Efficient resource use in simplified complete denture fabrication

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.

The Shear Bond Strength between Milled Denture Base Materials and Artificial Teeth: A Systematic Review

The data about bond strength between digitally produced denture base resins and artificial teeth are scarce. Several studies investigated shear bond strength values of milled denture base resins and different types of artificial teeth. The purpose of the present study was to compare and evaluate the available evidence through a systematic review. A bibliographic search was conducted in PubMed, Scopus, and Web of Science to assess adequate studies published up to 1 June 2022. This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The appropriate studies that determined the shear bond strength values between milled denture base resins and artificial teeth were selected. The initial search identified 103 studies, which were included in the PRISMA 2020 flow diagram for new systematic reviews. Three studies met the inclusion criteria, and all of them present a moderate risk of bias (score 6). Two studies found no statistical differences between heat-polymerized and CAD/CAM (milled) denture base materials when attached with different types of artificial teeth, while one study showed higher values of CAD/CAM (milled) denture base materials. Bonding agents ensure bonding strength at least similar to the conventional methods. In order to improve the quality of future studies, it would be advantageous to use a larger number of specimens with standardized dimensions and a blinded testing machine operator to decrease the risk of bias.

Evaluation of a novel 3D-printed custom tray for the impressions of edentulous jaws

PURPOSE

The purpose of this study was to evaluate a novel 3D-printed custom tray for impressions of edentulous jaws, and to compare it with conventional impression trays.

METHODS

Fifteen edentulous patients were enroled to evaluate the accuracy and border extension of a novel custom tray in the shape of a complete denture. Four impressions were made for each patient. Impressions made using novel custom trays were considered the experimental group, impressions made using conventional custom trays were considered the control group, and impressions made using final dentures and non-pressure custom trays were considered the reference groups. The experimental and control groups were compared with the reference groups using three-dimensional (3D) comparison analysis, and the impressions were further divided into regions. The root mean square (RMS) value was calculated to analyse the differences in impression morphology. Additionally, the experimental and control groups were compared to analyse border extension at standard locations.

RESULTS

Compared to the final denture impression as a reference, the diagnostic denture impression (RMS:0.146 ± 0.024 mm) was closer to the reference than the conventional impression (RMS:0.176 ± 0.047 mm), with a significant difference only in the secondary stress-bearing area. The border extension of the diagnostic denture impression was slightly longer than the conventional impression; however, the difference was not statistically significant.

CONCLUSIONS

The impressions made using the novel custom tray were similar to those made with a definitive complete denture. However, no significant differences were noted when compared with the conventional impressions.

Complete Denture Prostheses (CDP) Treatment and Care in Fiji: A Qualitative Study on Dental Professionals (DPs) Perspectives on the Triangle of Communication (ToC)

INTRODUCTION

Effective communication can aid in improving oral healthcare measures such as treatment outcomes and satisfaction of edentulous patients (EDPs) toward the treatment process. The triangle of communication (ToC) involves communication between the dentist, dental technician (DTech), and EDPs. This research aimed to explore the ToC between dental professionals (DPs) and patients undergoing complete denture prostheses (CDP) treatment in Fiji.

MATERIALS AND METHODS

A descriptive qualitative study was conducted among DPs under purposive sampling where focus group discussions were conducted at the four dental prosthetic clinics in Fiji. A semi-structured questionnaire with open-ended questions was applied to participants virtually via Zoom. The collected data were collated and analyzed manually using thematic analysis.

RESULTS

A total of 28 DPs participated in the study. Three themes were identified while exploring the ToC from DPs' perspectives on CDP treatment and care in Fiji: staff communication-dentist and DTech, ToC and information sharing (dentist-DTech and EDPs), and stage-by-stage procedural checks for CDP between DPs. Effective collaboration between dentists and DTechs is an essence of a successful CDP treatment outcome. Most DPs agreed to undergo continuous communication throughout the treatment to keep EDPs engaged throughout the treatment process. In addition, stage-by-stage procedural checks in dental clinics as well as in dental laboratories improved the quality of CDPs.

CONCLUSION

DPs highlighted predominantly the ToC between DPs and EDPs when receiving CDP treatment in Fiji as an essential tool for effective DP and patient engagement. Discussions should be complemented with the use of verbal, nonverbal, and written modes together with the utilization of interpreters to improve CDP treatment and care in Fiji.

Use of Facebow device in prosthodontics: A systematic review on randomized control trials

Aim

Recording the maxillomandibular relationship is important in various prosthodontic treatments. Evidence of face-bow transfer resulting in improved outcome is conflicting. Hence the objective of this study is to determine the use of face-bow transfer in prosthodontics.

Settings and Design

: Systematic review based on PRISMA guidelines.">.

Materials and Methods

A protocol was developed prior, which covered all aspects of the review. The databases explored were MEDLINE database, ScienceDirect, and Cochrane collaboration library. The PICO model included participants who received a complete denture/partial denture prosthesis. Intervention was the use of the face-bow device. Comparator was prosthesis made with a simple procedure of not using a face-bow device for prosthodontic rehabilitation. Outcomes were patient satisfaction with dentures, the stability of the dentures, esthetics, and time taken for clinical and laboratory procedures. Only randomized clinical trials were included in this study. The methodological quality of the studies was assessed according to the Cochrane risk of bias tool.

Statistical Analysis Used

Qualitative analysis.

Results

A total of 144 articles were identified. On excluding 4 duplicates and screening the title and abstracts of the rest of the records based on exclusion criteria only 15 studies were selected for review.

