Lingual Retention and the Elimination of the Visible Clasp Arm

Evaluation and comparison of retention and patient satisfaction with milled polyetheretherketone versus metal maxillary obturators

STATEMENT OF PROBLEM

Metal and polyetheretherketone (PEEK) have been used to rehabilitate maxillary defects with obturators, each having advantages and disadvantages. However, patient satisfaction with the obturator retention of each material is unclear.

PURPOSE

The purpose of this crossover clinical study was to compare retention and patient satisfaction between a milled cobalt chromium and a milled PEEK framework, each with a hollow bulb extension in polymethyl methacrylate (PMMA).

MATERIAL AND METHODS

Twenty patients who had received unilateral total maxillectomy and were treated in the prosthodontic department's maxillofacial clinic were enrolled in this crossover study. Each participant wore 2 different types of obturators for 6 months after insertion. Type CoCr received a milled cobalt chromium framework with a hollow bulb extension in PMMA first, and type Pk received a milled modified PEEK (BioHPP) framework with a hollow bulb extension in PMMA first. Patient satisfaction and retention force were measured immediately, at 3 months, and at 6 months after obturator insertions. The Fischer exact, chi-squared, and Monte Carlo tests were used to compare qualitative data. One-way ANOVA with the post hoc Tukey test was used for pair-wise comparison, and repeated measures ANOVA was used to compare before and after treatment at 3 and 6 months.

RESULTS

No significant difference was found between types in obturator insertion (P>.999), appearance of the upper lip (P>.999), mouth feeling (P=.301), pronunciation of words (P=.217), and talking in public (P=.589). A significant difference between types was found in speech after 6 months of obturator insertion (P=.016), swallowing liquids and food (P=.04), masticating foods (P=.007), appearance of clasps on anterior teeth (P=.002), satisfaction with appearance (P=.005), or avoidance of family events (P=.014) after 6 months of insertion. Types of obturators showed a statistically significant decrease in retention force with time (P<.001).

CONCLUSIONS

Although the retention force was less with PEEK than with Co-Cr clasps engaging the same undercuts, this retention force was adequate for retaining removable partial dentures. Co-Cr clasps can be considered better than PEEK clasps because they engage the same undercuts regarding loss of retention with time. Quality of life in patients after maxillary resection could be improved by using maxillary obturators. Type Pk was better than type CoCr in terms of esthetics, but the retention of the PEEK obturator after 6 months decreased because of wear, leading to difficulty swallowing food or liquids, mastication, and speech.

Color changes of polyetheretherketone (PEEK) and polyoxymethelene (POM) denture resins on single and combined staining/cleansing action by CIELab and CIEDE2000 formulas

PURPOSE

The purpose of study was to investigate the long-term effect of staining and/or cleansing solutions on the color stability of two non-metal removable partial denture materials.

METHODS

One hundred disks (25×3mm) of polyoxymethylene (POM) and polyetheretherketone (PEEK) were immersed in water, wine, coffee, cleanser and combo bath, simulating normal daily use. Color parameters in the CIELAB system was measured every 30 cycles up to 240 using a contact colorimeter and color differences estimated using ΔE_ab and ΔE₀₀ formulas. Two-way repeated measures ANOVAs and regression analyses were performed at α=0.05.

RESULTS

Regression analysis indicated a strong R² between color changes and number of cycles, for both materials. Tests of within-subjects effects for the ΔE_ab revealed significant differences among cycles and between the materials in the wine and coffee baths (p<0.001). Significant materialXcycles interactions were also recorded with all staining baths. ΔE₀₀ values were lower than ΔE_ab up to 63.6%. Tests within and between-subjects effects for the ΔE₀₀ gave similar but not the same with ΔE_ab results.

CONCLUSIONS

ΔE₀₀ found to correlate well with ΔE_ab. Long term exposure of both materials showed a progressive discoloration in all except control baths. POM discolored more than PEEK in coffee, and combo baths but not in cleanser. Discoloration was smaller in combo bath (where a cleanser was also used) indicating the effectiveness of a cleanser to prevent long term discoloration of both materials.

