Complete denture rehabilitation for a patient with Parkinson's disease using clinical strategies: A case report

OBJECTIVE

To present clinical strategies for prosthetic rehabilitation with complete dentures (CDs) of a Parkinson's disease patient.

CASE REPORT

An 82-year-old patient sought the Department of Dentistry at UFRN, reporting retention dissatisfaction and hamper to the mandibular CD adaptation. Patient-reported a dry mouth sensation, and exhibited disordered mandibular movements, tremors, and resorbed mandibular ridge. Aiming retention and stability, double molding with zinc enolic oxide impression paste, neutral zone technique, and non-anatomic teeth were proposed as clinical strategies. At delivery, identification and relief in the supercompression areas were performed to facilitate the acceptance and use of the new dentures.

CONCLUSION

The strategies promoted patient satisfaction regarding retention, stability, and comfort. This treatment may be considered for the rehabilitation of Parkinson's disease patients, favoring the adaptation process.

The effect of different denture cleansing solutions on the retention of polyetheretherketone locator attachments

PURPOSE

Prosthetic cleansing solutions have been reported to cause retention loss in implant locator attachments due to the chemical alterations of these attachments. This study aimed to investigate the effects of different denture cleansing solutions on attachments with different retention values.

MATERIALS AND METHODS

In this study, 160 polyetheretherketone locator attachments were divided into 4 groups according to their attachment retention values (yellow, pink, clear, and violet). Forty attachments from each group were soaked in four different cleansing solutions (n = 10). The attachments from the four groups were immersed in water, sodium hypochlorite, Corega, and Protefix solutions for a period equivalent to 6 months, according to the manufacturer's recommendations. The locator attachments were then subjected to testing using a universal testing machine. Maximum load to dislodgement according to different solutions was evaluated by one-way ANOVA test. Statistical significance was set at p < 0.05.

RESULTS

The effect of denture cleansing solutions on the retentive values of attachments was statistically significant (p < 0.001). Among all cleansing solutions, the highest retention value was found in the violet attachments, and the lowest retention value was found in the yellow attachments. The lowest retention value (0.72 ± 0.05 MPa) was observed when the yellow attachments were immersed in Protefix solution, and the highest retention value (1.96 ± 0.15 MPa) was observed when the violet attachments were immersed in the Corega solution.

CONCLUSION

For different colored attachments, different cleansing solutions can be suggested to patients.

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

OBJECTIVES

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Frictional wear of stud implant overdenture abutments after 2 years of in vitro simulated function

Progressive wear of the components of an implant-supported overdenture can lead to loss of denture retention, which affects masticatory function and the patient's quality of life. The primary objective of this in vitro study was to investigate frictional wear in a type of commonly used abutment and thereby estimate the general clinical lifespan of a typical stud abutment and establish a protocol for replacement. Therefore, simulated overdenture insertions and removals equivalent to 2 years of overdenture use were performed to evaluate surface changes in the metal stud abutment component. A digital caliper, scanning electron micrographs taken at ×500 magnification, and profilometer data were used to determine the wear rate and surface roughness. A universal testing machine was used to measure retention load force with 4 clear male nylon inserts (5.0-lb retention) during 2160 insertion and removal cycles. The results showed that with a 6-month replacement program for clear male nylon inserts, the frictional wear on the titanium nitride coating of abutments placed at a 0° position resulted in a decrease of up to 50% in removal forces of the inserts after a simulated 2 years of wear. The combination of wear of the titanium nitride coating and the decrease in retention load values suggests that stud abutments should be replaced after 2 years of use for optimal retention.

