Exploring lived experiences on the usage of removable complete dentures among edentulous patients attending Makerere University Dental Hospital, Kampala, Uganda

BACKGROUND

Edentulism remains a major disability worldwide, especially among the elderly population, although the prevalence of complete edentulism has declined over the last decades. In Uganda, the prevalence of edentulism in people aged 20 years and above is 1.8%. The therapy for edentulous patients can be realized through the use of conventional removable complete dentures, implant-supported prostheses, and computer-aided design and computer-aided manufacturing (CADCAM), however, the provision of removable complete dentures continues to be the predominant rehabilitation for edentulous patients. However, no published study has explored the lived experiences with removable complete dentures among the Ugandan population. The aim of the present study was to explore patients' lived experiences on the usage of removable complete dentures among Ugandan edentulous patients attending Makerere University Dental Hospital.

METHODS

This was a qualitative study approach using purposive sampling. Fifteen (15) respondents were selected across social demographics. Interviews were recorded and transcribed and themes were generated to draw a deeper meaning to the usage of removable complete dentures. A qualitative statistical package, Atlas Ti software was used to generate themes from the interviews followed by an interpretation of the generated data and the results were presented as text and in a table.

RESULTS

The reported key positive experiences due to removable complete denture rehabilitation were the improvement in speech, eating ability, regaining good facial appearance, better oral hygiene management, self-esteem and confidence to smile in public, and a feeling of completeness. However, respondents complained of pain and discomfort due to the looseness of dentures, inability to eat certain foods, and regular cleaning of dentures. The respondents did not go through proper informed consent processes before getting removable complete dentures.

CONCLUSION

The study found that patients were satisfied with their removable complete dentures rehabilitation due to the positive experiences registered, such as the ability to eat and talk well, and restoration of self-esteem, all of which improved their quality of life. However, they experience pain and discomfort due to the looseness of dentures.

Effect of repair and surface treatments on the strength of digitally fabricated resin-based dental prostheses: A systematic review of in vitro studies

OBJECTIVE

This review investigated the current literature pertaining to the repairability of computer-aided design-computer-aided manufacturing (CAD-CAM) milled and three-dimensional (3D) printed resin-based dental prostheses (RBDPs) as well as the appropriate surface treatment for each repair material that will produce adequate repair bond strength.

DATA/SOURCES

PubMed, Web of Science, and Scopus databases were searched for published articles involving repair of CAD-CAM RBDPs between January 2010 and June 2023. Data were collected and analyzed to reveal the surface treatment effects, suggested repair materials, and strength of repaired RBDPs.

STUDY SELECTION

Out of 164 retrieved titles, 11 studies were included, of which five investigated the repair of 3D-printed RBDPs, three investigated the repair of CAD-CAM milled resins, and three investigated both materials. Additionally, of the included studies, seven investigated denture base resins, three studied provisional restoration resins, and one evaluated 3D-printed intraoral splints. Various surface treatments were suggested, with air-abrasive methods being the most commonly used. Different materials for resin repair were proposed and used, including auto-polymerized, reline, and composite resins. For 3D-printed resins, repair with Bis-acrylic/Bis-GMA composites improved repair strength.

CONCLUSION

Surface treatments positively affected the repair strength of conventional and milled RBDPs. However, challenges remain relevant to the repair of 3D-printed resins owing to composition mismatches and fabrication techniques. Therefore, further investigation is required to develop new 3D-printed resins.

CLINICAL SIGNIFICANCE

CAD-CAM milled resins have satisfactory repair strength, which increases with surface treatment. The repair of 3D-printed resins has proven challenging even with surface treatments. However, composite resins are the materials of choice.

The Effect of Several Factors on the Patient's Satisfaction with the Complete Dentures and the Correlation with the Adaptation Period

OBJECTIVE

A great number of patients are completely satisfied with a regular denture, on the other hand, numerous patients are still not satisfied with their denture functions despite proper denture manufacture in relation to prosthetic standards.

AIM

To estimate the parameters of satisfaction for patients to improve the health care quality of patients and evaluate the effect of the adaptation period.

MATERIALS AND METHODS

A total of 136 patients who participated in this study were patients with complete dentures (CD), after placement of the CD, the patients were asked some questions (about esthetics, phonetics, comfort, quality of fit, and the masticatory efficiency) and the satisfaction of patients was evaluated by using Likert's scale, then recorded four readings, first at the placement visit, second after 1 month, third after 45 days, and last after 2 months.

