on the oral health-related quality of life in older adults

This paper reviews the literature to assess the effectiveness of oral health interventions in influencing oral health-related quality of life (OHRQoL) in older adults. Clinical studies published in 2010 onwards reporting oral health interventions in older adults and subsequent changes in OHRQoL were systematically searched in Medline, Web of Science and EMBASE databases. Reporting followed Preferred Reporting Items for Systematic Review and Meta-Analysis criteria. Eligibility evaluation and data abstraction from eligible studies were guided by predefined PICO questions and bias assessment by the Quality in Prognosis Studies tool. The search retrieved 144 articles. Of the 20 articles that met the eligibility criteria, 45% (9) reported a statistically significant improvement in OHRQoL. The majority of studies were conducted in adults with complete edentulism (70%) and mainly focused on implant provision to support a removable prosthesis (30%). The search indicates the limited scope of current literature on geriatric dental interventions, focusing mainly on denture realignments, denture fabrication and implant placement. Although the majority of the oral health interventions focused on edentulism and removable prostheses, there are many areas of oral health interventions and their potential impact on OHRQoL in this demographic group that have yet to be explored.

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.

Complete Denture Occlusion: Best Evidence Consensus Statement

PURPOSE

The occlusal scheme required for an edentulous patient is controversial. The purpose of this Best Evidence Consensus Statement was to evaluate the existing complete denture literature related to occlusal schemes.

MATERIALS AND METHODS

A literature search was limited to Meta-analyses, Systematic Reviews (SR), Randomized Controlled Studies (RCT) and Clinical Trials. Key Words were: Complete dentures, occlusion, harm; Complete dentures, occlusion alveolar bone loss; Complete dentures, occlusion, stability; Complete dentures, occlusion. Additional related articles were culled from the authors' library and reference lists in the articles found in the PubMed searches.

RESULTS

Of the 165 articles that met the initial search criteria, 34 related to the focus questions and were evaluated and rated.

CONCLUSIONS

There is strong support that the average denture patient, with good residual ridges and no neuromuscular problems, will function adequately with a properly fabricated complete denture regardless of the occlusal scheme. There is neither strong support for or against bilateral balanced occlusal schemes as it relates to patient satisfaction, preference or chewing ability. There is some support for increased alveolar bone loss with complete dentures that have a non-balanced occlusion. There is a need for bilateral balanced occlusal schemes for patients presenting with loss of stability and retention as a result of their presenting conditions (PDI III and IV).

Correction of a Class III Malocclusion with a Functional Shift and Severe Crowding

A forward functional shift of the mandible is a significant problem that can cause both functional and aesthetic complications for many patients. This shift usually occurs in growing patients, and it is unusual to see in adult patients. This case report shows an adult patient with a forwarding functional shift that caused both anterior and posterior crossbites with a pseudo class III dental and skeletal relationship. The patient also showed severe upper arch crowding with blocked-out canines and mild crowding in the lower arch. The treatment of this patient involved extraction of the upper right and left first premolars and the lower right first premolar, followed by opening of the bite to relieve the neuromuscular reflex of the forward protrusion of the mandible during centric occlusion and to correct both the anterior and posterior crossbites. Extraction spaces were closed using class III elastics and elastomeric chains. At the end of the treatment, good functional and aesthetic results were obtained after the elimination of the forward functional shift.

Choosing the denture occlusion - A Systematic review

Aim:

The aim of the study is to acquire evidence for the choice of occlusion with anatomic/modified anatomic teeth in complete denture prosthesis.

Settings and Design:

Systematic review following PRISMA guidelines.

Materials and Methods:

The study reviewed original articles on various occlusal schemes bilateral balance occlusion (BBO), lingual occlusion (LO), Canine guided occlusion (CG), posterior group function occlusion (PGFO) have been applied to the complete dentures and were analyzed for the objective or subjective or both evaluations. The data were collected in standard format with the needed information such as year of publication, type of study, occlusal schemes compared, test methodology used, sample size for experiment and control, assessment of retention, stability, and other factors which determine the quality of life and period of follow-up. The risk of bias was calculated using tools RoB2.0 and robvis. At all stages, the inclusion and exclusion of studies were discussed among the reviewers.

Statistical Analysis used:

Due to the heterogeneity in the data of the included studies no statistical analysis was used.

Results:

Of the 1896 articles screened only 17 studies were included in the systematic review. These were discussed amongst the reviewers regarding the various occlusion schemes used. The subjective and objective criteria used in the studies was tabulated separately. They were then analyzed for the risk of bias using the robvis 2 tool.

