Patients’ esthetic expectations and satisfaction with complete dentures

Salivary opiorphin levels in denture-related traumatic ulcers

OBJECTIVE

Opiorphin is a pentapeptide secreted in saliva and has a strong analgesic effect. Salivary opiorphin has been shown to increase in orofacial pain and may act as a pain reliever in pain caused by denture-related ulcers. The current study aimed to evaluate the salivary opiorphin levels in traumatic ulcers caused by ill-fitting dentures and demonstrate whether there is any correlation between trauma-related pain levels and salivary opiorphin levels.

MATERIALS AND METHODS

Twenty-two individuals with new full dentures and a complaint of pain due to ill-fitting were included in this study. Patients were asked to rate their level of pain on a visual analog scale (VAS). Then, saliva specimens were collected at the first visit with the complaint of pain and 7 days following the denture adjustment.

RESULTS

The average saliva opiorphin level before and after denture adjustment were 19.29 ± 5.44 and 15.78 ± 3.95 ng/mL, respectively. A dependent (paired) t-test determined that the mean salivary opiorphin level differed statistically significantly before and after the adjustment of the dentures.

CONCLUSIONS

The findings show that salivary opiorphin levels increase in pain associated with denture-related traumatic ulcers. Adjusting the dentures resulted in pain relief and a statistically significant reduction in opiorphin levels.

Esthetic rehabilitation for a Kennedy Class IV patient using detachable 3D printing diagnostic denture and removable partial denture with polyetheretherketone framework

For patients with high aesthetic expectation, using removable partial dentures (RPDs) to restore the missing teeth in the aesthetic area rapidly and obtain the patients' approval is challenging. This case described an alternative digital protocol to solve this situation. A detachable 3DP diagnostic denture was involved in the procedure, which not only allowed patient to evaluate the possible outcome of the RPD, but also can be duplicated to form a definitive RPD, by bonding a milled PEEK framework and a customized PMMA dentition containing posts, using a thermoplastic compression molding (CM)process.

Fracture toughness of conventional, milled and 3D printed denture bases

OBJECTIVES

The aim of this study was to determine and compare fracture toughness (K_IC) and work of fracture (WOF) of a conventional (C) denture base, using the notchless triangular prism (NTP) specimen K_IC test, with CAD/CAM (milled, M) and 3D-printed (P) materials at 7 d and 90 d.

METHODS

Lucitone 199 (C), Lucitone 199 CAD (M) and Lucitone Digital Print (P) (Dentsply, USA) were used to fabricate NTP specimens. Samples were stored in 37 °C water for 7 d (20/group) and 90 d (20/group) and conditioned in 23 °C water for 1 h prior to testing. For testing, samples were secured in custom-made jigs and loaded in tension until crack arrest/failure. The maximum-recorded load was used to calculate KIC. The results were analyzed by two-way ANOVA, Scheffé multiple mean comparisons (α = 0.05), independent t-tests and Weibull. WOF (in KJ/m²) was calculated by dividing the area under the load-displacement graphs by twice the corresponding crack-arrested cross sectional area of the fractured surfaces.

RESULTS

The results have shown that: 1) the tested materials had significantly different K_IC (P > C > M; p < 0.005) and WOF at both 7d and 90d; 2) ageing in 37 ºC water for 90 d resulted in a significant decrease of K_IC in the C and M groups (p < 0.001) and of WOF in all groups.

SIGNIFICANCE

The tested P denture base exhibited significantly higher K_IC and WOF, suggesting that it could be more resistant to crack propagation than the C and M materials tested. Water storage for 90 d significantly decreased K_IC of C and M materials and WOF of all.

