Complete Denture Occlusion: Best Evidence Consensus Statement

Occlusal parameters and wear of artificial teeth in complete dentures with lingualized versus bilateral balanced occlusion: a randomized clinical trial

OBJECTIVE

This study aimed to assess the occlusal contact area (OCA), occlusal contact number (OCN), bite force, and artificial tooth wear in complete dentures with lingualized and bilateral balanced occlusion.

METHODS

Edentulous participants who fulfilled the inclusion criteria were divided into the three groups as follows: group I, dentures with lingualized occlusion using interpenetrating polymer network artificial teeth; group II, dentures with lingualized occlusion using double cross-linked artificial teeth; and group III, dentures with bilateral balanced occlusion using anatomical micro-hybrid resin teeth. The silicone techniques were used to assess the OCA and OCN of the mandibular dentures and the Dental Prescale II was used to evaluate the bite force at the 2-week, 3-month, and 12-month follow-up visits. Occlusal contact analyzer software was used to assess the maxillary and mandibular posterior tooth wear at the 12-month follow-up visit. All data was analyzed using the SPSS software.

RESULTS

The OCA of group III was significantly higher than that of groups I and II at the 2-week follow-up visit, whereas group I was considerably higher than groups II and III at the 3-month and 12-month follow-up visits. The OCN of the three groups exhibited significant differences at all three follow-up visits. Groups I and II had significantly lower bite force than Group III at the three follow-up visits. At the 12-month follow-up visit, groups I and II had significantly higher wear than Group III.

CONCLUSIONS

As the duration of use increases, the occlusal contact area of complete dentures increases, regardless of the occlusal schemes. The bite force of lingualized occlusion is typically lower than that of bilateral balanced occlusion. The wear locations of artificial teeth differ between the two types of occlusal schemes. (Retrospectively registered: The Chinese Clinical Trial Registry, No. ChiCTR2300073420(11/07/2023)).

The Applications of 3D-Printing Technology in Prosthodontics: A Review of the Current Literature

Prosthodontics has become increasingly popular because of its cosmetic attractiveness. 3D printing has revolutionized prosthodontics, enabling the creation of high-quality dental prostheses. It creates detailed restorations, such as crowns, bridges, implant-supported frameworks, surgical templates, dentures, and orthodontic models. In addition, it saves production time but faces challenges such as elevated expenses and the requirement for innovative materials and technologies. This review gives insights into the uses of 3D printing in prosthodontics, presenting how it has significantly changed clinical practices. This article discusses different materials and techniques. Additionally, it showcases the capacity of 3D printing to improve prosthodontic practice and proposes prospects for future investigation.

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.

Maxillomandibular relationship record methods for computer-engineered complete dentures: a scoping review

OBJECTIVES

The purpose of this scoping review was to identify different methods employed for recording the maxillomandibular relationship (MMR) for computer-aided designed and manufactured (CAD-CAM) complete dentures (CDs).

MATERIALS AND METHODS

This scoping review followed the PRISMA-ScR guidelines and was developed according to Arksey and O'Malley and The Joanna Briggs Institute protocol. The methods were registered on the Open Science Framework (< osf.io/rf4xm> ). The focus question was: "What are the different techniques for recording the maxillomandibular relationship in the digital workflow used in CECDs?" Two investigators searched 3 online databases [MEDLINE (PubMed), Scopus, and Science Direct] independently. The inclusion criteria were clinical studies and reviews that assessed techniques for recording MMR using digital workflow for manufacturing of CECDs. A descriptive analysis was performed considering the study design, manufacturing system, clinical steps, and tools for the determination of MMR, and the difficulty level of procedures.

RESULTS

4779 articles were identified in the electronic search and 10 studies were included for data analysis. The review identified 4 commercially available CAD-CAM denture systems and 3 innovative methods suitable for abbreviating the number of appointments (2 to 4 visits). The trial denture is inherent to the procedure for the Baltic System and 3 innovative techniques. Three techniques (2 innovative and WholeYouNexteeth) demonstrated lower difficulty levels for performing the clinical procedures, regardless of the professional skills.

CONCLUSIONS

The commercially available and innovative techniques for the recording of MMR may provide predictability of the treatment. The techniques are effective, however, rely on the learning curve and the patient's clinical condition.

CLINICAL RELEVANCE

Recording of the maxillomandibular relationship is paramount for the manufacturing and functionality of complete dentures. Clinicians should be aware of the different tools and techniques described for registering the jaw relationship.