Conclusion:

No scheme is more superior to the other with the anatomic tooth forms. The use of alternative unbalanced schemes produces a similar satisfactory clinical outcome. The ridge classification also has a significant role to play in the preference for an occlusal scheme.

Oral health-related impact profile of patients treated with fixed, removable, and telescopic dental prostheses in student courses-a prospective bicenter clinical trial

Objectives

To analyze the oral health-related impact profile in patients treated with three different types of dental prosthesis in student courses.

Materials and Methods

This prospective bicenter clinical trial was conducted with 151 patients being treated with fixed (n = 70), removable (n = 61), or telescopic dental prostheses (n = 20) in clinical student courses of two German universities from October 2018 to October 2019. All patients completed three standardized German versions of the Oral Health Impact Profile (OHIP-G49/53) before prosthetic treatment (T0), at control after 1 week (T1), and after 3 months (T2), divided into five dimensions: (a) appearance, (b) oral function, (c) psychosocial impact, (d) linguistic limitations, and (e) orofacial pain. Data were analyzed with Kolmogorov–Smirnov, Wilcoxon signed-rank, Kruskal–Wallis, Mann–Whitney, and Cronbach’s alpha tests.

Results

Within T0–T1 and T0–T2, greater improvements were determined for removable compared with fixed dental prostheses for the dimensions’ oral function (p ≤ 0.014), linguistic limitations (p ≤ 0.016), and appearance (p ≤ 0.003). No significant differences were found between fixed and telescopic dental prostheses (p ≥ 0.104) or between removable (partial dental prosthesis with clasps and complete dental prosthesis) and telescopic dental prostheses (p ≥ 0.100). Within T1–T2, a significant improvement in orofacial pain could be determined (p = 0.007).

Conclusions

Restorations presented an improvement in oral health-related quality of life. Removable dental prostheses showed better improvement than fixed ones in various dimensions.

Clinical relevance

Knowledge about the influence of oral health-related quality of life on the three different types of prosthesis used in student courses can be of decisive help in dental consultations.

Patient satisfaction with occlusal scheme of conventional complete dentures

Occlusal scheme is a controversial topic that has been linked to patient satisfaction with conventional complete dentures (CCDs). This study aimed to compare the patient satisfaction with CCDs with four different occlusal schemes namely the lingualised occlusion (LO), buccalised occlusion (BO), fully bilateral balanced occlusion (FBBO) and partially group function occlusion (PGFO). In this clinical study, new CCDs were made for 121 patients; out of which, 97 patients (mean age of 57.87 ± 9.5 years) completed the 1-year follow-up. The CCD wearers were followed up at 1 month, 3 months and 1 year after CCD delivery. Data were collected via an interview and recorded in a checklist by a blinded examiner. The checklist included the demographic variables, the 19-item version of Oral Health Impact Profile for Edentulous Patients (OHIP-EDENT), and seven 100-mm line visual analogue scales (VASs) to assess the items related to patient satisfaction. The Kruskal-Wallis and Friedman tests followed by post hoc tests were used to compare the variables among the 4 groups and between the 3 follow-ups. P-value ≤ .05 was considered statistically significant for all tests. The patients with BO presented higher satisfaction scores for comfort, stability and retention at the 1-year follow-up compared with PGFO. Both PGFO and FBBO groups had higher physical pain scores compared with BO and LO. The psychological discomfort scores of FBBO group were significantly higher than those in LO group. Pairwise comparisons revealed no significant differences in the general patient satisfaction and total OHIP-EDENT scores between the 4 groups. For most items, within-group analysis showed significant improvement of the satisfaction scores and reduction of domain scores over time.

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

The search of an adequate occlusal scheme that maximizes dentures' stability and patients' satisfaction is an ultimate objective in every complete prosthodontic treatment. Many studies compared occlusal schemes in terms of retention, comfort and masticatory performance. The purpose of this article is to review literature about different occlusal schemes related to complete dentures' stability and edentulous patients' satisfaction, in order to select the most appropriate occlusal scheme. Thus, an electronic search was performed from PubMed (MEDLINE), Scopus, Cochrane, Google Scholar and Sciencedirect databases. 65 articles were identified of which 56 were selected to compose the present article. Within the limitations of this review, it has been concluded that edentulous patients prefer anatomic occlusal schemes to non-anatomic teeth. Furthermore, canine guidance seems to be efficace in terms of chewing comfort and dentures' retention, as well as lingualized occlusion. However, bilateral balanced occlusion does not confer a long-term masticatory performance and satisfaction to edentulous patients.