Edentulous Patient Satisfaction with Conventional Complete Dentures

Background and Objectives: Edentulism is considered to be an impediment impacting both patients’ quality of life and their nutrition. Conventional complete dentures are still a preferred treatment. However, there is no consensus on the most important factors which could substantially reduce the risk of patient dissatisfaction. This study evaluated the following determinants concerning patient satisfaction with complete maxillary and mandibular dentures: sex, denture-related functional and aesthetic aspects, and the degree of bone resorption. Materials and Methods: This study included 70 patients aged 34–81 years of age. All complete dentures were made by following the same technology. Visual analogue scales were used to assess patients’ overall satisfaction with dentures, comfort, ability to speak and chew, denture aesthetics, stability, and ease of prosthesis cleaning. Satisfaction with upper and lower dentures was rated separately. The degree of bone resorption was classified by using the Kalk and de Baat (1989) method. Results: The mean (SD) age of the study participants was 67.3 (10.4) years; 65.7% (n = 46) were females and 34.3% (n = 24) were males. There were no significant sex-based differences in resorption of the maxilla or mandibula. There were significant differences between maxillary and mandibular dentures, with lower mean satisfaction scores concerning chewing and maxillary complete dentures, and in regard to stability and comfort for mandibular complete dentures. There was a non-significant overall lower satisfaction with increased age. In multivariate analysis for mandibular complete dentures, aesthetics and stability significantly predicted the patient’s comfort levels, and the patient’s comfort significantly predicted overall satisfaction. For maxillary complete dentures, patient comfort and aesthetics significantly predicted overall patient satisfaction. Conclusions: Age, sex, and degree of resorption were not associated with patient satisfaction with complete dentures. Overall, patient satisfaction with both maxillary and mandibular complete dentures was related to their comfort level and denture aesthetics, and patient comfort itself was associated with stability of the mandibular denture.

Impact of an Auditory Mediated Patient Health Education (PHE) Program on Treatment Compliance and Satisfaction Among Patients Seeking Prosthodontic Care During COVID Pandemic - A Prospective Interventional Study

BACKGROUND

Patients health education by healthcare workers has been affected by pandemic guidelines. This study aimed to evaluate the influence of an audio-mediated intervention for patient health education (PHE) on treatment compliance and treatment satisfaction among patients seeking prosthodontic treatment during the Covid pandemic.

METHODS

A total of 666 patients (aged 40-70 years) who fulfilled the study criteria were treated for denture-associated disease. PHE for 5 different categories was performed using an educational audio (MP3) in the experimental group (Group E), and traditional methods (oral/verbal) in the control group (Group C). Patient/clinician satisfaction with the PHE program was evaluated with a pre-validated questionnaire, whereas treatment compliance and satisfaction were evaluated using a denture hygiene index (DHI) and a visual analog scale (VAS). Differences between qualitative variables were determined using the chi-square test, whereas continuous variables were assessed using an unpaired t-test. Differences were considered to be statistically significant at p ≤ 0.05.

RESULTS

Patient satisfaction with PHE was significantly higher and differed in the Group E for two parameters: education method (80%), educational material (94%). For all parameters of procedural education, patient/clinician satisfaction was significantly higher for Group E [method (93%), material (85%), patient preparation (89%), personalized education (84%), program (93%)]. From three different ratings of disease education, 70% in Group E rated education as "effective" as compared to 41% in the Group C. Effectiveness of post treatment, education measured through DHI, revealed a lower hygiene score in Group E (m = 1.18) as compared to Group C (m = 2.92), with differences being significant. For treatment satisfaction, patients in Group E rated higher for speech (m = 8.21), ease of chewing (m = 7.36), and general satisfaction (m = 7.9).

CONCLUSION

This study concluded that using audio as a means of imparting PHE positively influences the treatment compliance and satisfaction among outpatients and overcomes the drawback of wearing mask during the pandemic.

Extra-oral assessment of conventional and CAD-CAM complete denture appearance by dental professionals and CRDP wearers: A randomized survey

INTRODUCTION

Complete removable dental prostheses' (CRDPs) appearance may vary between conventional and contemporary CAD-CAM manufacturing techniques.

OBJECTIVES

The aim of this randomized survey was to analyze appreciation of CRDPs, manufactured with different techniques, by dental professionals and elder CRDP wearers.

