Treatment outcomes with mandibular removable partial dentures: a population-based study of patient satisfaction.

STATEMENT OF PROBLEM: Little is known about the outcomes of treatment with mandibular removable partial dentures provided by dentists in private dental practice. PURPOSE: This study examined 15 aspects of patient satisfaction and explored the factors found to be associated with dissatisfaction. MATERIAL AND METHODS: A questionnaire was mailed to people whose dental insurance claims included CPT Code 5214 within the last 5 years. A composite measure of treatment outcome was created by combining the responses to the 15 satisfaction items, and 10 factors were then tested statistically to determine their relationship to dissatisfaction. RESULTS: A majority of the respondents were satisfied with the prosthesis, but a substantial amount of dissatisfaction existed. Dissatisfaction was greater when there was no previous wearing experience or when there was an opposing maxillary removable partial denture. Respondents under the age of 60 expressed more dissatisfaction than did those over the age of 60, and subjects with lower levels of general health also reported less satisfaction. One third of the respondents believed their prosthesis required adjustment or replacement, and one fourth said the removable partial denture had caused a problem with the natural teeth. CONCLUSION: A majority of survey respondents treated with a mandibular removable partial denture in private dental practice were satisfied with the prosthesis, but a substantial amount of dissatisfaction existed. Dissatisfaction was related to age, health, prior experience with a prosthesis, and the type of opposing dentition.

Associations between initial, posttreatment, and postretention alignment of maxillary anterior teeth.

Contradictory findings from studies on pretreatment malalignment as a risk factor for relapse of maxillary incisor alignment may be due to inappropriate sample selection and measurement technique. In an attempt to clarify the issue, 745 sets of study models made before (T1) and after (T2) orthodontic treatment and at long-term out of retention (T3) were screened. On the basis of the configuration of the maxillary anterior teeth on the T3 study models, three groups were established: one with significant spacing (group 1, n = 30); one with significant irregularity (group 2, n = 49); and one with perfect alignment (group 3, n = 28). The occlusal surfaces of the 321 maxillary study models at T1, T2, and T3 were photocopied and the tooth anatomic contact points digitized. An algorithm was used to fit the dental arch to the digitized points. Amount of incisor rotation and anatomic contact point displacement of the maxillary anterior teeth relative to the dental arch were computer generated. Interdental spaces in the maxillary anterior segment, as well as overjet and overbite, were measured manually. Nonstructural data were collected from the charts. Logistic regression analyses revealed that irregularity was associated with greater anatomic contact displacement and with greater incisor rotation both at T1 and T2 (P < 0.01). Similar analyses also revealed that spacing was associated with greater interdental spaces at T1 and T2 (P < 0.01). Correlation analyses revealed that the pattern of pretreatment rotational displacement has a strong tendency to repeat itself after retention (P < 0.001), as opposed to the pattern of contact point displacement and interdental spacing.

Association of oral spirochetes from sites of periodontal health with development of periodontitis.

The purpose of this investigation was to determine whether the presence of disease-associated bacteria in health-associated plaque correlated with susceptibility to periodontitis over time. Sites of periodontal health were identified in 65 adults. Six months later (recall 1), plaque was collected from sites that remained in periodontal health, and specific bacteria were detected using monoclonal antibodies in a microscopic assay. The spirochete morphogroup was identified by phase contrast microscopy. The relationship between detection at recall 1 and development of periodontitis over two successive 6-month intervals (recalls 2 and 3) was evaluated by means of logistic regression using generalized estimating equations (GEE), from which odds ratios (OR) were estimated and tested for significance. Significant relationships were defined as those having ORs with P < 0.05. Ninety-three of 1,032 sites developed signs of early periodontitis over the 12-month interval between recall 1 and recall 3. The spirochete morphogroup (OR = 3.13, P < 0.001) and pathogen-related oral spirochetes (PROS) (OR = 3.68, P < 0.001) were significantly associated with healthy sites that developed periodontitis. The association of Treponema socranskii was not significant (OR = 3.62, P = 0.0918). Odds ratios for Campylobacter rectus, Eikenella corrodens, and Porphyromonas gingivalis were less than 2.0 and not significant. Treponema denticola was not detected in health-associated plaque from stable health sites and was detected in only three sites that progressed to periodontitis. These findings indicate that the presence of PROS and some unidentified spirochetes in health-associated plaque is associated with increased susceptibility to periodontitis.