Expectations and final evaluation of complete dentures by patients, dentist and dental technician

Policies Supporting Oral Health in Ageing Populations Are Needed Worldwide

This literature review examines the need to develop appropriate policies specific to the oral health needs of older people that are individualised, cost-effective, and sustainable. Poor oral health and impaired oral function negatively affect the health and quality of life of older adults. Developing care systems that aim to meet patients' normative needs as well as their perceived needs and expectations is one factor in successful delivery of appropriate dental care. Cost is another significant driver of utilisation, and many older adults worldwide lack adequate resources for dental care. Failure to address these issues results in poor outcomes and increased costs of dental and medical care. Disease prevention and control at early stages can preserve public and private financial resources as well as quality of life and well-being for older adults at any stage of life.

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.

Complete denture fabrication with polyetherketoneketone as a framework material: A clinical report

This clinical report describes the fabrication of conventional complete dentures with polyetherketoneketone (PEKK) frameworks made with computer-aided design and computer-aided manufacturing (CAD-CAM). No biologic or prosthetic complications were observed at the 1-year follow-up.

Clinical Oral Disorders in Adults Screening Protocol (CODA-SP) from the 2019 Vancouver IADR Consensus Symposium

BACKGROUND

The Clinical Oral Disorder in Elders (CODE) index was proposed in 1999 to assess the oral health status and treatment needs of older people who typically were edentate or had few natural teeth. Since then, more people are retaining natural teeth into old age and have oral disorders similar to younger adults. In addition, there has been further guidance on screening for disease that includes changes to the clinical indicators of several oral disorders and greater sensitivity to people's concerns about their oral health and care needs.

METHODS

Experts in dental geriatrics assembled at a satellite symposium of the International Association of Dental Research in June 2019 to revise the objectives and content of the CODE index. Before the symposium, 139 registrants were asked for comments on the CODE index, and 11 content experts summarised current evidence and assembled reference lists of relevant information on each indicator. The reference lists provided the base for a narrative review of relevant evidence supplemented by reference tracking and direct searches of selected literature for additional evidence.

RESULTS

Analysis of the evidence by consensus of the experts produced the Clinical Oral Disorders in Adults Screening Protocol (CODA-SP).

CONCLUSIONS

The CODA-SP encompasses multiple domains of physical and subjective indicators with weighted severity scores. Field tests are required now to validate its effectiveness and utility in oral healthcare services, outcomes and infrastructure.

The association between denture self-satisfaction rates and OHRQoL - a follow-up study

Backgroud

The objectives of this study were to try to identify the key dimension in satisfaction from the combination of satisfaction clusters, and its effect on the change of OHRQoL(Oral Health-related Quality of Life) of elderly denture users.

Methods

This follow-up study was conducted in subjects aged 65 years and over. All participants (n = 2128) completed questionnaires before and approximately 6 months after receiving complete denture. Information obtained by questionnaire included demographic characteristics, patients’ self-satisfaction rate and OHRQoL. The 6 satisfaction dimensions (including speaking, stability, esthetic, chewing, doctor and general dimensions) were classified as 5 cluster groups, which is the group of not at all satisfied in all dimensions (NAS); only satisfied with doctor and general dimensions(SDG); moderate satisfaction group(MS); quite satisfied group(QS); the highly satisfied group(HS) by an analysis of PCA (Principle component analysis) and CA (cluster analysis). Multiple linear regression was adapted to estimate the association between satisfaction and the responsiveness of OHIP-7T (Oral Health Impact Profile).

Results

When compared to the cluster “NAS”, the greatest improvement of OHRQoL after treatment was found in the group “HS” (β = 7.31(6.26–8.36), followed by group “QS” (β = 4.71(3.54–5.87)), group “MS” (β = 4.33(2.92–5.74)) and group “SDG” (β = 3.25(2.10–4.41)). An increasing trend was detected in patient-rating satisfaction and OHRQoL. The satisfaction cluster group is an important factor of OHRQoL after adjusting for other confounders.

Conclusion

Psychological-related aspects is the greatest impacting dimension on OHRQoL among denture wearers in Taiwan elderly. Better communication from the dental professional team with denture patients would improve their OHRQoL.