Conclusions

The use of the face-bow did not yield superior results for the quality of the prosthesis. Therefore, there is no evidence for the utility of face-bow transfer in complete denture treatment. However, no inference could be drawn for its utility in partial denture prosthodontics as there was no study to draw an inference.

A Comprehensive Systematic Review In Search Of Evidence for Pragmatic Altercations in Simplified Denture

Aim:

To explore the evidence available to evaluate if simplified dentures could be as effective as the conventional complete dentures.

Materials and Methods:

A total of 1,482 articles were obtained using keywords in a Boolean search operator in the PubMed search engine, Google Scholar and Cochrane Library. Duplicates were removed and the remaining articles were subjected to a title analysis which yielded a total of 20. Further analysis of the article abstracts led to an exclusion of four articles. The remaining 16 articles were subjected to full text analysis which finally yielded a total of 11 articles.

Results:

The cumulative results of the meta-analysis for oral health-related quality of life, patient satisfaction and professional quality of denture show no significant difference ( P > .05) between conventional and simplified dentures.

Conclusion:

Based on the available evidence adjusted for the potential literature/geographic bias, we conclude that the conventional procedures in complete denture fabrication such as facebow and gothic arch tracing do not improve the quality of the denture outcome from patients’ perspective and simplified dentures are equally effective as conventional complete dentures.

Efficiency of simplified versus traditional denture fabrication methods: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Conventional techniques (CTs) for complete denture fabrication involve a series of clinical and laboratory steps. A simplification of this process has been advocated, but whether simplified techniques result in acceptable treatment outcomes is unclear.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the efficiency of simplified denture fabrication techniques in comparison with CTs.

MATERIAL AND METHODS

The standard methodological procedures prescribed by the Cochrane Collaboration for systematic review and meta-analysis were used. An electronic search (MEDLINE through PubMed, Cochrane trial registry, and Scopus) and a manual search up to February 2020 were made to identify studies. Only randomized controlled trials involving edentulous adults requiring complete denture treatment were included.

RESULTS

Nineteen studies met the inclusion criteria. The pooled estimate of the included studies for patient satisfaction at 6 months marginally favored the simplified method of denture fabrication (standardized mean difference=0.02 [95% confidence interval {CI} -0.22 to 0.27]). The pooled estimate of the included studies for clinical time and cost of fabrication favored the simplified method (mean difference=-77.34 [95% CI -122.45 to -32.24] and mean difference=-85.89 [95% CI -170.02 to -1.77] respectively).

CONCLUSIONS

Simplified techniques were cost effective and less time consuming than the CT, with no significant difference in patient satisfaction or oral health-related quality of life. The high risk of bias and heterogeneity among studies requires that the results be considered cautiously.

Patient satisfaction, clinical outcomes and oral health-related quality of life after treatment with traditional and modified protocols for complete dentures

Background/purpose

Conventional complete denture treatment course requires six appointments, but modified protocol only takes four appointments. This study compared the conventional and modified protocol for complete denture fabrication regarding patient satisfaction and clinical outcomes.

Materials and methods

A total of 24 patients accepted complete denture treatment. According to complete denture treatment protocol, these patients were divided into the conventional group (group C, n = 12) and the modified group (group M, n = 12). Group C used the conventional protocol and required six appointments. Group M used the one-appointment master impression and jaw relation record technique, and it took four appointments. Data of oral health impact profile-14 (OHIP-14), satisfaction scale and the number of recalls in the first year were collected for the statistical analysis.

Results

The mean OHIP-14 scores in group C and group M were 13.79 ± 3.81 and 15.33 ± 5.25, respectively. In terms of satisfaction, the mean scores in group C and group M were 8.33 ± 0.61 points and 8.66 ± 1.13 points, respectively. There were no statistically significant differences between the group C and M in terms of participant ratings for satisfaction and OHIP-14. At the same time, the results indicated that group M significantly reduced the number of postinsertion visits (P < 0.05).

Conclusion

In terms of OHIP-14 and patients’ satisfaction, the modified treatment protocol is comparable to the conventional protocol. Based on the number of recalls in the first year, the modified treatment protocol has a better clinical outcome.

Is a two-step impression mandatory for complete denture fabrication on the severely resorbed mandible? A randomized trial on mastication, patient satisfaction and adjustments

OBJECTIVES

To compare one- vs two-step impression procedures for the provision of conventional complete dentures (CCDs) for edentulous individuals with severe mandibular resorption, in terms of (1) masticatory performance and ability; (2) satisfaction with mandibular CCDs; and (3) post-delivery adjustments.

METHODS

Fifty-two patients requiring maxillary + mandibular CCDs were randomly divided into two parallel arms according to the impression method of the mandibular ridge: (SI) single impression with stock trays (irreversible hydrocolloid); (TI) two-step impression in custom trays, with border molding (impression compound) followed by the impression itself (polyether). Mastication performance was evaluated by a colorimetric test, whereas patients answered questions on masticatory ability and satisfaction with mandibular CCDs (100-mm visual analogue scale). The number of post-delivery sessions for adjustments were also quantified. Outcomes were assessed at 3 and 6 months after delivery.

RESULTS

The masticatory performance was similar for both groups, regardless of time (3 months, P = 0.62; 6 months, P = 0.61). No significant difference was found for patient-reported (P > 0.05), i.e. masticatory ability (general ease of chewing and quality of grinding food; ability to chew specific foods), general satisfaction with the mandibular CCD (general satisfaction, comfort, aesthetics, ability to speak and to perform correct cleaning, retention and stability). Both methods resulted in a similar number of post-delivery adjustment sessions [SI: 3.8 (1.7); TI: 3.2 (1.4); P = 0.09].

