A survey of complete denture patients experiencing difficulties with their prostheses

Estimation of alpha amylase, cortisol, and pH level in saliva of patients wearing conventional and Biofunctional Prosthetic System complete dentures: A parallel randomized clinical trial

STATEMENT OF PROBLEM

Biofunctional Prosthetic System (BPS) complete dentures have been reported to maintain a harmonious relationship with the surrounding oral structures and provide improved adaptation compared with conventional complete dentures. However, an evaluation of salivary changes and its constituents between BPS and conventional dentures is lacking.

PURPOSE

The purpose of this parallel randomized clinical trial was to evaluate the alpha amylase, cortisol, and pH levels in saliva in participants provided with conventional and BPS complete dentures.

MATERIAL AND METHODS

Sixteen completely edentulous participants were recruited for providing with conventional and BPS dentures (n=8). The levels of alpha amylase, cortisol, and pH in their saliva were evaluated by using an enzyme-linked immunosorbent assay (ELISA), colorimetric, and pH meter before insertion and 1 week and 1 month after denture insertion. The data were analyzed with repeated measure ANOVA and the Student t test (α=.05).

RESULTS

The mean ±standard deviation for pH was 6.94 ±0.22 in conventional complete dentures and 7.04 ±0.12 in BPS dentures; for alpha amylase, it was 206.75 ±14.64 and 210.88 ±15.72 IU/mL; and for cortisol, it was 0.29 ±0.05 and 31 ±0.04 nmol/L before insertion and 1 week and 1 month after denture insertion. From the repeated measures ANOVA, the mean pH and salivary cortisol were not statistically different (P>.05), but salivary amylase was statistically different (P<.05). The Student t test showed no significant difference in pH (P>.05), but a statistically significant difference in alpha amylase and salivary cortisol levels was found between the 2 groups (P<.05).

CONCLUSIONS

No significant difference in salivary pH was found in completely edentulous patients provided with conventional or BPS dentures, but significant differences were found in levels of alpha amylase and salivary cortisol.

Use of oral health care services among older home care clients in the context of an intervention study

BACKGROUND

An increasing number of care-dependent older people living at home need external support to receive regular dental care.

OBJECTIVES

To investigate the use of oral health care services among old home care clients who participated in an intervention study focusing on oral self-care and nutrition.

MATERIALS AND METHODS

This study employed data from the multidisciplinary Nutrition, Oral Health and Medication (NutOrMed) intervention study with a population-based sample of 245 home care clients (74% female) aged 75 or more divided in intervention (n = 140) and two control groups (n = 105). The data were collected through interviews at baseline and 6-month follow-up.

RESULTS

At baseline, 43% of participants reported visits to oral health care within the previous year. At 6-month follow-up, this proportion was 51%. In the intervention group, the corresponding figures were 46% and 53%, and in the controls 39% and 48%. Adjusted regression analyses showed that this change was statistically significant (p = 0.008). In addition, higher education and toothache or other discomfort related to teeth or dentures at baseline were associated with increased use after the 6-month follow-up (OR = 1.1, 95% CI = 1.0-1.2; OR = 3.4, 95% CI = 1.5-7.9) but being edentulous indicated the opposite (OR = 0.2, 95% CI = 0.1-0.4). Belonging to the intervention group was not associated with increased use.

CONCLUSIONS

In older adults, any efforts to raise awareness of oral health are of great potential to increase use of services.

A randomized clinical study to assess the performance of a marketed denture adhesive in a model of food infiltration in healthy, edentulous adults

OBJECTIVES

An optimized food infiltration methodology was utilized to assess the objective and subjective efficacy of a marketed denture adhesive regarding denture dislodgment and infiltration and perception of food particles under maxillary and mandibular dentures. A pilot study helped optimize methodologies before the efficacy study.

MATERIALS AND METHODS

Participants were healthy adults (n =48 for both studies) with fair- to well-fitting and well-made full maxillary and mandibular dentures. In the pilot, groups were a denture adhesive applied in a conventional dabbed-on pattern, a denture adhesive applied in continuous strips, or no adhesive. In the efficacy study, groups were the Test denture adhesive (continuous strips pattern application) or no adhesive, employed in a crossover design. Food infiltration was investigated through measurement of peanut particle mass retrieved from under each denture (30-32 g chewed). No formal statistical testing was performed in the pilot. Statistical analysis in the efficacy study was performed using analysis of variance. Primary efficacy evaluation was combined peanut particle mass from both dentures. Secondary efficacy evaluations included peanut particle mass under separate dentures, participant-reported denture dislodgements, and awareness/rates of how bothersome peanut particles under dentures were.

