Articular Eminence Morphology of American Historic and Contemporary Populations.

OBJECTIVES: This study was performed to determine the values of the articular eminence inclination (AEI), the articular eminence height (AEH), and the length of the articular eminence curved line (AEL) among American prehistoric and contemporary populations. MATERIALS AND METHODS: The study was carried out on 120 human dry skulls divided into 4 groups: Illinois group (IP), Kentucky group (KP), African Americans group (AAP) and American Caucasians group (ACP). Each group comprised 30 human dry skulls. Measurements of AEI (by two methods), AEH and AEL were performed using computer software on 5 sagittal sections through silicone molds of the articular eminence. The obtained results were statistically analyzed at significance level of p < 0.05. RESULTS: No statistically significant differences of AEI, AEH and AEL values were obtained among American populations (IP, KP, AAP, ACP) neither by body side, sex and age (p > 0.05). The mean AEI M1 values ranged from 31.56° to 38.72°, the mean AEI M2 values ranged from 44.14° to 58.37°, the mean AEH ranged from 5.82 to 6.86 mm, and the mean AEL values ranged from 11.57 to 12.73 mm. CONCLUSIONS: AEI, AEH, AEL values are variables, but they did not differ significantly among American populations. Left-right differences as the result of natural body asymmetry were not statistically significant. Sex and age did not significantly affect the articular eminence morphology.

Simplified Prosthetic Rehabilitation of a Patient after Oral Cancer Removal.

The treatment of patients with oral cancer is complex: a multidisciplinary approach needs to be taken and maxillofacial and oral surgeons, an oncologist, a prosthodontist should be included, and a psychologist is often needed. This case report describes the prosthetic rehabilitation of a patient after surgical removal of oral cancer with obturator prosthesis. Resection cavity was located in central part of the hard palate and the condition belonged to Aramany class 3 maxillary defects. The two-step impression technique of denture bearing area was used and the resection of cavity was performed. A primary impression-the impression of denture bearing area was made using irreversible hydrocolloid material, while the second impression - the impression of resection cavity was made using condensation silicone material and obturator prosthesis framework. The obturator prosthesis replaced lost teeth, improved oral function and esthetics at minimal costs.

Oral Health-Related Quality of Life in Different Types of Mandibular Implant Overdentures in Function Longer Than 3 Years.

PURPOSE: The aim of this study was to evaluate the oral health-related quality of life (OHRQoL) of patients treated with three different types of mandibular implant overdentures (IOD) after at least 3 years in function. MATERIALS AND METHODS: A total of 122 patients treated with mini implant (50), locator (56), or bar (16) mandibular IODs participated. Modified plaque (PI) and gingival (GI) indices were also assessed. RESULTS: Older patients and patients with mini mandibular IODs were the most satisfied with their OHRQoL. The bar overdenture presented the worst PI and GI results. CONCLUSION: The mini mandibular overdenture patients were assessed with a better OHRQoL than those with bar and locator IODs.

Differences in skeletal components of temporomandibular joint of an early medieval and contemporary Croatian population obtained by different methods.

The temporomandibular joint (TMJ) is one of the most complex joints in the human body. The anatomical configuration of the TMJ allows for a large range of mandibular movements as well as transmission of masticatory forces and loads to the skull base. The measurements of the TMJ's anatomical structures and their interpretations contribute to the understanding of how pathological changes, tooth loss, and the type of diet (changing throughout human history) can affect biomechanical conditions of the masticatory system and the TMJ. The human TMJ and its constituent parts are still the subject of extensive investigation and comparisons of measurement methods are being made in order to determine the most precise and suitable measurement methods. The aim of this study has been to examine the morphology of skeletal components of TMJ of an early medieval population (EMP) in Croatia and to compare measured values with TMJ values of the contemporary Croatian population (CP) using various methods of measurement. The study was performed on 30 EMP specimens - human dry skulls, aged from 18 to 55 years, and 30 CP human dry skulls, aged from 18 to 65 years. Only fully preserved specimens (in measured areas) were included. The articular eminence (AE) inclination was measured in relation to the Frankfurt horizontal using two methods. Also, the AE height (glenoid fossa depth) and the length of the curved line - highest to the lowest point of the AE were measured. Measurements were performed on lateral skull photographs, panoramic radiographs and lateral cephalograms using VistaMetrix software on skull images. The results were statistically analyzed using SPSS statistical software. No statistically significant differences were obtained for AE parameters between the EMP and CP populations independent of age and gender. However, statistically significant (p<0.05) differences were revealed when comparing results of three different measuring methods. It could not be determined which of the used measurement methods is the most accurate due to the different results obtained as well as the presence of possible shortcomings and limitations of the various methods (measuring points are difficult to determine and/or they are not clearly observed in the investigated images to be precisely marked and measured; distortion and magnification of structures on radiographic images are present). Therefore, due to the limitations of this study, the obtained results could serve only as orienting information.