METHODS

Four participant groups, comprised of undergraduate students (n=10), postgraduate residents (n=10), dental technicians (n=10) and elder CRDP wearers (n=10), evaluated the appearance of maxillary CRDPs manufactured by six different techniques: three conventional methods 1. flask-pack-press (FP), 2. Injection-molded (IM), 3. intrinsically colored natural gingiva finish before injection-molded (NG) and three CAD-CAM methods 4. milled base with bonded prefabricated teeth (M), 5. fully milled including milled teeth (FM) and 6. rapid-prototyped including printed teeth (P). A randomized, blinded survey included 18 pairwise comparative assessments and 12 individual judgements of the CRDPs on general appearance as well as pink and white aspects. Statistical analyses included parametric- and nonparametric tests as well as linear regression models; the level of statistical significance was set at p<.05.

RESULTS

NG was preferred by the professional groups but not by the elder CRDP wearers (p<.05). P was scored lowest by all four participant groups (p<.05). CRDP wearers' ratings were less severe and within a narrower range. The ratings of the two CAD-CAM milled CRDPs (M and FM) were ranked closer to FP and IM); the order of preference was different depending on the participant groups.

CONCLUSIONS

The findings of this study revealed marked differences in the assessment of CRDP appearances between dental professionals and older CRDP wearers.

CLINICAL SIGNIFICANCE

A shared and informed approach to decision making concerning the CRDP appearance might foster denture acceptance and treatment success.

Implant-supported overdentures: part 1

The ability to provide high-quality complete dentures is a key skill for the GDP. The increasing prevalence and utilisation of implant-supported overdentures has opened the possibility of a wide variety of treatment options to support patient care, while also creating the need for primary care practitioners to have a greater awareness of commonly used prosthetic attachments.A thorough understanding of the advantages and disadvantages of implant-supported overdentures is essential to ensuring appropriate treatment planning, consent and maintenance. This two-part series explores various aspects of implant-supported overdentures including assessment of the patient, treatment planning, different attachment systems and maintenance requirements.Part one will explore availability of implants in the NHS, the commonly available implant attachment systems, including their relative advantages and disadvantages.

Sensitizing Family Caregivers to Influence Treatment Compliance among Elderly Neglected Patients-A 2-Year Longitudinal Study Outcome in Completely Edentulous Patients

Healthcare workers have reported a certain segment of geriatric patients that are suffering from abuse/neglect, which in turn has been associated with anxiety, depression, and helplessness in the individual. Family caregivers (blood relations), being the most common perpetrators of elder abuse and neglect (EAN), have also been shown to respond to sensitization if the type of EAN and the interventions are appropriate. This study was aimed to comparatively analyze the influence of intervention (psychotherapeutic sensitization of FCG) upon long-term (24 months) treatment maintenance and satisfaction in elderly neglected patients. One hundred and fifty patients (aged 41–80 years) suffering from elder neglect (EN) (self-confession) and their respective FCGs, fulfilling the study criteria, participated in this longitudinal 2-year study. The patients were randomly distributed (simple random, convenient) in two equal groups (75 each), namely Group (GP) A (control) and GP B (test). A standardized, complete denture treatment was initiated for all the participants. Both the FCGs and the patients of GP B were sensitized (psychotherapeutic education) for EN, while there was no such intervention in GP A. The influence of such intervention was measured for denture maintenance [denture plaque index (DPI) scores] and treatment satisfaction (10-point visual analog scale). Absolute/relative frequencies and means were major calculations during data analysis. Differences between the groups for any treatment compliance parameter was done through the unpaired t-test, while Karl Pearson’s test determined the level of relationship between variables (p-value < 0.05). Decrease in mean DPI scores (suggesting improvement) was seen among patients in GP A from 1 month (m = 2.92) to 24 months (m = 2.77). A negligible increase in DPI scores was observed among patients of GP B from 1 month (m = 1.38) to 24 months (m = 1.44). Differences in mean values between the two groups were statistically significant at 24-month intervals, while the relationship between the variables was nonsignificant. FCG sensitization through psychotherapeutic education shows a long-term positive influence on the treatment compliance (maintenance and satisfaction). Identifying the existence of EAN among geriatric patients, followed by psychotherapeutic education of FCGs is recommended for routine medical and dental long-duration treatment procedures.