RESULTS

The female patients' satisfaction related to phonetics was about 37.8% at the placement visit, but about 91.2% after 2 months; the male patients' satisfaction related to phonetics was about 44% at the placement visit, then 94.6% after 2 months; the female patients' satisfaction as related to esthetics was about 56.6% at the placement visit, but was about 89.8% after 2 months; the male patients' satisfaction as related to esthetics was about 68% at the placement visit, but about 89.4% after 2 months.

CONCLUSION

The satisfaction of the patient with their CD is affected by many factors such as phonetics, esthetics, comfort levels, the quality of fitness of the denture, and the mastication. The differences between gender in satisfaction in all parameters were non-significant, that is, p > 0.001. The adaptation period has an effect on the satisfaction rate of the completely edentulous patient with their CD.

Comparison of case-based learning combined with Rain Classroom teaching and traditional method in complete denture course for undergraduate interns

BACKGROUND

Complete denture, as an important restoration method for edentulism, is difficult to study for beginners, especially in linking the theory with clinical practice.

OBJECTIVE

This study was aimed to compare the teaching effects between case-based learning combined with Rain Classroom teaching and traditional lecture method in the clinical course of complete denture prosthesis for undergraduate interns.

METHODS

In a course called "Problems and treatment strategies of complete denture after wearing", interns were divided into two groups: one for traditional lecture-based teaching with PowerPoint slideshow (the control group, n = 28); and the other for case-based learning combined with Rain Classroom teaching, which published information before class, discussed specific clinic cases in class and got real-time interns' feedback via WeChat (the test group, n = 22). Both groups received the same exam and questionnaire survey after class. The Q&A participation of interns in class, theoretical test scores and questionnaire survey responses were used to evaluate the teaching effects. An independent sample t-test and the chi-square test or Fisher's exact test were used for statistical analysis in this study.

RESULTS

The Q&A participation of interns in the test group was much better than that of the control group. The average score on the theoretical test after class in the test group (72.14 ± 12.24) was significantly higher than that in the control group (61.29 ± 20.12) (P < 0.05). In the test group, 94.54% (21/22) of the interns preferred the new teaching mode.

CONCLUSION

Case-based learning combined with Rain Classroom teaching is helpful to enliven the classroom atmosphere, inspire studying enthusiasm, and achieve a good learning effect in both theory and clinical practice related to complete denture prosthesis.

Comparative cost analysis of different prosthetic rehabilitations for the edentulous maxilla: early results from a randomized clinical pilot study

Objectives/aim

To analyze and compare costs of different prosthetic rehabilitations for the edentulous maxilla.

Materials and methods

Patients with edentulous maxillae were rehabilitated with either of three implant-supported prosthetic protocols; removable overdenture supported by 2 implants (ISOD 2), fixed dental prostheses supported by 4 (ISFAFDP 4) or 6 (ISFAFDP 6) implants. Cost of treatment and costs during follow-up were registered and compared.

Results

Twenty-four patients were included: six patients received ISOD 2 treatment, eight patients received ISFADP 4 treatment and ten patients received ISFADP 6 treatment. Initial costs for ISFAFDP 6 were higher than costs for ISFAFDP 4 and ISOD 2, but there were no differences in cost for maintenance i.e., the ISOD treatment remained the least costly treatment alternative after 1-year follow-up.

Discussion

The lack of difference in cost for maintenance and repair over the first year suggests that implant-supported overdentures will remain the least costly treatment option for the edentulous maxilla, at least in a short-term perspective.

Conclusions

Removable maxillary overdentures supported by 2 implants may be a valid low cost treatment option.

Determination of occlusal connections in patients with congenital cleft lip and palate before and after their orthopedic rehabilitation