Articular Eminence Inclination in Medieval and Contemporary Croatian Population

Articular eminence inclination (AEI) of the temporomandibular joint leads the mandible in its movements. Therefore, the aim of the present study was to determine AEI values in medieval (MP) and recent (RP) Croatian population. The study was carried out on two groups of specimens: first group with 30 MP human dry skulls, while the other, serving as control group consisted of 137 dry skulls. The AEI was measured on lateral digital skull images as the angle between the best fi t line drawn along the posterior wall of the articular eminence and the Frankfurt horizontal plane. No statistically significant (p>0.05) differences between the left and right side AEI were found between MP skulls and RP skulls. The mean value of MP AEI was 45.5˚, with a range of 20.9˚-64˚. The mean RP AEI value was steeper (61.99˚), with a range of 30˚-94˚. Difference between the mean MP and RP AEI values was statistically significant (p<0.05). Values of AEI vary a lot. Nonsignificant differences between the left and right side AEI confirmed the natural left-right side asymmetry. The values of AEI differ between the RP and MP groups, most probably due to different type of food consumption in medieval time, and consequently different masticatory loads and forces.

Flexible Removable Partial Denture Prosthesis: A Survey of Dentists' Attitudes and Knowledge in Greece and Croatia.

PURPOSE: The aim of this study was to investigate through a questionnaire the knowledge, attitudes and possible differences in the use of flexible RPDPs among dentists in Greece and Croatia. MATERIAL AND METHODS: A questionnaire of 16 questions was originally created in English, translated into Greek and Croatian language following a two way translation and tested for apprehension, precision, clarity and homogeneity by a number of native English speaking Greek and Croatian dentists. Following the necessary corrections, the questionnaires replicated in two online surveys and their addresses with an informed consent were sent by emails to nearly 4000 dentists in each country to participate. Collected data were analyzed by chi-square tests at a= .05 level of significance. RESULTS: 378 dentists from Greece and 304 from Croatia participated in the study. 137(36.2%) dentists from Greece and 56(18.4%) from Croatia provided flexible RPDPs to their patients. Statistical analysis for all providers indicated no significant difference between genders (P>.05), significant differences between age groups (P<.01), years of practice (P<.05), specialization (P <.001), and instruction on flexible prostheses (P <.001). The analysis between the two countries showed differences for gender and age groups (P<.01) but no differences between experienced, specialized or instructed groups (P >.05). CONCLUSION: The survey indicated differences between the two countries in the percentages of dentists using, selecting and providing RPDPs for their patients. Practitioners' age, years in practice and instruction were associated with the provision of the prostheses, while comfort, esthetics and cost were the reasons for deciding to use the flexible RPDPs. CONCLUSION: Although dentists are not educated in their schools about flexible RPDPs, almost a third of them offer this treatment to their patients. Long term success of these devices depends on clinical education, more experience and definitely more research.

Knowledge and awareness of dental implants among elderly people in Croatia.

PURPOSE: The use of inserted dental implants is growing every day in order to improve retention and stability of complete removable dental prostheses (RDPs), especially in the mandible. Therefore, the aim of this study was to examine the knowledge and awareness of dental implants among elderly people wearing complete RDPs. MATERIALS AND METHODS: This study, based on answers from a questionnaire designed for the purpose of this study, included 301 participants wearing complete RDPs from elderly care homes with average age of 74 years. RESULTS: The awareness of dental implants was statistically significantly (p < 0.05) affected by the participants' age, residence size, and their level of education. Younger participants (x¯ = 70 years) had heard about dental implants (56.5%; p < 0.05) and believed in the possibility of retaining complete RPDs using dental implants (56.1%; p < 0.05). Among participants living in places with populations of 10,000 or fewer residents, more had not heard about dental implants (59.4%; p < 0.05). Among participants who had completed college/university or high school, there were a higher number of participants who had heard about dental implants (82.4%; p < 0.05). CONCLUSION: Although more than half of the participants had heard of dental implants, this did not mean they were well informed about the implant insertion procedure and the costs for such a treatment. In conclusion, awareness of dental implants in studied participants was insufficient. The results reinforce the need for better education and the provision of proper information to elderly people about dental implants and implant treatment options.