Impact of Sensitization of Family Caregivers upon Treatment Compliance among Geriatric Patients Suffering from Elder Abuse and Neglect

Geriatric patients in various outpatient department (OPDs) have been found to agonize from elder abuse and neglect (EAN). Such suffering imposes depressive states within individuals, which in turn affects treatment compliance. The objective of this study was to evaluate the impact of sensitization (psychotherapeutic) of family caregivers (FCGs) upon two denture treatment parameters (maintenance and treatment satisfaction) among EAN patients and compare the differences in outcome with non-abused patients. A survey of completely edentulous subjects (n = 860, aged 41–80 years) provided a sampling frame of 332 EAN patients from which 150 patients (including FCGs) fulfilling the study criteria were distributed (simple random, convenient) into two groups (Group A—control, Group B—test). FCG sensitization for subjects in Group B was performed by a clinical psychologist in 2–4 short (30 min) sessions. Demographic characteristics (frequency) were measured using a self-reported questionnaire, denture maintenance was measured using a denture hygiene index (scores), and treatment satisfaction was analyzed on a 10-point visual analog scale. Relevant data were calculated for means and absolute/relative frequencies. Any difference between two groups was estimated using an unpaired t-test while the level of relationship was determined by Karl Pearson’s test at a p-value of < 0.05. The results showed highest frequency (38.6%) for neglect, with elder neglect (EN) being most common (38.14% alone and 14% in combination). EN was found more if the FCG was a son (52%), in the age group (21–30 years), and with low education and low income (75%). Patients whose FCGs were counselled (Group B) demonstrated low denture plaque scores (mean = 1.38 ± 0.618), while demonstrating comparatively higher scores in six different parameters of treatment satisfaction. Differences between the two groups for both parameters were also found to be statistically significant. Psychotherapeutic counselling in the form of FCG sensitization brings better results of denture maintenance and treatment satisfaction.

Retrospective Comparison of Postinsertion Maintenances Between Conventional and 3D Printed Complete Dentures Fabricated in a Predoctoral Clinic

PURPOSE

A retrospective study to analyze the clinical performance of 3D printed complete dentures in edentulous patients compared with conventional complete dentures regarding postinsertion visits and patient reported outcomes.

MATERIAL AND METHODS

Electronic charts were reviewed to analyze 420 (maxilla 270, mandible 150) heat-polymerized conventional complete dentures (CCD) inserted between July 1, 2015 and June 30, 2016 and 217 (maxilla 130, mandible 86) 3D printed complete dentures (PCD) inserted between July 1, 2017 and June 30, 2018. Number of remakes, number of postinsertion adjustments, type and number of repairs, and patient reported complications were compared between two types of complete dentures. The frequency of denture repair and patient reported complications were analyzed using chi-square of independence test.

RESULTS

The frequency of pain and visible ulcer lesions in the maxilla was determined to be 46.67% with CCD and 36.15% in PCD (p = 0.047). There was no statistical significance in other items. The majority of esthetic concerns was dissatisfaction with the shape of dentures with CCD (4.67%) and they had statistically significant, less frequent, esthetic problems than PCD (11.63%) (p = 0.047).

CONCLUSIONS

Similar clinical performance was recorded between the two groups, but the overall pain and visible ulcer lesions were less in the printed complete dentures then the conventionally processed dentures. However, the esthetic aspect was better in conventionally processed complete dentures.

Influence of the height of the mandibular ridge on the masticatory function during the functional adaptation with new complete dentures

BACKGROUND

The period of functional adaptation to a new conventional complete denture embraces many transitory issues, and this period is directly related to the rehabilitation success.

