The Influence of Age, Gender, Mandibular Bone Height, Previous Experience with Prostheses, and Fabrication Methods on Masticatory Performance of Complete Denture Wearers

Appointments Needed for Complete Denture for Frail Older Adults Residing in Long-Term Care Facilities: A Cross-Sectional Study

Frail older adults who reside in long-term care (LTC) facilities face multiple barriers in receiving dental care. In edentulous LTC patients, the fabrication of complete dentures (CDs) can present challenges, leading to an increase in procedural or post-insertion appointments. The aim of this cross-sectional study was to document the number of fabrication and post-insertion follow-up appointments for CDs in frail older adults residing in LTC facilities. Data were collected from electronic patient records (AxiUm) and the Index of Clinical Oral Disorder in Elders (CODE) software utilized by the University of British Columbia Geriatric Dentistry Program from 2002 to 2018. A total of 362 CDs were fabricated between 2002 and 2018 in 272 patients. The mean number of visits required was 4.13 and 4.32, with standard deviations (Std) of 1.45 and 1.25 needed to fabricate maxillary CDs and mandibular CDs, respectively. The mean number of follow-up visits was 1.04 for maxillary dentures and 1.09 for mandibular dentures, with an Std of 1.25 for both, similar to the results obtained for adult patients in community dental clinics. Several factors were found to be associated with an increased number of CD fabrication and follow-up visits. Pre-operative assessment of the patient's cognitive/physical status and intra-oral condition may indicate the estimated time needed to fabricate CDs.

Simplified versus conventional complete dentures: A randomized crossover clinical trial

STATEMENT OF PROBLEM

A simplified approach to complete denture treatment, omitting the border molding and definitive impression appointment, was suggested as an alternative to the conventional approach. However, comparison clinical trials are lacking.

PURPOSE

The purpose of this randomized crossover clinical trial was to assess the satisfaction of edentulous patients and their oral health impact profile when provided with complete dentures fabricated through the simplified or the conventional approach.

MATERIAL AND METHODS

Forty completely edentulous patients seeking complete dentures were randomly divided into 2 groups (n=20). Each group received 2 sets of dentures. The first group received conventionally fabricated complete dentures, and the second group received complete dentures fabricated through the simplified approach. After 2 months, participants rated their overall satisfaction and their satisfaction regarding comfort, retention, stability, and efficiency of mastication and speech on a 100-mm visual analog scale (VAS). Participants also filled out the oral health impact profile for edentulous patients (OHIP-EDENT) questionnaire. Each group was then given the alternate set of dentures and reviewed again after 2 months. The results were analyzed by using the Mann-Whitney U and Wilcoxon-signed rank tests (α=.05).

RESULTS

The simplified complete dentures had significantly higher VAS scores for general satisfaction with maxillary dentures (P=.036), satisfaction with retention of maxillary dentures (P=.002), satisfaction with stability of maxillary dentures (P=.003), and satisfaction with speaking (P=.002). No statistically significant differences were found between the 2 groups regarding the other VAS items or OHIP-EDENT scores (P>.05).

CONCLUSIONS

The simplified denture fabrication approach required fewer appointments and resulted in higher patient satisfaction and similar OHIP-EDENT scores compared with the conventional approach. The simplified approach can be recommended over the conventional approach.