The aim of this study was to define and analyze the reproducibility of occlusal relationships according to the results of occlusogram in jaw closure using quantitative analysis of occlusion in adult patients with congenital cleft lip and palate before and after their prosthesis with different versions of dentures and types of their constructive features. Materials and methods. The study was conducted on 37 patients with congenital cleft lip and palate, 11 (29.73 %) of whom had right-sided clefts, 11 (29.73 %) – left-sided and 15 (40.54 %) – bilateral. The number of occlusal contact points was measured for all patients before the treatment and after the orthopaedic rehabilitation. Research results. Significant differences were found between the number of occlusal contact points before (unusually small number) and after orthopaedic treatment (significant increase), regardless of the type of cleft (p<0.001). Such conditions in the oral cavity significantly complicate the tactics of orthopaedic rehabilitation, which affects the need to find more complex options for combinations of fixed and removable orthopaedic structures. Conclusion. Based on the conditions and objectives of this study, the application of the basic principles of a multidisciplinary approach determine the possibility of rehabilitation of such patients by orthopedic methods by making different versions of orthopedic structures. Adequate and high-quality prosthesis for defects and deformations of the teeth rows and occlusion in patients with CCLP leads to improved occlusal relationships and increase in the number of occlusal contact points.

Factors associated with edentulous patients' willingness about implant-supported complete denture: a multivariate analysis

OBJECTIVE

The aim of this study was to evaluate the factors influencing edentulous patients' willingness about mandibular implant-supported complete denture.

MATERIALS AND METHODS

A cross-sectional study was carried out with 117 bimaxillary edentulous patients wearing removable complete dentures (CDs). Patients were assessed concerning denture-related items (number of previous mandibular CDs, previous denture wearing period, dentures maker professional, and regular wearing of previous mandibular dentures) and individual-related aspects, such as mandibular edentulousness period, mandibular bone height, and willingness to the use of mandibular implant-supported complete denture. Masticatory performance was evaluated by the median particle diameter. Mandibular bone height and satisfaction were assessed using a validated method. The Chi-square test was used for data analysis and prevalence ratios were adjusted by using multivariate Poisson regression, both with 95% confidence interval.

RESULTS

A total of 78 participants (66.7%) were interested in mandibular implant-supported overdenture (mean age 65.33 ± 9.49). Masticatory performance was not influenced by choosing mandibular implant-supported complete denture. The preference about mandibular implant-supported complete denture was correlated with longer mandibular complete denture experience (p = 0.021) and it was significantly associated with dissatisfaction about retention (p = 0.005).

CONCLUSION

Previous experience with mandibular complete dentures and dissatisfaction about retention influence the willingness about mandibular implant-supported overdenture.

CLINICAL RELEVANCE

Many factors are associated with rehabilitation preferences for edentulous patients and mandibular implant-supported complete denture is one of the available alternatives. Therefore, this study has demonstrated the factors influencing the decision to replace a mandibular conventional complete denture by dental implant treatment based on patient's outcomes. Such finding may be considered as a relevant aspect towards shared decision-making for prosthodontic rehabilitation of edentulous patients.

Multivariate analysis reveals oral health-related quality of life of complete denture wearers with denture adhesives: a multicenter randomized controlled trial

Purpose To investigate the difference in improvement of oral health-related quality of life (OHR-QoL) depending on the oral and denture conditions of a complete denture wearer when using a cream or powder type denture adhesive in a 10-center parallel randomized clinical trial.Methods Two hundred edentulous subjects who wore complete dentures were allocated to each of the three groups according to denture adhesive type: cream, powder, and control (saline solution). The materials were applied to the mucosal surface of the dentures for 4 days, and baseline data and data after the intervention were collected. OHR-QoL was assessed using the Japanese version of the modified Oral Health Impact Profile for Edentulous Patients (OHIP-EDENT-J) scale for outcome. Multivariate analysis was used to investigate improvements in OHR-QoL according to participant characteristics among complete denture wearers using these materials.Results OHIP-EDENT-J scores were significantly decreased in all groups after the intervention (p < 0.05); however, there were no statistically significant differences among the groups. Multiple logistic regression analysis revealed a significant association between the vertical height of the maxillary and mandibular alveolar ridge and OHIP-EDENT-J scores in the cream-type denture adhesive group. In contrast, there were no significant association between participant characteristics and OHIP-EDENT-J scores in the powder-type adhesive and control groups.Conclusions The use of denture adhesives could improve OHR-QoL for complete denture wearers. The cream-type denture adhesives may be expected to improve OHR-QoL in patients with poor residual ridge conditions compared with patients with good residual ridge conditions.

Occlusal Vertical Dimension: Best Evidence Consensus Statement

PURPOSE

Patients in need of extensive prosthodontic treatment may need restoration of their occlusal vertical dimension (OVD) due to tooth wear, tooth loss, or changes that have occurred to existing prostheses over time. Prosthodontic treatment is based on the clinical application of the available evidence regarding interocclusal distance (IOD), the positional stability of rest vertical dimension (RVD), and the effect of altering the OVD. Hence, the purpose of this consensus document is to examine available data related to IOD, RVD, and alteration of the OVD.

