Interarch space assessment in edentulous patients rehabilitated with complete removable dentures using open-access software.

BACKGROUND: The interarch space is defined as the vertical space between the edentulous ridge and the occlusal or incisal aspect of the opposing arch. Measuring the interarch space in a patient requiring an implant-supported fixed prosthesis is crucial for determining the prostheses to be used in each clinical situation. Depending on the measurements and other factors, such as the need for lip support or pink esthetics issues, decisions about the most convenient type of implant-supported prosthesis can be taken. Analogic workflow to measure the interarch space can represent a time-consuming and expensive procedure that may lead to inaccuracies. OBJECTIVE: To describe a step-by-step protocol to measure the upper and lower interarch space with open-access software, starting from the digital scan of the patient's complete dentures obtained with an intraoral scanner. METHODS: An extraoral scan (using an intraoral scanner) of the existing complete removable prosthesis is required to assess the interarch space for making an implant-supported prosthesis treatment planning. If the existing complete denture does not fulfill the required functional and esthetic parameters, a complete interim denture, a wax trial denture, or a printed denture prototype should be previously fabricated. The antagonist arch and the intermaxillary record scan also need to be obtained. Finally, all STL files are imported into an open-access software for measuring the interarch space. RESULTS: Open-source software can be used to measure the upper and lower interarch space from existing complete dentures following the step-by-step protocol outlined in this paper. CONCLUSION: Interarch space of edentulous patients rehabilitated with complete dentures can be measured with a 360 degrees scanning of the existing complete denture and open-access software by applying the protocol outlined in this paper. CLINICAL RELEVANCE: The clinician can assess and digitally measure the interarch space of edentulous patients requiring an implant-supported fixed prosthesis using an open access software.

Are UK graduates equipped with the skill set required to meet the demands of the UK's edentulous population?

As the UK witnesses a decline in the number of edentulous adults, there is a simultaneous reduction in the number of cases available to undergraduate dental students for the teaching of complete dentures. When edentulous adults are unable to function with conventional complete dentures, particularly pertaining to the mandibular denture, an implant-supported mandibular overdenture has been evidenced as the gold standard for edentulous patients. The evidence in favour of mandibular implant-supported overdentures is one of the most robust evidence bases for any clinical treatment and similarly it has been shown that undergraduate students are equally as capable in the provision of implant-supported overdentures as experienced prosthodontists. Yet there appears to be a disparity in the General Dental Council's undergraduate learning outcomes pertaining to care for edentulous adults. Furthermore, the UK seems to be falling behind in this respect in comparison to our European, American and Australian colleagues. This review looks at the evidence for the provision of implant-supported overdentures in the setting of the undergraduate dental curriculum, the potential barriers within this teaching forum and how well prepared UK undergraduates are for the clinical management of edentulous patients in the future.

Cost-effectiveness analysis of two impression methods for the fabrication of mandibular complete dentures.

OBJECTIVES: To compare the cost and to evaluate cost-effectiveness of fabricating mandibular complete dentures (CDs) using two different impression methods. METHODS: A crossover randomized controlled trial including 27 edentulous participants was performed. Mandibular CDs were fabricated using two different impression methods, as follows: (i) conventional method using a custom tray border moulded with impression compound and silicone and (ii) simplified method using a stock tray and alginate. Cost analysis was performed from a clinical practitioner's perspective. The total cost included labor cost, which was calculated using the time spent by dentists and technicians in fabricating CDs and their hourly wages, and the material costs, which were calculated using purchase prices. To evaluate cost-effectiveness, we used general patient satisfaction as an indicator of effectiveness and calculated the incremental cost effectiveness ratio (ICER). ICER represents the cost per one unit of effectiveness. RESULTS: The trial was completed by 24 participants. The total cost was 43,904 Japanese Yen (JPY) (330.91 EUR / 395.78 USD) for the conventional method and 39,792 JPY (299.93 EUR / 358.70 USD) for the simplified method, and this difference was statistically significant (p<0.001). The ICER showed a cost of 633 JPY (4.77 EUR / 5.70 USD) for every one point change in general patient satisfaction. CONCLUSIONS: The results indicated that the total cost of the conventional method was significantly higher than that of the simplified method (p<0.001). CLINICAL SIGNIFICANCE: The conventional impression method for fabricating mandibular CDs, which took additional 633 JPY (4.77 EUR / 5.70 USD) for improvement of general satisfaction, is supposed to be clinically meaningful1.

