Radiographic Screening of Patients in a Dental School using the Prosthodontic Diagnostic Index.

INTRODUCTION: Organization of the findings associated with various diagnostic aids plays a key role in formulating the treatment plan of the patients undergoing dental and medical treatment. Enhanced consistency in diagnosing and classifying prosthodontic patients is the basic purpose of various classification systems. Hence, we planned this study to classify partially edentulous patients and completely dentate patients at the undergraduate clinics using the prosthodontic diagnostic index (PDI). MATERIALS AND METHODS: This study included classification of 13,599 edentulous patients who attended the clinics of undergraduate students of all the levels. Screening of all the patients was done radiographically with a digital orthopantomograph (OPG), and the data were saved in the computer system. The intraoral periapical radiographs (IOPA) taken for all the affected areas were also saved in the system. Based on the OPG and IOPA, the patients were classified into various classes. All the data of the patients were recorded and analyzed. RESULTS: Total number of patients screened was 17,220, out of which 3,621 were under 18 years of age and were excluded from the study. Most of the patients belonged to the age group of 31 to 45 years: 5,360 (39.4%) patients (3,817 [43.0%] males and 1,543 [32.5%] females) were class I; 2,730 (20.0%) patients (1,729 [19.5%] males and 1,001 [21.1%] females) were class II; 4,576 (33.7%) patients (2,835 [32.0%] males and 1,741 [36.8%] females) were class III; and 933 (6.9%) patients (483 [5.5%] males and 450 [9.5%] females) were class IV. CONCLUSION: There is a need to introduce PDI as a screening tool during the initial examination of the patient and to achieve a proper distribution of the patients among various levels of students, interns, and postgraduates. CLINICAL SIGNIFICANCE: Introduction of PDI will improve the treatment planning and prognosis of edentulous patients.

Impact of periodontal maintenance on tooth survival in patients with removable partial dentures.

AIM: Removable partial dentures (RPDs) may have a negative impact on oral health and have the potential to cause further tooth loss, especially of abutment teeth. However, no evidence indicates the effective interval of regular periodontal maintenance after RPD provision. This practice-based cohort study aimed to examine the impact of regular periodontal maintenance visits on survival of RPD abutment teeth. MATERIALS AND METHODS: One hundred and ninety-two patients had been previously provided with 304 new clasp-retained RPDs at Osaka University Dental Hospital, Japan. Using the Kaplan-Meier method and log-rank test, 1094 abutments were analysed to illustrate survival curves and to compare each curve. According to the frequency of periodontal maintenance, study samples were divided into three groups; every 3-6 months (3-6M) group, 1-year (1Y) group and no-maintenance (NM) group. RESULTS: Seven-year cumulative survival rates were 83.7% (3-6M), 75.5% (1Y) and 71.9% (NM) respectively. Survival of abutment teeth in the 3-6M group was significantly better than both 1Y (p = 0.005) and NM (p < 0.001) groups. CONCLUSION: These longitudinal clinical data indicates that periodontal maintenance at least once in 6 months had the most favourable outcome. Frequent periodontal maintenance after RPD provision could be effective in preventing further tooth loss.

Accuracy of surgical guides made from conventional and a combination of digital scanning and rapid prototyping techniques.