MATERIALS AND METHODS

The search was limited to Clinical trials, Randomized Controlled Trials, Systematic Reviews and Meta-analyses. Key words were healthy patient, mean, range, interocclusal rest distance; healthy patient, mean, range, freeway space; and dentistry, interocclusal gap, and no citations appeared. Dentistry, interocclusal distance, revealed 5 not relevant citations. Dentistry, inter occlusal rest space, and dentistry, interocclusal rest distance, both had the same single not relevant citation. Dentistry, freeway space revealed over 7,000 citations. Dentistry, occlusal vertical dimension, revealed 253 citations, 7 of which were related to the search question but only 1 which was different from the previous search. Mandible, rest vertical dimension, age changes, found 7 citations, none relative to the question. Expanding the search to include journal article found 260 citations with only one relevant to the question. Mandible, rest vertical dimension, alteration, harm revealed no citations; mandible, occlusal vertical dimension, alteration, revealed 15 citations, 1 of which was relevant; mandible, occlusal vertical dimension, changes, revealed 75 citations, none of which were relevant; mandible, occlusal vertical dimension, rehabilitation revealed 10 citations, none of which were relevant. Expanding the search strategy to include Journal article, mandible, occlusal vertical dimension, alteration, received 159 citations, 4 of which were relevant; mandible, occlusal vertical dimension, restoration revealed 208 citations, 1 of which was relevant. Numerous other articles were culled by going through the reference lists of the aforementioned articles.

RESULTS

For IOD, 27 articles were found relevant to the search question, which confirmed a mean of 3.0 mm with ranges from 1 to 9 mm. Five articles revealed little evidence as to whether the RVD changes during life. For OVD, 20 articles, including 4 systematic reviews, revealed some evidence that skeletal growth continues from mid adolescence into mid adulthood; strong anecdotal evidence that some unopposed teeth will continue to erupt; no clinical evidence to support the concept that abraded teeth in occlusion in a patient with bruxism will undergo continuous eruption; and some evidence from clinical case reports that restoring OVD in patients with severe abrasion is a successful treatment.

CONCLUSIONS

There is a range of dimensions for the interocclusal distance (IOD) with many normal dental patients functioning with a higher or lower IOD than the commonly used 3.0 mm average dimension. The resting vertical dimension (RVD) is a 3-dimensional range with little evidence related to changes in the RVD during life. However, aging can cause a decrease in muscle tone which could affect the RVD. The restoration of the OVD can be successfully accomplished if proper diagnosis and treatment planning are performed.

Preprosthetic Management of "Flabby Ridge" on Edentulous Patient

For edentulous patients, the integrity of the osteomucosal-bearing surface is a significant factor for the balance of the future removable prosthesis. The supporting tissues are influenced by several factors. Physiological bone resorption, senescence, and changes caused by systemic diseases and polypharmacy lead to modifications in these tissues. Similarly, trauma caused by an ill-fitted prosthesis influences the degree of bone resorption and the development of hyperplastic tissue. The etiology of bone resorption is multifactorial and complex, with continuous individual variations that are often unexplained. Although, no study has been able to establish the importance of the different factors in relation to each other, it is often reported that chronic excessive mechanical pressure in relation to occlusal constraints is responsible for the appearance of local resorption's areas. The aim of this work is to present, through three clinical cases, the various factors involved in the alteration of the osteomucous-bearing surface and eventually, possible therapeutic attitude to deal with.

Comparison of Canine-Guided Occlusion with Other Occlusal Schemes in Removable Complete Dentures: A Systematic Review