CONCLUSIONS

Compared to a traditional approach, CCDs obtained from a single impression achieve similar masticatory performance/ability and patient satisfaction, even in patients with severely reabsorbed mandibular ridge. Both methods demand the same amount of post-delivery adjustment.

CLINICAL SIGNIFICANCE

A simplified impression technique which eliminates the secondary impression can provide CCDs of good clinical quality, which influences the OHRQoL, and satisfaction in the same extent they would by a two-step procedure, even for patients with severely reabsorbed mandibular ridges (ClinicalTrials.gov: NCT02339194).

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

OBJECTIVES

To evaluate the effectiveness of CCDs produced by two impression procedures for the mandibular ridge, in patients with severe mandibular atrophy.

METHODS

Fifty-two completely edentulous patients with severely resorbed mandibles were randomly allocated into two groups according to the impression procedure of the mandibular ridge: SI - single impression (stock tray and irreversible hydrocolloid); TI - two-step impression (custom tray, border molding with compound, and polyether). Assessments of oral health related quality of life (OHRQoL, primary outcome) and denture satisfaction were performed by using validated questionnaires. Denture quality was evaluated by means of functional tests.

RESULTS

Regardless of the technique, participants reported better OHRQoL (P < 0.001) in both follow-up periods (3 and 6 months after denture delivery), and groups resulted in similar OHIP-EDENT scores in its different domains (P > 0.05). Between-group differences were insignificant for general satisfaction (3 months, P = 0.699, 6 months, P = 0.392), as well as for aspects such as esthetics, comfort, mastication, speech, and prosthesis retention (P > 0.05). Overall clinical quality of the CCDs (P = 0.383) was similar between-group, as well as in specific aspects - interocclusal distance, occlusion, articulation, retention of the maxillary denture, and stability of both maxillary and mandibular dentures (P > 0.05).

CONCLUSIONS

Mandibular CCDs based on a single impression technique showed quality levels comparable to those generated by a two-step impression, both from the patient and clinician perspective.

CLINICAL SIGNIFICANCE

A simplified impression technique which eliminates the secondary impression can provide CCDs of good clinical quality, which influences the OHRQoL, and satisfaction in the same extent they would by a two-step procedure, even for patients with severely reabsorbed mandibular ridges. (ClinicalTrials.gov: NCT02339194).

Effectiveness of a simplified method for final impression in complete denture treatment: A pragmatic clinical trial

PURPOSE

This study aimed to compare two methods for final impression during the fabrication of complete dentures: a traditional method using custom trays (T-group) and a simplified method using the trial denture baseplate (S-group).

METHODS

A pragmatic clinical trial was conducted among edentulous individuals referred for conventional denture treatment. A consecutive sample of edentulous patients was assigned to two groups by cluster randomisation according to the final impression strategy, 30 in the T-group and 38 in the S-group. In the T-group, an auto-polymerising acrylic resin custom tray was used for impression; in the S-group, the final impression was performed using the try-in dentures. For both groups, zinc oxide eugenol paste was used as the impression material. The quality of the dentures was assessed using two rating scales (Functional Assessment of the Dentures and Kapur method). Moreover, clinical time for denture fabrication, number of post-insertion appointments for adjustments, patient satisfaction and post-treatment oral health-related quality of life impacts were also assessed.

RESULTS

There were no significant differences between groups regarding prosthodontic and patient-reported outcomes. The S-group demanded less clinical time (P = 0.002), with a 23.3% mean reduction in clinical time (P = 0.002) and lower number of appointments until the delivery of the dentures (S-group = 4.18 vs T-group = 5.0; P = 0.001).

CONCLUSIONS

This study showed that the alternative method for final impression is less time-consuming and has similar clinical outcomes when compared to the traditional final impression method. Findings suggest that this alternative may be considered when efficiency is a critical issue in healthcare services.

Teaching Complete Denture Procedures to Dental Students by Conventional or Simplified Methods: A Randomized Clinical Trial

With populations aging around the world, the need for complete dentures is likely to increase in Brazil and other developing countries, as well among low-income populations globally, making the teaching of cost-efficient techniques to dental students essential. The aim of this study was to evaluate the effectiveness of complete dentures fabricated by the simplified method in comparison to the conventional method regarding patients' oral health-related quality of life (OHRQoL) and satisfaction, dentures' functional quality, and masticatory performance of patients who were rehabilitated by dental students. From February 2016 to April 2017, final-year dental students at the Federal University of Alfenas, Brazil, were instructed to fabricate new complete dentures for 36 edentulous patients, who were randomly divided into two groups according to denture manufacturing method: simplified method or conventional method. Patients' OHRQoL and satisfaction and the prostheses quality were evaluated at one, three, and six months. Masticatory performance was evaluated at three months. The results showed there was no significant difference between the two methods regarding OHRQoL, patient satisfaction, prostheses quality, or masticatory performance (p>0.05). All aspects evaluated also remained constant for the same group (simplified method or conventional method) in all periods of evaluation (p>0.05). The study concluded that the simplified method for complete denture fabrication was able to produce protheses with functional quality and patient satisfaction comparable to those produced with the conventional method, even when made by dental students.

Success of Complete Denture Treatment, Detailed Investigation of Construction Protocols, Occlusal Schemes and Evaluation Questionnaires

Background/Aim: The successful outcome of conventional complete denture treatment can be defined with the use of both subjective and objective criteria. Denture satisfaction determinants may include denture quality, oral tissue condition, patient-dentist relationship, patient’s attitude toward dentures, patient’s personality and socioeconomic factors. Purpose: The aim of the current review was to identify and analyze the different construction protocols and occlusal schemes that contribute to the success of complete denture rehabilitation through the use of evaluation questionnaires.

