Is a two-step impression mandatory for complete denture fabrication on the severely resorbed mandible? A randomized trial on patient perception and denture quality

3D printing vs traditional workflow for the fabrication of mandibular implant overdentures: study protocol for a mixed-methods cross-over RCT

BACKGROUND

Complete tooth loss is a significant global oral health issue, particularly impacting older individuals with lower socioeconomic status. Computer-assisted technologies enhance oral healthcare access by the elderly. Despite promising in vitro reports on digital denture materials, evidence from randomized clinical trials (RCTs) is lacking to verify their performance. This cross-over RCT will investigate whether 3D-printed implant-retained mandibular overdentures (IMO) are more satisfactory for edentulous seniors than those made through traditional methods.

METHODS/DESIGN

We will recruit 26 completely edentulous participants (any sex/gender) based on the following eligibility criteria: age ≥ 60 years, no tooth extraction in the past 12 months, two implants in the lower jaw, and need for new dentures in both jaws. Each participant will receive two denture pairs, either manufactured by 3D printing or traditionally, to be worn in a random order. A timeline of 3 months with each denture pair will be considered for outcome assessment (total: 6 months). Patient satisfaction with dentures will be measured by the McGill Denture Satisfaction Questionnaire. We will evaluate other patient-reported outcomes (including oral health-related quality of life) as well as clinician-assessed quality and cost. At the end of the trial, participants will choose which denture pair they wish to keep and interviewed about their experiences with the 3D-printed IMO. The quantitative and qualitative data will be incorporated through an explanatory mixed-methods strategy. A final quantitative assessment will happen after 12 months with the preferred IMO to assess the long-term performance and maintenance needs.

DISCUSSION

This mixed-methods RCT will explore patient experiences with 3D-printed IMOs, aiming to assess the potential for altering clinical practice and dental public health policies. Our results will inform policies by showing whether 3D printing offers comparable outcomes at lower costs, facilitating greater access to oral care for the elderly.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT06155630, Registered on 04 December 2023. https://classic.

CLINICALTRIALS

gov/ct2/show/NCT06155630.

Simplified versus conventional complete dentures: A randomized crossover clinical trial

STATEMENT OF PROBLEM

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

PURPOSE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Performance of complete dentures fabricated with the simplified and the traditional technique: A randomized clinical trial

STATEMENT OF PROBLEM

The simplified technique has been recommended for the fabrication of removable complete dentures. However, a consensus regarding the performance of the simplified and the traditional techniques is lacking.

PURPOSE

The purpose of this randomized clinical trial was to compare the performance of prostheses fabricated with the simplified and the traditional techniques.

MATERIAL AND METHODS

Sixty participants were recruited and randomized into 2 groups: traditional technique (control group) and simplified technique (experimental group). The assessments were performed before treatment (baseline) and 2 and 4 months after adaptation to the new complete dentures. The variables evaluated were satisfaction, oral health-related quality of life (OHRQoL) by using the Brazilian version of the OHIP-EDENT, the quality of the prostheses, and, for the functional assessment, the masticatory performance and swallowing threshold. The data were analyzed by the Fisher exact test, the Mann-Whitney test, and the generalized equations estimating (GEE) method.

RESULTS

At baseline, the mean ±standard deviation quality of the prostheses was 5.3 ±2.3 for the traditional technique and 4.9 ±2.3 for the simplified technique, and at 4 months, it was 9.3 ±0.9 and 9.1 ±0.9, respectively. For masticatory performance, the mean ±standard deviation X50 at baseline was 5.7 ±1.4 for the traditional technique and 5.7 ±0.9 for the simplified technique, and at 4 months, it was 3.8 ±1.2 and 3.7 ±0.9, respectively. The mean ±standard deviation OHRQoL at baseline was 14.1 ±8.6 for the traditional technique and 12.5 ±9.4 for the simplified technique, and at 4 months, it was 3.2 ±4.3 and 2.6 ±5.1, respectively. The mean ±standard deviation satisfaction at baseline was 9.5 ±3.9 for the traditional technique and 9.3 ±4.2 for the simplified technique; after 4 months, it was 14.8 ±2.0 for both techniques. There was a significant improvement (P<.05) for all variables in the study when comparing them at the baseline to those at the evaluation after provision of new complete dentures. There was no significant difference in all analyzed variables (P>.05) between the 2 techniques for prosthesis fabrication.