Satisfaction in complete denture wearers with and without adhesives: A randomized, crossover, double-blind clinical trial

Background

The purpose of this study was to compare the satisfaction of patients regarding retention, stability and accumulation of particles with a randomized, double-blind crossed method in users with complete dentures with and without adhesive.

Material and Methods

Seventeen edentulous individuals were randomized and received new upper and lower complete dentures. After a period of adaptation, they participated in some masticatory tests and clinical revisions, after use the protheses with and without the use of two denture adhesives: Adhesive A (Fittydent, Fittydent International GmbH) and adhesive B (Corega, GlaxoSmithKline) at 0, 7 and 14 days. Satisfaction was measured immediately after each test through a survey using a VAS scale (0-10) and data were analyzed with McNemar's test with Bonferroni correction.

Results

The results showed significant differences (p<.01) between the study groups with adhesive A - B and the group without adhesive, but no significant differences were found between the two stickers for any of the variables studied.

Conclusions

Complete denture adhesives significantly improved the satisfaction of patients because a better retention, stability and less accumulation of particles of the food substitute between the denture and the mucosa is obtained compared with non-use of complete denture adhesives. Key words:Complete dentures, patient satisfaction, denture adhesives, clinical trials.

Differences in Lip Support with and without Labial Flanges in a Maxillary Edentulous Population. Part 2: Blinded Subjective Analysis

PURPOSE

To study the subjective differences in facial esthetics evaluations among lay people, general dentists, and prosthodontists, when evaluating images of patients wearing a maxillary denture with a labial flange in comparison to an experimental flangeless denture.

MATERIALS AND METHODS

A random sample of 20 maxillary edentulous patients from the original sample of 31 patients described in part 1 of the study was selected for this study. A total of 60 judges comprising 15 general dentists, 15 prosthodontists, and 30 lay people were recruited for subjective analysis. The judges were blinded about the objectives of the study and were asked to rate the facial esthetics of each image using a 100 mm visual analog scale (VAS) instrument. Four digital images per subject (total of 80 images) were evaluated in a random order, twice by all 60 judges. A repeated measures general linear mixed modeling method using restricted maximum likelihood estimation was performed using mixed procedure in a statistical software package to study the differences in evaluations.

RESULTS

The overall VAS ratings of facial esthetics for images with flangeless dentures were slightly lower compared to images with labial flanges, and this difference was statistically significant (p < 0.05). This was true for both profile and frontal images; however, the magnitude of the difference was too small (no greater than 4 mm on a 100 mm scale) to be clinically significant. There were no statistically significant differences in facial esthetics ratings irrespective of the background or gender of the judges.

CONCLUSIONS

Flangeless dentures resulted in slightly lower ratings of facial esthetics compared to images with a labial flange, but the differences were clinically insignificant. This was true for all judges comprising general dentists, prosthodontists, and lay people and for both frontal and profile images.

The removable acrylic partial denture in primary care: the experience and satisfaction of dental surgeons

Abstract Introduction The guidelines of the National Politics of Oral Health have led to the inclusion of elemental prostheses in the list of Primary Care procedures. Objective This paper aimed to evaluate the performance and satisfaction of dental surgeons with the implementation of Acrylic Partial Dentures. Metodology The sample was composed by 159 dental surgeons (sample calculation), in Belo Horizonte, MG, Brazil, selected via raffle (simple random sampling). A structured questionnaire was built with 72 questions on the daily practice of the performance of dental surgeons, using the SurveyMonkey platform. Result The results showed that for most of dental surgeons, the inclusion on the list of primary care procedures was a positive initiative and they have enjoyed the experience of using Acrylic Partial Dentures. Dental surgeons who had graduated in private institutions reported to have had more failures than those who had graduated in public institutions. The better prepared dental surgeons reported less difficulties and failures, and the more satisfied professionals with the performance of Acrylic Partial Dentures related had also experienced fewer failures. Considering the indication, the majority of participants did it according to the protocol of the institution (only for anterior teeth) but many revealed the use of dentures also for premolars. Conclusion Acrylic partial dentures have been a reality in the Brazilian social context even before their inclusion in the list of Primary Care procedures. Such inclusion indicates their relevance; however, it is necessary to have their confection systematized by a protocol in public services.

