A contemporary review of the factors involved in complete dentures. Part III: Support

doi:10.1016/0022-3913(83)90267-6

The Journal of Prosthetic Dentistry

Volume 49, Issue 3, March 1983, Pages 306-313

https://doi.org/10.1016/0022-3913(83)90267-6 Get rights and content

Abstract

Dentists must base their technique on an understanding of the biologic aspects of the relationship between the denture base and supporting tissues. Those tissues must be able to tolerate functional stresses without promoting patient discomfort and should be recorded in such a manner that these areas provide complete denture support. Anatomic regions that satisfy the requirements for providing primary support should make positive contact with the denture base under functional loading. Those that are less resistant to long-term changes or are unable to tolerate stress should be relieved of excessive contact with the denture base. Selection of those regions that should provide primary and secondary support depends on the anatomic variations unique to each patient.

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Quantitative 3D clinical analysis of the selective pressure impression technique directly measuring tissue displacement during impression making for complete maxillary dentures is lacking.
The purpose of this clinical study was to digitally compare impressions made of the edentulous maxillary ridge by using the selective pressure impression technique with different amounts of relief incorporated into custom tray designs.
Nine participants receiving maxillary complete dentures were enrolled in the study. An initial custom tray was fabricated in urethane dimethacrylate by using the alternative border molding technique without relief and scanned to create a standard tessellation language (STL) file from which 3 groups of custom trays were designed and 3D printed with 0.0-mm (no relief), 1.0-mm, and 3.0-mm relief over the anterior ridge and median palatal suture. Definitive impressions using each of the 4 custom trays were made with a consistent volume of light-body polyvinyl siloxane impression material. The definitive impressions were scanned, and the STL files were superimposed to investigate the topographical differences among the groups, each with respect to the no relief, 3D-printed custom tray definitive impression. Mean volumetric differences for all 3 groups were measured in areas where relief was used and statistically analyzed with the Friedman test (α=.05).
No significant difference was found among any of the 3 groups of superimposed impressions in areas of no relief, 1.0-mm, and 3.0-mm relief (P=.558). The mean difference ±standard deviation for each comparison in regions of the anterior ridge and median palatal suture were 0.07 ±0.06 mm for no relief, -0.03 ±0.07 mm for the 1.0-mm tray relief, and -0.04 ±0.09 mm for the 3.0-mm tray relief. The negative values in mean difference indicated less compression of underlying tissues compared with the reference border molded urethane dimethacrylate custom tray impression.
Although results showed less compression when compared with that of the control group, custom tray relief of 1.0 mm and 3.0 mm over the anterior residual alveolar ridge and median palatal suture did not significantly impact the resulting impression topography when compared with no relief custom trays.
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Nineteen qualified dentate participants were enrolled. An intraoral scanner was used to record soft tissue in buccal shelf area in different ranges of mandibular opening, which were maximum intercuspation, 10 mm, 20 mm, and 30 mm of interincisal distance. The experiment was performed by two examiners. The common area of each range was generated within the clinically acceptable denture adaptation range, which was represented as the potential denture covering area. Data were statistically analyzed using descriptive statistic, one-way repeated measure ANOVA, intraclass correlation coefficient (ICC), and the Pearson correlation test.
Trends of the mean distance of the potential denture covering area increased from the frenum area to the second premolar and the first molar area then decreased in the second molar area, along with the ranges of mouth opening increased. The distance in the second molar area had drastic percentage changes during the mouth opening. The mean distances changed significantly when the mouth opening increased (P < 0.001). All ICC values of intra-, inter-rater reliability indicated good to excellent reliability. The correlation between the results from two examiners was strong (P < 0.001).
The characteristic of the denture covering area posteriorly to the first molar area is inversely proportional in length to ranges of mouth opening.
Evaluating oxygen shielding effect using glycerin or vacuum with varying temperature on 3D printed photopolymer in post-polymerization
2022, Journal of the Mechanical Behavior of Biomedical Materials
Citation Excerpt :
