Predictors of Satisfaction with Dentures in a Cohort of Individuals Wearing Old Dentures: Functional Quality or Patient-Reported Measures?

3D printing vs traditional workflow for the fabrication of mandibular implant overdentures: study protocol for a mixed-methods cross-over RCT

BACKGROUND

Complete tooth loss is a significant global oral health issue, particularly impacting older individuals with lower socioeconomic status. Computer-assisted technologies enhance oral healthcare access by the elderly. Despite promising in vitro reports on digital denture materials, evidence from randomized clinical trials (RCTs) is lacking to verify their performance. This cross-over RCT will investigate whether 3D-printed implant-retained mandibular overdentures (IMO) are more satisfactory for edentulous seniors than those made through traditional methods.

METHODS/DESIGN

We will recruit 26 completely edentulous participants (any sex/gender) based on the following eligibility criteria: age ≥ 60 years, no tooth extraction in the past 12 months, two implants in the lower jaw, and need for new dentures in both jaws. Each participant will receive two denture pairs, either manufactured by 3D printing or traditionally, to be worn in a random order. A timeline of 3 months with each denture pair will be considered for outcome assessment (total: 6 months). Patient satisfaction with dentures will be measured by the McGill Denture Satisfaction Questionnaire. We will evaluate other patient-reported outcomes (including oral health-related quality of life) as well as clinician-assessed quality and cost. At the end of the trial, participants will choose which denture pair they wish to keep and interviewed about their experiences with the 3D-printed IMO. The quantitative and qualitative data will be incorporated through an explanatory mixed-methods strategy. A final quantitative assessment will happen after 12 months with the preferred IMO to assess the long-term performance and maintenance needs.

DISCUSSION

This mixed-methods RCT will explore patient experiences with 3D-printed IMOs, aiming to assess the potential for altering clinical practice and dental public health policies. Our results will inform policies by showing whether 3D printing offers comparable outcomes at lower costs, facilitating greater access to oral care for the elderly.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT06155630, Registered on 04 December 2023. https://classic.

CLINICALTRIALS

gov/ct2/show/NCT06155630.

Comparative effectiveness of types of denture adhesives in enhancing retention and function of complete dentures: a systematic review with network meta-analysis

OBJECTIVES

The purpose of this systematic review with network meta-analysis was to assess the comparative efficacy of various types of denture adhesives in complete denture patients.

MATERIAL AND METHODS

A search was conducted for trials published in Scopus, PubMed, and Cochrane Central Register of Controlled Trials from inception until July 2023 (PROSPERO: CRD42023451045). A network meta-analysis was performed to assess the comparative efficacy of different denture adhesive types and ranked using the Surface Under the Cumulative Ranking (SUCRA) system. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to assess the level of certainty of evidence.

RESULTS

Seventeen articles were included in the quantitative analysis. Cream denture adhesives significantly increased bite force in both incisal region (RR = 7.63[95%CI: 3.34, 11.91]) (P < .05) as well as premolar and molar regions (RR = 33.66[95%CI: 15.15, 52.16]). Cream adhesives significantly improved retention of dentures as assessed by the reduced number of denture dislodgments (RR = -5.35[95%CI: -9.93, -0.77]) (P = 0.022), Kapur's index of retention (maxillary denture) (RR = 0.80[95%CI: 0.18, 1.42]) (P = 0.012) and Kapur's index of retention (mandibular denture) (RR = 1.27[95%CI: 0.67, 1.87]) (P < .05). Powder adhesives significantly increased premolar and molar bite force (RR = 36.00[95%CI: 16.20, 55.79]) (P < .05) and Kapur's index of retention (mandibular denture) (RR = 1.54[95%CI: 0.58, 2.49]) (P = 0.002). None of the adhesives were statistically significant for remaining outcomes.

CONCLUSIONS

Cream and powder denture adhesives are effective in enhancing the retention of mandibular dentures (Kapur's index) and bite force in the premolar/molar region in complete denture wearers (moderate level of certainty of evidence).