Differences in Lip Support with and without Labial Flanges in a Maxillary Edentulous Population. Part 4: Patient-Centered Analysis

PURPOSE

To study the subjective differences in facial esthetics evaluations and the ability to distinguish facial changes due to changes in lip support, when evaluated by patients themselves. An additional objective was to study the differences between patients' self-evaluation versus evaluation of other patients.

MATERIALS AND METHODS

A total of 22 maxillary edentulous patients from the original sample of 31 patients described in Part 1 of the study, returned to participate in this part of the study. The 22 patients acted as judges for all images in this study, and were therefore un-blinded to the objectives and details of the study. Patients first completed evaluation of facial esthetics on a visual analog scale (VAS). Four digital images per patient (total of 88 images) were evaluated in a random order, twice by all 22 patients. The mean scores from all judgments were used as the outcomes to be analyzed. All patients then took a discriminatory sensory analysis test (triangle test) where they were required to correctly identify the image with a flangeless denture out of a set of 3 images. Both the VAS and triangle test ratings were conducted twice in a random order, and mean ratings were used for all analyses.

RESULTS

For VAS analysis, there were no statistically significant or clinically significant differences in facial esthetics ratings between flange and flangeless dentures (p < 0.05). This was true for both profile and frontal images, irrespective of self-evaluation versus evaluation of other patients, years of patient edentulism, and judge (patient) gender. For the triangle test, frontal images had a correct identification rate of 50.2% and profile images of 50.4%, and the difference was not significant. There were no significant differences in triangle test results with respect to self-evaluation versus evaluation of other patients and judge (patient) gender. For all patients, the likelihood of correctly identifying images with flangeless dentures was significantly greater than 1/3, which was the minimum chance for correct identification (p < 0.0001).

CONCLUSIONS

Flangeless dentures resulted in no differences in facial esthetics ratings for frontal and profile images, when evaluated by patients. When patients were forced to look for differences, flangeless dentures were detected in half of the image sets. These findings were similar for self-evaluation versus evaluation of other patients and for both patient genders.

Misfit evaluation of dental implant-supported metal frameworks manufactured with different techniques: Photoelastic and strain gauge measurements

This study aims to compare in-vitro the fitting accuracy of implant-supported metal frameworks used for full-arch orthodontic restoration. The hypotheses tested were as follows: (1) for a fixed implant morphology, strains developed within the framework depend on how the framework had been fabricated and (2) stresses transferred to the implant–bone interface are related to the amount of framework misfit. Metal frameworks were fabricated using four different manufacturing techniques: conventional lost-wax casting, resin cement luting, electrospark erosion, and computer-aided design/computer-aided manufacturing milling. Each framework was instrumented with three strain gauges to measure strains developed because of prosthetic misfit, while quantitative photoelastic analysis was used to assess the effect of misfit at the implant–resin interface. All the tested frameworks presented stress polarization around the fixtures. After screw tightening, significantly greater strains were observed in the lost-wax superstructure, while the lowest strains were observed in the luted framework, demonstrating consistent adaptation and passive fitting. No significant difference in stress distribution and marginal fit was found for bars fabricated by either computer-aided design/computer-aided manufacturing or spark erosion. This study suggested that, in spite of known limitations of in-vitro testing, direct luting of mesostructures and abutments should be the first clinical option for the treatment of complete edentulism, ensuring consistent passive fitting and effective cost–benefit ratio.

Color and gloss evaluation of titanium dioxide coating for acrylic resin denture base

PURPOSE

We examined the clinical appearance (color, gloss, and surface roughness) of TiO(2) coating on polymethyl methacrylate (PMMA) resin dentures.

METHODS

A spraying method, using air brushes, was used to generate thin uniform TiO(2) coating. PMMA resin, primer-coated PMMA, and TiO(2)-coated PMMA (with primer) specimens were compared.

RESULTS

The Commission Internationale de l'Eclairage (CIE) color system revealed color variations between the with/without coated samples. The TiO(2)-coated PMMA specimen displayed high levels of glossiness, highlighting the efficient self-cleansing actions of the denture. The measured surface roughness decreased upon primer coating, and increased following TiO(2) coating.