Choosing an adequate occlusion is challenging during the construction of artificial dentures, and critical for patient satisfaction. However, there is no conclusive evidence to support which occlusal design is more appropriate. The aim of this systematic review was to evaluate canine-guided occlusion in comparison to other occlusal schemes in removable complete denture wearers. The review was conducted according to the Preferred Reported Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. An extensive search was carried out on (PubMed (National Library of Medicine)), Scopus (Elsevier), Cochrane collaboration (Wiley), Science Direct (Elsevier) and Europe PMC (European Bioinformatics Institute). English and non-English studies were identified using keywords on canine-guided occlusion, denture occlusion, dental occlusion and artificial occlusal schemes. Out of 1759 articles searched, 18 were selected based on the inclusion criteria. The included studies were interpreted for the descriptive analysis for the calculation of occlusal schemes, occlusion assessment parameters, the outcome of the occlusal schemes and types of removable prosthesis used. The systematic analysis of occlusal schemes revealed that canine-guided occlusion is viable compared with other occlusal designs in terms of patient satisfaction, mastication, retention, esthetics, phonetics, oral-health-related quality of life and muscle activity. The type of occlusal scheme influences the complete denture patient’s’ masticatory efficiency, satisfaction, retention, phonetics and esthetics. Nevertheless, physical, physiological, mechanical and psychological factors play a vital role in the success of removable complete dentures. The canine-guided occlusal scheme is preferred because of its simplicity, less time consumption, good masticatory performance, ease of fabrication and modification into bilateral balanced occlusion if required. Further studies are required to reduce the controversies related to jaw relations, gnathology and occlusal schemes in complete dentures.

Evaluating the role of local host factors in the candidal colonization of oral cavity: A review update

Human oral cavity is home to a number of organisms, Candida albicans being one of them. This review article aims at understanding the correlation between the oral candidal colonization and the local host factors that may influence it with special emphasis on congenital craniofacial anomalies such as cleft lip and palate (CLP). Various scientific databases were searched online and relevant articles were selected based on the inclusion criteria. A comparative study was done to understand the interdependence of various factors (including CLP) and oral candidal colonization. The results revealed a strong association of certain local host factors which may influence the oral colonization of Candida species. Factors such as mucosal barrier, salivary constituents and quantity of saliva, congenital deformities like CLP, oral prostheses such as dentures/palatal obturators and fixed orthodontic appliances (FOAs) were identified. All these factors may directly affect the growth of Candida in the oral cavity. Although numerous studies have pointed a positive correlation between Oral Candidal colonization and local host factors such as oral prostheses, FOA, and oral mucosal barrier only one study has been done, in the Indian subcontinent with respect to the correlation of candidal colonization and CLP. After the evaluation of all the factors mentioned in various case studies, it can be concluded that the presence of local host factors such as orofacial clefts, dental prostheses, FOA, xerostomia, and atrophy of the oral mucous membrane lead to significant increase in candidal colonization, but since very few studies in regard to CLP have been done worldwide and in India, in particular, further studies are warranted.

Repairability of a 3D printed denture base polymer: Effects of surface treatment and artificial aging on the shear bond strength

OBJECTIVES

The present study aimed to evaluate the repairability of a 3D printed denture base material. The effects of surface treatments and artificial aging on the shear bond strength (SBS) were investigated.

METHODS

A total of 224 specimens were printed by digital light processing technology (Rapid Shape D30II) using a 3D printing denture base material (FREEPRINT denture). To evaluate the repairability, the SBS and failure modes were measured after surface treatment and artificial aging. Specifically, half of the specimens were further performed with thermocycling (5-55 °C, 5000 cycles) for artificial aging. The aged and non-aged specimens were further divided into four subgroups (n = 28) to simulate a denture base repair with one of the following treatments: control (without surface treatment), monomer (applying methylmethacrylate for 120 s), P600 (grinding with P600 silicon carbide paper) and sandblasting (blasted with 125 μm aluminum oxide with 2 bar), respectively. Surface roughness was measured (n = 6) and surface topography was observed by scanning electron microscopy (n = 2). A test rod was built on the sample surface using the same 3D printing material. Afterward, all specimens further underwent thermocycling (5-55 °C, 10,000 cycles).

RESULTS

For non-aged groups, no significant differences in SBS could be found (p < 0.05), and bondings failed cohesively in the denture base material. Regarding the aged control and monomer group, adhesive failures at the interface were primarily observed, and SBS values were statistically lower than those of the other groups (p < 0.05).

CONCLUSIONS

The 3D printed denture base material exhibited favorable repairability. For the realignment surface, the SBS at the bonding interface is satisfying and additional surface treatments could be not necessary. In contrast, the aged surface could significantly decrease the SBS; hence subtractive surface treatments are highly recommended.