Initial effects of a treatment by fixed partial dentures supported by mini dental implants from a patient's point of view.

Mini dental implants (MDIs) in dentistry are recommended for cases with adequate bone quality and height, but a lack of alveolar bone width. Some studies well documented successful usage of MDIs for a removable denture support, but studies of MDIs supporting fixed prosthodontic restorations are scarce. We aimed to study the effect of fixed partial dentures (FPD) therapy supported by MDIs or by MDIs and natural teeth, on patients self perceived oral health related quality of life (OHRQoL), self perceived oral aesthetics and self perceived chewing function. A total of 23 patients (10 female and 13 men, age range from 54 to 78 years) were included and 61 MDIs were inserted, 10 in the maxilla and 51 in the mandible. In 14 patients FPDs were constructed only on MDIs and in 9 patients FPDs were constructed on both, MDIs and natural teeth. FPDs on MDIs were replacing mostly mandibular incisors, the second maxillary incisors and the first maxillary premolars. Those FPDs supported by both, MDIs and natural teeth had some MDIs inserted in frontal regions to allow a FPD construction. The three questionnaires: the OHIP-CRO14 for the assessment of OHRQoL, the OES-CRO for assessment of oral aesthetics and the Chewing function questionnaire (CFQ) for assessment of chewing function have been administrated twice:prior to the MDIs insertion and three months after the FPD treatment supported by MDIs had been finished. The CFQ and the OHIP summary scores significantly decreased revealing better OHRQoL and better chewing ability after treatment, and the OES scores significantly increased indicating increased self perceived oral aesthetics (p < 0.01). Clinical examination revealed no periimplant inflammation. Patients' data supplement the initially promising clinical findings. However, further follow ups will be necessary to finally confirm the long term clinical benefit of MDIs.

Factors Affecting Oral Health-Related Quality of Life Among Elderly Croatian Patients.

OBJECTIVE OF WORK: Oral health-related quality of life (OHRQoL) as a multidimensional concept is affected by many factors. Therefore, the aim of this study was to determine which demographic and subjective factors are significantly affecting the OHRQoL among the elderly people wearing complete removable dental prostheses (CRDP). MATERIALS AND METHODS: This questionnaire-based study included 301 participants, residents of elderly care homes (in Zagreb and Slavonski Brod, Croatia) wearing maxillary and/or mandibular CRDP. The questionnaire used in this study consisted of two sections; the first section included questions giving general information and in the second section the Croatian version of Oral Health Impact Profile (OHIP)-49 questionnaire with 49 items representing seven OHIP domains was used. RESULTS: Participants were aged between 60-99 years, with average age of 74 ± 12.1 years. OHIP summary score was 26.5. The highest average OHIP mean values in the domain of functional limitation amounted to 6.7, physical pain 5.1, and physical disability 5.9. The participants' age, education, profession, residence place size, type of CRDP, and the time of denture wearing period all statistically significantly affected OHRQoL (p < 0.05). CONCLUSIONS: General and sociodemographic factors had a significant influence on the participant's subjective perception of oral health and OHRQoL. Younger participants, participants from rural places, those with lower levels of education, and shorter period of denture wearing demonstrated a higher impact on OHRQoL.

A two-step (altered cast) impression technique in the prosthetic rehabilitation of a patient after a maxillectomy: a clinical report.