The assessment of lower face morphology changes in edentulous patients after prosthodontic rehabilitation, using two methods of measurement.

Using two measurement methods (a three-dimensional laser scanning system and a digital caliper), this study compares the lower face morphology of complete edentulous patients, before and after prosthodontic rehabilitation with bimaxillary complete dentures. Fourteen edentulous patients were randomly selected from the Department of Prosthodontics, at the Faculty of Dental Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania. The changes that occurred in the lower third of the face after prosthodontic treatment were assessed quantitatively by measuring the vertical projection of the distances between two sets of anthropometric landmarks: Subnasale - cutaneous Pogonion (D1) and Labiale superius - Labiale inferius (D2). A two-way repeated measures ANOVA model design was carried out to test for significant interactions, main effects and differences between the two types of measuring devices and between the initial and final rehabilitation time points. The main effect of the type of measuring device showed no statistically significant differences in the measured distances (p=0.24 for D1 and p=0.39 for D2), between the initial and the final rehabilitation time points. Regarding the main effect of time, there were statistically significant differences in both the measured distances D1 and D2 (p=0.001), between the initial and the final rehabilitation time points. The two methods of measurement were equally reliable in the assessment of lower face morphology changes in edentulous patients after prosthodontic rehabilitation with bimaxillary complete dentures. The differences between the measurements taken before and after prosthodontic rehabilitation proved to be statistically significant.

Implants for the ageing population.

Dental implant treatment has established benefits over traditional alternatives. Age-related changes in systemic and oral health in conjunction with social, economic and resource considerations often introduce complexities into dental implant treatment of ageing patients. When time, opportunity, discomfort and maintenance costs are coupled with cost-benefit and quality of life predictions, otherwise simple treatment decisions can become more difficult. Implants for different types of prostheses in both arches and the different types of prostheses themselves present a variety of treatment challenges, risks, benefits and maintenance requirements. This narrative review discusses selective literature pertinent to the provision of dental implant treatment in the ageing population.

An Efficient and Cost-Effective Technique to Construct an Intraoral Central Bearing Tracing Device.

Intraoral central bearing tracing has been shown to be a predictable way of recording and verifying centric relation position for patients. Existing tracing devices are challenging to use due to several significant clinical limitations. In comparison to commercially available counterparts, this article presents a technique that simplifies instrumentation and clinical steps to make an intraoral tracer for making centric relation records, determining occlusal vertical dimension, and detecting deflective occlusal contacts in edentulous patients.

[Gerodontic consultation service for hospitalized geriatric patients: diagnosis and therapy (II)]. / Gerodontologischer Konsiliardienst bei stationären Geriatriepatienten: zahnmedizinischer Befund und zahnärztliche Massnahmen (II).

The aim of the study was to report on oral, dental and prosthetic conditions as well as therapeutic measures for temporarily institutionalized geriatric patients. The patients were referred to the dentist since dental problems were observed by the physicians or reported by the patients themselves. This resulted in a selection among the geriatric patients; but they are considered to be representative for this segment of patients exhibiting typical signs of undertreatment. The main problem was the poor retention of the prosthesis, which was associated to insufficient masticatory function and poor nutrition status. Forty-seven percent of the patients were edentulous or had maximally two radicular rests out of function. Altogether 70% of the maxillary and 51% of the mandibular jaws exhibited no more teeth. Eighty-nine percent of the patients had a removable denture, and it was observed that maxillary dentures were regularly worn in contrast to mandibular dentures. The partially edentate patients had a mean number of ten teeth, significantly more in the manidublar than maxillary jaw. Treatment consisted mainly in the adaptation and repair of dentures, tooth extractions and fillings. Only few appointments (mostly two) were necessary to improve the dental conditions, resulting in low costs. Patients without dentures or no need for denture repair generated the lowest costs. Slightly more visits were necessary for patients with dementia and musculoskeletal problems. The present findings show that regular maintenance care of institutionalized geriatric patients would limit costs in a long-term perspective, improve the oral situation and reduce the need for invasive treatment.