CONCLUSIONS

The simplified technique appears to be a suitable alternative to the traditional technique for the fabrication of complete dentures, with similar performance.

Perception of Edentulous Patients and Dental Professionals towards Care and Maintenance of Complete Denture Prostheses

METHODS

A descriptive qualitative study was conducted among 30 EDPs attending dental prosthetic clinics (DPCs) at the four centres in Fiji and 28 DPs at the four DPCs under purposive sampling. Semi-structured questionnaire with open-ended questions was used for in-depth interview (IDI) with EDPs via telephone and focus group discussion (FGD) with DPs virtually via Zoom. Participant responses were recorded and thematic analysis was used to manually analyze the verbatim transcripts.

RESULTS

Five themes were identified as perceptions of EDPs towards care and maintenance of CDP in Fiji: patient perceptions towards CDP, CDP care and maintenance, communication between DPs and EDPs, challenges faced in CDP, and management strategies to CDP care and maintenance. Seven themes were identified as perceptions of DPs: CDP guidelines, post-denture insertion advice, care and maintenance, challenges while treating EDPs, management strategies to challenges faced, communication and teamwork, and recommendations to improving quality of CDP delivery in Fiji.

CONCLUSION

Patients' perception towards care and maintenance of CDP was low. It is highly recommended for EDPs to adhere to CDP advice given by DPs whilst for DPs, it had been recommended to provide written, oral, and visual forms of CDP care and maintenance advice to EDPs for effectiveness.

Challenges faced by edentulous patients (EDPs) during complete denture prostheses (CDP) service delivery in Fiji - a qualitative study

BACKGROUND

Edentulism is a state of having no teeth in the oral cavity, an irreversible condition popularly known as the marker of disease burden on the oral health. For edentulous patients (EDPs) Complete Denture Prostheses (CDP) is a means to improve oral health. Due to limited studies in this area, this research aimed to explore the challenges faced by the EDPs during CDP service delivery in Fiji.

METHODS

A directed descriptive qualitative study was conducted among EDPs attending Dental Prosthetic Clinics (DPCs) at the four centres in Fiji under purposive sampling. A semi-structured questionnaire with open ended questions was used for in-depth interview with EDPs who had worn CDP for 1 year via telephone. Participant responses were recorded, transcribed verbatim and analyzed manually using thematic analysis.

RESULTS

A total of 30 EDPs participated in the study. Six themes were identified as challenges faced by the EDPs during CDP service delivery in Fiji: lack of information, non-compliance, overwhelmed by illness, reduction on quality of life (QoL) financial barriers to CDP treatment care and personal acceptance. 77% of EDPs felt they did not receive adequate information on CDP when attending DPCs which indicated the non-compliance nature irrespective of using and cleaning CDP on a daily basis. The Dental Professionals (DPs) at the DPCs gave their full support in attending to the CDP challenges faced by the EDPs in Fiji during the review clinics.

CONCLUSION

The EDPs expressed a variety of challenges that was faced while seeking appropriate CDP services in Fiji. The findings demonstrate the need to explore approaches to develop patients' engagement practices during CDP service delivery by the Dental professionals (DPs), which leads to effective oral health promotion in Fiji for CDP wearers.

Effect of lipid peroxidation on dental healthcare workers

Aim and Objective:

The relevance of the study was explained by the fact that free radicals, known to be a product of lipid peroxidation, damage the integrity of cell membranes and corresponding intracellular structures, disrupting their functioning. The purpose of this cross-sectional study was to investigate the effect of free-radical lipid peroxidation in the blood on the body of dentists without diseases of the bronchi and lungs.

Materials and Methods:

The chemiluminescent properties of the blood hemolysate of 65 dentists were measured. Blood was collected in a test tube with an anticoagulant, and the plasma was aspirated with a Pasteur pipette. The hemolysate was aspirated two times. Distilled water was added to the sediment of erythrocytes, the mixture was shaken, and centrifuged. Statistical processing of morphometric indicators was carried out using the software package “Statistica 6.0.”

Results:

The direct dependence of the spontaneous chemiluminescence (SCL) growth parameters in the blood hemolysate of dentists on their length of service was determined.

Conclusion:

The conclusions indicate a direct correlation between the growth parameters of the SCL index in the blood hemolysate of dentists and their length of service. The applied value of this study lies in the possibility of practical application of the results obtained to qualitatively investigate the effect of lipid peroxidation processes on the body of dentists.