This clinical report describes the prosthetic rehabilitation complicated by trismus (as a consequence of surgery and radiation therapy) of a patient with an acquired maxillary defect, after surgical removal of the right maxillary sinus tumor. The patient was restored with a partial removable dental prosthesis with a hollow bulb obturator to obtain orofacial rehabilitation and defect obturation. Precise obturation requires an accurate impression of the resection defect. A 2-step impression was performed because of trismus. A primary maxillary impression was made with an irreversible hydrocolloid, while a secondary (altered cast) impression was made with a silicone material by using the obturator cast framework as a tray. In that way an altered cast was produced. Subsequently, an obturator prosthesis was processed with a conventional technique.

Prosthetic modalities used to treat cleft palate patients in a university clinic: a 10-year review.

Cleft palate patients are not usually seen in general dental clinics, but this congenital anomaly is one of the most frequent of cases. General dental practitioners are usually unwilling or/and not sufficiently trained to treat such patients for whom rehabilitation and interdisciplinary cooperation is often needed. The aim of this study was to determine the incidence of prosthetic modalities most frequently used by licensed prosthodontists for prosthetic rehabilitation of cleft palate patients. Participants in this study were 56 cleft palate patients (aged 23-66 years) who received prosthetic treatment between 2000 and 2010. Patients' dental status and prosthetic modalities used were noted from patient records archived at Department of Prosthodontics, School of Dental Medicine, University of Zagreb. Data analyses revealed that combined prosthetic constructions (fixed + removable, p < 0.05) were the most frequently used. In a group of molar teeth, the most frequent fixed prosthetic modalities were crowns with rests; in a group of premolar teeth, telescopic crowns; on canines, metal ceramic crowns and telescopic crowns; and in a group of incisors, metal ceramic pontics (p < 0.05). Understanding the distribution of prosthetic modalities for cleft palate patients could serve to guide dental practitioners towards planning adequate prosthetic treatment for their patients since only a well-planned prosthetic therapy will result in satisfactory function and alleviation of the deformities.

Denture relining as an indicator of residual ridge resorption.

AIM: Residual ridges change in shape and reduce in size due to alveolar bone resorption. Therefore, the purpose was to investigate changes in denture base thickness (DBT) and interocclusal rest space (IRS) with regard to the denture relining procedure. METHODS: The IRS and DBT were measured (before and after denture relining) in the case of 74 patients and their removable dental prostheses by using a precise sliding gauge. The DBT measuring was performed in 6 points for maxillary and in 3 points for mandibular removable dental prosthesis. The IRS values were measured as the distance (in mm) between the incisal edges of the maxillary and mandibular central incisors with patient's mandible in a physiological "rest position" with head and neck in the upright posture. RESULTS: In a group of patients wearing maxillary and mandibular removable dental prosthesis mean values of DBT after denture relining were statistically significantly higher (p <0.05) in almost all measuring points. The IRS mean values after relining were statistically significantly lower (p <0.05). Statistically significant differences (p <0.05) of DBT were also observed in groups of "day-night time" and "day time" denture wearers, and in a group of patients for whom a period shorter than one year had passed since the last tooth extraction and the time when a functional impression for removable dental prostheses was taken. CONCLUSION: The DBT and IRS values change after the denture relining procedure due to the alveolar bone resorption. Therefore, these measures could be used as resorption indicators in dental practice.

Patient's satisfaction with removable dentures after relining.

AIM: To reveal patients' satisfaction with their old, usually poorly fitting dentures and the effect of denture relining to the patient's satisfaction. METHODS: Thirty seven denture wearers participated in study by filling out questionnaires about their satisfaction with dentures before and after relining. In that way the data indicating the subjective patient's experience and satisfaction were collected. RESULTS: Relined removable dentures included in study were on average 5.52 years (upper) or 4.86 years old (lower). Most of study participants (57%) were satisfied with their poor fitting dentures. Statistically significant was correlation between chewing discomfort and satisfaction, and the time elapsed from last tooth extraction to denture production. As this period was shorter, chewing discomfort was greater and satisfaction with chewing lower. Majority (53.3%) of denture wearers were considerably more satisfied with the chewing ability and felt better regarding the chewing discomfort after denture relining. Minority of the patients (22%) still used an adhesive for fixing the dentures after relining. CONCLUSION: Denture relining affects patient's satisfaction with their dentures. After relining patient's masticatory function was improved, satisfaction with chewing ability and comfort were greater, and denture hygiene better. Denture relining should be performed in order to improve denture fitting to a denture bearing area, thus positively affecting patient's satisfaction with his denture(s).

