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

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.

Comparative evaluation of hemispheric and masticatory laterality in complete dentures with two occlusal schemes - A prospective cohort study

Purpose

The lateralization can influence the choice of occlusion scheme, patient comfort and success of the prosthesis. The existence of favored masticatory side in complete denture patients and its influence with various occlusal schemes is less analyzed in the literature. The study objective was to compare the masticatory and hemispheric laterality in complete denture subjects rehabilitated with 2 different occlusal schemes at different time intervals.

Methodology

The cohort study recruited 26 patients in each group of balanced and non-balanced occlusion with definitive criteria. Conventional procedures were followed in denture fabrication. The hemispheric and masticatory laterality for all participants were established at 0,1,3- and 6-month intervals. The laterality was categorized as preferred chewing side (CPCS), predominant preferred chewing side (PPCS) and observed preferred chewing side (OPCS). The data on chewing side preference was analyzed by chi square test. (α = 0.05).

Results

Right side preference was predominant in 86.1% of non-balanced and 60.1% of balanced occlusion participants. The side preference among the 2 laterality and across time interval decreased in masticatory laterality of balanced occlusion participants (P < .05) when compared to non-balanced occlusion. (P > .05).

Conclusion

The balanced occlusion dentures had lesser masticatory side preference when compared to non-balanced occlusion complete denture.

Differences in quality of life and patient satisfaction between complete denture occlusion schemes: A parallel randomized control trial

STATEMENT OF PROBLEM

Bilateral balanced occlusion has been advocated over nonbalanced occlusion for improved removable complete denture stability and function. However, assessments of quality of life and patient satisfaction studies between the 2 occlusion schemes are lacking.

PURPOSE

The objective of this parallel randomized control trial was to determine the difference in quality of life and patient satisfaction between the nonbalanced and bilaterally balanced occlusal schemes.

MATERIAL AND METHODS

Sixty participants were included in the parallel randomized control trial of nonbalanced and bilaterally balanced complete dentures. Thirty were recruited into each group with definitive inclusion and exclusion criteria as per the Consolidated Standards of Reporting Trials (CONSORT) guidelines. Quality of life was estimated from the oral health quality of life (Oral Health Impact profile) for edentulous patients questionnaire, and patient satisfaction was analyzed from a visual analog scale. The estimation was made at 0, 3, and 6 months after denture insertion. The data were statistically analyzed with the Friedman, Mann-Whitney, and t test (α=.05).

RESULTS

The mean ±standard deviation Oral Health Impact profile score was 60.81 ±8.87 for nonbalanced dentures and 64.12 ±8.98 for bilaterally balanced dentures. The mean ±standard deviation visual analog scale score was 2.84 ±0.28 for nonbalanced dentures and 2.90 ±0.31 for bilaterally balanced dentures. The Mann-Whitney and t test indicated nonsignificant differences between the 2 groups and at different time intervals for Oral Health Impact profile and visual analog scale scores (P>.05).

CONCLUSIONS

The study detected no significant differences between the 2 occlusal schemes in quality of life or patient satisfaction.

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).

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.

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.

Recording an accurate maxillomandibular relationship by adding vertical stops to the occlusal rims

Complete denture fabrication includes accurate recording of the maxillomandibular relationship to ensure the functional requirements of occlusion and minimize the traumatic effects on the residual alveolar ridges. However, errors may occur when the occlusal rims have uneven and nonuniform occlusal contacts. The technique described is a straightforward method for recording an accurate silicone centric relationship record with dome-shaped baseplate wax added as vertical stops on the occlusal surface of the mandibular occlusal rim.

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.

Evaluation of Satisfaction Perceived by Prosthetic Patients Compared to Clinical and Technical Variables

Objectives:

The purpose of this study is to relate the clinical quality of the complete denture and specific anamnestic factors to the level of satisfaction perceived by patients. Also identifying possible prognostic parameters that could be predictive of future satisfaction.

Materials and Methods:

On the basis of a substantial existing literature, the most appropriate parameters to determine the prosthetic quality have been determined to evaluate the satisfaction perceived by patients about their denture; a completely new questionnaire has been drawn up. Ninety-eight patients have been included in the research, they have undergone a clinical examination, and they have filled out the questionnaire anonymously. The ANOVA test and Pearson correlation test have been employed to relate clinical and anamnestic factors to the overall satisfaction score.

Results:

The average level of patients’ satisfaction was between “quite satisfied” and “very satisfied.” There is no significant variability of satisfaction related to the type of prosthesis. The ANOVA test did not verify relationships between the overall satisfaction score and the anamnestic data examined. Pearson linear correlation coefficient between the overall prosthetic quality and the general satisfaction perceived by patients is 0.493 (P < 0.01). Extension of the prosthetic body (r = 0.478; P < 0.01) and retention (r = 0305; P < 0.05) are in correlation with the overall patients’ satisfaction.

Conclusion:

there is a moderately strong relationship between the overall prosthetic quality and the general satisfaction perceived by patients. Particularly, the retention and the adequate extension of the prosthetic body appear to be factors that are most associated with satisfaction. Instead, the anamnestic factors are not related to overall satisfaction score.