Material and Methods: A comprehensive literature search was performed through electronic databases (MEDLINE via PubMed) using the appropriate key words (complete denture construction, complete denture fabrication, complete denture occlusion and complete denture occlusal scheme). The related to the subject scientific papers were selected and evaluated for eligibility utilizing a predefined review process (English, full text articles, published from January 2000 up to April 2017).

Results: None of the analyzed studies identified significant differences between dentures constructed with simplified, CAD/CAM and traditional protocols in terms of general satisfaction and Oral Health Related Quality of Life scales. The same condition applied to the studies which compared complete dentures with bilateral balanced, lingualized, monoplane and canine guided occlusion.

Conclusions: Current scientific evidence suggested that patients could adapt comfortably to any type of bilateral balanced occlusal scheme and to complete dentures been fabricated with all types of complete denture construction protocol. Disease-specific questionnaires could be considered valuable tools and should be used to assess the outcome of any treatment modality.

Do traditional techniques produce better conventional complete dentures than simplified techniques? A 10-year follow-up of a randomized clinical trial

OBJECTIVES

The use of a simplified method (S) of fabricating complete dentures has been shown to be more cost-efficient than the traditional method (T), and there are no negative consequences that detract from the cost savings in the short term. However, it is not clear whether this remains constant over a decade. The objective of this study was to clarify patients' perspectives and determine any differences between the dentures fabricated with these two different techniques after a decade of use.

MATERIAL AND METHODS

Edentate individuals participated in a randomized controlled clinical trial and completed a 6-month follow-up from 2001 to 2003 (T group n = 50; S group n = 54). For this 10-year follow-up, they were interviewed by telephone. The assessment included whether the denture was still in use or replaced, the condition of the dentures, patient satisfaction and oral health-related quality of life (OHRQoL). Between and within-group differences and the factors that cause deterioration of oral health-related quality of life (OHRQoL) were determined.

RESULTS

Among 54 responders (25 T and 29 S), 14T and 21S kept the original dentures. Both groups were similar in ratings of satisfaction and OHRQoL (maxilla T: 80.0 S: 86.0, p = 0.36; mandibular; T: 66.1 S: 72.3, p = 0.48; OHRQoL T: 111.1 S: 108.5, p = 0.46). Irrespective of fabrication method, discomfort, chewing difficulty and esthetics were the factors that deteriorate OHRQoL (adjusted r = 0.76, p < 0.001).

CONCLUSION

The results indicate that the simplified method remains more cost-efficient than the traditional method over a 10-year period. (IRB approval: A09-E71-12 B McGill University, trial registry: ClinicalTrial.org; NCT02289443).

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.

Learning effects of different training models for border molding from the perspective of dental students

BACKGROUND

The aim of this study was to investigate the effects of different practical training models on the comprehension and evaluation of practical training among dental students.

METHODS

The study subjects were all sixth-year dental students at our institute, and the study took place over three consecutive years (n = 58, 63, and 65, respectively). In practical training, all students learned border molding, and practical models were modified each year from plaster models to silicone models and then to silicone models mounted in mannequins. Immediately after completing clinical training, all students were asked to complete questionnaires consisting of 21 items regarding their overall practical training and their clinical comprehension of border molding. All items were rated on a five-point Likert scale, and in order to reduce the large number of interrelated questions, exploratory factor analysis was carried out using maximum likelihood estimation with promax rotation (κ = 4) and Kaiser normalization. The number of factors was chosen using the Kaiser-Guttman rule, which states that the eigenvalue should be larger than 1, and the scree plot criteria. Items that scored less than 0.25 in communality and exhibited factor loading greater than 0.35 for more than one item were excluded. The defined factors were analyzed for the plaster models, the silicone models alone, and the silicone models with mannequins using the Kruskal-Wallis test and follow-up tests using Bonferroni-corrected Mann-Whitney U tests. The significance level was set at p < 0.05.

RESULTS

Exploratory factor analysis identified the following three factors: "knowledge of border molding"; "contents of practical training"; and "personal learning attitude". The students who used silicone models and mannequins gave significantly better evaluations on the "knowledge of border molding" (p < 0.001, both) and "contents of practical training" (p = 0.046, p < 0.001, respectively) subscales than those who used plaster models. No significant differences were observed between those who used silicone models and those who used mannequins. Moreover, no significant differences were found on the "personal learning attitude" subscale among students for any model.

CONCLUSIONS

The change in practical training models from plaster to silicone improved student evaluations of border molding training.

Cost-effectiveness analysis of two impression methods for the fabrication of mandibular complete dentures

OBJECTIVES

To compare the cost and to evaluate cost-effectiveness of fabricating mandibular complete dentures (CDs) using two different impression methods.

METHODS

A crossover randomized controlled trial including 27 edentulous participants was performed. Mandibular CDs were fabricated using two different impression methods, as follows: (i) conventional method using a custom tray border moulded with impression compound and silicone and (ii) simplified method using a stock tray and alginate. Cost analysis was performed from a clinical practitioner's perspective. The total cost included labor cost, which was calculated using the time spent by dentists and technicians in fabricating CDs and their hourly wages, and the material costs, which were calculated using purchase prices. To evaluate cost-effectiveness, we used general patient satisfaction as an indicator of effectiveness and calculated the incremental cost effectiveness ratio (ICER). ICER represents the cost per one unit of effectiveness.

