Evaluation of Clinical Periodontal Parameters of Abutment Teeth Supporting Distal-Extension Base Removable Partial Dentures: A Cross-sectional Study

To assess the clinical periodontal status of abutment teeth in regards of different design components of distal-extension removable partial dentures. Subjects (N=100) with acrylic or cobalt-chromium distal-extension removable partial dentures were enrolled and their periodontal parameters plaque and gingival indices [PI, GI], probing depths [PD], clinical attachment loss [CAL] and a mobility index [MI] evaluated. Denture base type, major connector, occlusal rests position, design of direct retainers, retention, stability and denture wearing habits were further evaluated. Acrylic RPDs were associated with higher mean±SE PI [1.70±0.74], GI [1.76±0.55], PD scores [2.47±1.02 mm] and CAL values [4.46±2.11 mm] compared to CO-CR RPDs [p⟨0.05]. For abutments, the PI [1.6±0.83], GI [1.72±0.57], PD [2.32±1.03] and CAL [4.26±2.08] were higher than their non-abutments counterparts [p⟨0.05]. CAL scores were found to be significantly higher for mandibular abutments compared to maxillary ones [P=0.002]. The highest PI [1.83±1.10] and GI [2.00±0.00] scores were associated with lingual bars and horse-shoe connectors, respectively. Full palatal coverage and lingual plates were associated with the highest PD [2.80±0.48] and CAL [4.70±0.37] scores. Acrylic RPDs, type of major connector, wrought wire clasps and distal occlusal rests may be considered as risk factors for periodontal disease progression in distal-extension removable partial denture wearers.

Comparison of the impact of two types of removable partial dentures on the periodontal health of the remaining teeth: A prospective clinical study

OBJECTIVE

To evaluate and compare the impact of two removable partial dentures (acrylic removable partial denture [ARPD] and metallic removable partial denture [MRPD]) on periodontal tissues of the remaining teeth in the first 12 months of denture use.

MATERIALS AND METHODS

This prospective clinical study included 40 patients, of which 20 received ARPDs, 20 received MRPDs, nine in the maxilla, and 11 in the mandible each. The patients were 45-65 years old; 24 were females, and 16 were males. Patients' demographic details, clinical indicators of periodontal complications, and biochemical measurement of Hs-C-reactive protein (CRP) and alkaline phosphatase (ALP) were considered. One-way analysis of covariance and Friedman were used to measure the differences in clinical periodontal parameters between the two types of dentures.

RESULTS

The significant findings were: Plaque index (PLAQ) scores for abutment teeth were higher in MRPD wearers (mean = 12.15) than ARPD wearers (mean = 10.45), whereas ARPD users had significantly higher mean bleeding on probing (BOP) values (mean = 1.5) than MRPD users (mean = 0.00); mobility of abutment teeth showed no significant differences; timeline comparisons showed a significant increase in the percentage of nonabutment teeth mobility in ARPD users (p = .028) compared with MRPD users over the same follow-up period (p = .102).

CONCLUSIONS

For a short-term period of 1 year, periodontal and mobility parameters have no significant impact on the abutment and nonabutment teeth of ARPD and MRPD users. Moreover, biochemical markers (CRP and ALP) for periodontal inflammation exhibited no significant difference in both types of dentures.

[The effect of astaxanthin on the adaptation of the oral mucosa to a removable denture]

THE AIM

Of this study was the evaluation of the effect of the antioxidant gel on the oral mucosa and reduction of the time of adaptation to a removable denture in patients with partial adentia.

MATERIAL AND METHODS

The study comprised 105 patients aged 30-65 years divided into three groups: the main group of 45 patients, the comparison group of 35 patients, the control group of 25 patients. The main group was given a prophylactic gel with natural astaxanthin after the delivery of a removable prosthesis. The patients of the control group and the comparison group do not received an antioxidant gel. Patients of all three groups underwent a study of the hygienic state of the oral mucosa and oral fluid to assess the state of oral microbiocenosis. The main group and the comparison group underwent visual examination and photoplanimetric control after the placement of a removable denture.

RESULTS

A positive preventive and anti-inflammatory effect of astaxanthin gel was found in patients who received an immediate and a partial removable dentures. The use of the gel for 7 days helps to reduce the values of hygiene indices, concentrations of bacterial plasmalogen and endotoxin in the oral fluid in the short-term perspective.

CONCLUSION

Preventive dental gel with astaxanthin decreases the time of adaptation to removable dentures by 1.7-2 times and reduces the risk of prosthetic stomatitis due to its wound-healing, anti-inflammatory and antimicrobial actions.

Biological complications of removable dental prostheses in the moderately reduced dentition: a systematic literature review

OBJECTIVES

The aim of the present study was a systematic review and subsequent meta-analysis on biological complications of removable prostheses in the moderately reduced dentition.

MATERIALS AND METHODS

A systematic literature search in established medical databases (MEDLINE, EMBASE, BIOSIS, SciSearch, Cochrane, FIZ Technik Web) and a hand search of relevant dental journals was conducted. The search terms were relevant MeSH terms, free search terms, and combinations of the two. The search included randomized controlled trials, prospective and retrospective studies with data on biological complications of removable dental prostheses in the moderately reduced dentition with at least 15 participants, an observation period of at least 2 years, and a drop-out rate of less than 25%. The selection of relevant publications was carried out at the title, abstract, and full-text level by at least two of the authors involved. The publications included were tabulated and analyzed.

RESULTS

Of the original 12,994 matches, 1923 were analyzed by title, 650 by abstract, and 111 according to the full text. A total of 42 publications were ultimately included. The following parameters were evaluated.

TOOTH LOSS

Results varied, depending on the observation period, between 0 and 18.1% for clasp-retained removable dental prostheses (RDPs), between 5.5 and 29% for attachment-retained RDPs, and between 5.5 and 51.7% for double crown-retained RDPs.

CARIES

Results varied, depending on the observation period, between 0 and 32.7% for clasp-retained RDPs, between 1.8 and 29% for attachment-retained RDPs, and between 1.8 and 16.4% for double crown-retained RDPs.