In clinical settings, dental prosthesis is commonly used as treatments to restore lost teeth and reestablish oral functions (Li et al., 2021). Intra-oral prostheses are supported by oral tissues and endure various functional stresses (Jacobson and Krol, 1983; Anusavice et al., 2012). With the development of digital dentistry, computer-aided design (CAD) and additive manufacturing (AM) provide customized approaches for various dental treatments and have the potential to provide advanced solutions for fabricating dentures, especially those that require a freeform design (Revilla-Leon and Ozcan, 2019; Anadioti et al., 2020).
The photosensitive resin used in additive manufacturing is cured by free radical polymerization by UV irradiation. However, undesired reaction with oxygen during polymerization inhibits polymerization and results in an under-cured polymer. Therefore, in this study, the hypothesis that successful oxygen shielding in the post-polymerization step could affect the properties of the final polymer was tested. 3D printed specimens using denture base resin were post polymerized either by immersion in glycerin for oxygen shielding (GL group) or placed in a medium-low vacuum chamber at 5 × 10⁻² Torr (VA group). Specimens cured with no additional conditioning served as the control (CON group). To consider the effect of temperature, all groups were additionally compared with 80 °C and without an increase in temperature (room temperature) during post-polymerization. Fourier transform infrared spectroscopy was used to measure the monomer conversion ratios between different groups. In addition, the mechanical properties were quantified by the micro-hardness, flexural strength, and elasticity of the surface, and the water sorption and solubility. Dynamic mechanical analysis (DMA) was conducted to observe the trend in storage and loss modulus between the groups against temperature. Differences in the surface as a function of the post-polymerization conditions were qualitatively observed by scanning electron microscopy (SEM).
The result shows that oxygen shielding during post-polymerization showed an increase in the degree of conversion (DC) and hardness of the resin surface. The highest DC was observed for GL group specimens at both room temperature and 80 °C. This result was confirmed by the SEM micrographs of the resin surface, where the interface between the layers of the GL group structure becomes more robust. However, a difference was observed between the samples prepared at room temperature and 80 °C. The flexural modulus was highest in the GL group, followed by the VA group, and lowest in the CON group at 80 °C. No difference in water absorption was observed for any groups, but high water solubility was observed in the GL group at room temperature. Overall, more significant differences in the properties were observed for the samples post-polymerized at 80 °C than at room temperature. The results of DMA analysis to determine the glass transition temperature showed a similar trend in all groups, and the storage modulus and loss rate obtained in the same experiment decreased in the order of GL, CON, and VA.
In conclusion, an oxygen shielded post-polymerization environment at elevated temperature effectively improves the mechanical properties of photosensitive resin.
Impact of adding palatal rugae to complete dentures on patient satisfaction and oral health–related quality of life: A randomized crossover clinical trial
2021, Journal of Prosthetic Dentistry
Citation Excerpt :
A limit on the minimum duration of edentulism was necessary because significant ridge remodeling occurs during the first few months and can impact the fit of any denture provided.46 A 2-month duration was considered sufficient to eliminate any carryover effect, as 2 to 4 weeks are generally required to achieve adaption in complete dentures wearers.4 The negative impacts of palatal coverage compared with no coverage have been reported.7,8,10,11
The addition of palatal rugae to complete dentures has been suggested to improve the satisfaction of patients with different oral functions. However, clinical studies to support these claims are lacking.
The purpose of this randomized, single-blind, 2-period crossover trial was to assess the satisfaction of edentulous patients and their oral health impact profile when provided with complete dentures with palatal rugae compared with a polished palate.
Edentulous patients aged 45 to 80 years, with no relevant medical conditions, seeking complete dentures at a university hospital between May and July 2019 were recruited. Each participant received new complete dentures. After a 1-week adaptation period, the participants were randomly allocated to 2 sequences through a computer-generated sequence. In the first sequence, palatal rugae were added to the complete dentures, and after 2 months, the palatal rugae were removed and the dentures used for another 2 months. In the second sequence, the opposite sequence was followed: polished palate first and palatal rugae second. After each period, a blinded dentist asked participants to rate their general satisfaction on a 100-mm visual analog scale (primary outcome) and to rate their satisfaction regarding eating, taste perception, speaking, phonetics, and ease of cleaning. Participants were also asked to fill the 20-item oral health impact profile for edentulous patients (OHIP-EDENT). The paired sample t test and the Wilcoxon test were used (α=.05).