Teeth Rehabilitation and Nutritional Influence on Diabetic Patients: A Review

Diabetes mellitus (DM) is a globally prevalent endocrine and metabolic disorder characterized by hyperglycemia. Its complications significantly impact both the quality and longevity of the patient's life with a substantial burden on the healthcare system. Missing teeth make individuals more susceptible to malnutrition compared to those with functional teeth. This is especially true for people with diabetes, as the condition is closely linked to both oral health and food intake. Natural teeth loss can significantly reduce an individual's ability to chew food, leading to a decrease in the quality and quantity of their nutrition. Prosthodontics is a dental specialty that replaces missing teeth with artificial ones. Replacing missing teeth may prevent the risk of malnutrition due to decreased ability to chew. Good oral health is important for overall health, especially for those with conditions such as diabetes. Artificial teeth replacement may improve nutrition intake by improving chewing ability. Therefore, the ultimate objective of rehabilitating a patient's oral cavity is to replace the shape and function in terms of chewing performance to a degree that is as close to normal as feasible. The purpose of this review is to explore the literature showing the link between natural teeth loss and nutrition in individuals with DM, with a special focus on prosthodontic management. Several oral complications occur in diabetic patients specifically teeth loss, which in turn affects mastication function. This in turn cause malnutrition and affect glucose level. It is imperative for healthcare providers to take an interdisciplinary approach in order to improve the dental and nutritional status and overall well-being of DM patients.

The impact of residual ridge morphology on the masticatory performance of complete denture wearers

Statement of the problem

Morphology of the residual ridge (RR) is expected to influence the masticatory performance (MP) of complete denture (CD) patients, but considerable details of this relationship are unknown.

Purpose

We aimed to investigate the association between the objective MP and RR morphology of CD wearers and other contributory factors affecting their MP.

Materials and methods

Sixty-five patients with well-fitting upper and lower CDs with no complaints of pain were enrolled. The objective MP was measured using test gummy jelly and a fully automated measuring device. The RR form was divided into U-type, V-type, I-intermediate, and F-Flat, then combinations of upper and lower RR forms (combined RR) were classified. The height was measured using CD's denture basal surface replicas, while occlusal contact of CDs was assessed using a tooth contact analysis system. The relationship between surveyed factors and MP was evaluated using Spearman's rank correlation, Kruskal-Wallis test, generalized linear regression, and analysis of covariance.

Results

Participants with F-F and V-F combined RR forms had the lowest MP, while those with U-U and U-I forms had the highest MP, regardless of RR height. Participants with low RR height had the lowest MP, and those with high RR height had the highest MP, regardless of RR form. The analysis of covariance revealed that mandibular RR height, combined RR forms, and total occlusal contact area significantly affected the MP.

Conclusions

Our findings confirmed that the mandibular RR height, RR form combinations, and occlusal contact influence the MP of CD wearers.ClinicalImplications:The MP of CD wearers varied, depending on the height and form of the RR, as well as the occlusal contact area of the CDs. The results of this manuscript show that the morphology of the denture bearing area and the occlusion of the CDs are essential factors in predicting the treatment outcome of CD wearers. This allows the clinician to fabricate a complete denture with the denture basal surfaces adjusted and occlusion provided according to the patient. CD patients can be educated on how to chew to improve MP based on their own RR morphology.

Chewing Efficiency Test in Subjects with Clear Aligners

The aim of this study was to evaluate the masticatory function of subjects with clear aligners and to propose a simple and repeatable method for the clinical and experimental evaluation of masticatory function. For the testing we used almonds, a natural substance that can be easily found and stored, has intermediate consistency and hardness, is insoluble in saliva, and has the ability easily lose the moisture absorbed in the mouth. Thirty-four subjects using the Invisalign® (Align Technology, Santa Clara, CA, USA) protocol were randomly selected. This was an “intercontrol test”, i.e., all subjects under the same conditions acted as controls but also as cases whilst wearing the clear aligners. Patients were asked to chew an almond for 20 s, once with aligners and once without aligners. The material was then dried, sieved, and weighted. Statistical analysis was performed to investigate any significative differences. In all our subjects, the efficiency of chewing with clear aligners was found to be comparable to the efficiency of chewing without clear aligners. In detail, the average weight after drying was 0.62 g without aligners and 0.69 g with aligners, while after sieving at 1 mm, the average weight was 0.08 g without aligners and 0.06 g with aligners. The average variation after drying was of 12%, and after sieving at 1 mm, it was 25%. In summary, there was no substantial difference between chewing with or without clear aligners. Despite some discomfort in chewing, the clear aligners were well tolerated by most subjects, who wore them without difficulty even during meals.

