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

Pain-related analysis on a resorbed ridge with various denture occlusal schemes using finite element method

Resorbed alveolar ridges, particularly in the lower jaw, have a small denture supporting area, which may cause the stress distribution of mastication load to exceed the pressure-pain threshold (PPT) and induce pain in the mucosa or potentially worsen the ridge resorption. Thus, choosing the ideal occlusal scheme among bilateral balanced (BBO), lingualized (LO), and monoplane (MO) for such conditions becomes crucial. The experiment was conducted using the finite element method on a modeling of a resorbed alveolar ridge in the lower jaw with three dentures placed on top, each of which was given different loading points according to the tooth arrangement of BBO, LO, and MO. The axial load was 100 N, and the resultant oblique loads on BBO and LO were 119 N and 106 N, respectively. The von Mises stresses for BBO, LO, and MO were observed in nine denture-supporting areas, and the results showed that the axial load did not produce stresses that exceeded the PPT value (0.64925 MPa) for BBO, LO, and MO with the highest value on area H, 0.43229 MPa, 0.39715 MPa, and 0.31576 MPa, respectively. However, the oblique load direction showed that the BBO had more areas (area E 0.80778 MPa and area H 0.76256 MPa) that exceeded the PPT than LO (area E 0.64394 MPa). The lingualized occlusal scheme is ideal for patients with resorbed alveolar ridge conditions, especially in terms of limiting interferences when the denture is functioning while maintaining comfort but still providing good masticatory performance and satisfactory esthetics.

Stereophotometric facial changes in edentulous older adults after rehabilitation with complete dentures

OBJECTIVES

To evaluate the facial characteristics of edentulous older adults who underwent rehabilitation using complete dentures, and to compare them with dentate individuals.

BACKGROUND

Edentulism rehabilitation with complete dentures aims to restore occlusion and facial aesthetics.

MATERIALS AND METHODS

The study included 102 edentulous participants needing prosthodontic rehabilitation with complete dentures and 30 with a natural dentition (aged >65). The 3D facial scans were performed using an Artec optical scanner. Superficial facial landmarks were identified, and 16 parameters were calculated. Regional analysis with the superimposition of two scans was used to calculate the average distances and percentage of non-matching surfaces in the 11 regions. Paired and independent t-tests (α = .05) were used to test for group differences, as appropriate.

RESULTS

After rehabilitation with complete dentures, facial changes were most noticeable in the perioral region: wider rima oris, longer upper lip, wider upper vermilion, and more protruded profile. The comparison of facial regions without and with dentures showed fuller and curvier cheeks, with no direct influence of dentures. The edentulous faces with dentures appeared shorter and more retruded than those of dentate individuals. A narrower lower vermilion, retruded upper lip, and more flattened facial profile were observed in females with dentures than in their dentate peers.

CONCLUSION

Besides the expected positive influence of rehabilitation with complete dentures on facial appearance in the perioral region, there are some unexpected changes, such as fuller cheeks, but there is still deficiency in vertical facial dimensions and a more flattened facial profile.

Quantifying the facial proportions in edentulous individuals before and after rehabilitation with complete dentures compared with dentate individuals: A 3D stereophotogrammetry study

STATEMENT OF PROBLEM

Facial collapse is associated with edentulism, and while the provision of complete dentures promotes masticatory function and esthetics, whether complete dentures restore facial proportions to the natural appearance found in dental individuals is unclear.

PURPOSE

The purpose of this clinical study was to assess the facial profiles of edentulous individuals before and after treatment with complete dentures and compare these profiles with those of dentate individuals matched by age as the control.

MATERIAL AND METHODS

Sixty White participants were recruited as 2 groups: 30 edentulous participants provided with complete dentures in both arches and 30 participants with natural teeth and normal occlusion. Facial analysis was performed through 3D stereophotogrammetry. Linear, angular, surface, and perimeter facial measurements were made and statistically analyzed with paired and independent t tests (α=.05).