Parkinson's disease - The dentist's role as part of the healthcare team

Parkinson's disease is a neurodegenerative disease that results in patients exhibiting uncontrolled movements, changes in saliva production, and difficulty in swallowing and speech. Understanding the staging of the disease and the available therapies allows dentists to treat these patients safely and with compassion to meet their oral health care needs for an optimal quality of life. This appraisal discusses Parkinson's disease as it relates to clinically relevant facts to manage and treat the oral health care needs of these patients in the short and long term including general dental care recommendations. Important observations related to Parkinson's disease include disease causation,; stages, pharmacologic treatment, the effects on saliva, mastication, dysphagia, and aspiration pneumonia. Dental recommendations are made for the dentate, the partially edentulous, and the completely edentulous Parkinson's patients with a focus on late-stage concerns. Optimizing dental health will help maintain the quality of life as the disease progresses. In late stages of Parkinson's disease, dental treatment should focus on keeping the patient comfortable and out of pain.  While benign neglect is an often-used term, compassionate therapy in the late stages of Parkinson's disease is a more compelling term for defining the patient's needs.  Since dysphagia in Parkinson's patients has been underdiagnosed, neurologists must be aware of the important part that dentists play in the early diagnosis for these patients.  Early referral to a dentist is vital to mitigate the unfortunate consequence of the need for extensive dental care in late-stage patients.

In vitro comparison of antifungal activity of conventional alcohol sprays and antimicrobial photodynamic therapy on acrylic denture resin

BACKGROUND

Traditionally, alcohol sprays are used for disinfection of acrylic-base denture surfaces. A limited number of studies have assessed the role of antimicrobial photodynamic therapy (aPDT) in this regard; however, it remains debatable whether conventional alcohol sprays are superior to aPDT in terms of antifungal activity or vis versa.

OBJECTIVE

The aim of the present in vitro study is to compare the antifungal activity of conventional alcohol sprays and aPDT on acrylic denture resin.

METHODS

Individuals wearing complete dentures at least on one arch were included. Dentures were randomly divided into three groups. Groups 1-3 were disinfected with an alcohol-based antiseptic spray and aPDT, respectively. Assessment of oral yeast growth was done using swab samples. The culture mediums were incubated at 37∘C for 72 hours and viewed through a microscope. The numbers of colony forming units (CFU/ml) were determined. P< 0.05 were considered statistically significant.

RESULTS

At baseline, the mean CFU/ml in Groups 1-3 were comparable. After disinfection, a statistically significant reduction in microbial CFU/ml was observed in Groups 1 (P< 0.05) and 2 (P< 0.05) compared with baseline. In Group 3, there was no difference in CFU/ml throughout the study. After disinfection, there was no difference in microbial CFU/ml in dentures in Groups 1 and 2.

CONCLUSION

Conventional alcohol sprays are as effective as aPDT towards reducing oral yeasts CFU/ml on acrylic denture resin.

Fully digital workflow for replicating treatment dentures: A technique for jaw relation transfer and dynamic occlusal adjustment

This technique report presents a novel method of digitally replicating a treatment denture and converting it into a definitive denture. The procedure accurately duplicates the appearance of the mucosal surface and border of the treatment dentures, mounts the jaw relation on a virtual articulator to arrange artificial teeth, and optimizes the occlusion based on recorded mandibular motion tracks. This technique uses personalized jaw relation transfer and dynamic occlusal adjustment to establish balanced occlusion, which accomplishes the digital duplication of the treatment denture with high accuracy and minimal effort.

Clinical performance of and patient satisfaction with conventional complete dentures with different occlusal schemes: A systematic review of systematic reviews

STATEMENT OF PROBLEM

The complete denture occlusal scheme may influence clinical performance and patient satisfaction. However, a consensus on which occlusal scheme should be used for complete denture users is lacking. As a result, many dentists choose the scheme based on their preferences and clinical experience.

PURPOSE

The purpose of this review was to assess the methodological quality and summarize the scientific evidence from secondary studies about the influence of occlusal schemes on the clinical performance of and patient satisfaction with complete dentures.

MATERIAL AND METHODS

Ten sources were surveyed according to the patient, intervention, comparison, outcome (PICO) strategy. Systematic reviews that evaluated the clinical performance and patient satisfaction (O) of rehabilitated edentulous patients with conventional complete dentures (P) under different occlusal schemes (I/C) were included. Methodological quality was assessed by using A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 tool by 2 authors independently. The effect of each occlusal scheme in comparison with others was summarized and classified as positive, neutral, negative, or inconclusive based on the conclusions of the systematic review concerning clinical performance and patient satisfaction outcomes.