Retention Capacity of Original Denture Adhesives and White Brands for Conventional Complete Dentures: An In Vitro Study

(1) Introduction: Denture adhesives (DAs) promote stability, chewing ability, and quality of life. The objective of this study was to compare the effectiveness of original brand DAs and white brands in their retention of conventional complete dentures. (2) Methods: This study followed the recommendations of the international standard ISO 10873. Three original brands of DA (Corega® Fixação 3D, GlaxoSmithKline®, Stafford Miller Ltd., Dungarvan Co. Waterford, Ireland), KuKident® Pro Procter & Gamble Technical Centres®, Ltd., Whitehal Lane, Germany and Elgydium® Fix, Laboratórios URGO® SL, Florida, Spain) were compared to three white brands (Fixação Extra Forte Pingo Doce®, Laboratórios Cosmodent®, Cantabria, Spain), Fixador de Próteses (Continente®, Propack®,Gmbh, Ladenburg, Germany) and Creme Fixador de Próteses (Auchan®, Ellipse®, Roubaix, France). Their retention capacities were analyzed using a mechanical test device. (3) Results: The mean retentive ability of original brand adhesives (M = 11.16, SD = 5.27) was significantly higher (t(298) = 11.88; p < 0.001) than that of the white brands (M = 5.92, SD = 1.18). When comparing all brands, statistically significant differences were also observed, F(5.294) = 707.68 (p < 0.001). The generic adhesive results were more homogeneous. The generic brands from Continente® (M = 5.24, SD = 0.94) and Auchan® (M = 5.80, SD = 0.79) were not significantly different, while the Pingo Doce® brand obtained significantly higher mean retention results (M = 6.71, SD = 1.28). (4) Conclusions: The original brands of DA have a significantly higher retentive ability than the white brands. Elygidim® Fix had the worst result of the three original brands, and the product from Pingo Doce® had the best result among the three white brands.

The Association of Dietary Intake, Oral Health, and Blood Pressure in Older Adults: A Cross-Sectional Observational Study

Hypertension is related to impaired mastication that causes malnutrition, declining the general health of older adults. This study assessed the role of dietary intake in the relationship between oral health and blood pressure. Eight hundred ninety-four adults aged ≥65 years who independently lived in rural regions of Japan participated in this study. Hypertension was classified according to the guidelines of the Japanese Society of Hypertension. The oral condition was evaluated by analyzing the remaining teeth, occlusal force, posterior occlusal support, masticatory performance, oral moisture, and oral bacterial level. Dietary intake was assessed using a brief self-administered dietary history questionnaire. Mann-Whitney U, chi-square, Kruskal-Wallis tests, and logistic regression analyses were used to elucidate the factors related to hypertension. Normotensive, hypertensive, and history of hypertension were observed in 30.9%, 23.8%, and 45.3% of the participants, respectively. The factors significantly associated with the hypertension were age, body mass index, posterior occlusal support condition, and sodium-to-potassium ratio related to salt intake and/or vegetable intake. Participants without posterior occlusion significantly had higher risk of hypertension (odds ratio = 1.72). This study suggested that there was an association between oral health and hypertension, while the loss of occlusal support may influence nutritional intake conditions.

Incidence and risk factors for non-adaptation of new mandibular complete dentures: a clinical trial

OBJECTIVE

To investigate the incidence and risk factors for non-adaptation of the conventional mandibular complete denture (CMCD).

MATERIALS AND METHODS

A total of 108 edentulous patients were rehabilitated with complete dentures (CDs) and followed up at 3- and 6-month intervals. Adaptation was confirmed based on chewing, phonetics, and comfortable swallowing with the CDs. The risk factors among sociodemographic and patient-centered factors were analyzed. Statistical analyses included the chi-square test and then a multivariate analysis.