RESULTS

In the pilot, the median peanut particle mass was lower with either pattern application compared with no adhesive. In the efficacy study, peanut particle mass under combined dentures was lower with than without adhesive (geometric mean [product of values]: 5.56 vs. 29.13 mg) with a between-group geometric mean ratio (adhesive over no adhesive) of 0.19 (95% confidence interval: 0.12, 0.30) favoring the Test adhesive (p < .0001). Similar Test adhesive beneficial outcomes in both studies included significantly fewer denture dislodgements and awareness and how bothersome peanut particles under dentures were. Treatments were generally well-tolerated.

CONCLUSIONS

These findings, including reduced peanut particle infiltration, fewer denture dislodgments, and lower ratings of bothersomeness, corroborate those studies investigating the benefits of denture adhesive in preventing food infiltration.

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

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

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

Objective:

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

Materials and Methods:

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

Results:

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

Conclusion:

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

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.

Utilization of denture adhesives and the factors associated with its use: a cross-sectional survey

Background

An increase in the number of elderly edentulous patients likely leads to a greater demand for dentures and denture adhesives. As denture adhesives have both positive and negative features, dentists need to know the types of denture adhesive users to be able to provide instruction to denture wearers on how to use denture adhesives effectively. This study aims to examine the utilization of denture adhesives and associated factors.

Methods

Seven closed-ended questionnaires were developed for a web-based survey. After that, Fisher’s exact tests were performed to determine the difference in the denture adhesive usage rate by gender, type of denture, last dental visit, and smoking status. A multivariate-adjusted logistic regression analysis was performed with denture adhesive use or non-use as the dependent variable and the other items as independent variables. Next, Fisher’s exact tests and a multivariate-adjusted logistic regression analysis were performed with the type of denture adhesives as the dependent variable in the same way. Statistical analyses were performed for all denture wearers, complete denture wearers, and partial denture wearers. The level of statistical significance was set at p = 0.05.

Results

A total of 1470 denture wearers in Japan participated in this study. Of these, 318 used denture adhesives, while 212 (66.7%) used cream; 74 (23.3%) used home liner; 25 (7.9%) used powder; four (1.3%) used sheets; and three (0.9%) used several types. The Fisher’s exact tests revealed that the ratios of using denture adhesives were significantly higher for complete denture wearers (p < 0.001), last dental visit over 1 year (p = 0.005), and smokers (p = 0.005). For partial denture wearers, the ratio was significantly higher in smokers (p = 0.262). The multivariate adjusted logistic regression revealed that denture adhesive use or non-use were significantly associated with the type of denture and smoking status in all denture wearers, and just smoking status in partial denture wearers. There were no significant results about the type of denture adhesive selection.

Conclusions

From all denture wearers, complete denture wearers and smokers are more likely to use denture adhesives. In addition, smokers significantly use denture adhesives if they are partial denture wearers.

A randomized clinical study to evaluate the effect of denture adhesive application technique on food particle accumulation under dentures

Food ingress under dentures is a common problem that may be reduced by denture adhesive use. The objective of this study was to explore the effect of the mode of application of a denture adhesive on reducing accumulation of food particles under dentures. This was a single-centre, controlled, single-blind, randomized, three-treatment, three-period, crossover study in participants with complete, removable well-fitting, well-made upper/lower dentures. Treatments were: 1) experimental denture adhesive application (test adhesive) applied with a precision applicator as continuous strips; 2) marketed denture adhesive (positive control) applied using a flat ribbon nozzle as dabs; 3) no adhesive. Food-occlusion testing was performed by assessing peanut particle migration under dentures with denture retention/stability evaluated using the Kapur Index (Olshan modification). Differences were assessed using an ANOVA model. Adhesive oozing and perceptions of the adhesives were assessed by questionnaire. All 83 randomized participants completed the study. There were no significant differences between positive control or test adhesives versus no adhesive, or between test adhesive and positive control, for mass of peanut particles recovered from dentures. Both adhesives had significantly higher retention and stability scores compared with no adhesive (all P < .01). Participants reported significantly higher scores for denture comfort, confidence, satisfaction and movement with both adhesives versus no adhesive (all P < .01). No differences in adhesive ooze were reported between adhesives. No adverse events were reported. In conclusion, there was no difference in performance, as measured by peanut particle mass recovered from upper/lower dentures, for the test adhesive, positive control and no adhesive.