RESULTS

The search led to the inclusion of 10 systematic reviews. Seven were classified as of critically low, 2 as low, and 1 as moderate methodological quality. The following occlusal designs were included and analyzed: bilateral balanced occlusion, lingualized occlusion, canine guidance, group function, and monoplane occlusion. Bilateral balanced occlusion and canine guidance obtained satisfactory results for both outcomes. Lingualized occlusion showed a trend toward better results than other occlusal schemes for normal and resorbed ridges. Group function presented mainly inconclusive results, and monoplane occlusion did not deliver satisfactory outcomes.

CONCLUSIONS

The present overview concluded that occlusal schemes might interfere with the clinical performance of and patient satisfaction with complete dentures. Lingualized, bilateral balanced, and canine guidance are preferred compared with monoplane occlusion, but lingualized occlusion tends to show better results in some reviews. However, the results should be carefully considered because of the low quality of the systematic reviews included.

Comparison of Masticatory Efficiency and Patient Satisfaction of Injection-Molded Conventional Complete Dentures and Biofunctional Prosthetic System Dentures: A Parallel Randomized Clinical Trial

Introduction Complete loss of natural teeth severely compromises the masticatory efficiency of geriatric patients and directly affects their general health. Biofunctional prosthetic system (BPS) has been developed as an alternate method of denture fabrication to match the higher expectations of patients. Studies comparing BPS dentures with injection-molded conventional complete dentures (IM-CCD) are lacking. Our study aimed to compare the masticatory efficiency and patient satisfaction of BPS dentures with IM-CCD. Methods This trial was designed as a randomized, prospective, single-center, double-blinded study with two parallel arms (BPS group and IM-CCD group) having an equal allocation (1:1). Completely edentulous patients aged 45-80 who visited our outpatient department between January and August 2018 were screened and enrolled according to our inclusion and exclusion criteria. Random sequence generation was done using an online randomization program. Allocation concealment was done using sequentially labeled opaque envelopes. The participants and the outcome assessors were blinded. A single operator performed all the clinical procedures in both groups under the guidance of the instructor. The age and gender of the patients were recorded for demographic data at baseline. Primary outcomes were assessed six weeks after denture insertion. The number of denture adjustments required during the first six weeks after denture delivery was recorded as the secondary outcome. Masticatory efficiency was evaluated by the volumetric single-sieve method. An abbreviated version of the Oral Health Impact Profile questionnaire for edentulous patients (OHIP-EDENT) was used for patient satisfaction scores. The total OHIP-EDENT score was calculated by adding all the responses to the 19 questions (ranging from 0 to 38). Individual domain scores were calculated by adding the response to all the questions in that domain. All the data obtained were tested for normality using the Kolmogorov-Smirnov test. Data were analyzed using either unpaired Student's T-test or Mann-Whitney U test for normal and non-normal data, respectively. The gender characteristics of the sample were compared using Chi-Square test. Results Two patients in the IM-CCD group and one patient in the BPS group were lost to follow-up. Hence only the secondary outcome data were analyzed for these patients. Primary outcome data of patients who were lost to follow-up were excluded from the analysis. No significant differences (p>0.05) were found between the two groups for age and gender characteristics of the samples. Masticatory efficiency for both peanut and carrot was found to be significantly higher (p<0.05) in the BPS group than in the IM-CCD group. No significant differences (p>0.05) in the mean scores were observed between the two groups for total OHIP-EDENT scores or the individual domain scores. No significant differences (p>0.05) were observed between the groups for the number of denture adjustments done. Conclusion Within the limitations of the trial, it can be concluded that the BPS dentures significantly improved the masticatory efficiency for both hard (carrots) and soft (peanuts) foods compared to the IM-CCD. However, there was no difference between the masticatory-related complaints domain scores between the two dentures. No significant differences were found between BPS dentures and IM-CCD with respect to overall patient satisfaction scores or post-insertion denture adjustments.

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.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2021 dental literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to coverage of this broad topical area. Specific subject areas addressed, in order of the appearance in this report, include COVID-19 and the dental profession (new); prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence daily dental treatment decisions with an emphasis on future trends in dentistry. With the tremendous volume of dentistry and related literature being published daily, this review cannot possibly be comprehensive. Rather, its purpose is to update interested readers and provide important resource material for those interested in pursuing greater details on their own. It remains our intent to assist colleagues in negotiating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the patients and dental problems they encounter.