STATEMENT OF PROBLEM: Surgical guides aid in accurately placing dental implants to achieve a predictable restorative outcome. Which surgical guide fabrication technique results in the most accurately fitting surgical guide is unknown. PURPOSE: The purpose of this investigation was to determine the internal fit of dental implant surgical guides on dentate and edentulous ridges by using implant surgical guides fabricated from conventional and computer-aided design/computer-aided manufacturing (CAD/CAM) techniques. MATERIAL AND METHODS: Eighty surgical guides were fabricated from conventional and CAD/CAM techniques; half were designed from Kennedy Class 2 (K2) casts, and half were designed from Kennedy Class 3 (K3) casts. Conventional surgical guides were fabricated from acrylic resin. The CAD/CAM surgical guides were scanned by using cone beam computed tomography (CBCT) or an optical scan (OS). The guides were printed with stereolithography (SL) or 3-dimensional digital printing (3DP). All surgical guides were cemented to their respective design casts, sectioned, and measured at standardized locations. A 2-way ANOVA and the post hoc Fisher least square difference t test was performed (α=.05). RESULTS: The 2-way ANOVA indicated that the difference between surgical guide groups and Kennedy class was statistically significant (P<.05) and the interaction between groups and Kennedy class was statistically significant (P<.05). The OS/3DP CAD/CAM guide was the best-fitting cast for the K2 cast group, and the conventional guide was the best-fitting guide for the K3 group. CONCLUSIONS: Conventionally fabricated and OS surgical guides have greater accuracy of fit than CBCT scanned surgical guides.

A tomographic study of the mandibular condyle position in partially edentulous population.

BACKGROUND AND OBJECTIVES: The Influence of the loss of teeth on the condylar position and on temporomandibular joint (TMJ) dysfunction syndrome remains a c ontroversial issue. This study analyses the condylar position by means of a tomogram in partially dentate subjects which serves as a guide to predict which of the partially dentate statuses is prone to develop TMJ dysfunction syndrome in personnel without symptoms of the same. METHODOLOGY: Eighty personnel were enrolled in this study consisting of Kennedy's class I, II, III, IV and control to analyze the condylar position by means of a tomogram. In all the five groups TMJ sectional tomogram programmed in a panoramic radiographic machine (PLANMECA PM 2002 CC PROLINE) was taken with the subjects at maximal intercuspal position and rest position. Tomograms were evaluated using linear measurements of the anterior and posterior intra-articular joint spaces on the basis of drawings and tracings. RESULTS: The results of the study revealed a predominance of reduced posterior condylar space in Kennedy's class I and II. A disparity was seen between the maximum intercuspal position and rest position, where the posterior joint space was reduced in the rest position. CONCLUSION: Within the limitations of this study, it has been revealed that in Kennedy's classes I and II, for partially dentate personnel, a posterior displacement of the c ondyles was seen. This predisposition would suggest towards the necessity of restoring the missing dentition in order to maintain the har mony of the stomatognathic system.

Maxillary implant-retained partial overdenture with Dolder bar attachment: a clinical report.

This article describes a technique for maintaining a maxillary Kennedy III partial removable dental prosthesis design in a patient who had non-restorable failing abutments by replacing the abutments with dental implants. Two implants were placed immediately after extraction of the abutment teeth in the anterior maxilla. After the implants were fully integrated, a Dolder bar attachment was fitted onto the implants. A new maxillary partial removable dental prosthesis was fabricated using the implants and the remaining natural teeth as abutments to restore function and esthetics. With the aid of dental implants, this Kennedy III maxillary removable dental prosthesis design could provide additional retention and support by promoting cross-arch stability and tissue, implant and tooth support. The patient's satisfaction was significantly increased.

[Impact of the edentulousness on the quality of life related to the oral health of the Congolese]. / Impact de 'édentement sur la qualité de vie liée à la santé orale des congolais.

BACKGROUND: No studies on the perception of tooth loss effects in their daily lives of edentulous were performed in Congolese Bantu. OBJECTIVES: To assess the severity of the impact of edentulism on the quality of life of partially edentulous Congolese and analyze the influence of age, sex, missing teeth, the location of gaps and pairs of posterior dental occlusion in this impact. METHOD: This descriptive cross-sectional study was conducted in the University Clinics of Kinshasa (CUK) and the Centre Boyambi Army Hi Kinshasa/Gombe. One hundred and eighty one edentulous adults and non-denture wearers clinically examined were asked to complete the questionnaire OHIP 14. RESULTS: Average severity was 11.67 ± 8.74 on a scale of 0-56. Statistically missing teeth, location of gaps and pairs of posterior dental occlusion residual alter this severity. The poor quality of life was noted in patients who had lost more than 5 teeth (17.04 ± 7.26), anterior losses (17.32 ± 9.42) and less than 4 pairs of posterior occlusion (17.84 ± 6.13). Difficult chewing and concern were the most reported items. CONCLUSION: Severity of the influence of tooth loss on the daily life of Congolese people is low. All edentulous does not necessarily cause a very poor quality of life. Increasing the number of lost teeth, presence of anterior gaps and reduction of posterior occlusion pairs below 4 disrupt the quality of life of partially edentulous.