CONCLUSIONS

The thin TiO(2) coating afforded high levels of glossiness while maintaining the color of the denture base material.

Patients' Expectation Before and Satisfaction After Full-Arch Fixed Implant-Prosthesis Rehabilitation

This study evaluated patients' expectation before and satisfaction after full-arch fixed implant-prosthesis rehabilitation. Other variables that could influence patient satisfaction with this therapy were also evaluated. Using a visual analog scale (VAS), a sample of 28 patients assigned scores for their expectation before and satisfaction after therapy regarding chewing, esthetics, comfort, and phonetics. They also completed a questionnaire concerning their evaluation of the dentists' conduct. The average VAS scores were high for both expectation prior to treatment and satisfaction after treatment, and there was no statistical difference between them. Women presented higher expectations than men regarding esthetics (P = 0.040), phonetics (P = 0.043) and comfort (P = 0.013). Significant differences were not found between VAS scores with clinical variables (arch, radiographic bone quality, surgical bone quality, and implant inclination), educational level, and patients' evaluation of the dentists' conduct. Considering the results obtained in this study, expectation before implant-supported, full-arch fixed prosthesis therapy were met following treatment, with women having higher expectations than men.

Evaluation of psychological guidance impact on complete denture wearer's satisfaction

The purpose of this study was to evaluate the impact of psychological intervention on edentulous patients' satisfaction with complete clinically satisfactory complete dentures. The survey was conducted in China Medical University involving 84 individuals receiving complete dentures at this institution from August 2013 to March 2014. Participants were randomly allocated to intervention and control groups consisting of 42 subjects, respectively. In the intervention group, individuals received oral health education and psychological intervention before and after the whole process. In the control group, 42 cases received doctor's regular advice after treatment. Satisfaction regarding aesthetic, speech, mastication, retention and comfort was rated in the first and third month after prosthesis treatment. Patients overall aesthetic, speech, mastication and retention were significantly improved in both intervention and control groups in 3 months later after prosthesis treatment when compared with the first month (P < 0·05). No significant difference existed for comfort in control group. Patient scores on aesthetic, speech, mastication and retention at both first and third month evaluations (P < 0·05) differed between the control and intervention groups. However, there was no difference for their scores related to comfort (P > 0·05) in first and third month. The study concludes that psychological intervention plays a significant role in improving patient satisfaction with complete dentures.

Correlation of previous experience, patient expectation and the number of post-delivery adjustments of complete dentures with patient satisfaction in a Brazilian population

A number of variables may influence the outcome of complete denture therapy. The objective of this study was to verify possible correlations between previous experience with dentures, patient expectation and the number of post-delivery adjustments with patient satisfaction after treatment. One hundred patients (mean age 61·9 ± 10·3) rated their previous experiences with complete dentures and their expectations before and satisfaction after treatment on a visual analogue scale (VAS) using scores from 0 (worst results) to 10 (best results). The number of post-delivery adjustments and other patient-related clinical variables was also noted. Patient expectation scores were higher than previous experience scores and satisfaction after treatment scores. Positive and weak correlations were found between previous chewing experiences with complete dentures, with regard to chewing expectations and comfort of use. Phonetics and comfort of use in previous experiences presented a positive correlation with expectations for chewing, aesthetics, phonetics and comfort of use. Groups of patients with different levels of education presented significant differences in expectation scores regarding comfort of use as well. A negative and weak correlation was found between phonetics satisfaction and the number of post-delivery adjustments. Patients' expectations for the therapy were higher than their satisfaction after treatment. Previous experiences with complete dentures could slightly influence patients' expectations and satisfaction, whereas lower scores for previous experience with complete dentures caused lower scores for both expectation and satisfaction. Patients' educational levels and the number of post-delivery adjustments influenced negatively the expectations about comfort of use and patient satisfaction, respectively.