Dental service utilization by independently dwelling older adults in Manitoba, Canada.

OBJECTIVES: The objectives of this study were to determine the rate of use of dental services by independently living older dentate and edentulous adults and the factors affecting utilization. METHODS: Data were derived from the cross-sectional Manitoba Study of Health and Aging. A personal interview included over 240 questions addressing sociodemographics, well-being, oral and general health, and health service utilization. Variables that were significantly associated with visitation on bivariate analysis were entered into separate logistic regressions for dentate and edentulous participants. The Anderson model of health service utilization was used to categorize variables with significant independent effects as predisposing, enabling and need factors. RESULTS: The 1,751 participants had a mean age of 76.2 years (standard deviation 7.1); 58.5% were women and 72.7% were edentulous. Only 383 participants (21.9%) reported having visited a dentist in the past 6 months. The visitation rate for dentate seniors (36.2%) was significantly higher (p < 0.001) than that for edentulous seniors (13.5%). Multiple logistic regression analysis revealed significant independent effects of 5 variables for each group. Predisposing factors predicting visitation for both groups were higher level of education and frequent use of professional services. For dentate adults, dental visitation was predicted by 3 enabling factors (main supporting person not a family member, fewer restrictions on activities of daily living and residence in a major urban centre) but no need factors. For edentulous participants, dental visitation was predicted by only 1 enabling factor (higher income) and 2 need factors (recent dental problems and longer duration of denture use). DISCUSSION: Regular dental visits are important in maintaining good health, for edentulous as well as dentate seniors. Despite this fact, older Manitobans, especially the edentulous, are not accessing care in an appropriate manner. One unexpected finding was that despite equivalent abilities, cognitive status and health problems, those who had a family member as their main supporting person were less likely to have a dental visit than those supported by non-family members. This may relate to resistance from family members to provide appropriate support for dental visits, an issue considered by some to be a form of elder abuse. CONCLUSION: Despite some common predisposing factors, the variables influencing dental utilization were different for dentate and edentulous participants, with enabling factors playing a bigger role for the dentate and need factors of greater importance for the edentulous. These findings seem to indicate that older dentate adults who visit the dentist do so because they can, while older edentulous adults who visit the dentist do so because they must.

Association between diet, social resources and oral health related quality of life in edentulous patients.

To assess whether there was an association between diet, oral health related quality of life and social resources in a population of older edentulous adults, and, to assess the impact of provision of new complete replacement dentures. This study was carried out at Cork University Dental Hospital in Ireland. In this prospective clinical study, 35 edentulous adults who requested new complete dentures completed pre-treatment questionnaires which included validated oral health status, social resources and nutritional assessment questionnaires. New dentures were provided and the impact of treatment on oral health related quality of life, diet and ability to chew food was assessed. Satisfaction with dentures and oral health related quality of life improved following provision of new dentures. However, food choice remained similar to pre-treatment choice, and subjects were rated as medium risk for poor nutritional status on the Mini Nutritional Assessment (MNA) score. Oral health related quality of life and diet were not correlated. Three quarters of the sample felt they had no nutritional problems. However, approximately 70% reported that they had changed their food choices because of dental problems and that financial cost was a barrier to dental treatment. Food selection among the group studied was not ideal, and not improved by the provision of new dentures. There was no association between diet and oral health related quality of life. Further research is needed to improve our understanding of the relationship between oral health and diet.

A comparison of the validity of generic- and disease-specific measures in the assessment of oral health-related quality of life.

