Reducing the risk of failure in complete denture patients

A completely digital workflow aided by cone beam computed tomography scanning to maintain jaw relationships for implant-supported fixed complete dentures: A clinical study

STATEMENT OF PROBLEM

The conventional workflow for the fabrication of implant-supported fixed complete dentures (IFCDs) is complex and makes it impossible to maintain jaw relationships. A fully digital workflow might solve this problem.

PURPOSE

The purpose of this clinical study was to develop a completely digital workflow aided by a cone beam computed tomography (CBCT) scan for the fabrication of IFCDs and to evaluate the accuracy of this workflow with regard to the maintenance of jaw relationships.

MATERIAL AND METHODS

All participants received a preoperative CBCT scan while wearing radiographic diagnosis dentures and occluding in the maximum intercuspal position. After the implant surgery, CBCT scanning, intraoral scanning, and stereophotogrammetry were performed to identify jaw anatomy, soft tissue, and the 3-dimensional (3D) locations of the implants, respectively. Then, all data were merged to transfer jaw relationships and generate digital casts to fabricate interim prostheses. A posttreatment CBCT scan was performed while the participants were wearing the interim prostheses and occluding in the maximum intercuspal position. The preoperative and postoperative jaw relationships were compared by CBCT cephalometric analysis. A meaningful and unacceptable difference was defined as 0.8 degrees and 2.4 degrees, respectively.

RESULTS

Six participants (6 jaw relationships, 9 arches, and 58 implants) were included. All interim prostheses were stable and achieved symmetric occlusion after only minimal adjustment. A total of 18 angles were measured. Three angles revealed a meaningful minimal difference, and 1 angle revealed an unacceptable minimal difference. No prosthodontic complications were reported during the study.

CONCLUSIONS

A completely digital workflow for fabricating IFCDs achieved sufficient accuracy for the maintenance of jaw relationships throughout the treatment.

Estimation of IZOD impact strength between different concentrations of chitosan-reinforced denture base resins

Background

Poly-methyl methacrylate (PMMA) is an universally acceptable denture base material. Efforts are made to increase the applications with the addition of new constituents. Chitosan has established antifungal properties. The mechanical properties of Chitosan-denture base composite is less evaluated in the literature. This study estimates the differences in impact strength of material for different concentrations of chitosan-reinforced denture base resins.

Aim

The study estimated the differences in IZOD impact strength of denture base resin reinforced with 0%, 5%, 10% and 15% of chitosan by weight.

Materials and Methods

The acrylic samples were fabricated in according to ISO 180 regulations. The study had four test groups (n = 10). ACh0 was the control group with no reinforcements. ACh5, ACh10 and ACh15 had chitosan reinforcement of 5%, 10% and 15% by weight. The samples were processed by conventional heat polymerization cycle and tested in IZOD impact testing machine. The data were recorded and statistically analyzed with Kruskal-Wallis test.

Results

The mean impact strength was high in ACh5 (4.25 ± 1.05 kJ/m²) compared to ACh0 (2.88 ± 0.60 kJ/m²), ACh10 (3.63 ± 0.40 kJ/m²), ACh15 (3.38±0.60 KJ/m²). Statistically significant differences between the test groups was determined by Kruskal-Wallis and post hoc Bonferroni test (Chi-square = 12.843, P = .005, df = 3).

Conclusion

The impact strength of denture base resin increased with 5% chitosan compared with other percentage of chitosan. No statistical significant relationship was observed between the groups.

Mechanical properties and surface roughness of chitosan reinforced heat polymerized denture base resin

PURPOSE

The antifungal property of chitosan (Ch) in denture base resin (DBR) was well established. Ch influence on the mechanical properties of DBR is less studied in the literature and is vital for clinical success of denture. This study estimates the effect of different concentrations of Ch on the flexural strength (FS), fracture toughness (FT), impact strength (IS) and surface roughness (Ra) in heat polymerized DBR.

METHODS

A total of 160 samples were divided into 4 groups (n =10) by weight percentage - Ch 0, Ch 5, Ch 10, Ch 15. FS and FT were estimated by three-point bending test. IS was determined by Charpy test. Ra was evaluated by non-contact laser surface profilometer. The tested samples were characterized by scanning electron microscope and Fourier transformation infra-red spectroscopy. Data were statistical analyzed with one-way ANOVA and Post hoc Bonferroni test.

