Longitudinal Assessment of Denture Maintenance Needs in an Overdenture Population

Clinical parameters that affect performance and patient satisfaction of root-retained overdentures: A systematic review of randomised controlled clinical trials

OBJECTIVE

To evaluate clinical parameters that affect the performance of root-supported overdentures (ROD) and to identify the possible factors that may affect it.

BACKGROUND

ROD still serve as an alternative and successful treatment plan nowadays for partially edentulous patients. Nonetheless, there is not yet conclusive evidence about their clinical evaluation.

MATERIALS AND METHODS

A search strategy was developed following a PIO (Population, Intervention, Outcome) framework including an electronic search in the following databases: PubMed, Cochrane Library and Scopus. The systematic search included only randomised controlled clinical trials (RCTs), published until January 2023 in English language and was performed by two independent reviewers. Quality assessment of the included studies was conducted according to the Cochrane Risk of Bias tool.

RESULTS

The final selection of studies included 11 RCTs. Clinically relevant variables derived from this search were: Complications, with caries being the most frequently reported, periodontal aspects and bone changes around abutment teeth. Additionally, methods and clinical suggestions for the maintenance of these restorations and patient-related outcomes were assessed. According to the risk of bias assessment, nine studies were considered of high risk, whereas only 2 of low risk. A meta-analysis was not feasible.

CONCLUSION

Within the limitations of this systematic review, ROD remain a viable treatment plan, offering better denture stability and bone preservation around abutment teeth and high patient satisfaction. Thorough oral hygiene and regular follow-ups are of utmost importance. Further well-designed RCTs are necessary for firmer conclusions.

Rehabilitating a severely worn dentition with removable prosthodontics

In the next part of this series on tooth wear management, we discuss the indications and clinical stages for the provision of removable prostheses for the treatment of severely worn and depleted dentitions. The general design features of a complex prosthesis are described for reorganised occlusal schemes and maintenance guidelines are explained. In addition, the clinical stages for three different situations are described: removable-only approaches, and combined fixed and removable in the same arch and separate arches. The value of providing removable prostheses in worn dentitions allows the immediate rehabilitation of severely worn teeth taking a non-invasive and retrievable approach when the remaining dentition is of poor quality or structure and/or there are missing teeth.

Comparison of tensile bond strength of ball attachments made of different materials to root canal dentin after chewing simulation

BACKGROUND

Debonding of ball attachments is one of the complications that annoy teeth supported overdenture wearers. The polyetheretherketone (PEEK) and polyetherketoneketone (PEKK) polymers are widely applied in the dental field. The purpose of the current study was to compare the tensile bond strength of ball attachments made of such materials and the commonly used titanium ones after 5 years of overdenture insertion and removal (5000 cycles) in addition to chewing simulation (1,200,000 cycle).

METHODS

Extracted mandibular canines (N = 60) were randomly allocated into three groups and received ball attachments; titanium (group TI; N = 20), PEEK (group PE; N = 20), PEKK (group PK; N = 20). In each group, the samples were divided into two subgroups whereas tensile bond strength was measured pre aging (T0; n = 10) and post aging (T1; n = 10). Tensile bond strength was measured by the Pull out test using the Universal testing machine. Failure mode analysis was determined by examination of the samples' surfaces under 65X stereomicroscope. The resulting data followed normal distribution and the significance level was set at (α = 0.05).

RESULTS

One Way Anova showed statistically significant difference between the three groups (P < .00001). PostHoc Tukey test showed statistically significant difference between the groups TI and PE, TI and PK and no statistically significant difference between the groups PE and PK. Paired t test showed statistically significant difference in the tensile bond strength pre and post aging in each group.

CONCLUSIONS

PEEK and PEKK ball attachments could be concluded to have a higher tensile bond strength compared to the titanium ones when bonded to root dentin. Tensile bond strength of such attachments may decrease with aging as well. Clinically, the higher tensile bond strength may have a lesser rate of debonding and thus reduced patient apprehension.

Novel PEEK Retentive Elements versus Conventional Retentive Elements in Mandibular Overdentures: A Randomized Controlled Trial