Comparison of Three Prosthodontic Treatment Modalities for Patients with Periodontally Compromised Anterior Mandibular Teeth: A 2-year follow-up study

OBJECTIVES

To prospectively assess self-perceived chewing function (CF) and oral health-related quality of life (OHRQoL) in geriatric patients after receiving three different treatment modalities in the mandible: removable partial denture (CD-RPD), complete denture (CDs), or complete overdenture supported by mini dental implants (CD-MDI). At baseline, all patients had mobile anterior teeth (1 mm or >) and missing posterior teeth in the mandible. Patients were completely edentulous in the maxilla. After treatment, patients were recalled at the 3-month and the 2-year post-treatment period.

MATERIALS AND METHODS

A total of 176 patients participated (CD group, n=68; CD-RPD group, n=58; CD-MDI group, n=50). Self-reported CF was assessed using the Chewing Function questionnaire (CFQ), The OHRQoL was evaluated using the OHIP14 questionnaire, which the patients completed 1. before treatment, 2. three months after treatment, and 3. at the 2-year post-treatment stage.

RESULTS

The OHRQoL and the self-perceived CF significantly improved in all groups after treatment (p<0.01). The highest improvement of a CF was recorded in the CD-MDI group. The OHRQoL was significantly higher in the CD-MDI group in comparison to the CDs group after treatment (p<0.01). At the 2-year post-treatment stage, self-perceived CF significantly further improved in the CD-MDI group, while it worsened in the CD and the CD-RPD groups (p<0.01). The same pattern was recorded for the OHIP14 summary scores. The highest amount of denture repairs and adjustments was recorded in the CD-RPD group, although maintenance was also demanding in the CD-MDI group.

CONCLUSION

Within the limitations of this study, rehabilitation with mandibular MDI retained overdenture can be considered as preferred treatment with the constant improvement of OHRQoL and a chewing function in comparison to mandibular CD or mandibular RPD option in patients with mobile anterior mandibular teeth.

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.

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.

Effect of neutral zone technique on marginal bone loss around implant-supported overdentures

Aim:

The aim of this study was to compare changes in marginal bone height around immediately loaded implants supporting a mandibular overdenture constructed according to the neutral zone technique with changes around overdentures constructed according to the conventional methods.

Materials and Methods:

Twelve completely edentulous male patients were randomly allocated to two equal groups of patients. Patients in the first group received conventionally constructed complete dentures and patients in the second group received complete dentures constructed using the neutral zone record. All the patients received two single-piece titanium implants placed bilaterally in the mandibular canine regions using flapless surgery, which were then immediately loaded by the dentures. Marginal bone height was radiographically evaluated at baseline and 6, 12, and 18 months after implant loading.

Results:

There was a significant loss in marginal bone height around the supporting implants in each study group. However, no significant differences in marginal bone height were recorded between the study groups over the observation period (P > 0.05).

Conclusion:

Marginal bone height changes induced by overdentures constructed with neutral zone technique on immediately loaded implants are not different from those changes induced by overdentures constructed with a conventional method.

Evaluation of psychological guidance impact on complete denture wearer's satisfaction

The purpose of this study was to evaluate the impact of psychological intervention on edentulous patients' satisfaction with complete clinically satisfactory complete dentures. The survey was conducted in China Medical University involving 84 individuals receiving complete dentures at this institution from August 2013 to March 2014. Participants were randomly allocated to intervention and control groups consisting of 42 subjects, respectively. In the intervention group, individuals received oral health education and psychological intervention before and after the whole process. In the control group, 42 cases received doctor's regular advice after treatment. Satisfaction regarding aesthetic, speech, mastication, retention and comfort was rated in the first and third month after prosthesis treatment. Patients overall aesthetic, speech, mastication and retention were significantly improved in both intervention and control groups in 3 months later after prosthesis treatment when compared with the first month (P < 0·05). No significant difference existed for comfort in control group. Patient scores on aesthetic, speech, mastication and retention at both first and third month evaluations (P < 0·05) differed between the control and intervention groups. However, there was no difference for their scores related to comfort (P > 0·05) in first and third month. The study concludes that psychological intervention plays a significant role in improving patient satisfaction with complete dentures.