ENDODONTIC TREATMENT

Results varied, depending on the observation period, between 3.5 and 19.2% for clasp-retained RDPs, between 6.9 and 16.4% for attachment-retained RDPs, and between 0.6 and 13.9% for double crown-retained RDPs.

TOOTH FRACTURE

Results varied, depending on the observation period, between 1.7 and 5.3% for clasp-retained RDPs, between 12.7 and 40% for attachment-retained RDPs, and between 0.4 and 4.4% for double crown-retained RDPs.

TOOTH MOBILITY

There were no changes or improvements for clasp-retained RDPs. The better the pre-treatment and supportive care is, the smaller the differences are. For double crown-retained RDPs, a slight increase was found in one study. The results for the parameters probing depth and radiological bone loss were inconclusive.

GINGIVAL RECESSION

Gingival recession seemed to be favored by a mandibular sublingual bar. Compared to fixed restorations, removable restorations seemed to be associated with a more pronounced need for dental treatment. Stringent pre-treatment and supportive care reduced the complication rates.

CONCLUSIONS

Heterogeneous study designs and data analyses rendered a meta-analysis impossible, so that an evaluation at the highest level of evidence could not be performed.

CLINICAL RELEVANCE

Within the limitations of this study, it would be correct to state that removable dental prostheses require intensive maintenance. Suitable pre-treatment and supportive care can lower the complication rates, in the absence of which they constitute trigger factors for (additional) biological complications.

A Five-Year Retrospective Assay of Implant Treatments and Complications in Private Practice: Restorative Treatment Profiles of Long-Span, Implant-Supported Fixed and Removable Dental Prostheses

PURPOSE

To describe the restorative treatment profiles of long-span (> three units), implant-supported dental prostheses (LIDPs) prescribed in 27 private practices in the state of Victoria, Australia, during the period from January 1, 2005, to December 31, 2009. The restorative treatment profiles of these prostheses refer to the framework/veneering materials, number of prosthetic units/supporting implants, location in the oral cavity, retention methods, and cantilever designs. LIDPs refer to implant-supported prostheses of fixed or removable design; namely, fixed partial dentures (IFPDs), fixed complete dentures (IFCDs), removable partial dentures (IRPDs), and complete overdentures (IODs).

MATERIALS AND METHODS

Private dental practitioners providing implant treatment in Victoria, Australia, were invited to enroll in this study, which was conducted through a dental practice-based research network (the eviDent Foundation). The enrolled practitioners' clinical records of the implant treatments provided during the specified period were accessed for data collection. Descriptive statistics, cross-tabulations, and linear mixed models were conducted for data analyses.

RESULTS

During the study period, 627 LIDPs were prescribed to 556 patients by 18 general dentists and 5 prosthodontists. LIDPs were more common in the maxilla than in the mandible except in the case of IODs. Of the fixed prostheses, 60% replaced missing teeth in more than one sextant, 33% in the anterior sextant, and 7% in the posterior sextant. The average number of prosthetic units per implant was higher in mandibular compared to maxillary IFPDs/IFCDs (2.5 vs 1.9, respectively, P < .001). Cantilever pontic(s) were present in 68% of IFCDs (more often in the mandible than in the maxilla) compared to 28% of IFPDs (use of cantilever pontics was about the same in the maxilla and mandible). Screw retention was the most commonly reported retention method in IFPDs/IFCDs (95%). Locator attachment was used for the majority of IRPDs/IODs (83%).

CONCLUSION

The clinicians enrolled in this study preferred fixed over removable LIDPs for partially dentate and maxillary edentulous cases. For mandibular edentulous patients, IODs were prescribed more often than IFCDs. A retrievable retention design was favored for IFPDs/IFCDs. IFPDs were predominantly metal-ceramic, and metal-acrylic designs were more popular for IFCDs.

Evaluation of the Periodontal Status of Abutment Teeth in Removable Partial Dentures

The purpose of this study was to evaluate whether the use of removable partial dentures affects the periodontal status of abutment teeth. An observational cross-sectional study was done on a sample of patients rehabilitated with removable partial dentures (2010 to 2013). At a recall appointment, a clinical examination was done to collect data related to the rehabilitation and periodontal status of the abutment teeth. Of 145 invited patients, 54 attended the requested follow-up appointment (37.2%). Mean patient age was 59.1 years, and the study population was 42.6% male and 57.4% female. The mean follow-up time for the prosthesis was 26 months. Abutment teeth had higher values in all periodontal variables (P < .001). Occlusal clasps had the worst results in relation to clasps with a gingival approach (P < .005). Significant differences were also found in mandibular abutment teeth of Kennedy Class I and II compared to Class III (P < .048). The periodontal status of the abutment teeth of removable partial dentures is affected by these rehabilitations. A recall program for these patients involving removable prosthodontics and periodontology appointments is mandatory.

Chronological grey scale changes in supporting alveolar bone by removable partial denture placement on patients with periodontal disease: A 6-month follow-up study using digital subtraction analysis

OBJECTIVES

The purpose was to assess the early effects of removable partial denture (RPD) placement on abutment teeth in patients with periodontal disease.

METHODS

Fifteen distal-extension RPDs and 19 abutment teeth were evaluated in 13 patients with moderate-to-severe periodontal diseases. Clinical periodontal records and grey level (GL) score based on digital subtraction radiography were measured on the day of denture placement (baseline) and at 1day, 1 week, 1 month, 3 months, and 6 months after the placement. Occlusal force on total dentition (Ft) and abutment tooth (Fa) were recorded with (baseline) and without denture on the day of the placement, and with denture in the follow-up examinations.

RESULTS

No statistically significant difference between a follow-up period and the baseline was found in the clinical periodontal and occlusal force records, except for Ft with denture on the day of the placement, which was significantly lower than the baseline (p<0.05). The GL at distal crestal of the abutment was significantly higher at 1 week after the placement than at the baseline (p<0.05), while the scores of following examinations returned to the baseline level.

CONCLUSIONS

The distal crestal bone of the abutment tooth transitorily reacts to mechanical stress due to the denture placement, while this does not suggest a detrimental effect within the limitation of the study design with a short-term observation period.

CLINICAL SIGNIFICANCE

The RPDs can be safely used for patients with periodontal diseases for at least 6 months if they are properly placed and maintained by professional care.