CLINICAL RELEVANCE

Cream and powder denture adhesives are effective in improving the retention and function of complete dentures.

Comparison of retention and denture base adaptation between conventional and 3D-printed complete dentures

Background. In recent years, complete denture construction has been revolutionized using computer-aided designing and computer-aided manufacturing (CAD-CAM) technology. This clinical study compared the retention and denture base adaptation of 3D-printed complete dentures fabricated using dimethacrylate-based resins with a photoinitiator versus conventional complete dentures. Methods. Ten completely edentulous patients were nominated for this study. Each patient received two complete dentures. One complete denture was conventionally fabricated, while the other was digitally fabricated through 3D printing of dimethacrylate-based resins with a photoinitiator. Denture base adaptation for both dentures was evaluated using surface matching software. Denture retention was also evaluated using a digital force meter at the time of complete denture insertion (T0 ), after three months (T3 ) and six months (T6 ) of denture use. Results. Regarding adaptation (mean misfit values), a statistically insignificant difference was detected between the two differently fabricated complete dentures. In addition, comparable satisfactory retention values were observed for both conventionally fabricated and 3D-printed dentures; however, there was an insignificant increase in retention over time. Conclusion. 3D-printed complete dentures fabricated using dimethacrylate-based resins could be a promising alternative to conventionally fabricated complete dentures with satisfactory denture base adaptation and retention.

Perception of Edentulous Patients and Dental Professionals towards Care and Maintenance of Complete Denture Prostheses

Methods

A descriptive qualitative study was conducted among 30 EDPs attending dental prosthetic clinics (DPCs) at the four centres in Fiji and 28 DPs at the four DPCs under purposive sampling. Semi-structured questionnaire with open-ended questions was used for in-depth interview (IDI) with EDPs via telephone and focus group discussion (FGD) with DPs virtually via Zoom. Participant responses were recorded and thematic analysis was used to manually analyze the verbatim transcripts.

Results

Five themes were identified as perceptions of EDPs towards care and maintenance of CDP in Fiji: patient perceptions towards CDP, CDP care and maintenance, communication between DPs and EDPs, challenges faced in CDP, and management strategies to CDP care and maintenance. Seven themes were identified as perceptions of DPs: CDP guidelines, post-denture insertion advice, care and maintenance, challenges while treating EDPs, management strategies to challenges faced, communication and teamwork, and recommendations to improving quality of CDP delivery in Fiji.

Conclusion

Patients' perception towards care and maintenance of CDP was low. It is highly recommended for EDPs to adhere to CDP advice given by DPs whilst for DPs, it had been recommended to provide written, oral, and visual forms of CDP care and maintenance advice to EDPs for effectiveness.

Trueness of Intaglio Surface of Milled Digital Dentures Designed from Intraoral Scans

PURPOSE

To asses trueness of the intaglio surface of milled dentures fabricated according to a fully digital protocol starting from intraoral scans in a clinical study by means of 3-dimensional (3D) digital analysis.

MATERIALS AND METHODS

Ten maxillary and 10 mandibular dentures, designed from intraoral scans and milled in-house, were studied. Intraoral scans were compared with the scans of intaglio surface of milled dentures. To this end, they were aligned, trimmed and used in a metrology software to measure their mean 3D distance, absolute mean deviation, and other parameters. Measured differences for all parameters were statistically investigated. Subgroup analysis for the maxillary and mandibular dentures was performed using independent samples t-test or, in case of non-normal distribution, by means of Mann-Whitney test.

RESULTS

Using a mean of 24.9 ±2.8 measurement points/mm² , a mean 3D distance of 0.0006 ±0.007 mm between intraoral scans and the scans of the intaglio surface of milled dentures was measured. The corresponding absolute mean deviation was 0.055 ±0.032 for maxillary dentures and 0.061 ±0.016 for mandibular dentures; such a difference between arches was statistically significant (p = 0.035).

CONCLUSIONS

Milled dentures fabricated using a fully digital protocol and intraoral scans have accurate intaglio surfaces. It is reasonable to assume that they may achieve an adequate fit.