The effect of periodontal status and occlusal support on masticatory performance: the Suita study.

AIM: In this study, we investigated the effect of differences in periodontal status in the masticatory performance of dentate subjects with the same occlusal supporting area. MATERIALS AND METHODS: The subjects of the analysis were classified into those of Eichner A1-3 (n = 1094) and Eichner B1-4 (n = 529). Subjects' periodontal status was evaluated on the basis of the Community Periodontal Index (CPI). The number of functional teeth and occlusal support were investigated, the latter on the basis of the Eichner Index. Furthermore, masticatory performance was investigated by means of test gummy jelly. For each group, periodontal status was classified in two different ways, either with/without moderate periodontitis (CPI Code ≤2/≥3) or with/without severe periodontitis (CPI Code ≤3/4), and masticatory performance was compared between the various groups. RESULTS: In subjects who were Eichner A1 and B3, masticatory performance was significantly lower in subjects with moderate periodontitis compared with those without, and in subjects with severe periodontitis compared with those without. CONCLUSION: Periodontal disease affects masticatory performance not only if occlusion is established by natural dentition with no tooth loss but also if occlusal support has decreased.

Finite element analysis of an implant-assisted removable partial denture during bilateral loading: occlusal rests position.

STATEMENT OF PROBLEM: When implants are incorporated into an existing partial removable dental prosthesis, the acrylic resin base can fracture. It is therefore essential to study the mechanical behavior of partial removable dental prostheses by using stress and deformation analysis. PURPOSE: The purpose of this study was to analyze the effect of the occlusal rest position on the implant-assisted partial removable dental prosthesis by finite element analysis. MATERIAL AND METHODS: A Faro Arm scan was used to extract the geometrical data of a human partially edentulous mandible. A standard plus regular neck (4.8×12 mm) implant and titanium matrix, tooth roots, and periodontal ligaments were modeled by using a combination of reverse engineering in Rapidform XOR2 and solid modeling with the Solid Works CAD program. The model incorporated a partial removable dental prosthesis and was loaded with standard bilateral forces. A uniform pressure was applied on the occlusal surface so as to generate an equivalent net force of 120 N for both the left and right prosthesis. The finite element analysis program ANSYS Workbench was used to analyze the stress and strain distributions in the implant-assisted partial removable dental prosthesis. RESULTS: Maximum stresses were significantly high for the metal framework compared to the acrylic resin surface, and these stresses were different for the mesial and distal arm designs. The maximum stress in the metal framework for the mesial arm design was 614.9 MPa, and it was 796.4 MPa for the distal arm design. The corresponding stresses in the acrylic resin surface were 10.6 and 8.6 MPa. CONCLUSIONS: Within the limitation of this study, it was found that moving the position of the occlusal rest from the mesial to distal side of the abutment teeth improved the stress distribution in the metal framework and acrylic resin denture base structures.

Partial Edentulism based on Kennedy's classifcation: an epidemiological study.