Masticatory efficiency and muscular activity in removable partial dental prostheses with different cusp angles

STATEMENT OF PROBLEM

The loss of posterior teeth has a negative effect on the masticatory efficiency and activity of mastication muscles. How these muscles are affected by partial removable dental prostheses (PRDPs) with different cusp angles is unknown.

PURPOSE

The purpose of this clinical study was to evaluate the influence of different cusp angles, with anatomic (33 degrees), semianatomic (20 degrees), and nonanatomic teeth (0 degree), on the masticatory efficiency and muscular activity of participants receiving mandibular bilateral distal PRDPs.

MATERIAL AND METHODS

Fifteen participants consented to the evaluation of masticatory efficiency and electromyographic (EMG) activity with a PRDP with a unified bilateral design. The cusp angles of the artificial teeth were randomly changed from anatomic (33 degrees), semianatomic (20 degrees), and nonanatomic teeth (0 degree). Masticatory efficiency was evaluated by recording 5 parameters, including number of strokes, and time of mastication while the EMG activities of the masseter and temporalis muscles, measured using surface electromyography. The data were analyzed with 1-way ANOVA and the Tukey multiple post hoc test with statistical software (α=.05).

RESULTS

With regard to masticatory efficiency, PRDPs with anatomic and semianatomic teeth exhibited higher masticatory efficiency than those with nonanatomic teeth, whereas no significant differences were found between PRDPs with anatomic and semianatomic teeth. With respect to EMG activity, the least EMG activity was observed in PRDPs with anatomic teeth, whereas the highest activity was observed with nonanatomic teeth. No significant differences were found between the effect of PRDPs with anatomic and semianatomic teeth on masseter activity.

CONCLUSIONS

Changing the cusp angle from 33 to 20 degrees in PRDPs did not influence the masticatory efficiency or the EMG activity of the masseters. However, it did lead to increased EMG activities of the temporalis muscle. PRDPs with nonanatomic teeth were associated with a significant decrease in masticatory efficiency accompanied by a significant increase in EMG activity.

Too Much To Swallow? A Case Report Of An Ingested Denture

Ingested foreign bodies can prove a significant and potentially fatal threat. A case is reviewed where a patient swallowed his upper Kennedy Class I removable partial denture, highlighting the potential problems of this prosthesis design and the management of this scenario.

Complications associated with implant-retained removable prostheses

Implant-supported removable prostheses improve patients' satisfaction with treatment and quality of life. Improvements in the implant's surface and in attachment elements have made this treatment method very successful. However, some biological and mechanical complications remain. Mechanical complications associated with implant-supported overdentures and implant-supported removable partial dentures are loss of retention of attachment systems, the need to replace retention elements and to reline or repair the resin portion of the denture, and implant fracture. Despite their success, implant-supported removable prostheses require periodic maintenance.

The influence of the design of mandibular major connectors on gingival health

BACKGROUND

The objective of this study was to assess the influence of lingual bar and lingual plate major connectors on plaque retention and gingival health among patients who presented in University College Hospital (UCH), Ibadan, Nigeria.

METHODS

This comparative intervention study was carried out among fifteen patients aged 28 to 60 years with Kennedy class III lower edentulous arch. Two metal dentures with different major connector designs (lingual plate and lingual bar) were fabricated for each patient. After professional scaling and polishing, a baseline score of the oral hygiene was done using the plaque index of Sillness and Loe and the gingival health using the gingival index of Loe and Sillness. Each patient was randomly assigned either a denture with the plate or bar design to use for three months and then recalled for reassessment of oral hygiene and gingival health. Professional scaling and polishing was done post removal and a new baseline assessment of oral hygiene and gingival health recorded. The dentures were now exchanged and the second major connector design inserted. Each patient was recalled for reassessment of the oral hygiene and gingival health after three months. The level of plaque accumulation and gingival inflammation with the use of lingual plate and bar dentures were determined and compared.

RESULTS

There was no statistically significant difference in the mean plaque index score for the lingual bar design at three months and the mean plaque index score at three months for the lingual plate (p > 0.05). However, a statistically significant lower mean gingival index score was noted three months post insertion for lingual bar designs when compared to plate designs.

CONCLUSION

Within the limitation of this study, better gingival health was noted with the bar designs when compared with the plate designs.

Failures in the rehabilitation treatment with removable partial dentures

BACKGROUND

Despite being functional and having aesthetic benefits, the acceptance of patients regarding the use of removable partial dentures (RPDs) has been low. In part, this is due to the deleterious effects that causes discomfort to the patient. Success depends not only on the care expended by the patient, including daily care and oral hygiene, but also on common goals set by their professional and clinical staff, aiming beyond aesthetics, to incorporate issues of functionality and the well-being of patients.

METHODS AND RESULTS

For rehabilitation treatment with RPDs to reach the desired level of success without damaging the support structure, all the steps (diagnose, cavity preparation, adaptation of the metal structures, functional of distal extension and posterior follow-up) in the rehabilitative treatment should be carefully developed. A literature review was carried out, searching through MEDLINE (PubMed) articles published between 1965 and December 2012 including clinical trials and reviews about the use of RPDs.

CONCLUSIONS

This study describes factors that lead to failures and complications in oral rehabilitation through the use of RPDs and suggests possible solutions.

Increased vertical dimension of occlusion: signs, symptoms, diagnosis, treatment and options

During the planning of oral rehabilitation, the vertical dimension of occlusion (VDO) is one of the first parameters to be measured since its improper restoration can lead to the failure of any prosthetic rehabilitation. A decreased VDO can lead to the appearance of lesions, such as angular cheilitis, facial disharmony, and temporomandibular disorders; meanwhile, an increased VDO may lead to the onset of joint and muscle pain, tension in functional speech, difficulty in swallowing, impaired chewing, tooth sensitivity due to traumatogenic forces, pathologic bone resorption, abnormal wearing of teeth, the appearance of an elongated face, and a facial expression of fatigue. Most scientific articles deal with methods and techniques for re-establishing VDO in edentulous patients or those who have lost their tooth reference due to prosthetic preparations. However, patients with increased VDO are also found in everyday practice. One treatment option for these patients is occlusal adjustment by selective tooth wear; it is still possible to perform orthodontic intrusion and/or orthognathic surgery in severe cases. The aim of this study was to discuss signs, symptoms, diagnosis, and treatment, and to report a clinical case of a patient with increased VDO.