RESULTS

FS, FT and IS improved with Ch addition when compared to control group. Ch5 showed higher "FS, FT, IS. (p<0.001)". Increased Ra was observed in Ch5 and Ch10 with significant statistical differences among the g roups. (p <0.001) Ch15 displayed decrease in Ra compared to control group.

CONCLUSIONS

The addition of Ch to DBR improved the "FS, FT, IS at 5%wt and Ra at 15%wt" of Ch.

A pilot study of digital recording of edentulous jaw relations using a handheld scanner and specially designed headgear

The present study aimed to establish and evaluate a method for recording edentulous jaw relations digitally without occlusal bases, using a handheld scanner and specially designed headgear. The headgear maintained the mandibular position. Ten edentulous patients’ upper (U) and lower edentulous jaw models (L) were prepared and scanned. A handheld scanner was used to capture the labial alveolar ridge mucosa relations in the upper and lower anterior arches directly (Dr). U and L were registered to Dr (test group). Complete dentures of patients in the intercuspal position were used to construct the relationship between U and L (control group). Differences in jaw relations in the test and control groups, in terms of vertical difference, displacement and rotation of the anterior and posterior, and displacement and rotation of the left and right were assessed using the Hotelling’s T² test. The differences in the mean values and the mean of the absolute values of the jaw relations between groups were not statistically significant (P = 0.331) and significant (P = 0.016), respectively. Our findings show that it is possible to make digital recording of edentulous jaw relations by using a handheld scanner and headgear.

Final-impression techniques and materials for making complete and removable partial dentures

BACKGROUND

Edentulism is relatively common and is often treated with the provision of complete or partial removable dentures. Clinicians make final impressions of complete dentures (CD) and removable partial dentures (RPD) using different techniques and materials. Applying the correct impression technique and material, based on an individual's oral condition, improves the quality of the prosthesis, which may improve quality of life.

OBJECTIVES

To assess the effects of different final-impression techniques and materials used to make complete dentures, for retention, stability, comfort, and quality of life in completely edentulous people.To assess the effects of different final-impression techniques and materials used to make removable partial dentures, for stability, comfort, overextension, and quality of life in partially edentulous people.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 22 November 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Register of Studies, to 22 November 2017), MEDLINE Ovid (1946 to 22 November 2017), and Embase Ovid (21 December 2015 to 22 November 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on language or publication status when searching the electronic databases, however the search of Embase was restricted by date due to the Cochrane Centralised Search Project to identify all clinical trials and add them to CENTRAL.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) comparing different final-impression techniques and materials for treating people with complete dentures (CD) and removable partial dentures (RPD). For CD, we included trials that compared different materials or different techniques or both. In RPD for tooth-supported conditions, we included trials comparing the same material and different techniques, or different materials and the same technique. In tooth- and tissue-supported RPD, we included trials comparing the same material and different dual-impression techniques, and different materials with different dual-impression techniques.

DATA COLLECTION AND ANALYSIS

Two review authors independently, and in duplicate, screened studies for eligibility, extracted data, and assessed the risk of bias for each included trial. We expressed results as risk ratios (RR) for dichotomous outcomes, and as mean differences (MD) or standardised mean differences (SMD) for continuous outcomes, with 95% confidence intervals (CI), using the random-effects model. We constructed 'Summary of findings' tables for the main comparisons and outcomes (participant-reported oral health-related quality of life, quality of the denture, and denture border adjustments).