OBJECTIVE

This clinical trial evaluated the influence of the height of mandibular ridge on the masticatory function of complete denture (CD) wearers during the adaptation period.

METHODOLOGY

A total of 28 individuals wearing new CDs (NR, n=14, normal mandibular ridges, 64±12.5 years, 9 female; RR, n=14, resorbed mandibular ridges, 69±6.8 years, 9 female) were assessed at 24 hours, 30 days, three months and six months after the insertion of the CDs for masticatory performance (MP, sieves method), satisfaction with CDs (questionnaire) and maximum occlusal bite force (MOBF) (gnatodynamometer). The classification of the mandibular ridges followed the Kapur index. Data of MP and MOBF were analyzed by two-way ANOVA and satisfaction with CDs was analyzed by Generalized Estimating Equations (GEE), α=.05.

RESULTS

Participants with NR presented better masticatory performance (p=.000 - NR 30.25±9.93%, RR 12.41±7.17%), general satisfaction (p=.047), retention of mandibular denture (p=.001), chewing ability (p=.037), and comfort of wearing a mandibular denture (p=.000). Regardless of the mandibular ridge, MP (p=.000) was higher at three (21.26±12.07%) and six months (24.25±12.26%) in comparison to 24 hours (18.09±10.89%), the MOBF (p=.000) was higher at three months (78.50±6.49 N) compared to 24 hours (57.34±5.55 N) and 30 days (62.72±5.97 N), and the comfort of wearing a mandibular denture (p=.002) at three months (1.61 ± 0.07) was greater than 24 hours (1.29±0.10) and 30 days (1.36±10).

CONCLUSIONS

The study suggests that the participants with NR have higher MP and satisfaction with their CD, regardless of the follow-up period after the insertion of the new CD. After subjects received the CD, a period of 3 months was necessary for achieving better achievement MOBF, MP, and self-perceived comfort with the mandibular denture, regardless of the height of the mandibular ridge.

Facial aesthetic evaluation of rehabilitation effects in edentulous patients with varying degrees of residual ridge resorption by 3D stereophotogrammetry

BACKGROUND

Residual ridge resorption impairs patients' satisfaction with complete denture (CD) treatment, but influence of bone resorption on the aesthetic rehabilitation of edentulous patients still remains unclear due to insufficient quantitative investigations.

OBJECTIVES

To quantitatively evaluate the effects of residual ridge resorption on facial aesthetic reconstruction in elderly edentulous patients.

METHODS

According to radiological examination, a total of 19 edentulous subjects were categorised into two groups, atrophic patients (APs) and non-atrophic patients (NAPs). Before CD treatment and 3 months after treatment, patients were asked to complete the Orofacial Esthetic Scale (OES). The changes in facial appearance were measured by 3D stereophotogrammetry, and the facial parameters of two groups were compared.

RESULTS

The patient's subjective satisfaction of oro-facial aesthetics and 3D objective assessment of facial appearance improved after CD treatment. Subnasale-gnathion (Sn-Gn) significantly increased from 60.13 ± 3.91 mm to 62.27 ± 3.82 mm. After rehabilitation, glabella-subnasale (G-Sn)/Sn-Gn, nasolabial (Cm-Sn-Ls) and mentolabial (Li-Sm-Pg) significantly decreased and were closer to normal values. Moreover, the subtraction value between G-Sn/Sn-Gn and normal value before treatment of APs and NAPs was 14.47 ± 8.04% and 6.94 ± 3.69%, respectively (P = .026), while after treatment, the values decreased to 10.61 ± 6.33% and 3.86 ± 2.31% (P = .013), respectively.

CONCLUSION

The increased volume of lips and cheeks played an important role in the facial aesthetic reconstruction of edentulous patients. NAPs tended to have more attractive faces after CD treatment, as their facial profile parameters (G-Sn/Sn-Gn and Cm-Sn-Ls) were closer to normal Chinese with well-balanced faces.