Retention Capacity of Original Denture Adhesives and White Brands for Conventional Complete Dentures: An In Vitro Study

(1) Introduction: Denture adhesives (DAs) promote stability, chewing ability, and quality of life. The objective of this study was to compare the effectiveness of original brand DAs and white brands in their retention of conventional complete dentures. (2) Methods: This study followed the recommendations of the international standard ISO 10873. Three original brands of DA (Corega® Fixação 3D, GlaxoSmithKline®, Stafford Miller Ltd., Dungarvan Co. Waterford, Ireland), KuKident® Pro Procter & Gamble Technical Centres®, Ltd., Whitehal Lane, Germany and Elgydium® Fix, Laboratórios URGO® SL, Florida, Spain) were compared to three white brands (Fixação Extra Forte Pingo Doce®, Laboratórios Cosmodent®, Cantabria, Spain), Fixador de Próteses (Continente®, Propack®,Gmbh, Ladenburg, Germany) and Creme Fixador de Próteses (Auchan®, Ellipse®, Roubaix, France). Their retention capacities were analyzed using a mechanical test device. (3) Results: The mean retentive ability of original brand adhesives (M = 11.16, SD = 5.27) was significantly higher (t(298) = 11.88; p < 0.001) than that of the white brands (M = 5.92, SD = 1.18). When comparing all brands, statistically significant differences were also observed, F(5.294) = 707.68 (p < 0.001). The generic adhesive results were more homogeneous. The generic brands from Continente® (M = 5.24, SD = 0.94) and Auchan® (M = 5.80, SD = 0.79) were not significantly different, while the Pingo Doce® brand obtained significantly higher mean retention results (M = 6.71, SD = 1.28). (4) Conclusions: The original brands of DA have a significantly higher retentive ability than the white brands. Elygidim® Fix had the worst result of the three original brands, and the product from Pingo Doce® had the best result among the three white brands.

The Effect of Denture Cleansing Solutions on the Retention of Precision Attachments: An In Vitro Study

This study aimed to investigate the effect of different cleansing solutions on the retention of precision attachments. A precision attachment patrix was embedded into acrylic resin and the matrix was placed onto the patrix. The red (high retention, 8 N), yellow (regular retention, 6 N), and green (reduced retention, 4 N) plastic matrixes of the attachments (n = 32) were soaked in three different denture cleansing solutions (sodium laureth sulfate, sodium bicarbonate-sodium perborate, sodium bicarbonate) for a duration simulating 6 months of clinical use. The control group was soaked in tap water. A universal testing machine was used to measure the retention values of attachments after they were soaked in denture cleansers. The retention values were compared among the groups with repeated-measures analysis of variance followed by the Tukey HSD test (p = 0.05). Yellow attachments were affected by sodium laureth sulfate, sodium bicarbonate-sodium perborate, and water (p = 0.012). Green attachments’ retention increased after immersion in sodium laureth sulfate (p = 0.04) and water (p = 0.02). Red attachments’ retention increased after immersion in sodium laureth sulfate or sodium bicarbonate-sodium perborate (p = 0.045). Water did not affect the retention of red attachments. Because sodium bicarbonate tablets did not affect the retention of attachments, clinicians may recommend their use as a cleanser. Clinicians also may inform patients using fixed and removable partial prostheses with precision attachments of a possible increase in retention after the use of sodium laureth sulfate or when using sodium bicarbonate-sodium perborate with yellow and red attachments.

An Alternative Incorporation Technique for Minimizing Complications in Attachment-Retained Implant Mandibular Overdentures: Technical Report

The present technical report aimed to display an alternative incorporation method for ball/stud attachments in mandibular implant overdentures (MIO) to prevent or minimize metal housing debonding and attachment malpositioning. Precoating of metal housings with auto-polymerizing acrylic resin (AAR) and fabrication of straight AAR bars onto metal housings for optimal parallelism were used as new techniques. The glossy flat surfaces of metal housings (matrices) were sandblasted and precoated with a thin layer of AAR in the laboratory. Straight acrylic resin bars (3 cm long and 3 mm in diameter) were obtained and attached to these flat metal housing surfaces using a surveyor. The metal housings carrying the AAR bars were then placed intraorally onto ball/stud attachments, accurately positioned parallel to each other, and perpendicular to the long axes of implants and bound to the MIO with AAR.