[Osteoradionecrosis of the jaw, presumably caused by a removable partial denture]

An 81-years-old man developed a severe osteoradionecrosis of the mandible following surgery and radiotherapy in the head and neck area as a result of a carcinoma at the front ofthe floor of the mouth. Presumably, the osteoradionecrosis had been developed by an injury of the oral mucosa due to a removable partial denture. There are no uniform guidelines for the treatment of osteoradionecrosis of the jaw bones. Treatment modalities vary from removal of sequesters, sometimes long-term use of antibiotics, treatment with hyperbaric oxygen and wide surgical resection with or without reconstruction of the jaw.

The association of denture stomatitis and partial removable dental prostheses: a systematic review

PURPOSE

The aim of this systematic review was to analyze the evidence on the occurrence of denture stomatitis (DS) and potential risk factors in patients wearing partial removable dental prostheses (RDPs).

MATERIALS AND METHODS

MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews were searched and complemented by manual searching. Outcome measures were the presence of DS in patients wearing partial RDPs and an assessment of associated risk factors. All types of experimental and observational studies investigating an association between DS and the wearing of partial RDPs were included. Methodologic quality and level of evidence were assessed using valid scales. Two authors performed study selection, data extraction, and quality assessment independently.

RESULTS

A total of eight studies met the inclusion criteria. The prevalence of DS in partial RDP wearers ranged from 1.1% to 36.7%. Data on the potential risk factors were not consistent. Despite the heterogeneity and methodologic quality of included studies, an association between DS and the wearing of partial RDPs was found.

CONCLUSIONS

There is some evidence that the presence of DS is associated with the wearing of partial RDPs. However, because of methodologic limitations and cross-sectional designs of research studies, no cause-effect relationship could be inferred. Future research should provide higher levels of evidence to confirm the etiology of DS in partial RDP wearers.

[Basis of the algorithm of patient conducting using removable dentures in case of partial teeth loss]

Paper is devoted to the actual problem in stomatology - removable dentures influence upon the intensity of prosthetic bed relief changes. Study of prosthetic bed relief in patients who for 2 years had used plate removable and clasp dental prostheses was done. The most pronounced prosthetic bed relief changes were seen under plate type of prostheses with prolonged defects the least - in patients with plate type of prostheses with short defects. In cases of end defects under clasp dental prostheses changes of prosthetic bed relief exceeded relief changes under plate type of prostheses during all terms of use. Based upon the received data algorithm of patient conducting during different terms of use by plate removable and clasp dental prostheses.

Incidence and association of root fractures after prosthetic treatment

PURPOSE

Common reasons for tooth extractions include periodontal disease, dental caries and root fracture. The purpose of this study was to investigate the association of tooth loss after prosthetic treatment, particularly incidences due to root fracture, which occur frequently and are difficult to prevent.

METHODS

Data were collected from consecutively selected medical records of patients taken over 3 years after their initial visit to Osaka University Dental Hospital. Collected data included (1) age and gender, (2) number of teeth at the initial visit and number of extracted teeth, (3) reasons for extraction, (4) restored with or without a post and (5) abutment of removable partial dentures (RPDs). A Chi-squared test was applied among the reasons for extraction, whether the tooth was restored with a post or not and clasped or not. A logistic regression analysis was used to determine the associations of root fracture with the patient data.

RESULTS

This study included 101 patients (296 extracted teeth). The reasons for extraction included periodontal disease (64.6%), caries (25.3%) and root fracture (10.1%). The percentage of root fracture was significantly higher for female than male, for restored teeth with posts than without posts and for abutment of RPDs than for non-abutment teeth. Logistic regressions showed that root fractures were significantly associated with gender and abutments.

CONCLUSION

The most frequently stated reasons for tooth extraction after prosthetic treatment were periodontal disease and dental caries, followed by root fracture. Root fractures were significantly associated with gender and abutment teeth of RPDs.

Characteristic features of impacted denture cases in Nigeria

OBJECTIVE

The study was designed to determine the characteristic features of impacted dentures, the patients presenting with them and to determine the pattern of distribution of cases in a cross-section of Nigerian Teaching Hospitals.

MATERIALS AND METHODS

Self-administered questionnaire was distributed among Ear Nose and Throat (ENT) resident doctors during an update course at University College Hospital (UCH), Ibadan, Oyo State, Nigeria. Demographic variables, number of cases encountered over a 10-year period and characteristics of impacted dentures and those of the victims were requested.

RESULT

62.5% of the respondents indicated that the patients were males in the 30-65 years age bracket and that most of them were not satisfied with their dentures at the time of impaction. All the respondents indicated that the cases involved were partial dentures, most of which were upper acrylic dentures without clasps. The highest self-reported number of denture impaction cases (22) was recorded in Lagos University Teaching Hospital (LUTH).

CONCLUSION

The preliminary report shows that cases of denture impaction usually involve upper partial dentures without clasps in dissatisfied male denture wearers within 30-65 years age bracket.

[Etiopathogenesis of complication caused by removable full dentures]

The goal of the research was to study the complications caused by removable dentures. For these reason 890 patients were investigated. It was found that the pathologic changes in oral cavity are the results of: poor quality of denture, unfavorable condition before and after prosthesis. The factors responsible in the development of complications after orthopedic treatment were identified: living conditions, quality and toxicity of dentures materials. The received results give an ability to determine the common disturbance in the maxillo-facial system and use adequate methods and remedies to avoid complications caused by removable orthopedic construction.

[Removable partial dentures. Oral functions and types]

A removable partial denture enables the restoration or improvement of 4 oral functions: aesthetics, mandibular stability, mastication, and speech. However, wearing a removable partial denture should not cause oral comfort to deteriorate. There are 3 types of removable partial dentures: acrylic tissue-supported dentures, dentures with cast metal frameworks en dentures with cast metal frameworks and (semi)precision attachments. Interrupted tooth arches,free-ending tooth arches, and a combination of interrupted as well as free-ending tooth arches can be restored using these dentures. Well-known disadvantages of removable partial dentures are problematic oral hygiene, negative influence on the remaining dentition and limited oral comfort. Due to the advanced possibilities of fixed tooth- or implant-supported partial dentures, whether or not free-ending, or tooth- as well as implant-supported partial dentures, the indication of removable partial dentures is restricted. Nevertheless, for the time being the demand for removable partial dentures is expected to continue.