RESULTS

The trial was completed by 24 participants. The total cost was 43,904 Japanese Yen (JPY) (330.91 EUR / 395.78 USD) for the conventional method and 39,792 JPY (299.93 EUR / 358.70 USD) for the simplified method, and this difference was statistically significant (p<0.001). The ICER showed a cost of 633 JPY (4.77 EUR / 5.70 USD) for every one point change in general patient satisfaction.

CONCLUSIONS

The results indicated that the total cost of the conventional method was significantly higher than that of the simplified method (p<0.001).

CLINICAL SIGNIFICANCE

The conventional impression method for fabricating mandibular CDs, which took additional 633 JPY (4.77 EUR / 5.70 USD) for improvement of general satisfaction, is supposed to be clinically meaningful¹.

Efficacy of conventional treatment with composite resin and atraumatic restorative treatment in posterior primary teeth: study protocol for a randomised controlled trial

INTRODUCTION

Despite the widespread acceptance of conventional treatment using composite resin in primary teeth, there is limited evidence that this approach is the best option in paediatric clinics. Atraumatic restorative treatment (ART) using high-viscosity glass ionomer cement has gradually become more popular because it performs well in clinical studies, is easy to handle and is patient friendly. Therefore, the aim of this randomised clinical trial study is to compare the restoration longevity of conventional treatment using composite resin with that of ART in posterior primary teeth. As secondary outcomes, cost-efficacy and patient self-reported discomfort will also be tested.

METHODS AND ANALYSIS

Children aged 3-6 years presenting with at least one occlusal and/or occlusal-proximal cavity will be randomly assigned to one of two groups according to the dental treatment: ART (experimental group) or composite resin restoration (control group). The dental treatment will be performed at a dental care trailer located in an educational complex in Barueri/SP, Brazil. The unit of randomisation will be the child. A sample size of 240 teeth with occlusal cavities and 188 teeth with occlusal-proximal cavities has been calculated. The primary outcome will be restoration longevity, which will be clinically assessed after 6, 12, 18 and 24 months by two examiners. The duration of the dental treatment and the cost of all materials used will be considered when estimating the cost-efficacy of each treatment. Individual discomfort will be measured after each dental procedure using the Facial Scale of Wong-Baker.

ETHICS AND DISSEMINATION

This clinical trial was approved by the local ethics committee from the Faculty of Dentistry of the University of São Paulo (registration no. 1.556.018). Participants will be included after their legal guardians have signed an informed consent form containing detailed information about the research.

TRIAL REGISTRATION NUMBER

www.clinicaltrials.gov, NCT02562456; Pre-results.

Does a face-bow lead to better occlusion in complete dentures? A randomized controlled trial: part I

OBJECTIVES

In a double-blinded randomized controlled clinical trial, the impact of face-bow registration for remounting complete dentures (CDs) on the occlusal parameters (part I) was evaluated.

MATERIALS AND METHODS

New CDs of 32 patients were duplicated and mounted after intraoral pin registration according to mean settings (group 1) and (group 2) using a face-bow (arbitrary hinge axis). The vertical dimension was reduced to the first occlusal contact point, and a bite record was fabricated in the articulator. The number of contacts and the number of teeth in contact were evaluated by a computer program (laboratory result). After randomization, half of the CDs were adjusted according to protocol of group 1 and group 2 and delivered to the patients. After 3 days (T1) and 84 days (T2), clinical static contact points and teeth in contact were counted. Contact points and teeth in contact of both groups (laboratory results) and at different moments (clinical results) were analyzed statistically with the F test and bootstrapping.

RESULTS

Laboratory: No. 2 (face-bow) showed more occlusal contact points than no. 1 (mean setting), p > 0.05. The number of teeth with at least one occlusal contact was significantly higher in no. 2 (p = 0.027). Clinic: The mean number of teeth with at least one clinical contact point was significantly higher in no. 1 (no. 1 = 7.13, no. 2 = 5.31; p = 0.042). Extent of the vertical shift poorly correlated with number of laboratory occlusal contact points (R ² = 0.017).

CONCLUSIONS

Considering the complex multistep study design, a limited number of participants, and referring to one specific arbitrary face-bow, the following conclusion could be drawn: no substantial difference by the use of the arbitrary face-bow compared to a mean setting could be determined, when changing the vertical dimension in the articulator within a remounting procedure of complete dentures.

CLINICAL RELEVANCE

Further research is necessary to determine the effects of different arbitrary face-bows on the fabrication and adaptation of removable dentures.

Influence of a face-bow on oral health-related quality of life after changing the vertical dimension in the articulator: a randomized controlled trial. Part II

OBJECTIVES

In a double-blind randomized controlled clinical trial, the impact of face-bow registration for remounting complete dentures (CDs) on oral health-related quality of life (OHRQoL) was evaluated.

MATERIALS AND METHODS

New CDs of 32 subjects were clinically remounted using intraoral pin registration. CDs were transferred into a semi-adjustable articulator corresponding to group #1: mean settings with Bonwill triangle and Balkwill angle, and group #2: arbitrary hinge axis with a face-bow registration. After occlusal adjustment, subjects were followed up after 3 (T1) and 84 (T2) days. The primary outcome was the change of OHRQoL by OHIP-G49, while as secondary outcome, mucosal alterations were evaluated over time. Mean values of OHIP-G49 total sum scores and OHIP-dimensions were calculated for baseline (T0) and days 3 (T1) and 84 (T2) after intervention. Based on bootstrapping methods (changes of total OHIP sum score) and the Wilcoxon test (changes of sum scores of OHIP dimensions), analyses of between-group differences were performed.