Success of Complete Denture Treatment, Detailed Investigation of Construction Protocols, Occlusal Schemes and Evaluation Questionnaires

Background/Aim: The successful outcome of conventional complete denture treatment can be defined with the use of both subjective and objective criteria. Denture satisfaction determinants may include denture quality, oral tissue condition, patient-dentist relationship, patient’s attitude toward dentures, patient’s personality and socioeconomic factors. Purpose: The aim of the current review was to identify and analyze the different construction protocols and occlusal schemes that contribute to the success of complete denture rehabilitation through the use of evaluation questionnaires.

Material and Methods: A comprehensive literature search was performed through electronic databases (MEDLINE via PubMed) using the appropriate key words (complete denture construction, complete denture fabrication, complete denture occlusion and complete denture occlusal scheme). The related to the subject scientific papers were selected and evaluated for eligibility utilizing a predefined review process (English, full text articles, published from January 2000 up to April 2017).

Results: None of the analyzed studies identified significant differences between dentures constructed with simplified, CAD/CAM and traditional protocols in terms of general satisfaction and Oral Health Related Quality of Life scales. The same condition applied to the studies which compared complete dentures with bilateral balanced, lingualized, monoplane and canine guided occlusion.

Conclusions: Current scientific evidence suggested that patients could adapt comfortably to any type of bilateral balanced occlusal scheme and to complete dentures been fabricated with all types of complete denture construction protocol. Disease-specific questionnaires could be considered valuable tools and should be used to assess the outcome of any treatment modality.

Influence of the dental prosthetic status on self-perceptions of health and treatment needs: A cross-sectional study of middle-aged adults with chronic disease

Background

Subjective aspects of dental prosthesis need in middle-aged adults are poorly explored, especially when the population presents chronic diseases. Objectives: To investigate if the use and necessity of dental prosthesis influence the self-perceptions of health and dental treatment need in middle-aged adults with chronic diseases.

Material and Methods

A cross-sectional study was performed in 210 middle-aged adults. Socio-demographic aspects, dental services use, oral and general perceptions of health, dental treatment need and OIDP were assessed using a standardized questionnaire. One trained dentist evaluated the use and necessity of dental prosthesis. Data were analyzed using Chi-square and multivariate logistic regression (p<0.05).

Results

The use of dental prosthesis showed a proportion of 2.2:1 for upper to lower arch. Dental prosthesis need was largely prevalent (90 and 95% in upper and lower arch, respectively). The self-perceptions of dental treatment need and oral health were associated with the use and necessity of dental prosthesis (p<0.05), which could not be observed in relation to the general self-perception. The adjusted model demonstrated that the subjective necessity of dental treatment was 16.04 (1.92-133.7) fold higher in individuals with necessity of rehabilitation in the lower arch. Besides, a positive self-perception of oral health (satisfied) was 2.59 (1.38-4.85) more expressive in individuals that used a dental prosthesis in upper arch.

Conclusions

The self-perception of oral health was influenced by the use of maxillary dental prosthesis in individuals with chronic disease. Moreover, individuals were more likely able to perceive treatment need when the lower jaw was affected by tooth loss. Key words:Tooth loss, epidemiology, personal satisfaction, aged, chronic disease.

Patient satisfaction with occlusal scheme of conventional complete dentures: A randomised clinical trial (Part II)

The occlusion of choice is a controversial topic in conventional complete denture (CCD) treatment. This study aimed to compare patient satisfaction with CCD with partially group-function occlusion (PGFO), fully bilateral balanced occlusion (FBBO), buccalised occlusion (BO), lingualised occlusion (LO) and the entire balanced group. Participants received new CCDs with PGFO. All steps of patient enrolment, denture fabrication, assessments during the follow-up period and data collection were carried out exactly the same as part 1 of this research project. All patients were recalled at 1 and 3 months after delivery for data collection using the shortened version of oral health impact profile for edentulous patients (OHIP-EDENT) questionnaire and 7 visual analog scales (VASs) for the quality of CCD based on general patient satisfaction, masticatory function, ability to speak, comfort, stability, retention and aesthetics. Data were analysed using the Wilcoxon signed-rank test, the Kruskal-Wallis test and Mann-Whitney test via SPSS version 18.0 (α = 0.05). Thirty participants completed the follow-up period for PGFO group. The mean age ± standard deviation of the new participants was 57.97 ± 6.93 years. Participants reported significantly less satisfaction in terms of comfort, stability and retention of denture with PGFO compared to balanced groups. Also, using OHIP-EDENT questionnaire, significantly higher physical pain score was noted for PGFO group compared to BO and LO. Higher physical disability score was noted in PGFO compared to LO. Participants receiving CCDs with PGFO reported lower satisfaction in terms of comfort, stability and retention of denture and higher physical pain and physical disability than the balanced occlusal schemes.