Removable partial dentures

On one side, prosthodontic reconstructions compensate for the sequelae of negative changes in the oral cavity; on the other side, they often enhance or accelerate them. As a consequence of negative changes in the oral cavity over time, treatment planning for RPDs becomes highly complex. A set of reliable criteria is necessary for decision-making and problem management It appears that the majority of published data on RPDs does not depict high effectiveness of this treatment modality. From a strict point of view of evidence-based dentistry, the level of evidence is low if not missing for RPDs. Randomized controlled trials on RPDs are difficult to design, they are not feasible for some questions due to the complexity of the material, or may remain without clinical relevance. The literature rarely gives information on the denture design, tooth selection, and management of the compromised structural integrity of teeth. So far treatment outcomes with RPDs must be considered under the aspect of bias due to the bias in indication and patient selection for RPDs. Better clinical models should be elaborated with more stringent concepts for providing RPDs. This encompasses: risk analysis and patient assessment, proper indications for maintenance or extraction of teeth, strategic placement of implants, biomechanical aspects, materials, and technology. Although there is a tendency to offer fixed prostheses to our patients, this might change again with demographic changes and with an increase in the ageing population, an increase in their reduced dentition, and low socioeconomic wealth in large parts of the world.

Prolonged foreign body impaction in the oesophagus

It is not unusual for a foreign body to be swallowed and become lodged in the oesophagus. It is, however, very unusual for such a foreign body to remain lodged for a period of six months. This particular case, a 37-year-old man, is interesting because of the length of time the foreign body, a denture, remained in the oesophagus without complications, its successful removal and the nature of the foreign body, which is prone to cause complications on prolonged stay or during removal.

The influence of posterior occlusion when restoring anterior teeth

When any type of esthetic restorative procedure is being considered or performed, a comprehensive diagnosis and treatment plan is required. Attention to the diagnostic signs of the loss of posterior support (LPS) and their influence on the anterior dentition will guarantee a more predictable outcome. Historical solutions and their inadequacies are addressed. Patient presentations are utilized to demonstrate contemporary treatment of patients requiring esthetic rehabilitations who are lacking posterior support.

[Application of sublingual bar to removable partial denture of a patient complaining of major discomfort to lingual plate]

PATIENT

A 62-year-old man complained of discomfort during insertion of lower removable partial denture (RPD). Existing denture was highly objectionable to tongue and intolerable to wear due to volume and contour of its lingual aspect. The treatment plan included fabrication of an interim denture and altering its shape until it did not lead to discomfort, followed by fabrication of a final denture. Consequently, RPD using sublingual bar was found to be the most comfortable to wear and was fabricated as final denture. The patient was ready to insert the final denture and restoration of masticatory function was accomplished.

DISCUSSION

In cases with unfavorable anatomic conditions such as a lack of mouth-floor depth, lingual plate should be applied as first choice, and when it is not well tolerated by the patient, sublingual bar should be applied.

CONCLUSION

Sublingual bar is suggested to be one of the least objectionable major connectors.

[Serious complications following (removal after) ingestion of a partial denture]

Complications occurred in a 41-year-old woman (case 1) following a first attempt to remove a partial denture by oesophagoscopy. These were: laceration of the oesophagus with subsequent mediastinitis, pneumothorax, and pneumopericardium. With a second oesophagoscopy the denture was removed from the oesophagus using a flexible endoscope with a latex hood. Following antibiotic treatment the patient recovered. With a 45-year-old man (case 2) who had also swallowed a denture, the denture initially could not be localized. It was eventually recovered from the gastric antrum using a flexible scope with a latex hood, also in the second attempt. Psychiatric and mentally handicapped patients run a high risk of denture ingestion. Ingested dental prostheses are often radiolucent, and are difficult to visualize using conventional radiological methods. Extraction of the ingested foreign objects can lead to severe complications. This is why in this type of case, we recommend having an expert remove from a foreign object with the use of a flexible scope fitted with a latex hood. It is advisable to make removable dental prostheses radiopaque or to avoid using them with the identified risk-group.

Denture-related osteonecrosis of the maxilla associated with oral bisphosphonate treatment

BACKGROUND

Bisphosphonates are a class of agents used to treat various systemic conditions. Despite the benefits of bisphosphonates, osteonecrosis of the jaws is an important complication in a subset of patients who receive this drug treatment.

CASE DESCRIPTION

A 66-year-old woman was referred to an oral surgeon at a private surgical center because of a pressure wound in the margins of a removable maxillary denture. The patient reported that she had received oral alendronate sodium treatment for eight years. A clinical examination revealed a palatal ulcer with exposed necrotic gray bone at its center. The clinician performed an excisional biopsy and separated two palatal rotational flaps to enable an adequate blood supply to reach the operated-on area.

CLINICAL IMPLICATIONS

This report, together with growing evidence in the literature, serves to alert treating physicians and dental practitioners about the potential complication of maxillary and mandibular bone necrosis in patients receiving bisphosphonate therapy.

[Serious complications following removal of an ingested partial denture]

Complications occurred in a 41-year-old woman following an attempt to remove a partial denture by oesophagoscopy. These were: laceration of the oesophagus with subsequent mediastinitis, pneumothorax, and pneumopericardium. At a second oesophagoscopy the denture was removed from the oesophagus using a flexible hood. Following antibiotic treatment the patient recovered. In a 45-year-old man who had also swallowed a denture, the denture could not initially be localized. It was eventually recovered from the antrum using a flexible scope with a flexible hood. The patient was discharged from hospital in a good condition. Psychiatric and mentally handicapped patients run a high risk of denture ingestion. Ingested dental prostheses are often radiolucent, and are difficult to visualize using radiological methods. Extraction of the ingested foreign objects can lead to severe complications. This is why in this type of case, we recommend the use of a flexible scope and a flexible hood attachment.