Photobiomodulation in Endodontic, Restorative, and Prosthetic Dentistry: A Review of the Literature

Objective: To provide a review of the literature about the photobiomodulation therapy (PBMT) dental treatment protocols in endodontic, restorative, and prosthetic dentistry based on validated clinical studies published so far. More specifically, this study was carried out to carefully review therapeutic protocol of PBMT in clinical studies and their conclusions. Background data: The importance of using low-power lasers and photobiomodulation (PBM) is increasing in dentistry mainly due to their painless and noninvasive function. However, lack of sufficient clinical studies has led to unclear results regarding PBMT in dentistry, and also lack of an available precise protocol for clinicians. Moreover, scarcity of clinical studies in this area has made conduction of a precise systematic review study difficult. Methods: In our study, published clinical studies up to April 2019 were reviewed from library sources, Google Scholar, PubMed and Medline, Elsevier, Embase, Cochrane, Scopus, and Web of science (ISI). Inclusion criteria included those presented in clinical trials and case report/case series, language (English), and studies available in full text. Exclusion criterion was in vitro studies. Results: In general, findings of clinical studies have shown that PBMT can have a significant role in reducing postoperative dental pain, increasing depth of anesthesia, improving tooth hypersensitivity, reducing inflammation of the tissue, and helping wound healing. Conclusions: A review of clinical studies showed that the use of alternative or adjunctive PBMT is of great importance in controlling postoperative pain after endodontic treatments. In addition, evidence suggests that different parameters of light can be efficient in the treatment of tooth hypersensitivity. Nevertheless, lack of sufficient clinical studies and reliable results do not allow introducing a precise treatment protocol.

Maintaining occlusal stability by selecting the most appropriate occlusal scheme in complete removable prosthesis

The search of an adequate occlusal scheme that maximizes dentures' stability and patients' satisfaction is an ultimate objective in every complete prosthodontic treatment. Many studies compared occlusal schemes in terms of retention, comfort and masticatory performance. The purpose of this article is to review literature about different occlusal schemes related to complete dentures' stability and edentulous patients' satisfaction, in order to select the most appropriate occlusal scheme. Thus, an electronic search was performed from PubMed (MEDLINE), Scopus, Cochrane, Google Scholar and Sciencedirect databases. 65 articles were identified of which 56 were selected to compose the present article. Within the limitations of this review, it has been concluded that edentulous patients prefer anatomic occlusal schemes to non-anatomic teeth. Furthermore, canine guidance seems to be efficace in terms of chewing comfort and dentures' retention, as well as lingualized occlusion. However, bilateral balanced occlusion does not confer a long-term masticatory performance and satisfaction to edentulous patients.

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.

Rare Giant Upper Lip Epidermal Cyst in a Patient Wearing a Denture

Epidermal cysts are intradermal or subcutaneous cystic tumors that frequently occur in the face, scalp, neck, and body trunk. Acquired cases of epidermal cyst commonly occur as a result of various surgical operations, chronic irritation, or trauma, all of which may trigger the occurrence of the invagination of squamous epithelium. A 57-year-old man presented with a palpable mass 7 cm×2 cm in size in the upper lip. The patient had a 3-year history of wearing a denture to restore missing bilateral maxillary central and lateral incisors, accompanied by inflammatory findings on the buccal mucosa due to chronic lip irritation. The resected oval-shaped cyst had a size of 5.5 cm×3.0 cm×2.5 cm, and it was an encapsulated mass with a well-defined margin. The histopathology was typical of epidermal cyst. This case of a rare giant upper lip epidermal cyst in a patient wearing a denture may be of interest to clinicians.

Aspects of Malpractice in Prosthodontics

Crowns, fixed partial dentures, and removable dentures are the popular prosthetic dental restorations in current dental practice. Prosthodontic rehabilitation of the mouth, particularly in advanced and complex cases, requires careful planning, adequate clinical skills, and exacting technical standards. While a successful outcome is the ultimate goal for any prosthodontic treatment, complications, injuries, dissatisfaction, and/or failure may occur. When such events develop as a result of negligence or violation of standards of care, they are considered under the term of malpractice and may incur ethical and medico-legal implications. This paper reviews and highlights some aspects of malpractice in prosthodontics. The current state of prosthodontic malpractice on a global level will also be evaluated. Standards of prosthodontic care, current literature of prosthodontic malpractice, where and how prosthodontic malpractice occurs, and recommendations for the future are presented. A thorough understanding of what is quality prosthodontic care and what disrupts this care can be a useful guard against professional litigation and may protect patients from poor quality of dental prosthetic care.