Oral health-related quality of life in patients with non-metal clasp dentures: a randomised cross-over trial

We investigated the efficacy of non-metal clasp dentures (NMCDs) with regard to the oral health-related quality of life (OHRQoL) and compare the findings with those for conventional metal clasp-retained dentures (MCDs). This single-centre, randomised controlled, two-phase, open label, cross-over trial included 28 partially dentate individuals. The patients were randomised to receive MCDs followed by NMCDs, or the opposite sequence (n = 14 in each group); each denture was worn for 3 months. OHRQoL was evaluated using the Oral Health Impact Profile-Japanese version (OHIP-J) at entry (T-entry; before treatment with the first denture) and at 3 months after treatment with each denture (T3). An examiner evaluated denture stability, oral appearance and surface roughness before denture delivery (T0) and at T3 and denture hygiene at T3. A total of 24 patients completed the trial. There were no complications related to the dentures, abutment teeth or denture-bearing mucosa during the follow-up periods for both dentures. The mean OHIP summary score was lower for NMCDs than for MCDs, and the difference (9 points) was greater than the minimal important difference (6 points), indicating the difference was clinically relevant. The effect size was medium (0·70). Statistical analyses with linear mixed models found a significant effect of the denture type on the OHIP summary score and scores for the Oro-facial appearance, Oro-facial pain and Psychological impact domains (NMCD < MCD; P < 0·05). The results of our study suggest that NMCDs allow for better OHRQoL compared with MCDs.

Evaluation of roughness and micromorphology of epoxy paint on cobalt-chromium alloy before and after thermal cycling

It has been suggested that the epoxy paint used to coat metal substrates in industrial electrostatic painting applications could also be used to mask metal clasps in removable dental prostheses (RDP). The purpose of this study was to evaluate both the influence of thermal cycling and the in vitro roughness of a surface after application of epoxy paint, as well as to assess the micromorphology of a cobalt-chromium (CoCr) based metal structure. Sixty test specimens were fabricated from a CoCr alloy. The specimens were separated into three groups (n = 20) according to surface treatment: Group 1 (Pol) - polished with abrasive stone and rubbers; Group 2 (Pol+Epo) - polished and coated with epoxy paint; Group 3 (Epo) - air-abraded with aluminum oxide particles and coated with epoxy paint. The surface roughness was evaluated before and after 1000 thermal cycles (5°C and 50°C). The surface micromorphology was verified by scanning electron microscopy (SEM). The two-way repeated measures ANOVA showed significant differences among surface treatments (p < 0.0001), but no difference was found before and after thermal cycling (p = 0.6638). The CoCr-based metal alloy surfaces treated with epoxy paint (Groups 2 and 3) were rougher than the surfaces that were only polished (Group 1). Thermal cycling did not influence surface roughness, or lead to chipping or detachment of the epoxy paint.

Multicentre prospective evaluation of implant-assisted mandibular bilateral distal extension removable partial dentures: patient satisfaction

OBJECTIVE

To compare the levels of patient satisfaction with either conventional mandibular bilateral distal extension partial dentures or those assisted by bilateral distal implants.

MATERIALS AND METHODS

Forty-eight participants who were dissatisfied with their existing conventional mandibular distal extension dentures opposing complete maxillary dentures were selected for a multicentre prospective study in New Zealand, Colombia and the Netherlands. A control group of 12 participants in New Zealand received conventional mandibular partial dentures. Three test groups involving 36 participants in New Zealand (12), Colombia (12) and the Netherlands (12) received bilateral distal implants in the second molar regions. After conventional loading, the test group participants initially had healing caps placed on the distal implants providing support only, followed after approximately 6 months by ball abutments (retentive anchors) for support and retention. Patient outcomes were determined with questionnaires completed at specific stages of the study for up to 3 years.

RESULTS

Visual analogue scale, Likert and oral health impact questionnaires before and after treatment indicated improved results. There were significantly improved parameters of overall satisfaction, stability, chewing and appearance after 3 years (P < 0.05). There were also improvements on stability, chewing and overall satisfaction. Speech also improved, but not significantly. Ball abutments (retentive anchors) on the distal implants, as opposed to healing caps improved patient satisfaction for stability, chewing and overall satisfaction. Changing to ball abutments (retentive anchors) revealed significant improvement by participant response when evaluating parameters of stability, chewing and overall satisfaction (P < 0.05).

CONCLUSION

Mandibular implant-assisted removable partial dentures are a preferable treatment option for patients with complaints about their conventional distal extension partial dentures.

A removable partial denture using an esthetically designed round-rest distal clasp on maxillary anterior abutment teeth: a clinical report

A round-rest, distal depression clasp is suggested as an esthetic alternative to a conventional clasp for maxillary anterior teeth serving as abutments for a removable partial denture. A lingual round rest provides support for the prosthesis, and a mesiolingual reciprocating plate is present. A split minor connector engages a distal depression for retention. The facial surface of the abutment displays no metal and provides an esthetic result.