[Comparative analysis of the results of patient prosthetic treatment by removable arch and elastic constructions in cases of end mandibular defects based on microcirculation study of prosthetic bed tissues]

Study was performed of the microcirculation in gingival tissues of prosthetic bed in patients with end mandibular defects treated by removable arch and elastic constructions in order to increase prosthetic treatment efficacy. It was established that most favourable stimulating effect upon trophics was achieved in patients who had received removable plate constructions made according to the technology of thermoinjection system produced by the company Valplast on nylon base.

A comparison of oral health related quality of life between complete and partial removable denture-wearing older adults in Korea

The purpose of this study was to compare the oral health related quality of life (OHRQoL) between older Korean adults with complete and partial removable dentures using oral health impact profile (OHIP). A pool of 4250 Korean older adults was identified by random stratification by area from the sample cohort of Korean National Survey of Oral Health in the year of 2000. Out of the potential pool, 445 subjects with removable partial dentures (RPDs) or complete dentures (CDs) agreed to be interviewed by telephone. Each question in the survey was about how frequently each event was experienced during the past 12 months. To analyse the association between OHIP scores and removable denture status, bivariable analysis and multiple linear regression analysis were used. RPD users showed higher scores on eight items than CD users. They were 'breath stale', 'food catching', 'sensitive teeth', 'toothache', 'tense', 'unable to brush teeth', 'less tolerant to family members' and 'irritable with others'. RPD users might be associated with higher scores of functional limitation, physical pain and psychological discomfort than CD users. RPD users had slight tendency to be associated with higher OHIP-49 score than CD users, but it was not statistically significant. The findings of the present study confirm that there is no general OHRQoL difference between RPD and CD users. But in the items and subscales of OHIP, RPD users might experience more impaired OHRQoL than CD users.

[Case report of enterobrosis and diffuse peritonitis caused by a swallowed removable partial denture]

A female patient, aged 62 years, unexpectedly swallowed a removable partial denture (RPD) during the supper. The doctor failed to take out the RPD from her stomach under the gastroscope during the emergency treatment at the first day. 2 days later, the PRD blocked the intestinal tract and its metal clasps penetrated the wall of the intestine near the ileocecal junction, it soon leaded to enterobrosis and diffuse peritonitis. At last, abdominal operation was conducted to take the RPD out from the intestine and enterobrosis was patched up successfully. Diffuse peritonitis was also cured by intravenous infusion of antibiotics for about 1 week.

[The effects of removable partial dentures on abutment teeth in elder patients]

PURPOSE

To analyse the effects of removable partial dentures on abutment teeth in elder patient and to discuss the reason of the effects and the preventive measures.

METHODS

95 aged patients with removable partial dentures were involved in the investigation, the rate of dental caries, fractures and missing in their abutment and non abutment teeth and the reason were recorded and analysed. X2 test was used for the statistical comparison.

RESULTS

The removable partial denture in 5 years after wearing, the dental caries rate of the abutment teeth (17.38%) was significantly higher than the non abutment teeth (7.10%) (P<0.01). The missing abutment teeth (27.01%) extracted because of fracture or loose that made by periodontal disease and dental caries which can not be reserved was significantly higher than that of non abutment teeth (7.79%).

CONCLUSION

The effect on abutment teeth of removable partial denture in aged patients were complex and it can increase the rate of dental caries , fracture and missing of abutment teeth.

Quality of life and masticatory function in denture wearers

Successful prosthodontic treatments for a patient with removable partial dentures including maxillofacial prostheses hopefully brings about psychological wellbeing as well as improved health. The purpose of this study was to investigate the relationship between quality of life (QOL) and the various aspects of denture function. At first, a questionnaire with a visual analog scale with 16 question items concerning denture and/or eating problems, the present state of health, psychological and physical wellbeing, life satisfaction, and QOL was developed. To discuss the validity and reliability of the questionnaire, 48 outpatients who wore a denture were asked to fill it out. Next, to discuss the difference in QOL of the patient with various kinds of dentures and conditions, 103 outpatients were asked to complete the newly developed questionnaire. The questionnaire which contained four factor areas with eight questions for denture patients was developed by factor analysis with Varimax rotation. The reliability of the QOL scale was confirmed by reliability analysis (Cronbach's alpha = 0.784). The QOL score of edentulous patients with a complete denture having some trouble chewing was significantly lower than that of other denture patients. It was suggested that the wearing of a denture significantly affected the QOL of elderly persons.

Prevalence of temporomandibular disorder signs in patients with complete versus partial dentures

OBJECTIVES

To determine the prevalence of signs of a temporomandibular disorder (TMD) in completely edentulous patients wearing upper and lower complete dentures (CD) and to compare this to the prevalence of signs in partially edentulous patients wearing upper and lower clasp-retained acrylic removable partial dentures (RPD).

MATERIALS AND METHODS

A questionnaire and a clinical examination were used to assess 200 patients. One hundred of these were complete denture wearers being treated for the provision of replacement CD. The other 100 patients were partially edentulous patients, who had RPD replacing upper and lower partially missing teeth and their supporting structures.

RESULTS

It was shown that there was a statistically significant difference between the two groups regarding the presence of temporomandibular signs. Partially edentulous patients wearing upper and lower RPD had a significantly higher prevalence of TMD signs than edentulous patients wearing CD (36% compared to 17%). They also exhibited significantly (P<0.04) more signs of joint tenderness (18%) on clinical examination compared to (5%) only in the CD-wearing patients. Tenderness upon palpation in the periauricular region was the most common site reported in both groups.

CONCLUSIONS

The partially edentulous patients (wearing RPD) exhibited more TMD signs when compared with the CD-wearing patients. Significantly, more partially edentulous patients had joint tenderness (P<0.04) than did CD-wearing patients. The masseter muscle most commonly demonstrated muscle tenderness.

Aerobic bacteria in the oral cavity of patients with removable dentures

PURPOSE

Determination of bacterial composition in the oral cavity of patients with removable dentures and with own dentition (without dentures).