BACKGROUND: The aim of this study was to determine the incidence of different Kennedy's classes of partial edentulism during 18 months period. MATERIALS AND METHODS: Patients were clinically examined for various Kennedy's classes of partial edentulism in the outpatient department (OPD), prosthodontics, GPRDCH, Kurnool (Andhra Pradesh). RESULTS: Of the total 1,420 OPD patients, Kennedy's class III was the most frequent classification encountered (62%) and followed by Kennedy's class I (18%), class II (11%), and class IV (9%) in decreasing order. CONCLUSION: The patients with various Kennedy's classes of partial edentulism can be offered various treatment modalities like removable cast partial dentures, fixed partial dentures, over dentures and implant supported dentures. This study can be crucial for screening the population for incidence of tooth loss as a factor of gender and age. Clinical significance: Tooth loss appears to have an important role in the loss of esthetics and mastication. Study of incidence of various classes of partial edentulism provides clinically useful information for dental training and continuing education.

A hinged two-part partial denture used in conjunction with severely tilted teeth: a case report.

A two-part sectional denture can be a useful treatment option when the presence of severe hard tissue undercuts compromises the provision of a satisfactory conventional prosthesis. This article presents a case report illustrating the effective use of a hinged two-part denture in restoring a mandibular Kennedy Class IV edentulous area. A sectional denture approach was selected because of severe proximal and lingual undercuts.

Minimal intervention dentistry and older patients part 2: minimally invasive operative interventions.

UNLABELLED: As described in the first paper of this two part series, the expansion of our older population and the concomitant reduction in levels of edentulism will result in an increase in the number of patients presenting in general practice with complex restorative challenges. The application of the concepts of minimal intervention dentistry and minimally invasive operative techniques may offer a powerful armamentarium to the general dentist to provide ethical and conservative treatment to older patients. CLINICAL RELEVANCE: When it is unavoidable, operative intervention should be as minimally invasive as practicable in older patients to preserve the longevity of their natural dentition.

[Rehabilitation by composite prosthesis combining milling of embedded bilateral edentulous: a clinical report]. / Prothèse composite et fraisages. A propos d'un cas clinique de réhabilitation d'un edentement encastré bilateral au maxillaire.

The treatments with composite prosthesis require the completion of milling. These precision preparations in the fixed prosthesis promote the integration of removable partial denture with metallic framework in mechanical (prosthetic balance), physiological, aesthetical and psychological point of view. Their conception and realization are always subordinated to the balance principles of the removable partial denture. The precision they require need the use of a dental milling machine working along the predetermined insertion axis of the partial denture casting and require an excellent communication and a close collaboration between dentist and experienced technician of laboratory. In this paper, after a recalling about the milling (definition, description, interests), we will detail the steps to achieve clinical and laboratory needs for a rehabilitation by composite prosthesis combining milling, and it will be illustrated through a clinical case with a bilateral tooth-supported edentulous in the maxilla.

Functional dental status and oral health-related quality of life in an over 40 years old Chinese population.

OBJECTIVES: This study aimed to assess oral health-related quality of life (OHRQoL) related to dental status. MATERIAL AND METHODS: One thousand four hundred sixty-two Chinese subjects over 40 years, dentate in both jaws, were categorized in a hierarchical functional classification system with and without tooth replacements. OHIP-14CN scores were used to assess OHRQoL and analyzed using multivariable logistic regression including five dental conditions ('≥10 teeth in each jaw'; 'complete anterior regions'; 'sufficient premolar regions' (≥3 posterior occluding pairs (POPs)); 'sufficient molar regions' (bilaterally ≥1 POP); and tooth replacement) after adjustment for five background variables. Likelihood ratios for impaired OHRQoL (OHIP total score ≥5) were assessed at each level of the classification system. RESULTS: In the hierarchical scheme, OHIP-14CN total scores were highest in branch '<10 teeth in each jaw' (8.5 ± 9.5 to 12.3 ± 13.2). In branch '≥10 teeth' scores ranged from 6.2 ± 7.7 to 8.3 ± 9.3. The most important dental condition discriminating for impact on OHRQoL was '≥10 teeth in each jaw' (Likelihood ratio 1.59). In this branch subsequent levels were discriminative for impaired OHRQoL (Likelihoods 1.29-1.69), in the branch '<10 teeth in each jaw' they were not (Likelihoods 0.99-1.04). Tooth replacements were perceived poorer as their natural counterparts (odd ratios, 1.30 for fixed and 1.47 for removable appliances). CONCLUSIONS: OHRQoL was strongly associated with the presence of at least 10 teeth in each jaw. The hierarchical classification system predicted approximately 60 % of subjects correctly with respect to impaired OHRQoL. CLINICAL RELEVANCE: From an OHRQoL perspective, natural teeth were preferred over artificial teeth.