RESULTS

Mean values (MV) of OHIP-G49 sum scores decreased in both groups from T0 (#1 48.56; #2 45.46) to T1 (#1 31.43 (p = 0.012); #2 43.20) and to T2 (#1 29.06; #2 29.40), which represents an improvement in OHRQoL. MV of OHIP-dimension sum scores decreased from T0 to T1 in both groups (#1 seven dimensions; #2 four dimensions); the decrease of sum scores was tested as not statistically significant (p > 0.05).

CONCLUSIONS

From the patient's perspective, mean-value-based remounting methods are of value. The use of a face-bow was not perceived as superior.

CLINICAL RELEVANCE

From the patient's perspective, remounting of CDs will be positively perceived, irrespective of the use of a face-bow.

Effectiveness of conventional treatment using bulk-fill composite resin versus Atraumatic Restorative Treatments in primary and permanent dentition: a pragmatic randomized clinical trial

Background

Clinical studies are being conducted in less strict conditions in order to establish an adequate scientific basis for decision making. The aim of this pragmatic randomized clinical trial is to evaluate the effectiveness of single and multiple-surfaces restorations performed following the Atraumatic Restorative Treatment (ART) premises compared with Conventional Treatment (CT) using bulk fill composite restorations in primary and permanent teeth.

Methods/design

A total of 1,214 5-to-13 year-old children with at least one single or multiple-surface dentin caries lesion in primary or permanent molars will be selected in public schools of Barueri-SP, Brazil. The participants will be randomly assigned into 2 groups: CT (caries removal with bur and restoration performed with Scotchbond™ Universal Adhesive system associated with Filtek Bulk Fill – 3 M/ESPE) and ART (Caries removal with hand instruments and restoration with high viscosity glass ionomer cement Ketac Molar Easy Mix – 3 M/ESPE). Ten untrained dentists will perform the treatment in in dental offices located at public schools. The restorations will be evaluated after 6, 12 and 24 months by an independent trained and calibrated examiner. The restoration and tooth survival, the cost-effectiveness analysis between the two groups and the operators’ preferences regarding the techniques will be also evaluated. Kaplan-Meier survival analysis and log-rank test will be applied for the restoration and tooth survival. All the average event rates in the two groups will be modelled and compared with a Cox proportional hazard shared frailty model since there is an operator-cluster effect. The significance level for all analyses will be 5 %.

Discussion

Our hypothesis is that despite similar expected effectiveness between ART using high viscosity GIC and conventional treatment using bulk fill composite resin when treating single or multiple-surface in posterior primary and permanent teeth, ART will present superior cost-effectiveness. The results of this trial will support decision-making by clinicians and policy makers.

Trial registration

NCT02568917. Registered on May 10th 2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s12903-016-0260-6) contains supplementary material, which is available to authorized users.

The importance of a two-step impression procedure for complete denture fabrication: a systematic review of the literature

The literature has questioned the real need for some clinical and laboratory procedures considered essential for achieving better results for complete denture fabrication. The aim of this study was to review the current literature concerning the relevance of a two-step impression procedure to achieve better clinical results in fabricating conventional complete dentures. Through an electronic search strategy of the PubMed/MEDLINE database, randomised controlled clinical trials which compared complete denture fabrication in adults in which one or two steps of impressions occurred were identified. The selections were made by three independent reviewers. Among the 540 titles initially identified, four studies (seven published papers) reporting on 257 patients evaluating aspects such as oral health-related quality of life, patient satisfaction with dentures in use, masticatory performance and chewing ability, denture quality, direct and indirect costs were considered eligible. The quality of included studies was assessed according to the Cochrane guidelines. The clinical studies considered for this review suggest that a two-step impression procedure may not be mandatory for the success of conventional complete denture fabrication regarding a variety of clinical aspects of denture quality and patients' perceptions of the treatment.

Simplified Complete Denture: A Systematic Review of the Literature

PURPOSE

Many procedures are used to construct traditional (T) complete dentures; however, a simplified (S) method requiring fewer steps and less time is available. This systematic review intends to summarize the modeling of simplified methods for complete dentures and evaluate the differences between the T method and S method. With this review, we hope to lay the foundation for proposing a standardized fabrication method for "simplified dentures."

METHODS

The MEDLINE (via PubMed) and EMBASE databases were searched for articles on simplified complete dentures published in English before April 2014. Eleven articles were included. One was about one-step complete dentures, two were about SET (simplified treatment of edentulous patients), and the others were about the normal simplified method, which includes impression, occlusal registration, and try-in. Seven were randomized controlled clinical trials (RCTs). The time, cost, patient satisfaction, clinical effects, masticatory performance, masticatory ability, and professional evaluation reported in these studies were compared.

RESULTS

We summarized the different techniques of fabricating complete dentures and discussed the RCTs of the normal complete technique. None of the RCTs identified significant differences between the S and T groups in terms of patient ratings for general satisfaction, OHIP-edentulous scale, denture quality, or masticatory ability. At the same time, the T method was significantly more expensive and required more time to complete than the S method.

CONCLUSIONS

Current scientific evidence suggests that the S method can replace or partly replace the T method. Moreover, specific rules should be devised to restrict the simplified construction, and detailed research should be conducted.