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.

Longevity of complete dentures: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Patients and clinicians are aware of the efficacy and benefits of complete dentures, but evidence regarding their longevity is limited.

PURPOSE

The purpose of this systematic review was to examine the literature describing the longevity of complete dentures and to review variations in longevity by denture type and duration of follow-up.

MATERIAL AND METHODS

Four electronic databases were searched by using key terms: MEDLINE, CINAHL (EBSCO), Dentistry and Oral Sciences Databases, and The Cochrane Library. Studies meeting the inclusion criteria were reviewed according to an established protocol and data extracted. Reference lists of identified studies were examined. Risk of bias was assessed by using the AXIS tool. Weighted means and weighted standard deviations were calculated. Pooled complete denture failure proportions were estimated by using random effects models based on the DerSimonian and Laird method.

RESULTS

The search yielded 21 607 unique abstracts, of which 273 met the inclusion criteria. Assessment of the full-text articles reduced this number to 42. Of these, 24 studies were rated as having low risk of bias and 18 as very low. The weighted mean ±standard deviation longevity of maxillary complete dentures was 10.3 ±3.8 years, of mandibular dentures was 8.6 ±2.6 years, and of both maxillary and mandibular dentures was 10.8 ±4.7 years. The pooled failure proportion for complete dentures observed for 2 years or less was 0.05 (95% confidence interval [CI]: 0.00-0.10), 5 to 6 years was 0.12 (95% CI: 0.08-0.16), and 10 years or more was 0.41 (95% CI: 0.28-0.53).

CONCLUSIONS

Complete dentures, fabricated primarily in university settings, were found to have a weighted mean ±standard deviation longevity of 10.1 ±4.0 years. The failure rate of these prostheses increased with denture age, and the longevity of maxillary dentures was greater than that of mandibular dentures.

Subjective and objective measures for evaluating masticatory ability and associating factors of complete denture wearers: A clinical study

STATEMENT OF PROBLEM

The masticatory ability of complete denture (CD) wearers can be evaluated subjectively and objectively. Although an objective measure reflects a person's ability to masticate food, it is rarely used in clinical practice. Moreover, the factors associated with subjective and objective masticatory ability of CD wearers remain unclear.

PURPOSE

The purpose of this clinical study was to identify subjective and objective measures that better reflect the masticatory ability of CD wearers and to investigate their associating factors.

MATERIAL AND METHODS

Masticatory ability was evaluated in 130 CD wearers by using subjective and objective measures. The subjective indicators were oral impact on eating and denture satisfaction based on eating or mastication ability. Masticatory performance was objectively measured by using a median peanut particle size. The maximum occlusal force, number, and area of occlusal contacts were determined from a pressure-sensitive sheet. CD retention and stability were classified into acceptable and unacceptable denture quality following the CU-modified Kapur criteria. The occlusal pattern and oral conditions were examined and recorded. Intraexaminer reliability in determining CD quality and oral condition was shown by a Kappa score of 0.90 to 0.95. Multivariable linear and logistic regressions were performed to analyze the associations between CD quality, maximum occlusal force, and masticatory ability. The Spearman correlation was used to determine the association between subjective and objective measures. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) between subjective and objective measures were calculated.

RESULTS

Unacceptable CD quality was significantly associated with oral impact on eating, eating dissatisfaction, and larger peanut particle size (P<.001). Peanut particle size increased with lower maximum occlusal force, which was related to fewer occlusal contacts and the female sex. The highest to lowest adjusted R² values were related to masticatory performance, oral impact on eating, and eating satisfaction models. Among participants with unacceptable CD quality, 16% had higher masticatory performance, 25%, had no oral impact on eating, and 33% reported eating satisfaction. The sensitivity and specificity values of subjective measures in predicting lower masticatory performance were approximately recorded at 74% and 90%, respectively, whereas PPV and NPV were at 90% and 77%, respectively.