Oral hygiene and gingival health in patients with fixed prosthodontic appliances--a 12-month follow-up.

The aim of this study was to assess and observe the oral hygiene and gingival condition in patients before and after fixed prosthodontic therapy through a 12-month period in combination with oral hygiene instructions. It was also analysed how factors, such as type of fixed prosthodontic appliance, constructive material, the position of a fixed partial denture (FPD) in the mouth, age and gender influenced oral hygiene. The dental arches were divided into three segments each and teeth and gingiva were examined using the Plaque and Gingiva Index by Silness and Löe, and for the mineralized deposits assessment the Calculus Index by Green and Vermillion was employed. The preliminary examination was conducted before the prosthodontic therapy, and the reexaminations were carried out 14 days, 1, 6 and 12 months after crown and/or FPD placement. A total of 93 subjects from the original study group of 146 patients attended all clinical examinations, while the rest was excluded. The sample consisted of 60 women, 33 men at age between 21 and 95 (average 51.8). A total of 39 patients had single crowns (C), 50 FPDs and 5 C+FPD. The frequency of plaque found during the preliminary visit was higher than that found in the other periods (p < 0.001). Patients with C showed better oral hygiene levels than patients with FPDs or C+FPDs (p = 0.001). Our results revealed no significant difference in oral hygiene status among patients with FPDs made of different materials (p = 0.083). The worst hygiene levels were found in patients with fixed prosthodontic appliances in both jaws (p = 0.012). Younger patients showed better hygiene levels than the older ones (p = 0.002). Our research showed that appropriate educational and motivational measures can lead to improved oral hygiene, even after FPD placement. Presumably, the oral health in a group of adult patients can be kept acceptable by providing a prophylactic oral hygiene program.

Prosthetic rehabilitation of a patient with mandibular resection prosthesis using mini dental implants (MDIs)--case report.

Physical disfigurement and functional impairments associated with facial trauma are a challenge to a prosthodontist, because even novel sophisticated surgical reconstructive techniques fail to provide adequate support for dental resection prosthesis. Therefore, different endosseous implants are often used as prosthesis-supporting elements. Manufacturers of dental implants have recently presented mini dental implants (MDIs) with diameter of only 1.8-2.4 mm. These implants allow very suitable prosthetic solutions within the range of their indications due to good osseointegration success rates, simple surgical technique, and immediate loading possibility. In this report, a case was presented for prosthetic rehabilitation including implantation of two Sendax type (IMTEC, Ardmore, Oklahoma, USA) MDIs in mental region, to obtain better retention and stability of the mandibular resection prosthesis and to improve function, phonation and aesthetics. The use of these implants, among aforementioned preferences, is also very cost-effective, so this implantation possibility should be taken into consideration during prosthetic treatment planning.

Differences in articular-eminence inclination between medieval and contemporary human populations.

The articular-eminence inclination is an important element in the biomechanics of the temporomandibular joint and the entire masticatory system; however, very little is known about this inclination in archaeological human populations. Therefore, the aim of this study was to determine the values of, in addition to the differences between, the articular-eminence inclination in medieval and contemporary human populations. The study was carried out on two dry skull groups. The first group consisted of 14 dry skulls from the medieval culture group Bijelo Brdo (BB) of East Croatia, and the other consisted of 137 recent dry skulls from the osteologic collection of the Institute of Anatomy (IA) in Zagreb. All BB skulls were dentulous, whereas the IA skulls were divided into dentulous and edentulous groups. The articular-eminence inclination was measured in relation to the Frankfurt horizontal plane on digital images of the skull's two lateral views using AutoCAD computer software. The mean value of the articular-eminence inclination in the BB sample group (49.57°) was lower, with a statistical significance (p<0.01), than those of the IA dentulous (61.56°), the IA edentulous (62.54°), and all the combined IA (61.99°) specimens. Because the values of the articular-eminence inclination can vary a lot with reference to the number of specimens and the different methods used for measuring, the obtained values yield only orientational information. Further investigations including a larger number of medieval specimens are needed to confirm the results obtained from this study.

Immediate implantation in infected tooth sockets.