Relation between Clinical Oral Dryness Score and Denture Satisfaction among Patients' in a Tertiary Care Centre, India

INTRODUCTION

Xerostomia is a subjective feeling of dryness commonly seen in elderly populations which impairs the quality of life. Due to loss of lubricating property of saliva the buccal mucosa, tongue and lips tend to stick leading to dry, freckled, ulcerated and sore mucosa which is of major concern to the patient to use complete denture.

AIM

The aim of the study was to assess the relation between oral dryness score and denture satisfaction among elderly patients.

MATERIALS AND METHODS

A cross-sectional study was conducted in prosthodontics department of a dental institution. Patients wearing dentures for at least six months were invited to participate in study. Visual Analogue Scale (VAS) with scores ranging from 0-100 was used to assess patient's satisfaction and clinical oral dryness score was assessed using the criteria described by Osailan SM et al., with scores ranging from 0-10. Data was analysed with SPSS software (version-20) and Kendall's tau-b correlation was used to determine the relationship between mean denture satisfactions and mean clinical oral dryness scores.

RESULTS

A total of 220 participants were included in the study based on inclusion criteria. Mean dryness score of the participants was 1.8±0.6 and mean VAS-score for denture satisfaction was 74.32±21.20 for aesthetics, for chewing ability the mean score was 62.31±19.64 and for phonetics it was 67.82±30.60. Strong negative correlation between VAS-scores and oral dryness scores was observed.

CONCLUSION

Clinical oral dryness score is one of the important factors which influence denture satisfaction. Dentist should consider in predicting prognosis.

Case-based learning: A study to ascertain the effectiveness in enhancing the knowledge among interns of an Indian dental institute

OBJECTIVE

Time and again, it has been shown that active learning promotes critical thinking, and this environment has to be fostered in dental education too. Therefore, the present study was carried out with an aim to know the effectiveness of case-based learning (CBL) in enhancing the knowledge of dental interns of a dental institute in India.

MATERIALS AND METHODS

This pre-post single-blinded, experimental study was conducted in two sessions on a purposive sample of 45 dental interns who gave informed consent. The interns answered a pretest questionnaire comprising questions related to their knowledge of hyperplastic tissue in complete denture patients. The interns were randomly allocated into three subgroups for thorough discussion. Each group viewed all three parts of a case related to hyperplastic tissue and presented the case in the presence of a facilitator. The facilitator discussed the subject with the three subgroups. A post-test was conducted immediately, and the results were compared with the pretest. The facilitator explained about hyperplastic tissue with an audio-visual aid after the post-test was administered. The perception of interns toward CBL was assessed by a standard questionnaire.

RESULTS

On analysis, the comparison of the overall knowledge scores pre- and post-CBL showed a statistically significant increase from 9.8 ± 2.14 to 12.6 ± 1.37 (P < 0.001).

CONCLUSION

CBL proved to be effective in enhancing the knowledge of dental interns.

Prognoses of new complete dentures from the patient's denture assessment of existing dentures

OBJECTIVES

The aim was to determine prognostic factors affecting frequent post-delivery adjustments of new complete dentures using patients' assessments of existing complete dentures.

MATERIALS AND METHODS

A total of 125 edentulous participants (56 men, 69 women; mean age, 76.4 years) who required new complete dentures evaluated existing dentures using the patient's denture assessment (PDA), a questionnaire regarding the self-assessment of dentures composed of 22 question items and containing six subscales: "function," "lower denture," "upper denture," "expectation," "esthetics and speech," and "importance." Moreover, the numbers of post-delivery adjustments of new dentures were recorded. A multiple logistic regression analysis was performed to identify significant factors for frequent adjustments of new dentures with five subscales of the PDA (excluding "importance"), level of mandibular ridge resorption, and age as independent variables.

RESULTS

The analysis showed that "function," "esthetics and speech," and level of mandibular ridge resorption were significant variables for a frequent number of post-delivery adjustments of new complete dentures.

CONCLUSIONS

The results suggested that patients' assessments of existing dentures using the PDA might allow a prediction of prognosis for complete denture treatments. Additionally, low "function" scores and high "esthetics and speech" scores for existing dentures and high levels of mandibular ridge resorption were significant prognostic factors affecting frequent post-delivery adjustments of new complete dentures.