MATERIAL AND METHODS

Bacteriological investigations were performed in 55 patients from the department of internal medicine (32 diabetic patients) and 40 patients treated in surgical department (25 patients with malignancy). Palate mucosa and tongue dorsa swabs were collected from two groups of patients, and additionally swabs from mucosal part of denture surfaces in prosthetic patients. Cultures in oxygenic and microaerophilic (5% CO2) conditions were conducted on solid non-selective and selective media as well as media enriched with 5% sheep blood. Standard procedures of bacterial culture and identification were applied.

RESULTS

Among 95 of examined patients, 57 (60.0%) with removable dentures and 38 (40.0%) had their own dentition. As far as prosthetic patients were concerned, the rate of bacterial isolations from palate, tongue dorsa and denture plaque swabs were generally comparable (p > 0.05); in number and species compositions. Statistically significant differences were observed in the bacterial composition of denture plaques, palate and tongue dorsa in patients with and without abdominal cancers. Patients without cancer did not reveal staphylococci and enteric bacteria in the samples from a various sites of their oral cavities. These bacteria were most common in cancer patients. Similar (in number and species) composition of bacteria occurred in palate and tongue swabs in patients without dentures (p > 0.05). The incidence rate of aerobic bacteria in denture plaques and palatal mucosa of patients with (37/57; 64.9%) and without (20/57; 35.1%) denture associated stomatitis were comparable (except for Neisseria spp.).

CONCLUSIONS

1) Generally, there were no statistically significant differences in species composition of bacteria isolated from the hard palate and tongue dorsa in patients with and without removable dentures. 2) Staphylococcus spp. and Gram-negative enteric bacilli were isolated more often from denture plaque, palate and tongue dorsa of cancer patients than from patients without cancer (p < 0.05). 3) Staphylococcus spp. was isolated more frequently from denture plaques of diabetic patients compared with non-diabetic patients (p < 0.05). 4) No significant differences observed in isolation frequencies (%) of aerobic bacteria in denture plaques and palatal mucosa of patients with and without denture associated stomatitis.

Impact of dry mouth on oral symptoms and function in removable denture wearers in Japan

OBJECTIVE

The purpose of this study was to determine the association of dry mouth with oral symptoms and function, such as denture instability, discomfort, soreness in denture-bearing tissue, and dissatisfaction with chewing, tasting, or speaking in removable denture wearers.

STUDY DESIGN

The subjects were 493 removable denture wearers with a mean age of 67.3 years. Perception of oral dryness was measured by a questionnaire. A multiple logistic regression analysis was used to determine the effect of the dry mouth on oral symptoms and function after controlling for age and gender.

RESULTS

Oral dryness during eating was related to dissatisfaction with chewing (odds ratio, 10.5; P < .001) and speaking (odds ratio, 3.5; P < .05) and overall dissatisfaction (odds ratio, 6.3; P < .01) in complete denture wearers. Feeling of dry mouth was likely to be associated with soreness in denture-bearing tissues in both complete and removable partial denture wearers.

CONCLUSIONS

There was a significant association of the perception of dry mouth among a group of denture wearers with oral symptoms and function.

[A case report of a speech disturbance patient treated by a magnetic attachment overdenture]

PATIENT

A 50-year-old female who wore a cast-clasp-supported removable partial denture (RPD) complained of speech disturbance, because the clasps disturbed her tongue movement during speech. She wished to receive dental implant treatment, but it was difficult to solve the esthetic problem by the planned implant-supported fixed partial denture. Therefore, the RPD (overdenture) supported by magnetic attachments was inserted to recover the speech disturbance.

DISCUSSION

The treatment outcome of this patient was evaluated with a self-administered questionnaire. The results suggested that the RPD with magnetic attachments improved the patient's pronunciation, esthetics and quality of life.

CONCLUSION

It was suggested that the magnetic attachment overdenture effectively solved the speech disturbance.

Use of a light-polymerized composite removable partial denture base for a patient hypersensitive to poly(methyl methacrylate), polysulfone, and polycarbonate: a clinical report

This article describes a light-polymerized composite denture base used for a patient with hypersensitivity to poly(methyl methacrylate) (PMMA), polysulfone (PSF), and polycarbonate (PC). A urethane-dimethacrylate (UDMA) composite was used as an alternative to fabricate both the denture base and the custom artificial teeth. Immediately after placing the new prosthesis, allergic symptoms disappeared from the patient's mucous membrane. The denture has functioned satisfactorily for more than 2.5 years without recurrence of the hypersensitivity.

Esophageal impacted dentures

OBJECTIVES

This study aims to highlight the problems associated with impacted acrylic dentures and proffers advice to check them.

PATIENTS AND METHODS

Retrospective review of all cases of impacted acrylic dentures over a 16-year period.

RESULTS

Twenty-two adults had impacted esophageal acrylic dentures of which 16 (72.7%) and six (27.3%) were males and females, respectively (M:F ratio = 2.7:1) with age range 23-77 years. Fourteen patients (63.6%) had worn their dentures for more than 10 years without check-up, and 54.5% presented within 48 hours of impaction. The common symptoms in all the patients were difficulty with swallowing, throat pain and discomfort, followed by tenderness in the neck in 15 (68.2%). Dentures were extracted through esophagoscopy (17 cases) and cervical (three cases) esophagotomy, respectively. Observed complications included pulmonary edema in one and esophageal perforation in five patients.

CONCLUSION

Endoscopic extraction of dentures carries a high risk of perforation. Extraction of an impacted denture via esophagoscopy can be undertaken under direct vision and in an ideal situation with judicious use of the Shears forceps. In the absence of these, the safest option is an esophagotomy. Proper treatment planning in the fabrication of dentures with incorporation of radiopaque materials in the dental resins and adequate postdenture delivery instructions are necessary as preventive measures.