Although immediate implantation has not been previously recommended in infected sites, it is now becoming a procedure of choice in modern implant dentistry. We report a case of a 65-year-old male patient, who required multiple tooth extractions in the lower jaw and fabrication of a new overdenture in the lower jaw and a complete denture in the upper jaw. Immediate implantation in infected tooth sockets followed extraction. Two NobelReplace Tapered implants (Nobel BioCare, Zürich, Switzerland), one 13 mm long and 4.3 mm wide and the other 13 mm long and 5.0 mm wide, were placed in the position 33 and 43. The site was sutured and a temporary denture was fabricated by adjusting the old denture. After a period of three months the implant site was reopened and healing abutments were placed. Impressions were made using the Impregum Penta Soft (3M ESPE, St. Paul, Minn, USA) polyether material. Ball Abutment Titanium" was used as a patrix attachment and a matrix was inserted into the denture. Clinical examination and x-ray analysis after six months showed no significant changes of the implants. Bone resorption was within standard values. Although it is still a controversial subject, immediate implantation in infected sites can be a safe and predictable procedure if surgical protocols are followed. However, further research is needed to draw firm conclusions.

A study of the surface topography and roughness of glazed and unglazed feldspathic ceramics.

The aim of this study was to obtain the 3-D qualitative and quantitative nanoscale data of the surface topography and surface roughness of glazed and unglazed feldspathic ceramics. Twelve samples composed of Ni-Cr alloy (Wiron 99, Bego Germany) and feldspathic ceramics (IPS Classic, Ivoclar-Vivadent, Schaan, Liechtenstein) were prepared, and divided into two groups, dependent of the surface final finishing; 6 unglazed and 6 glazed samples. The surface of the samples was recorded and analysed by atomic force microscopy (AFM, Veeco Instruments, Santa Barbara, CA, U.S.A.). According to the results of this study, unglazed ceramic surface is significantly rougher than the glazed one, showing significantly higher root mean square (RMS), mean roughness (Ra) and maximum height (Z range values) (p < 0.01), higher crystallites with sharper peaks and deeper pores. The roughness parameters of the unglazed samples were almost twice or even more higher than of the glazed samples. Exposed unglazed ceramic surfaces can therefore promote antagonistic tooth wear.

Optoelectronic pantography diagnostics of temporomandibular disorders in patients with bruxism.

Temporomandibular disorders (TMD) is a joint term that encompasses a number of clinical symptoms that involve the teeth, masticatory musculature and temporomandibular joints (TMJ). They are a frequent cause of orofacial medical conditions. The aetiology of disorders is complex and individual etiologic factors are not sufficiently defined. Bruxism, in its centric or eccentric form, is becoming a frequent problem for dentists. The purpose of this study is to show factors of the condyle leading in patients with bruxism by optoelectronic pantography, and to establish the possibility of using optoelectronic pantography in the diagnostic procedure of TMD. Patients were selected (N = 42), with incomplete sets of teeth, without prosthodontic appliances and with traces and symptoms of TMD. After completing the history questionnaire a clinical check up and plaster cast analysis patients with bruxism were selected (N = 22) and without bruxism (N = 20). During the study optoelectronic String-condylocomp LR3, Dentron, D-Höchberg (software JAWS 30) was used. This study showed the possibility of applying optoelectronic pantography in TMD diagnostics and compares history, clinical and condylographic parameters in TMD patients with and without bruxism. Optoelectronic pantography enables us, by using relatively easy methods, to determine a more accurate diagnosis, highly important when choosing therapeutic methods and control of the aforementioned disorders.

Comparative study of condylar inclination settings in two types of semiadjustable articulators.

The purpose of this study was to research the possible influence of difference in construction of mechanical joint in arcon and nonarcon articulators, upon the adjustment of condylar inclination by intraoral protrusive record. The determination of condylar inclination by protrusive record in two types of articulators was performed on 30 examinees, and the adjustment of condylar inclination in each articulator was done for left and right joint. In arcon articulator the measured values for condylar inclination were higher and the mean difference for right joint was 7.4 degrees, and for the left joint 7.2 degrees The found differences are statistically significant for both, left and right joint, at the level of P < 0.001. There is possible influence of difference in construction of mechanical joint upon the adjustment of condylar inclination by intraoral protrusive record. The arcon articulator, due to constant relation between occlusal plane and mechanical fossa, reproduces the movements more accurately.