Modern application of the Skinner vertical movement stress director for distal extension partial removable dental prostheses: A clinical report.

This article describes the prosthetic rehabilitation of a partially edentulous patient with a partial removable dental prosthesis (PRDP) designed to dissipate stress transmission to the denture foundation and abutment teeth. The Skinner stress director is considered an alternative design for managing partially edentulous patients.

Oral health-related quality of life and nutritional status of institutionalized elderly population aged 60 years and above in Mysore City, India.

OBJECTIVE: To assess whether oral health-related quality of life (OHRQoL) is associated with nutritional status in the institutionalised elderly population of Mysore. BACKGROUND: Malnutrition in the elderly has an evident impact on their general health and quality of life. Analysis of data of the Geriatric Oral Health Assessment Index (GOHAI) and their association with the Mini Nutritional Assessment (MNA) results improves our understanding of the complex relationship between oral health and malnutrition. MATERIALS AND METHODS: The study was conducted among the institutionalised elderly population in Mysore city, Karnataka. Data on socio-demographic, oral health status were gathered. OHRQoL was evaluated using GOHAI, and malnutrition risk using MNA. RESULTS: Out of 141 elderly, 41.1% were men and 58.9% were women with mean age of 72.2 ±7.5 years. Mean GOHAI score was 47.03 ± 9.2, with 69.5% had low perception of oral health. Mean MNA score was 9.91 ± 2.4, 15.6% were malnourished, 52.5% were at risk of malnutrition and 31.9% were adequately nourished. A strong association was found between the mean GOHAI and MNA scores. CONCLUSION: Oral health-related quality of life was associated with nutritional deficit, and it requires a greater integration between dentistry and nutrition in the health promotion of older adults.

Clinical importance of recipient site characteristics for vertical ridge augmentation: a systematic review of literature and proposal of a classification.

This review evaluated the characteristics of vertical alveolar defects that were augmented via onlay bone grafting or guided bone regeneration. Information regarding the anatomic site, type of edentulism, and defects' dimensions were extracted. The experiments differed vastly in the description of the defects' features. Aiming to mitigate the confounding effect of recipient site's morphology in future experiments, a classification of vertically deficient recipient sites is proposed.

Removable dental prosthesis splint. An occlusal device for nocturnal bruxing partial denture users.

Nocturnal bruxing is a parafunctional activity of the masticatory system that may create problems for removable dental prosthesis (RDP) users. Such problems may include root fractures, increased mobility of abutment teeth, excessive wear of resin denture teeth, minor connector bending, or denture base cracking. This clinical report presents an occlusal device fabricated for an RDP patient. The device used existing ERA attachments for added retention designed with the intended purpose of protecting the definitive fixed and RDP from damage due to nocturnal bruxing activity and providing for even distribution of parafunctional forces.

A survey of removable partial denture casts and major connector designs found in commercial laboratories, Athens, Greece.