CLINICAL RELEVANCE

It may be difficult for edentulous persons to adapt to new complete dentures, especially those who have complaints about mastication and swallowing with existing dentures and poor mandibular ridges, but are satisfied with esthetics and speech.

Retention of denture bases fabricated by three different processing techniques - An in vivo study

Aim:

Distortion due to Polymerization shrinkage compromises the retention. To evaluate the amount of retention of denture bases fabricated by conventional, anchorized, and injection molding polymerization techniques.

Materials and Methods:

Ten completely edentulous patients were selected, impressions were made, and master cast obtained was duplicated to fabricate denture bases by three polymerization techniques. Loop was attached to the finished denture bases to estimate the force required to dislodge them by retention apparatus. Readings were subjected to nonparametric Friedman two-way analysis of variance followed by Bonferroni correction methods and Wilcoxon matched-pairs signed-ranks test.

Results:

Denture bases fabricated by injection molding (3740 g), anchorized techniques (2913 g) recorded greater retention values than conventional technique (2468 g). Significant difference was seen between these techniques.

Conclusions:

Denture bases obtained by injection molding polymerization technique exhibited maximum retention, followed by anchorized technique, and least retention was seen in conventional molding technique.

Retrospective Analysis of Implant Overdenture Treatment in the Advanced Prosthodontic Clinic at the University of Illinois at Chicago

The aim of the present retrospective study was to evaluate the clinical outcomes of implant-supported overdenture treatment provided by prosthodontic specialty residents. Twenty-three patients with 25 implant-supported overdentures (IODs) participated in the study. Seventy-four implants were placed by periodontic, prosthodontics, or oral and maxillofacial surgery students. All prostheses were fabricated in the advanced prosthodontics clinic at University of Illinois at Chicago. The condition of the peri-implant soft tissue, implants, and prostheses were evaluated. Complications and any maintenance were documented. Patients completed an oral health impact profile-14 and semantic differential scale questionnaires. Statistical analyses were performed using SPSS statistical software. Twenty mandibular and 5 maxillary IODs were evaluated. Ninety-seven percent of the attachments were locators (Zest Anchors) and 3% ball attachments. None of the implants had lost osseointegration, but 14 implants (19%) had developed marginal bone loss in one-third of the implant length or more. Fourteen (19%) implants had developed dehiscence, which ranged from 1 to 4 mm. A variation in the width of the keratinized tissue, gingival, plaque, and calculus index was observed. There was a statistically significant relationship between the presence of plaque and the bleeding on probing on the buccal aspect of implants (P = .012). The incidence of dehiscence was significantly higher on the midfacial when the keratinized tissue was less than 2 mm (P &lt; .0001). The majority of the complications were prosthetic in nature, such as broken denture teeth (74%) and worn or loose matrices (35%). Debris was observed in 19% of the locator abutments, and 36% of the overdentures were not stable in application of anterior force. Patients were compliant with oral hygiene protocols and their chewing ability was high (mean = 8.0). The overall experience was pleasant (mean = 7.5); the treatment provided good esthetics (mean = 8.3) and great satisfaction (mean = 8.5). From an educational and clinical perspective, IOD therapy has been documented to be a predictable and successful treatment option. Patients should be informed of the required maintenance and the possible complications related to IOD therapy.

Do flexible acrylic resin lingual flanges improve retention of mandibular complete dentures?

Objectives:

The aim of this study was to compare the retention of conventional mandibular complete dentures with that of mandibular complete dentures having lingual flanges constructed with flexible acrylic resin “Versacryl.”

Materials and Methods:

The study sample comprised 10 completely edentulous patients. Each patient received one maxillary complete denture and two mandibular complete dentures. One mandibular denture was made of conventional heat-cured acrylic resin and the other had its lingual flanges made of flexible acrylic resin Versacryl. Digital force-meter was used to measure retention of mandibular dentures at delivery and at 2 weeks and 45 days following denture insertion.

Results:

The statistical analysis showed that at baseline and follow-up appointments, retention of mandibular complete dentures with flexible lingual flanges was significantly greater than retention of conventional mandibular dentures (P < 0.05). In both types of mandibular dentures, retention of dentures increased significantly over the follow-up period (P < 0.05).

Conclusions:

The use of flexible acrylic resin lingual flanges in the construction of mandibular complete dentures improved denture retention.