CONCLUSIONS

CD retention and stability impact objective and subjective masticatory ability. Objective masticatory performance is the best measure for evaluating the masticatory ability of CD wearers, followed by oral impact on eating and eating satisfaction. A 3.6-mm peanut particle size is suggested as a cutoff value for identifying CD wearers with impaired masticatory ability.

Impacts of Denture Retention and Stability on Oral Health-Related Quality of Life, General Health, and Happiness in Elderly Thais

Purpose

This study investigated denture and patient related factors associated with oral health-related quality of life (OHRQoL) of complete denture wearers and their association with general health and happiness.

Methods

This retrospective cohort study comprised 130 participants with complete edentulism, with maxillary and mandibular complete dentures treated at Chulalongkorn University Dental School during 2010-2017. The primary outcome was the presence of overall and domain-specific Oral Impacts on Daily Performances (OIDP). Secondary outcomes were diagnosed and perceived general health, and happiness. Denture retention and stability were classified as acceptable or unacceptable following the CU-modified Kapur criteria. Five esthetic-assessment criteria of the harmonization and proportions between facial and dental anatomical landmarks were measured from patient's photographs. Age, sex, previous complete denture experience, and denture age were recorded. The associations between each variable and oral impacts were analyzed using bivariate logistic regression, and the factors with p < 0.25 were further adjusted using multivariable analysis. Associations between oral impact scores and general health and happiness were assessed using Spearman's rank correlation.

Results

The most frequent oral impacts were on physical domain, while social domain was the least affected. Denture retention/stability was significantly associated with both overall and specific domains of oral impact. Happiness was found to be strongly correlated with perceived general health, but marginally with oral impact scores.

Conclusions

Unacceptable complete denture retention and stability are substantial risk factors for impaired OHRQoL in complete edentulism. Maintaining optimal denture retention and stability in denture wearers is essential for good oral health and well-being with the goal of enhancing happiness.

Insatisfação com os serviços odontológicos entre idosos brasileiros dentados e edentados: análise multinível

Resumo Avaliou-se a insatisfação com os serviços odontológicos entre idosos brasileiros dentados e edentados e sua associação com variáveis contextuais e individuais. Foram utilizados os dados do Levantamento Nacional de Saúde bucal realizado em 2010 e dados contextuais referentes aos municípios. Análises descritivas, bivariadas e multinível foram realizadas. Incluiu-se 1.989 idosos. Destes, 11,2% dos idosos dentados e 22,1% dos edentados estavam insatisfeitos. Entre os dentados, a insatisfação foi associada com variáveis contextuais (localização do município, índice de desenvolvimento humano, Índice de GINI, presença de Centro de Especialidades Odontológicas e cobertura das equipes de saúde bucal) e individuais pertencentes à atenção à saúde e condições de saúde bucal. Para os idosos edentados, não foi identificado associação com variáveis contextuais. Apenas o motivo do uso do serviço e a satisfação com dentes e boca foram associados. Identificou-se uma prevalência considerável de insatisfação com os serviços, sendo maior entre os idosos edentados. Entre os idosos dentados, foi observado associação com variáveis contextuais.

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.

Single-implant overdentures retained by the Novaloc attachment system: study protocol for a mixed-methods randomized cross-over trial

BACKGROUND

Overdentures retained by a single implant in the midline have arisen as a minimal implant treatment for edentulous mandibles. The success of this treatment depends on the performance of a single stud attachment that is susceptible to wear-related retention loss. Recently developed biomaterials used in attachments may result in better performance of the overdentures, offering minimal retention loss and greater patient satisfaction. These biomaterials include resistant polymeric matrixes and amorphous diamond-like carbon applied on metallic components. The objective of this explanatory mixed-methods study is to compare Novaloc, a novel attachment system with such characteristics, to a traditional alternative for single implants in the mandible of edentate elderly patients.