Removable Partial Dentures for Older Adults

Improvements in oral health including increased retention of natural teeth have given rise to a partially dentate older population. Replacement of missing natural teeth is important to improve function, aesthetics and quality of life for this patient group. A variety of options are available to replace missing teeth in partially dentate older adults, including fixed, removable and implant retained prostheses. This article will discuss the provision of removable partial dentures including treatment planning and denture design. When planning removable partial dentures, careful attention must be paid to stabilising the patient prior to delivering any prosthesis. Partial dentures should be designed to minimise the potential for plaque accumulation with carefully designed metal based frameworks. Acrylic resin can also be utilised with attention to detail to minimise the risk of damage to delicate supporting tissues. Removable dentures have the advantage that they can be readily added to in the event of further tooth loss which may be particularly relevant for older adults. Partial dentures which optimise support, retention and stability can function very successfully and significantly improve patients' oral health related quality of life.

Randomized Clinical Study Comparing Three Experimental Denture Adhesives and Fixodent® versus No Adhesive

OBJECTIVES

Denture adhesives can improve function, retention, stability, and bite force in well-fitting dentures. This single-center, randomized, five-arm, examiner-blind, crossover clinical study aimed to compare three experimental adhesives ("Adhesive 1," "Adhesive 2," "Adhesive 3") with slightly different formulations and a commercially marketed "Positive control" with a "No Adhesive" arm using incisal bite force measurements over 12 hours in subjects with a moderately well- to well-fitting maxillary denture.

METHODS

Institutional review and informed consent were obtained and qualified subjects were randomly assigned to a treatment sequence. Prior to adhesive application, subjects were asked to bite on a transducer with increasing force until their maxillary denture dislodged (bite force measurement). This procedure was repeated at 0.5, 1, 3, 6, 9, and 12 hours after adhesive application, with results recorded electronically. Treatment differences in the area over baseline (AOB) were analyzed using an ANCOVA model.

RESULTS

A total of 48 subjects completed the study. All experimental formulations showed statistically significantly higher bite force measurements compared to the No Adhesive arm at all time points (p < 0.0001 for Adhesive 1 and Adhesive 2 at all times; p < 0.003 for Adhesive 3 at all times). While numerical values for bite force favored the Positive control for the duration of the study, there were no significant statistical differences at any time point between Adhesive 2 and the Positive control, and only over three and six hours compared to Adhesive 1. However, differences favored the Positive control compared to Adhesive 3 at all time points.

CONCLUSIONS

All denture adhesives gave statistically significantly better bite force AOB in moderately well- to well-fitting dentures compared to no adhesive. All denture adhesives tested were generally well tolerated.

The effect of denture adhesive on the efficiency of complete denture in patients with different alveolar ridges

BACKGROUND

Denture adhesives are used to improve retention, stability, and efficiency of complete dentures. Proper use of denture adhesives has benefits for patients. Evaluating the effect of denture adhesives on efficiency of complete dentures in patients with different alveolar ridges was the purpose of this study.

MATERIALS AND METHODS

This cross-over randomized clinical trials study was conducted on 90 patients who were wearing well fitted complete dentures. The patients were categorized into three groups based on clinical and radiographic situations of residual ridges. Group I with mild resorption, group II with moderate resorption, and group III with severe resorption. The patients who had recently received their dentures and the primary complications had been resolved were asked to use denture adhesive according to the instructions. The patients answered two different questioners in 1 week and 2 months of using denture adhesive. The answers were analyzed by means of variance and Chi-squared tests (P < 0.05).

RESULTS

Retention, chewing, talking, self-confidence, and efficiency of dentures were improved in all patients. No statistical significant differences in these parameters were observed between the three groups (P > 0.05). Increased retention and adaptation made 64.4% of these patients willing to continue using the adhesive after the study. Forty-three percent of patients reported moderate satisfaction of using this adhesive.

CONCLUSION

Using denture adhesive in well-fitted complete dentures resulted in an improvement in retention, talking, chewing, ease of use, self-confidence, and efficiency of dentures. The use of denture adhesive is, therefore, recommended to patients wearing dentures with some problems.

Using Electromagnetic Articulography to Measure Denture Micromovement during Chewing with and without Denture Adhesive

Purpose

To study the effects of denture adhesive upon denture micromovements in three dimensions during the chewing of hard, sticky, and tough food items observed using a novel method involving an electromagnetic articulograph (EMA) speech research system.