Fifty participants were randomized, of whom 6 dropped out. No significant differences were found between ratings for the 2 palatal contours in terms of general satisfaction 2.32 (95% confidence interval: -3.65 to 8.29, P=.438), eating 1.70 (95% confidence interval: -4.05 to 7.46, P=.554), taste perception 0.57 (95% confidence interval -5.04 to 6.17, P=.839), phonetics 1.48 (95% confidence interval -4.46 to 7.41, P=.618), or speaking 3.68 (95% confidence interval: -1.92 to 9.28, P=.192). However, satisfaction with ease of cleaning dentures with palatal rugae was significantly less 12.16 (95% confidence interval: 6.81 to 17.50, P<.001). The differences in the OHIP-EDENT total scores were not significantly different -1.75 (95% confidence interval: -3.7 to 0.23, P=.082). Differences in each item ratings were also found to be not significantly different (P>.05), except for the frequency of mealtime interruption (P=.041), which was reported to increase when rugae had been provided.
Complete dentures with palatal rugae were not perceived to improve patient satisfaction or oral health–related quality of life. However, they were perceived to be more difficult to clean and to increase frequency of interruptions during eating.
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2018, Journal of Prosthetic Dentistry
Citation Excerpt :
The PSP is defined as “the most distal extension of attached keratinized mucosa overlying the mandibular ridge crest formed by the scarring pattern after extraction of the most posterior molar.”4 Jacobson and Kroll37 agreed with the cause of the PSP and opined that the firmly bound masticatory mucosa along with the muscle attachments provide a stress-bearing region that is relatively resistant to alveolar bone resorption. The RMP, a mass of tissue consisting of nonkeratinized mucosa located posterior to the retromolar papilla, is composed of overlying loose glandular connective tissue and contains fibers of the temporalis tendon, the buccinator and superior constrictor muscles, and the pterygomandibular raphe.4,38
Lack of an accepted definition for the ascending ramus of the mandible means no common reference point is available for clinical or research dialogue.
The purpose of this review was to determine whether the ascending ramus has been defined, by using a search of published studies.
PubMed was searched, using terms “ascending ramus” and “mandible.”
The search found no acceptable definition of the ascending ramus of the mandible.
An acceptable definition for the ascending ramus of the mandible is lacking, and one is proposed here.
Clinical complications and quality assessments with computer-engineered complete dentures: A systematic review
2017, Journal of Prosthetic Dentistry
Computer-engineered complete dentures (CECDs) have significant potential as shown by recent reports of outcomes and specific applications. An understanding of complications and quality assessment factors associated with CECDs from compiled data is lacking in published reports.
The purpose of this systematic review was to determine the clinical complications and quality assessments related to CECDs.
Electronic searches of publications in English from January 1984 to September 2016 were performed in MEDLINE and Cochrane databases, with the results enriched by manual searches and citation mining to address 2 population intervention comparison outcome (PICO) questions: what are the clinical complications associated with CECDs, and what are the quality assessments with CECDs?
A review of 5 selected articles (limited data) on CECDs revealed patient dissatisfaction related to overall outcome (25.49%), inadequate retention (20.73%), and esthetic concerns (15.09%) as common complications. Quality assessment factors that were used to report complications were identified.
Patient dissatisfaction, inadequate retention, and inadequate esthetics were the most common complications with CECDs. The addition of a trial placement option for CECDs could result in a better clinical outcome, reducing the incidence of other complications related to occlusal vertical dimension, centric relationship, tooth arrangement, and esthetics, improving patient satisfaction, and reducing remakes. The difficulty in reading the digital preview for an objective assessment before fabrication is a unique but not a common, complication for CECDs.

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^*: Assistant Clinical Professor, Removable Prosthodontics.

^**: Chief of Dental Services, Removable Prosthodontics.

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A contemporary review of the factors involved in complete dentures. Part III: Support

Abstract

J Prosthet Dent

J Prosthet Dent

J Prosthet Dent

J Dent

J Am Dent Assoc

J Prosthet Dent

J Prosthet Dent

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J Am Dent Assoc

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