METHODS/DESIGN

We will carry out a randomized cross-over clinical trial comparing Novaloc attachments to Locators for single-implant mandibular overdentures in edentate elderly individuals. Participants will be followed for three months with each attachment type; patient-based, clinical, and economic outcomes will be gathered. A sample of 26 participants is estimated to be required to detect clinically relevant differences in terms of the primary outcome (patient ratings of general satisfaction). Participants will choose which attachment they wish to keep, then be interviewed about their experiences and preferences with a single implant prosthesis and with the two attachments. Data from the quantitative and qualitative assessments will be integrated through a mixed-methods explanatory strategy. A last quantitative assessment will take place after 12 months with the preferred attachment; this latter assessment will enable measurement of the attachments' long-term wear and maintenance requirements.

DISCUSSION

Our results will lead to evidence-based recommendations regarding these systems, guiding providers and patients when making decisions on which attachment systems and implant numbers will be most appropriate for individual cases. The recommendation of a specific attachment for elderly edentulous patients may combine positive outcomes from patient perspectives with low cost, good maintenance, and minimal invasiveness.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03126942 . Registered on 13 April 2017.

Denture Stomatitis: Causes, Cures and Prevention

Removable dentures are worn by 20% of the UK population and two thirds of these individuals have denture stomatitis. Poor oral hygiene is commonplace among this group, as is smoking and xerostomia, which also contribute to the development of denture stomatitis. A complex polymicrobial biofilm is able to proliferate on the surface of denture materials and matures to form visible denture plaque. This denture plaque biofilm stimulates a local inflammatory process that is detectable clinically as erythema, and hyperplasia. Systemically, denture plaque represents a potential risk factor for systemic disease, in particular aspiration pneumonia. Respiratory pathogens have been detected in the denture plaque and overnight denture wear has been linked to an increased risk of aspiration pneumonia. There is a general lack of evidence on the adequate management of denture stomatitis and we present a protocol for use in the primary care setting.

Using Electromagnetic Articulography to Measure Denture Micromovement during Chewing with and without Denture Adhesive

Purpose

To study the effects of denture adhesive upon denture micromovements in three dimensions during the chewing of hard, sticky, and tough food items observed using a novel method involving an electromagnetic articulograph (EMA) speech research system.

Materials and Methods

Ten volunteers (mean age 60.9 ± 10.4 years) with fair‐ or poor‐fitting complete maxillary dentures were enrolled. Chewing experiments were conducted using two treatments (adhesive or no‐adhesive control) and three foods: carrots (hard), raisins (sticky), and processed meat stick (tough). Denture micromovement was measured through a novel application of a Northern Digital Wave EMA System. Three‐dimensional denture position was captured during mastication using three sensors embedded into a replica denture for each subject. Following individual characterization of a “home” reference position, the Euclidean Distances from Home (DfH) were calculated for each recorded sample of the chewing experiments. The DfH at each sample represented the denture movement for that 1/100th of a second of the activity. The DfH data were then summarized as the mean DfH, the maximum DfH, and total distance traveled by the denture. Several thresholds were also analyzed, including the percent of time that the DfH ≥1.5 mm, ≥2.0 mm, and ≥2.5 mm.

Results

With adhesive treatment, the mean DfH of dentures during chewing was reduced by 26.8% for carrot, 30.3% for raisin, and 31.0% for meat stick, when compared with no‐adhesive treatment (p < 0.001 for all comparisons). Similar results were also seen for the maximum DfH and total distance travelled endpoints across foods. For the threshold endpoints, adhesive treatment was associated with a statistically significant reduction in denture micromovements at all three thresholds across foods. At the threshold of DfH ≥ 1.5 mm, adhesive treatment was associated with a reduction in micromovement by 61.6%, 56.2%, and 70.0% with carrot, raisin, and meat stick, respectively (p ≤ 0.004 for all comparisons).

Conclusions

Observations of denture movement using the Wave EMA System were able to differentiate systematically between adhesive treatment and no‐adhesive treatment for denture micromovements during different chewing challenges. Use of adhesive was associated with statistically significant reductions in denture micromovements for hard, sticky, and tough foods as measured with both distance and threshold endpoints.