UNLABELLED: In recent years, a number of instruments have been developed to measure the outcomes of oral disease. The Oral Health Impact Profile (OHIP) is the most sophisticated and comprehensive measure developed to date. At present, reports of the use of this measure are confined to descriptive population studies. OBJECTIVES: The aim of this study was to compare the validity of the OHIP with a generic health-related quality of life measure, the SF36. METHODS: Study subjects were in three groups, namely, edentulous patients seeking dental implants ("implant subjects", n = 32), edentulous patients seeking conventional dentures ("edentulous control", n = 35) and dentate patients ("dentate control", n = 21). All subjects completed an OHIP and SF36 prior to receiving any treatment. The edentulous subjects also completed a subjective assessment of satisfaction with their existing conventional dentures. OHIP data were computed using the simple count and weighted scores methods. RESULTS: The median number of negative impacts reported for each group was: 17 (implant subjects), six (conventional control) and one (dentate control). OHIP sub-scale scores were significantly higher (P < 0.001) for implant subjects than control subjects. There were no significant differences between the SF36 sub-scale scores. There was a significant correlation (P < or = 0.01) between aspects of satisfaction with conventional dentures worn by the edentulous subjects and OHIP sub-scale scores. Correlations between denture satisfaction variables and SF36 scores were not significant. CONCLUSIONS: It was concluded that the OHIP shows good discriminant and construct validity properties. As it is oral specific, it will be of greater use in measuring outcomes of oral disorders than generic measures such as SF36. This finding will be relevant when considering the use of health-related quality of life measures to target resources and measure the outcome of clinical intervention.

Classification system for complete edentulism. The American College of Prosthodontics.

The American College of Prosthodontists has developed a classification system for complete edentulism based on diagnostic findings. These guidelines may help practitioners determine appropriate treatments for their patients. Four categories are defined, ranging from Class I to Class IV, with Class I representing an uncomplicated clinical situation and a Class IV patient representing the most complex and higher-risk situation. Each class is differentiated by specific diagnostic criteria. This system is designed for use by dental professionals who are involved in the diagnosis of patients requiring treatment for complete edentulism. Potential benefits of the system include: 1) better patient care, 2) improved professional communication, 3) more appropriate insurance reimbursement, 4) a better screening tool to assist dental school admission clinics, and 5) standardized criteria for outcomes assessment.

Predicted distribution of treatment needs for caries across three indicator age groups by the year 2031.

New Zealand is undergoing a demographic transition which is resulting in fewer young people and greater numbers of elderly people. A dental transition is also occurring by which more elderly people are retaining more teeth. Projections of the caries experience of three indicator adult age groups show that the bulk of future restorative demands on the dental-care system will come from those in the middle-aged and elderly groups. Such a trend requires an increase in gerodontological input at all levels of dental education and training.

[Dental treatment need of the edentulous patient]. / De zorg voor de edentate oudere.

The gradually decreasing percentage of adults wearing complete dentures in The Netherlands might easily lead to misunderstandings concerning the future prosthetic treatment need. If the percentage edentulous people aged 65 years and older, for example, would be the same as in 1983, then as a consequence of the ageing of the population, the number of edentulous persons in 2020 will be 2.3 million (in 1983: 1.4 million). It is, therefore, concluded that the prosthetic treatment need will not diminish in the next 40 years, but probably will increase strongly.

Denture service use in a selected population in a prepaid dental program.

Rates of use of dental services for a large population of employees enrolled in a prepayment plan were examined. During a three-year period, the number of complete denture services that were provided declined steadily. Also, the number of simple and surgical extractions decreased, and there was an increase in the rate of use of periodontic and endodontic services.

Guidelines for professional quality dentures for the financially disadvantaged.

The purpose of this project was to evaluate and report on the timing of procedures involved in complete denture service based on criteria for assessment of quality and to determine the effectiveness of a model of such a delivery system in terms of success of treatment and reduction of cost. It can be concluded that the denture care system may and can be used as a model to provide the base line reference to compare with other denture care delivery systems; the use of criteria for assessment of quality is not only efficient, but is also practical; and a complete denture treatment service of the quality defined by the criteria developed for this model can be provided to patients.