Patients' expectation and satisfaction with removable dental prosthesis therapy and correlation with patients' evaluation of the dentists

OBJECTIVE

Considering that patients' satisfaction is one of the most important goals in conducting removable dental prosthesis (RDP) therapy and the fact that there are many factors which influence this parameter, the present study aims to evaluate the expectation before and satisfaction after therapy with RDP in patients who seek such therapy. As a secondary objective, other variables that may be associated with patient satisfaction are also evaluated, such as gender, age, Kennedy's classification of the arch supporting the RDP, the number of RDP adjustments after delivery and patients' evaluation of the dentists' conduct.

MATERIALS AND METHODS

A sample of 44 patients who received RDP therapy were assigned visual analog scale scores for their expectation before and satisfaction after therapy regarding chewing, aesthetics, comfort and phonetics. They also completed a questionnaire concerning the dentists' conduct.

RESULTS

There was no statistically significant difference among scores concerning different genders, age, number of post-delivery settings and arch involved in the RDP. Regarding patients' evaluation of the dentists' conduct, there was a predominance of positive evaluations, but only different answers to the statement (i.e. 'The dentist I saw thoroughly explained the recommended treatment before it commenced') present statistically significant different scores for chewing (p = 0.040) and phonetics (p = 0.046).

CONCLUSIONS

The average visual analog scale scores were high for both expectation prior to treatment and satisfaction after treatment; however, the scores for expectations were higher than those for satisfaction.

Creating natural-looking removable prostheses: combining art and science to imitate nature

Patient awareness of dental appearance has increased, resulting in more demanding esthetic requests. There is also strong evidence that increased esthetics is highly significant for complete denture acceptance and success. Taking notice of patients' perceptions of natural appearance and esthetics, the clinician can incorporate their preferences in the construction of individualized dentures that will be harmonized with their facial characteristics. Despite the evolution of materials and techniques, the vast majority of dentures still fail to look natural. Thus, producing prostheses that defy detection and successfully restore the appearance of edentulous patients remains a challenge for the clinician. This paper presents a clinical case where immediate loading of implants supporting a mandibular overdenture was combined with an opposing conventional maxillary denture to satisfy the high functional and esthetic demands of the patient. It also emphasizes the individualized esthetic performance through customization during their fabrication while taking into consideration the various clinical parameters affecting rehabilitation of the edentulous jaw.

CLINICAL SIGNIFICANCE

Implant-retained overdentures can significantly improve the patients' function. The esthetic performance of these restorations however, may not be satisfying the patients' expectations and demands. Customizing the artificial gingival areas and individual staining of the prefabricated acrylic teeth may improve the esthetic performance creating natural-looking removable prostheses.

Concepts for designing and fabricating metal implant frameworks for hybrid implant prostheses

Edentulous patients have reported difficulties in managing complete dentures; they have also reported functional concerns and higher expectations regarding complete dentures than the dentists who have treated them. Some of the objectives of definitive fixed implant prosthodontic care include predictable, long-term prostheses, improved function, and maintenance of alveolar bone. One of the keys to long-term clinical success is the design and fabrication of metal frameworks that support implant prostheses. Multiple, diverse methods have been reported regarding framework design in implant prosthodontics. Original designs were developed empirically, without the benefit of laboratory testing. Prosthetic complications reported after occlusal loading included screw loosening, screw fracture, prosthesis fracture, crestal bone loss around implants, and implant loss. Numerous authors promoted accurately fitting frameworks; however, it has been noted that metal frameworks do not fit accurately. Passively fitting metal implant frameworks and implants have not been realized. Biologic consequences of ill-fitting frameworks were not well understood. Basic engineering principles were then incorporated into implant framework designs; however, laboratory testing was lacking. It has been reported that I- and L-beam designs were the best clinical option. With the advent of CAD/CAM protocols, milled titanium frameworks became quite popular in implant prosthodontics. The purpose of this article is to discuss current and past literature regarding implant-retained frameworks for full-arch, hybrid restorations. Benefits, limitations, and complications associated with this type of prosthesis will be reviewed. This discussion will include the relative inaccuracy of casting/implant fit and improved accuracy noted with CAD/CAM framework/implant fit; cantilever extensions relative to the A/P implant spread; and mechanical properties associated with implant frameworks including I- and L-beam designs. Guidelines will be proposed for use by clinicians and laboratory technicians in designing implant-retained frameworks.