Materials and Methods

Ten volunteers (mean age 60.9 ± 10.4 years) with fair‐ or poor‐fitting complete maxillary dentures were enrolled. Chewing experiments were conducted using two treatments (adhesive or no‐adhesive control) and three foods: carrots (hard), raisins (sticky), and processed meat stick (tough). Denture micromovement was measured through a novel application of a Northern Digital Wave EMA System. Three‐dimensional denture position was captured during mastication using three sensors embedded into a replica denture for each subject. Following individual characterization of a “home” reference position, the Euclidean Distances from Home (DfH) were calculated for each recorded sample of the chewing experiments. The DfH at each sample represented the denture movement for that 1/100th of a second of the activity. The DfH data were then summarized as the mean DfH, the maximum DfH, and total distance traveled by the denture. Several thresholds were also analyzed, including the percent of time that the DfH ≥1.5 mm, ≥2.0 mm, and ≥2.5 mm.

Results

With adhesive treatment, the mean DfH of dentures during chewing was reduced by 26.8% for carrot, 30.3% for raisin, and 31.0% for meat stick, when compared with no‐adhesive treatment (p < 0.001 for all comparisons). Similar results were also seen for the maximum DfH and total distance travelled endpoints across foods. For the threshold endpoints, adhesive treatment was associated with a statistically significant reduction in denture micromovements at all three thresholds across foods. At the threshold of DfH ≥ 1.5 mm, adhesive treatment was associated with a reduction in micromovement by 61.6%, 56.2%, and 70.0% with carrot, raisin, and meat stick, respectively (p ≤ 0.004 for all comparisons).

Conclusions

Observations of denture movement using the Wave EMA System were able to differentiate systematically between adhesive treatment and no‐adhesive treatment for denture micromovements during different chewing challenges. Use of adhesive was associated with statistically significant reductions in denture micromovements for hard, sticky, and tough foods as measured with both distance and threshold endpoints.

Shortcomings of prosthodontic rehabilitation of patients living in long-term care facilities

Removable dentures are a non-invasive, cost-effective prosthodontic solution for the reduced dentition. Their intended purpose is the rehabilitation of harmonious oral function and aesthetics on a long-term basis. The prevalence of removable dentures among patients of advanced age is high and the quality of the dentures is often poor. The aim of this study was to find the most important shortcomings of removable dentures and address the main targets for improving the quality of prosthodontic rehabilitation. The records from dental check-ups in Austrian residential homes were analysed retrospectively. Dental anamnesis questionnaires and data from the clinical examinations of 105 denture wearers were analysed. The functional condition and retention of 192 dentures had been assessed, as well as the impact of the dentures on the intra-oral tissues. Insufficient denture retention was very common, particularly in the lower jaw (56·0%). Problems with the masticatory function were reported by 26.7% of the denture wearers, 11·4% were dissatisfied with the denture aesthetics, and 4·8% had difficulties with phonetics. Traumatic ulcers were found in 18·1%. Cracks, broken pieces (6·3%) or missing denture teeth (2·1%) were rare. It may be assumed that the findings of the present study also apply to a great percentage of community-dwelling seniors. The most important issues in prosthodontic rehabilitation with removable dentures are denture retention and masticatory function. Regular dental check-ups, denture adjustment and, when necessary, relining can maintain the primary denture quality and prevent damages of the oral tissues caused by ill-fitting dentures.

New Clasp Assembly for Distal Extension Removable Partial Dentures: The Reverse RPA Clasp

Several clasp types are used in distal extension removable partial dentures. In some cases the terminal abutments have only distal retentive undercuts that can be occupied by bar clasps; however, bar clasps may be contraindicated with no suitable alternative. This article presents a reasonable solution by introducing a new clasp design as a modification to the well-known RPA clasp. The design includes a mesial rest, proximal plate, and buccal retentive arm arising from the rest and extending to reach the distal retentive undercut.

Pre-prosthetic surgery: Mandible

Pre-prosthetic surgery is that part of oral and maxillofacial surgery which restores oral function and facial form. This is concerned with surgical modification of the alveolar process and its surrounding structures to enable the fabrication of a well-fitting, comfortable, and esthetic dental prosthesis. The ultimate goal of pre-prosthetic surgery is to prepare a mouth to receive a dental prosthesis by redesigning and smoothening bony edges.