RESULTS

The mean age ±standard deviation was 63.16 ±7.33 years for the edentulous participants and 60.43 ±5.34 years for the dentate controls, without statistical differences between ages (P=.105). The facial profiles of the edentulous group with and without complete dentures were statistically different (P<.05) in 6 linear and 5 angular measurements. After quantifying the facial collapse by comparing edentulous individuals without complete dentures and the control dentate group, the results showed that the majority of differences occurred in the middle and lower third of the face, evidencing shortening in these areas with differences in facial measures of around 2 to 5 mm less in the edentulous group. However, statistically significant differences between the participants with complete dentures and the control dentate group were found in only 2 linear measurements (the distance between the right and the left exocanthion to cheilion), in the sealed lip angle and the left gonial angle, and in the surface and perimeter (P<.05).

CONCLUSIONS

Tooth loss affected the facial proportions in the lower third of the face. The provision of complete dentures restored their facial appearance but not precisely to the facial proportions of individuals with a natural dentition, as considerable differences were detected in surface and perimeter measurements.

Adaptation to New Dentures and 5 Years of Clinical Use: A Comparison between Complete Denture and Mini-implant Mandibular Overdenture Patients based on Oral Health-Related Quality of Life (OHRQoL) and Orofacial Esthetics

Objective of work

It is unclear how long patients need to adapt to new dentures. This study assessed adaptation and five years of clinical use, comparing complete denture wearers (CDs) and mini-implant mandibular overdenture wearers opposing a maxillary CD (MDI-OD), based on oral health reported quality of life (OHRQoL) and orofacial esthetics (OES).

Material and Methods

A total of 36 subjects in the CD group (25 females) and 30 subjects in the MDI group (20 females) completed the 5-year study. All patients received new CDs, but in the MDI-OD group, four mini-implants were inserted interforaminally in the mandible before denture manufacture. Participants filled in the OHIP-EDENT and OES questionnaires one day after dentures’ delivery, on the 3^rd, 8^th, 15^th, 30^th day, and at the 1-, 3- and 5-year follow-up examinations. Statistical analysis comprised descriptive methods, X² test, independent t-test, Friedman, and Mann-Whitney test.

Results and Conclusions

Both groups' adaptation to new dentures was completed within a month. The MDI-OD group had significantly better OHRQoL in all follow-ups except for the 3^rd and 8^th day, probably due to soreness and pain, the reason why the MDI-OD group had limitation in functioning in the first days after new dentures’ delivery. Already after the third year and at the fifth year, OHRQoL worsened (p<0.01) in both groups. However it was significantly more pronounced in the conventional CD wearers (p<0.01) than in the MDI-OD group. Orofacial esthetics was highly scored in both groups. The scores dropped down only after three years, equally in both groups.

Keywords

OHRQoL, OES, prospective study, complete dentures, mini-implants, adaptation

MeSH Terms

Complete Dentures; Dental Implants; Quality of Life; Dental Esthetics

Evaluation by 3D stereophotogrammetry of facial changes in edentulous patients after rehabilitation

OBJECTIVE

To assess facial changes after oral rehabilitation with complete dentures (CDs) by 3D technology allows understanding the results of a treatment that changes facial proportions. Precise outcome parameters can improve decision making. This descriptive observational research aimed to assess facial changes in completely edentulous patients after oral rehabilitation with a CD by a 3D stereophotogrammetry system.

METHODOLOGY

30 edentulous patients (7 men and 23 women), aged 50 to 75, were analyzed with stereophotogrammetry at 28 previously determined anthropometric landmarks, at 2 different times: T1, before treatment, and T2, after inserting the CDs. Images were analyzed with a specific software for linear and angular measurements. The paired t-test was used to compare timestamps (α=0.05).

RESULTS

Major changes were observed in 7 of the 13 linear measures and 7 of the 9 angular measures. The following linear measurements had an increase: Sn-Gn (lower third of the face), Ls-Li (height of the vermilion lip), and ChL-ChR (mouth width). Sn-Ls (nasal philtrum height) decreased. For angular measurements, Sn-St-Pg (lower facial convexity) angles increased, and the Prn-Sn-Ls (nasolabial angle) and GoR-Pg-GoL (mandible convexity) angles decreased.

CONCLUSIONS

Major facial changes in newly rehabilitated edentulous patients with CDs included an increase of the lower third of the face, of the vermilion lip, of mouth width, and of the lower facial convexity, and a decrease of the nasolabial angle and mandible convexity.