Background. Many patients suffer from lack of retention of conventional mandibular overdentures due to loss of clip retention over time. Computer-aided design-computer-aided manufacturing (CAD-CAM) milled polyether ether ketone (PEEK) materials may be used for the construction of retentive housing and clips for improving retention of implant-supported overdentures. Objective. To compare retention and patient satisfaction of implant-supported mandibular overdentures retained by conventional nylon clip and metal housings for ball attachments versus PEEK clip and housings. Methods. Twenty-two participants were divided into 2 equal groups (n = 11). The conventional group received implant-supported mandibular overdentures retained by metal housings and nylon retentive elements, while the PEEK group received implant-supported mandibular overdentures retained by PEEK retentive elements and housings. The PEEK retentive elements were made using computer-aided design and computer-aided manufacturing (CAD-CAM). The evaluation included measuring the retention by applying a gradual pulling up force by force meter and patient satisfaction with a 7-point visual analog scale (VAS) at overdenture insertion and 3, 6, and 12 months subsequently by a research interviewer. Results. The PEEK group showed statistically significantly increased retention force ( $P<0.05$ ) at the time of insertion (37.6/17.79) and after 3 months (33.9/16.78), 6 months (32.7/15.97), and 12 months (31.65/13.05). The conventional group had a statistically significantly higher mean overall satisfaction ( $P<0.05$ ) at the time of insertion (65/82.18). No statistically significant difference was found after 3 months (87.81/84.72). The PEEK group showed statistically significantly higher mean overall satisfaction ( $P<0.05$ ) after 6 months (86.36/80.18) and 12 months (85.45/79.54). Conclusions. According to the results of this study, the PEEK retentive material provided more retention than did the conventional material and led to improved patient satisfaction. The study was registered at clinical trials.gov (https://clinicaltrials.gov/ct2/show/NCT05079048).

Attachment-Retained Unilateral Partial Denture versus Tooth Implant-Supported Prosthesis in Mandibular Distal Extension Cases: A Randomized Controlled Trial

Objective:

To evaluate patients’ satisfaction, biting force measurement, and radiographic evaluation of abutment teeth of tooth implant-supported fixed partial denture, unilateral attachment, and conventional partial denture in mandibular distal extension cases.

Materials and Methods:

Twenty-four participants were selected according to the following criteria: participants with unilateral mandibular distal extension with last standing second premolar abutment; participants having abutments with sufficient occluso-gingival height and good periodontal condition. Participants were divided into the following three equal groups: participants of the implant group received fixed tooth implant-supported fixed partial dentures, attachment group participants received unilateral attachment removable partial dentures, and conventional group participants received conventional removable partial dentures. The evaluation included patient satisfaction using “OHIP14” questionnaires, biting force measurement, and radiographic evaluation of terminal abutments using the ANOVA test.

Results:

Participants of the implant group were mainly satisfied with their prosthesis than the attachment group, which is higher than the conventional. Regarding biting force measurement, there is a statistically significant difference (p < 0.05) between all groups, including the implant group and attachment group, as well as between attachment and conventional group (p < 0.05). The conventional group showed statistically significant (p < 0.05) highest mean bone loss, while there was no statistically significant difference between implant and attachment groups; both showed statistically significantly lower mean amounts of bone loss.

Conclusion:

The tooth implant-supported fixed prosthesis could be considered a superior line of treatment for managing distal extension cases. Unilateral attachment, which is considered an excellent alternative in the case of implant placement, is not recommended.

In vitro investigation of the impact of remaining tooth structure on the tensile failure loads of overdenture copings

BACKGROUND

The purpose of this in vitro study was to evaluate the impact of the remaining tooth structure on the retention of overdenture cast metal copings.

MATERIAL AND METHODS

A freshly extracted intact mandibular human canine (length 25 mm) was selected and endodontically treated. An incisal reduction of 4 mm with no ferrule preparation was performed and a post space of 12 mm was created. By using polyvinyl siloxane duplication material and autopolymerizing polymethylmethacrylate resin, ten resin teeth analogs (control group) were obtained. A second set of ten resin teeth analogs (group 1) was created by preparing on the original natural tooth a 360o ferrule design of 1 mm in height and by using the same procedural technique. The canine was further reduced by an additional 1 mm, resulting in a ferrule of 2 mm in height, measured from the initial incisal reduction, thus a third set of ten resin teeth analogs (group 2) was created. For every tooth analog in all groups a dome-shaped metal coping was cast and luted with a glass ionomer cement. All specimens were subjected to tensile load testing until decementation occurred.

RESULTS

The specimens in the control group exhibited a mean failure load of 87.21 ± 18.26 N, while the 1 mm ferrule group recorded a higher mean failure load of 125.43 ± 8.79 N and the 2 mm ferrule group recorded the highest mean failure load of 146.12 ± 23.38 N. One-way ANOVA revealed significant differences (F= 28.04, p<0.001) in the tensile failure loads between all of the groups being tested.

CONCLUSIONS

The metal copings with a 2 mm ferrule design exhibited the highest retention values, followed by the 1 mm ferrule and the no ferrule design, with the differences among them being statistically significant. Key words:Ferrule effect, In vitro study, Metal copings, Overdenture, Tensile stress.