MAIN RESULTS

We included nine studies in this review. Eight studies involved 485 participants with CD. We assessed six of the studies to be at high risk of bias, and two to be at low risk of bias. We judged one study on RPD with 72 randomised participants to be at high risk of bias.Overall, the quality of the evidence for each comparison and outcome was either low or very low, therefore, results should be interpreted with caution, as future research is likely to change the findings.Complete denturesTwo studies compared the same material and different techniques (one study contributed data to a secondary outcome only); two studies compared the same technique and different materials; and four studies compared different materials and techniques.One study (10 participants) evaluated two stage-two step, Biofunctional Prosthetic system (BPS) using additional silicone elastomer compared to conventional methods, and found no evidence of a clear difference for oral health-related quality of life, or quality of the dentures (denture satisfaction). The study reported that BPS required fewer adjustments. We assessed the quality of the evidence as very low.One study (27 participants) compared selective pressure final-impression technique using wax versus polysulfide elastomeric (rubber) material. The study did not measure quality of life or dentures, and found no evidence of a clear difference between interventions in the need for adjustments (RR 0.81, 95% CI 0.38 to 1.70). We assessed the quality of the evidence as very low.One study compared two stage-two step final impression with alginate versus silicone elastomer. Oral health-related quality of life measured by the OHIP-EDENT seemed to be better with silicone (MD 7.20, 95% CI 2.71 to 11.69; 144 participants). The study found no clear differences in participant-reported quality of the denture (comfort) after a two-week 'confirmation' period, but reported that silicone was better for stability and chewing efficiency. We assessed the quality of the evidence as low.Three studies compared single-stage impressions with alginate versus two stage-two step with elastomer (silicone, polysulfide, or polyether) impressions. There was no evidence of a clear difference in the OHIP-EDENT at one month (MD 0.05, 95% CI -2.37 to 2.47; two studies, 98 participants). There was no evidence of a clear difference in participant-rated general satisfaction with dentures at six months (MD 0.00, 95% CI -8.23 to 8.23; one study, 105 participants). We assessed the quality of the evidence as very low.One study compared single-stage alginate versus two stage-two step using zinc-oxide eugenol, and found no evidence of a clear difference in OHIP-EDENT (MD 0.50, 95% CI -2.67 to 3.67; 39 participants), or general satisfaction (RR 3.15, 95% CI 0.14 to 72.88; 39 participants) at six months. We assessed the quality of the evidence as very low.Removable partial denturesOne study randomised 72 participants and compared altered-cast technique versus one-piece cast technique. The study did not measure quality of life, but reported that most participants were satisfied with the dentures and there was no evidence of any clear difference between groups for general satisfaction at one-year follow-up (low-quality evidence). There was no evidence of a clear difference in number of intaglio adjustments at one year (RR 1.43, 95% CI 0.61 to 3.34) (very low-quality evidence).

AUTHORS' CONCLUSIONS

We conclude that there is no clear evidence that one technique or material has a substantial advantage over another for making complete dentures and removable partial dentures. Available evidence for the relative benefits of different denture fabrication techniques and final-impression materials is limited and is of low or very low quality. More high-quality RCTs are required.

Managing the Unstable Mandibular Complete Denture – Tooth Placement and the Polished Surface

Constructing satisfactory conventional mandibular complete dentures is often challenging in comparison to the upper counterpart partially due to differences in the anatomy of the denture-bearing area. This problem is exaggerated in the atrophic mandible, where supporting structures are frequently ill-defined and suboptimal in quality. Implant-retained prostheses offer well recognized benefits but are not always a feasible options, so conventional methods must be relied upon. The importance of impression quality and registration has been reviewed previously. This article aims to discuss the influence of tooth placement, the polished surfaces and the neutral zone on the success of lower dentures. Clinical relevance: This article highlights the importance that polished surface contouring and tooth prescription can have on the outcome of lower dentures. Techniques for assessing and recording the neutral zone are explained, along with alternative occlusal schemes.

Training Plates: A Solution for Patients Unable to Tolerate a Removable Prosthesis

Dealing with patients who are unable to tolerate dentures can present a challenge to the general dental practitioner (GDP). Careful assessment of patients and their dentures will identify any causes of the intolerance to dentures. Training plates are a useful technique that can be used to allow patients to become accustomed to removable prosthesis but will inevitably lengthen the treatment process. CPD/Clinical Relevance: Training plates offer a possible solution to general dental practitioners who treat patients who are struggling to tolerate dentures.

Functional Impressions in Complete Denture and Overdenture Treatment

Tooth loss can cause loss of occlusal, masticatory, esthetic, physiognomic, phonetic and psychosocial function of patients. The most frequently used treatment method of completely edentulous patients and patients with a small number of remaining teeth are complete dentures or overdentures. One of the most important clinical and laboratory procedures in their fabrication is functional impression taking. The aim of this paper was to present procedures of taking functional impressions in fabrication of complete dentures and overdentures, using standardized techniques and materials. An accurate functional impression together with other correctly performed clinical and laboratory procedures ensure good retention and stability of dentures, which is a precondition for restoring patients' lost functions.

Complete dentures revisited

The aim of the article is to assist practitioners in the diagnosis and management of complete denture problems by addressing the problems from a theoretical viewpoint and in a clinically diagnostic way.

CLINICAL RELEVANCE

To assist practitioners and undergraduates to understand the clinical basis of complete denture prosthodontics.