A 5-year follow-up study on the prosthetic rehabilitation of the elderly in Helsinki, Finland

In 1990, 364 elderly (76-86 years) inhabitants of Helsinki, Finland, attended a dental and oral examination study that was conducted as part of the Helsinki Aging Study. In spring 1996, these subjects were recalled for a 5-year follow-up. Between the baseline and follow-up examinations, 114 (31%) subjects had deceased (86 women and 28 men), whereas 134 had either moved, were too ill, or refused to participate in the follow-up. Follow-up examination was conducted for 113 subjects (79 women and 34 men), with the participating rate being 46%. Five subjects became edentulous during the follow-up. Of the subjects, 61% had 1-32 teeth at follow-up. In these subjects, the mean number of teeth decreased from 14.9 (+/-8.3) to 13.5 (+/-8.6) (P < 0.0001). Prosthetic status changed in 40% of the elderly dentate people: 25% received new prostheses whereas 15% lost prostheses that were not replaced. New fixed partial dentures were made in five maxillae and in nine mandibles during the follow-up. Acrylic removable partial dentures (ARPD) were most frequently used: 35% of dentate subjects had an ARPD. Subjects with removable prostheses had higher levels of salivary microbes and higher root caries incidence than those with natural teeth. Furthermore, the presence of removable prostheses at baseline, together with the male gender, was clearly associated with tooth loss during follow-up. This study indicates that fixed rather than removable prostheses should be used in elderly patients. The need for a removable denture ought to be carefully considered.

Oral health and treatment needs of the long-term hospitalised elderly

OBJECTIVES

To determine the oral health and treatment needs of the long-term hospitalised elderly.

SETTING

The Laakso long-term hospital, Helsinki, Finland.

DESIGN

A cross-sectional study with clinical oral examinations.

SUBJECTS

All long-term patients (n = 260) aged 60 and older.

MAIN OUTCOME MEASURES

Edentulousness, presence and hygiene of dentures, mucosal findings, number of teeth, functioning teeth and tooth remnants, level of dental hygiene, and need for operative treatment.

RESULTS

Subjects' mean age was 83.3 years (SD = 8.1); 42% were edentulous, 45% of women and 33% of men (p = 0.12). With no gender difference, 41% had removable dentures, but one in four were considered to be in need of repair or replacement. Denture hygiene was good in 19%, moderate in 44%, and poor in 37%, and for men worse than for women (p = 0.02). Stomatitis was found in 25%, and angular cheilitis in 28% of the denture wearers. The dentate subjects had on average 12.4 (SD = 8.6) teeth with a clear difference by age (p = 0.03), but no difference by gender. Dental hygiene was considered poor. Of the dentate subjects, 37% were in need of restorations, 51% of periodontal therapy and 42% of extractions.

CONCLUSIONS

Oral cleanliness should be improved with regards to dentures and teeth. More attention should be focused on dental care of the long-term hospitalised elderly.

Traumatic Lesions of the Gingiva: A Case Series

BACKGROUND

The most recent classification of periodontal diseases includes a new section on traumatic gingival lesions. Traumatic lesions of the gingiva are thought to be highly prevalent, yet the periodontal literature contains few references on the topic. The purpose of this article is to present a broad spectrum of traumatic gingival lesions of iatrogenic, accidental, and factitious origin.

METHODS

Twelve clinical cases were selected to document chemical (due to aspirin, snuff, and peroxide), physical (due to malocclusion, flossing, removable partial denture, oral piercing, and self-inflicted trauma), and thermal (due to overheated ultrasonic scaler, hot food, and ice) injury to the gingiva.

RESULTS

Chemical, physical, and thermal gingival injuries of iatrogenic, accidental, or factitious origin can have a variety of presentations with overlapping clinical features. Although the appearance and associated symptoms of a gingival lesion may be suggestive of a particular traumatic etiology, useful or confirmatory diagnostic information is often discovered through careful history-taking. The management of gingival injuries typically requires elimination of the insult and symptomatic therapy. If permanent gingival defects resulted from the injury, periodontal plastic surgery may be necessary.

CONCLUSIONS

A variety of chemical, physical, and thermal injuries may involve the gingiva. Accidental and iatrogenic injuries are often acute and self-limiting, while factitious injuries tend to be more chronic in nature.

Analysis of the prevalence of different topographical characteristics of the residual ridge in mandibular free-end arches

This study observed the prevalence of different types of residual ridge inclination in free-ends of mandibles and reported possible correlative factors that may affect resorption. For this purpose, periapical radiographs and individual data collected from a sample of 64 hemiarches were used. Two radiographs were taken of each free-end, and tracing was employed to determine the angles formed by the resorption configuration in the area of the 1st mandibular molar. The following conclusions were drawn: 1) the great majority of alveolar ridges were distally descending; 2) the average angle was wider for users of mandibular removable partial dentures; 3) the results obtained suggest that the type of opposing maxillary arch affects the inclination of mandibular ridges; 4) greater inclination was observed when the 2nd bicuspids of the mandible were the abutment teeth; 5) no significant correlation was established between age, sex and residual ridge resorption.

Swallowed partial dentures

Swallowed or inhaled partial dentures can present a diagnostic challenge. Three new cases are described, one of them near-fatal because of vascular erosion and haemorrhage. The published work points to the importance of good design and proper maintenance. The key to early recognition is awareness of the hazard by denture-wearers, carers and clinicians.

[Candida albicans adhesion to plastics during correction of removable dentures]

Colonisation of denture soft lining materials by Candida albicans can result in clinical problems. The presence of Candida albicans on the upper fitting surface of the denture is a major causative factor in denture-associated chronic atrophic candidosis (denture stomatitis). The fitting surface of denture can act as a reservoir of Candida albicans. The goal of our experiment was to determine of candidal adherence to two soft lining materials -- Ufi gel C temporary and Ufi gel P permanent. Results of experiment show that adherence of Candida albicans to the Ufi gel C temporary was significantly move than for Ufi gel P permanent.

Evaluation of articulation of Turkish phonemes after removable partial denture application

In this study, the adaptation of patients to removable partial dentures was evaluated related to articulation of Turkish phonemes. Articulation of /t,d.n,l,r/, /g,k/, /b,p,m/ and /s,z,ş,v,f,y,j,h,c/ phonemes were evaluated by three speech pathologists, on records taken from 15 patients before the insertion of a removable partial denture, just after insertion, and one week later. The test consisted of evaluation of phoneme articulation of independent syllables in terms of distortion, omission, substitution, mass effect, hypernasality and hyponasality. Data were evaluated with Cochrane Q. McNemar and Kruskal-Wallis tests. The results showed that for some phonemes, problems in articulation occurred after the insertion of a removable partial denture while for others a significant amelioration was observed after the insertion of a removable partial denture. In general, problems in articulation of evaluated phonemes were resolved after one week of use.