Impact of the radiographic examination on diagnosis and treatment decision of caries lesions in primary teeth--the Caries Detection in Children (CARDEC-01) trial: study protocol for a randomized controlled trial

BACKGROUND

Although most clinical guidelines throughout the world indicate that clinicians take two bitewings for detecting caries lesions in primary molars of all children, evidence for this recommendation is essentially based on cross-sectional studies performed in laboratory settings or using convenience samples. The benefits and impact of performing radiographs on diagnosis and treatment decision of caries lesions in primary teeth, mainly considering relevant outcomes for patients, have not been evaluated yet. Thus, the aim of this randomized clinical trial will be to evaluate the impact of performing radiographic examination adjunct to the visual inspection for detecting and making treatment decision regarding caries lesions in primary teeth compared with visual inspection performed alone. We will consider different outcomes related to children's health and welfare.

METHODS/DESIGN

To reach this objective, 250 children ages 3 to 6 years who sought dental treatment in our dental school will be randomly allocated in two groups according to the diagnostic strategy used for caries detection: visual inspection performed alone or visual inspection associated to radiographic examination. Two trained and calibrated examiners will carry out the examinations and elaborate the treatment decision plan. Then, children will be treated and followed up for 2 years, with evaluations after 12 and 24 months after the inclusion of children in the study. Children will also return after 6 and 18 months to reinforce the preventive orientations. Primary outcome will be the number of dental surfaces in need of dental treatment at the follow-up. Secondary outcomes will be the components of the primary outcome separately, as well as, proportion of false-positive results, the oral health-related quality of life, cost-efficacy, cost-adjusted life years, and number of new lesions in the first permanent molars.

DISCUSSION

Our working hypothesis is that radiographic examination would actually exert little influence on patient-centered outcomes, and visual inspection would be enough as diagnostic strategy for caries detection in primary teeth.

TRIAL REGISTRATION

NCT02078453. Registered 4 March 2015.

Evidence-based practice and barriers to compliance: Face bow transfer

PURPOSE

To recapitulate a 2003 study inquiring of US dental schools whether they teach the face bow transfer by means of a survey in order to determine if compliance with clinical evidence has improved.

METHODS

The same 54 dental schools surveyed in 2003 were asked the same question regarding whether they teach the use of the face bow transfer in the complete denture curriculum.

RESULTS

Teaching of the face bow transfer has increased in prevalence from 84% of surveyed schools in 2003 to 93.75% of surveyed schools in 2015.

CONCLUSIONS

This finding is especially interesting in light of the fact that there is no compelling evidence supporting the use of the face bow transfer with regard to improving patient outcomes. With respect to the continued unjustified teaching of the face bow transfer, some possible reasons for non-compliance with best available evidence are presented using the medical literature for reference.

New proposal of silver diamine fluoride use in arresting approximal caries: study protocol for a randomized controlled trial

BACKGROUND

Approximal surfaces are a challenge to caries lesions control. Silver diamine fluoride (SDF) is a simple,low-cost and promisor intervention for arresting caries lesions, but it has never been tested on approximal surfaces. Our aim is to evaluate the efficacy and cost-efficacy of SDF in arresting initial lesions compared to resin infiltration and exclusively flossing (control group). Our second aim is to assess discomfort and satisfaction regarding interventions.

METHODS/DESIGN

This is a randomized clinical trial, double-blinded, placebo-controlled study. Children/adolescents presenting at least one approximal initial caries lesion in primary molars/permanent premolars and molars will be included. Surfaces with advanced dentine lesions identified by radiography and participants who refuse to participate or present negative behaviors will be excluded. A minimum sample size of 504 surfaces will be required for each subgroup. Individuals will be randomly allocated in three groups of interventions: SDF, resin infiltration, and control group. Depending on the allocation, the patients will receive the active treatment and respective placebo therapies. All patients will be oriented to daily flossing the included surfaces. Our primary outcome will be caries progression by clinical and radiographic examinations. Appointments will be timed and costs of materials will be considered to calculate cost-efficacy. Patient discomfort will be assessed after interventions. Parent and patient satisfaction with the treatment will be collected after treatment and in the last follow-up visit. Individuals will be assessed at 1 and 3 months after treatment to evaluate dental biofilm and at 6, 12, and 24 months to assess caries progression by visual examination and/or radiography. Multilevel analyses will be used to verify if the type of treatment influenced on the tested outcomes. Costs will be compared and analyses of cost-efficacy will be performed. Poisson analysis will test the association between intervention and reported discomfort and satisfaction.

DISCUSSION

Our hypothesis is that SDF is the most cost-efficacious option from all tested interventions. If our hypothesis is confirmed, the use of SDF in private and public contexts could represent an easier and effective option in the treatment of enamel approximal caries in children/adolescents.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT01477385), Initial release: 11/16/2011: last update: 06/02/2014.

Simplified versus traditional techniques for complete denture fabrication: a systematic review

STATEMENT OF PROBLEM

A number of methods have been described for the fabrication of complete dentures. There are 2 common ways to make conventional complete dentures: a traditional method and a simplified method.

PURPOSE

The purpose of this study was to conduct a systematic review to compare the efficiency of simplified and traditional methods for the fabrication of complete dentures.

MATERIAL AND METHODS

The review was conducted by 3 independent reviewers and included articles published up to December 2013. Three electronic databases were searched: MEDLINE-PubMed, The Cochrane Library, and ISI Web of Science. A manual search also was performed to identify clinical trials of simplified versus traditional fabrication of complete dentures.

RESULTS

Six articles were classified as randomized controlled clinical trials and were included in this review. The majority of the selected articles analyzed general satisfaction, denture stability, chewing ability and function, comfort, hygiene, esthetics, speech function, quality of life, cost, and fabrication time.