RESULTS

After 3 months, 38.0% of patients showed non-adaptation to CMCDs. Non-adaptation was significantly associated with the absence of previous mandibular denture experience (p = 0.042), ulcerations after 15 days of rehabilitation (p < 0.001), and a reduced posterior mandibular ridge (p = 0.035). After 6 months, this incidence decreased to 14.1%. The factors associated with non-adaptation were ulcerative lesions after 15 (p < 0.001) and 30 (p < 0.001) days of the delivery of CDs and the non-regular use of mandibular CDs (p < 0.001).

CONCLUSION

The incidence of non-adaptation was higher after 3 months, with reduction after 6 months. Sociodemographic variables did not influence the adaptation. After 3 months, the absence of previous experience, traumatic ulcers, and reduced mandibular ridges hindered the adaptation of patients to mandibular CDs. After 6 months, only the occurrence of ulcerative lesions and non-regular wear of dentures were risk factors for non-adaptation.

CLINICAL RELEVANCE

A considerable number of patients have difficulties in adapting to the mandibular dentures. Identifying the factors of non-adaptation of the dentures will contribute to increasing the predictability of this critical adaptation period.

Does the use of an adhesive improve conventional complete dentures? A systematic review of randomized controlled trials

STATEMENT OF PROBLEM

A consensus on whether the use of a complete-denture adhesive provides a clinical benefit remains unclear.

PURPOSE

The purpose of this systematic review of randomized controlled trials was to evaluate the use of adhesive in complete dentures in terms of retention and stability, patient-reported outcomes measures, and masticatory performance.

MATERIAL AND METHODS

A search was performed in PubMed, Web of Science, and Cochrane Library for articles up to October 2020. The Cochrane collaboration tool was used to analyze the risk of bias. The grading quality of evidence and strength of recommendations (GRADE) tool was used to assess the certainty of the evidence.

RESULTS

Thirteen studies were included with a total of 516 participants with a mean age of 65.5 years. Most studies reported a significant improvement in the retention and stability, patient-reported outcomes measures, and masticatory performance of complete dentures with the use of denture adhesive compared with no-denture adhesive. Newly developed denture adhesives were reported to have promising results. Most studies presented a low risk of bias, but the certainty of the evidence was classified as low to moderate.

CONCLUSIONS

Participants had improved treatment outcomes when using denture adhesives because they significantly improve the retention and stability, patient-reported outcomes measures, and masticatory performance. However, further high-quality studies are needed to confirm these results with newly developed denture adhesives.

Efficiency of simplified versus traditional denture fabrication methods: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Conventional techniques (CTs) for complete denture fabrication involve a series of clinical and laboratory steps. A simplification of this process has been advocated, but whether simplified techniques result in acceptable treatment outcomes is unclear.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the efficiency of simplified denture fabrication techniques in comparison with CTs.

MATERIAL AND METHODS

The standard methodological procedures prescribed by the Cochrane Collaboration for systematic review and meta-analysis were used. An electronic search (MEDLINE through PubMed, Cochrane trial registry, and Scopus) and a manual search up to February 2020 were made to identify studies. Only randomized controlled trials involving edentulous adults requiring complete denture treatment were included.

RESULTS

Nineteen studies met the inclusion criteria. The pooled estimate of the included studies for patient satisfaction at 6 months marginally favored the simplified method of denture fabrication (standardized mean difference=0.02 [95% confidence interval {CI} -0.22 to 0.27]). The pooled estimate of the included studies for clinical time and cost of fabrication favored the simplified method (mean difference=-77.34 [95% CI -122.45 to -32.24] and mean difference=-85.89 [95% CI -170.02 to -1.77] respectively).

CONCLUSIONS

Simplified techniques were cost effective and less time consuming than the CT, with no significant difference in patient satisfaction or oral health-related quality of life. The high risk of bias and heterogeneity among studies requires that the results be considered cautiously.