PURPOSE: This survey was conducted to study the prevalence of partial edentulism, the type of removable partial denture (RPD) support, the type of major connectors, and the frequency of their use in relation to the partial edentulism classes encountered, concerning patients in Athens, Greece. MATERIALS AND METHODS: The material comprised 628 final casts for RPDs. Each cast was photographed in a way that would allow the number of existing teeth, the classification of partial edentulism, the RPD support, and the particular parts of the metal framework to be identified. Data collected were analyzed statistically using prevalence tables and the χ(2) test. RESULTS: Two hundred seventy six (43.9%) casts were for the maxilla and 352 (56.1%) for the mandible. The most frequently encountered group was Kennedy class I for both arches, while class IV was the classification least encountered (p < 0.001). Of all RPDs constructed, 96.8% had a metal framework (tooth-borne and tooth/tissue-borne), while 3.2% of the RPDs were frameless (tissue-borne, acrylic dentures). The U-shaped palatal connector (horseshoe) in the maxilla and the lingual bar in the mandible were the most frequently used for all partial edentulism classes, at 55.2% and 95%, respectively. CONCLUSIONS: Analysis of the casts revealed that the type of major connectors selected does not comply with the indications for their applications, considering the lack of dental history and clinical examination. This notes the need for further training dentists and dental technicians in aspects of RPD framework design.

Finite element analysis of an implant-assisted removable partial denture.

PURPOSE: This study analyzes the effects of loading a Kennedy class I implant-assisted removable partial denture (IARPD) using finite element analysis (FEA). Standard RPDs are not originally designed to accommodate a posterior implant load point. The null hypothesis is that the introduction of posteriorly placed implants into an RPD has no effect on the load distribution. MATERIALS AND METHODS: A Faro Arm scan was used to extract the geometrical data of a human partially edentulous mandible. A standard plus regular neck (4.8 × 12 mm) Straumann® implant and titanium matrix, tooth roots, and periodontal ligaments were modeled using a combination of reverse engineering in Rapidform XOR2 and solid modeling in Solidworks 2008 FEA program. The model incorporated an RPD and was loaded with a bilateral force of 120 N. ANSYS Workbench 11.0 was used to analyze deformation in the IARPD and elastic strain in the metal framework. RESULTS: FEA identified that the metal framework developed high strain patterns on the major and minor connectors, and the acrylic was subjected to deformation, which could lead to acrylic fractures. The ideal position of the neutral axis was calculated to be 0.75 mm above the ridge. CONCLUSION: A potentially destructive mismatch of strain distribution was identified between the acrylic and metal framework, which could be a factor in the failure of the acrylic. The metal framework showed high strain patterns on the major and minor connectors around the teeth, while the implant components transferred the load directly to the acrylic.

Prevalence of temporomandibular joint dysfunction and its signs among the partially edentulous patients in a village of North Gujarat.

UNLABELLED: There is disagreement about the association between missing teeth and the presence of temporomandibular disorder (TMD). AIM: To investigate whether, the span of edentulousness, gender, number of quadrants involved, pathological migration and the type of kennedy's classification are related to the temporomandibular joint (TMJ) dysfunction signs. MATERIALS AND METHODS: Clinical examination of 250 patients (males 99 and females 151) was done among the age group of 35 to 45 years. The patients were partially edentulous for 6 months or more and did not wear any kind of prosthesis. RESULTS: Among 250 subjects, females showed more TMJ dysfunction signs. Clicking sounds were present in 46.5%, mandibular deviation was present in 40% of individuals, TMJ tenderness was observed in 32% and masseter was involved in 32% of individual. Temporomandibular joint dysfunction signs in relation to pathologic migration of teeth show that clicking and mandibular deviation was present in 54.5 and 49.2% and among muscles masseter muscle tenderness 41.9% was more commonly present. Masseter muscle tenderness 64.1% was seen in individuals who were edentulous for more than 5 years. CONCLUSION: Females subjects had a significantly higher prevalence of TMJ dysfunction signs then male subjects. As the span and time of edentulousness, the number of missing teeth and the number of quadrant involved increased, the signs of dysfunction became more prevalent. Among the TMJ dysfunction signs deviation and clicking sound were most frequently observed. The masseter muscle was most commonly affected and demonstrated muscle tenderness.