CONCLUSIONS

Although the studies reviewed demonstrate some advantages of simplified over traditional prostheses, such as lower cost and clinical time, good chewing efficiency, and a positive effect on the quality of life, the reports related the use of different simplified methods for the fabrication of complete dentures. Additional randomized controlled trials that used similar simplified techniques for the fabrication of complete dentures should be performed with larger sample sizes and longer follow-up periods.

Método simplificado versus convencional de confecção de próteses totais: práticas adotadas pelos Cirurgiões-Dentistas

Introdução: A fim de reduzir custos e tempo clínico envolvidos com o tratamento, Dentistas têm utilizado métodos simplificados, omitindo ou abreviando partes da técnica de confecção das próteses totais. Objetivo: Levantar as práticas utilizadas pelos Cirurgiões-Dentistas para a confecção de próteses totais. Material e método: Os dados foram levantados por meio de um formulário eletrônico contendo perguntas relativas ao perfil e aos procedimentos clínicos utilizados, a fim de quantificar o uso de métodos simplificados e convencionais, bem como para determinar a relação com o perfil desses profissionais. Os resultados foram analisados por meio de análise de Aglomerados. Resultado: As respostas foram dadas, em sua maioria, por homens, tendo a prática clínica como sua principal fonte de renda e clínica privada ou conveniada como ambiente principal de trabalho (n=119). Grande parte dos entrevistados relatou realizar duas moldagens por arcada, utilização de articulador semiajustável com arco facial, determinação de plano oclusal por meio de guias anatômicos, utilização de meios métricos para análise da dimensão vertical de oclusão e determinação direta da relação cêntrica. O próprio Cirurgião-Dentista relatou ser o responsável na fase de seleção de dentes. A estatística identificou dois Aglomerados, com base nas características demográficas e na prática clínica, sendo um grupo formado por generalistas adeptos de perfis mais simplificados e outro formado por profissionais mais especializados em prótese que realizam técnicas convencionais. Conclusão: A adoção de técnicas simplificadas é associada àqueles Dentistas com perfil mais generalista, enquanto protesistas tendem a trabalhar mais de acordo com a Academia.

A randomized trial on simplified and conventional methods for complete denture fabrication: cost analysis

PURPOSE

This study aimed to quantify the costs of complete denture fabrication by a simplified method compared with a conventional protocol.

MATERIALS AND METHODS

A sample of edentulous patients needing conventional maxillary and mandibular complete dentures was randomly divided into group S, which received dentures fabricated by a simplified method, and group C, which received conventionally fabricated dentures. We calculated direct and indirect costs for each participant including unscheduled procedures. This study assessed 19 and 20 participants allocated into groups S and C, respectively, and comparisons between groups were conducted by the Mann-Whitney and Student's t-test (α = 0.05).

RESULTS

Complete denture fabrication demanded median time periods of 173.2 and 284.5 minutes from the operator for groups S and C respectively, and 46.6 and 61.7 minutes from the dental assistant (significant differences, p < 0.05). There was no difference between groups regarding postinsertion adjustments. Group S showed lower values for costs with materials and time spent by patients than group C during the fabrication stage, but not during adjustments.

CONCLUSIONS

The median direct cost of complete denture treatment was 34.9% lower for the simplified method. It can be concluded that the simplified method is less costly for patients and the health system when compared with a conventional protocol for the rehabilitation of edentulous patients.

Face-bow transfer in prosthodontics: a systematic review of the literature

An extensive search for randomised controlled clinical trials was accomplished to compare dental prostheses and occlusal splints constructed with or without face-bow transfer, and question whether face-bow transfer may present better clinical results than simpler approaches. Studies were identified by searching electronic databases (PubMed/MEDLINE, Latin American and Caribbean Literature on the Health Science, and Brazilian Bibliography of Dentistry). The keywords 'dental articulator', 'semi-adjustable articulator', 'face-bow', 'jaw relation record' and 'occlusal splint therapy' were used. The minimum inclusion requirements were (i) randomised controlled trials with patients of any age, (ii) comparison between dental prostheses or occlusal splints constructed with or without face-bow transfer and (iii) assessment of clinician's time, number of occlusal contacts, patient satisfaction or masticatory function. The search resulted in the identification of 8779 articles. Subsequently, 8763 articles were excluded on the basis of title and abstract. By the end of the search phase, eight randomised controlled trials were considered eligible. Current scientific evidence suggests that face-bow transfer is not imperative to achieve better clinical results in prosthodontics. Randomised clinical trials suggest that simpler approaches for the construction of complete dentures and occlusal splints may present acceptable results, while no clinical study has investigated its use in fixed and removable partial dentures.

A randomised trial of a simplified method for complete denture fabrication: patient perception and quality

Complete denture fabrication involves a series of complex technical procedures. Nevertheless, simplified methods may be as effective as conventional ones albeit the lesser use of time and resources, without disadvantage for the patient. This study compared a simplified method for complete denture fabrication to a conventional protocol in terms of oral health-related quality of life (OHRQoL), patient satisfaction and denture quality. Forty-two edentulous patients requesting treatment with complete dentures were randomly allocated into two study groups. Group S received dentures fabricated by a simplified method and Group C received conventionally fabricated dentures. Before interventions and after three and 6 months following insertion, OHRQoL and patient satisfaction were analysed by specific instruments. A prosthodontist assessed denture quality 3 months after delivery. Groups presented no difference for OHRQoL, denture quality and general satisfaction. Differences regarding patient satisfaction with some aspects of the dentures were found after 3 months (S > C), but were insignificant at 6 months. It was concluded that the simplified method is able to produce dentures of a quality comparable to those produced by the conventional method, influencing OHRQoL and patient satisfaction similarly.