Linear Dimensional Change in Acrylic Denture Teeth Positions Factored by Different Processing Techniques and Occlusal Forms: An In Vitro Study

The current literature lacks substantial evidence for the effect of denture base processing techniques and posterior denture tooth forms on denture tooth shifts due to denture base resin polymerization. The aim of this study was to evaluate the combined effect of PMMA-based denture processing techniques (compression packing and injection molding) and posterior tooth forms (semi-anatomic and non-anatomic) on the linear dimensional shift of denture teeth following denture processing in both horizontal and vertical dimensions. Two different complete denture fabrication techniques were used to prepare forty ideal maxillary complete dentures using two different types of posterior tooth forms. The used fabrication techniques were conventional heat polymerized compression packing and injection molding. The posterior tooth forms used in the current study were non-anatomic tooth (0 degrees) and semi-anatomic tooth forms (approximately 20 degrees). Initial linear measurements (vertical and horizontal) were taken from pre-specified points for the central incisor and first molar. Specimens were randomly divided into four groups (n = 10), and denture processing was performed using the two techniques. Final linear measurements were recorded. The linear change in dimension for all six parameters was calculated by deducting the after values from the before values. Since the discrepancies were both positive and negative in magnitude, the absolute value of the difference was taken for further analysis. This value represents the dimensional change. T-tests were used to compare the mean dimensional changes. Furthermore, the mean dimensional changes for all the six parameters were compared using a two-way analysis of variance. The alpha error was set at 5%, and a p-value of less than 0.05 was considered statistically significant. The injection molding technique showed significantly fewer tooth movements in both the vertical and horizontal measurements as compared to the conventional compression packing technique. The non-anatomic tooth showed significantly fewer changes in tooth movement as compared to semi-anatomic teeth in both the compression and injection techniques. This study can guide the selection of a proper processing technique for a particular posterior tooth form, thus minimizing occlusal discrepancies and reducing occlusal corrections during laboratory and clinical remount procedures.

The Neutral Zone Approach with CAD/CAM Record Bases

Lack of adequate retention, support, and stability in the complete denture can be attributed to a poor fit or incorrect shape of the polished surfaces. This article presents a case using the neutral zone technique effectively with the fabrication of computer-aided design and computer-aided manufacturing (CAD-CAM) record bases in an edentulous patient with severely resorbed alveolar ridges and discusses the overall treatment steps and clinical implications of this technique. A stable neutral zone and an accurate jaw relation were recorded using CAD-CAM record bases and stability of complete denture was optimized by arranging denture teeth and reforming polishing surfaces in the neutral zone. A new complete denture was fabricated for a patient with atrophic alveolar ridges by a technique utilizing the neutral zone with CAD-CAM record bases. This article is protected by copyright. All rights reserved.

Edentulous Patient Satisfaction with Conventional Complete Dentures

Background and Objectives: Edentulism is considered to be an impediment impacting both patients’ quality of life and their nutrition. Conventional complete dentures are still a preferred treatment. However, there is no consensus on the most important factors which could substantially reduce the risk of patient dissatisfaction. This study evaluated the following determinants concerning patient satisfaction with complete maxillary and mandibular dentures: sex, denture-related functional and aesthetic aspects, and the degree of bone resorption. Materials and Methods: This study included 70 patients aged 34–81 years of age. All complete dentures were made by following the same technology. Visual analogue scales were used to assess patients’ overall satisfaction with dentures, comfort, ability to speak and chew, denture aesthetics, stability, and ease of prosthesis cleaning. Satisfaction with upper and lower dentures was rated separately. The degree of bone resorption was classified by using the Kalk and de Baat (1989) method. Results: The mean (SD) age of the study participants was 67.3 (10.4) years; 65.7% (n = 46) were females and 34.3% (n = 24) were males. There were no significant sex-based differences in resorption of the maxilla or mandibula. There were significant differences between maxillary and mandibular dentures, with lower mean satisfaction scores concerning chewing and maxillary complete dentures, and in regard to stability and comfort for mandibular complete dentures. There was a non-significant overall lower satisfaction with increased age. In multivariate analysis for mandibular complete dentures, aesthetics and stability significantly predicted the patient’s comfort levels, and the patient’s comfort significantly predicted overall satisfaction. For maxillary complete dentures, patient comfort and aesthetics significantly predicted overall patient satisfaction. Conclusions: Age, sex, and degree of resorption were not associated with patient satisfaction with complete dentures. Overall, patient satisfaction with both maxillary and mandibular complete dentures was related to their comfort level and denture aesthetics, and patient comfort itself was associated with stability of the mandibular denture.