Case report: a patient who had not removed her lower denture for 54 years.

BACKGROUND: A 71-year-old female presented with a left submandibular space abscess. This was found to be due to large accumulations of calculus on the lingual flanges of her lower denture ulcerating the floor of the mouth. She had not taken the prosthesis out since it was provided as an immediate denture after extractions 54 years previously. At presentation she could not take her denture out as the calculus locked the denture under lingual undercuts. The denture was sectioned in the midline to remove it and the submandibular abscess was drained via a neck incision. FINDINGS: Prior to removal the denture was remarkably stable and she had enjoyed a long period of problem free denture wearing and had had exceptional value from it. There was also surprisingly little mandibular alveolar bone resorption. CONCLUSION: The case demonstrates what may happen if a lower denture is not taken out for over half a century. The calculus on the lingual flanges provided both stability and retention for the denture, and it appeared to have protected the ridge from resorption. While the calculus may have provided some surprising benefits to her lower denture it ultimately led to a serious infection.

Short-term post-operative pain and discomfort following insertion of mini-implants for retaining mandibular overdentures: a randomized controlled trial.

The retention of removable dentures by mini-implants is a relatively recent treatment modality and may lead to minimal post-operative trauma. This study compared post-operative pain and discomfort following the insertion of mini-implants (two or four) or two standard-size implants for the retention of mandibular overdentures. One hundred and twenty edentulous participants (mean age 59.5 ± 8.5 years) were randomly allocated into three groups according to received treatment: (GI) four mini-implants, (GII) two mini-implants or (GIII) two standard implants. Seven days after implant insertion, patients answered questions (100-mm VAS) relating to pain, swelling, and discomfort with chewing, speech and hygiene, considering their experiences during the 1st and 6th day. Groups were compared by two-way anova (α = 0.05). All participants (GI: 38; GII: 42; GIII: 40) were analysed after 7 days. At the 6th day, GI felt significantly higher pain than GII and GIII. GI also reported more difficulty in performing oral hygiene practices than GIII during the 1st day. There was no significant difference between groups for the other questions and periods. No participant suffered unexpected side effects. The use of four mini-implants induces more intense post-operative pain at the 6th day than the insertion of two mini- or conventional fixtures, as well as more difficult oral hygiene on the 1st day. Clinicaltrials.gov, NCT01411683; FAPESP, 2011/00688-7 and 2011/23347-0.

Reactive osteocartilaginous metaplasia in denture wearers: a rare trauma-related lesion.

OBJECTIVE: To present a case of reactive osteocartilaginous metaplasia (ROCM) in the anterior edentulous mandibular ridge. BACKGROUND: The ROCM secondary to chronic mechanical denture trauma is rare and appears as a focal sometimes painful mass on or near the crest of the edentulous alveolar ridge in long-term denture wearers. The literature review disclosed 24 cases involving more commonly the posterior portion of the mandible. MATERIALS AND METHODS: An 80-year-old female was referred for the evaluation of a painful, submucosal nodule extending into the vestibular mucosa of the anterior edentulous mandibular region. Microscopically, cartilaginous regions exhibiting sparse hyperchromatic or binucleated chondrocytes transitioned into areas of ossification. RESULTS: The diagnosis was ROCM. The presence of osteocartilaginous tissue displaying bizarre histopathological features can create a diagnostic dilemma. CONCLUSION: Complete conservative surgical excision of this lesion has a very good prognosis. Surgical augmentation of the sharp edentulous mandibular ridges might be needed to avoid continuous irritation and possible recurrence.

Residual ridge resorption, lower denture stability and subjective complaints among edentulous individuals.

Residual ridge resorption in the mandible after tooth loss may lead to worsening of complete denture stability and to various subjective complaints. The aim was to evaluate the association between radiologically assessed residual ridge resorption in the mandible, clinically assessed stability of lower complete denture and subjective complaints among elderly denture wearers. The study population consisted of 326 (115 men and 211 women) edentulous subjects aged 60-78years, all of whom were wearing complete dentures in the mandible. Data on subjective complaints were obtained from questionnaires and interviews. Denture stability was assessed clinically. Residual ridge resorption was analysed from panoramic radiographs. The results showed that women were significantly more often satisfied with their lower dentures and reported fewer problems with eating than men. They also had significantly more often residual ridge resorption than men. Among women, residual ridge resorption was significantly associated with poor chewing ability, low satisfaction with dentures and poor denture stability. Among men, residual ridge resorption did not associate with subjective complaints or denture stability. Poor satisfaction with dentures associated significantly with poor denture stability in both genders. In conclusion, these results highlight the importance of denture maintenance treatment. As the extent of residual ridge resorption in the mandible was the most important factor that increased dissatisfaction with lower complete dentures, it is also important to inhibit the progression of resorption by preventing tooth loss or by using implant-retained dentures.

Mandibular Actinomyces osteomyelitis complicating florid cemento-osseous dysplasia: case report.

BACKGROUND: Apart from neoplastic processes, chronic disfiguring and destructive diseases of the mandible are uncommon. CASE PRESENTATION: We report, perhaps for the first time, the simultaneous occurrence of two such conditions in one patient, in a case that emphasizes the importance of bone biopsy in establishing the correct diagnosis. Florid cemento-osseous dysplasia (FCOD) is a chronic, disfiguring condition of the maxillofacial region. This relatively benign disease is primarily observed in middle-aged women of African ancestry. Cervicofacial actinomycosis is an uncommon and progressive infection caused by bacilli of the Actinomyces genus that typically involves intraoral soft tissues but may also involve bone. The accurate diagnosis of actinomycosis is critical for successful treatment. A diagnosis of osteomyelitis caused by Actinomyces bacteria was diagnosed by bone biopsy in a 53 year-old African-American woman with a longstanding history of FCOD after she presented with a new draining ulcer overlying the mandible. CONCLUSIONS: Clinicians should be aware of the possibility of actinomycosis arising in the setting of FCOD, and the importance of bone biopsy and cultures in arriving at a definitive and timely diagnosis.

Fracture of the genial tubercles associated with a mandibular denture: a clinical report and review of the literature.

We report a case of fractured genial tubercles associated with a mandibular denture in an elderly female patient and review the literature reports of this condition over the past 50 years. The period without natural teeth and the amount of atrophy of the mandible appear to be associated with the condition, especially when atrophy has reached an extent where the genial tubercles become a direct part of the denture bearing area. The signs and symptoms generally associated with this condition include pain and swelling, haematoma of the floor of the mouth, painful and limited movement of the tongue, dysphagia and painful swallowing, and an obvious experience of discomfort while wearing the lower denture. The radiographic assessment of the mid-line region of the face on conventional radiograph views is often complicated by superimposition of the spine, and therefore computerised or cone-beam volumetric tomography will provide a better view of the fractured segment. The management of the condition is either by conservative care, or by surgical exposure and removal of the fractured tubercles. Irrespective of the chosen mode of treatment, the reports indicate that recovery can be expected to be uneventful in a relatively short period of time. Consensus suggests that the indications for surgical intervention in fractures of the genial tubercles are minimal, as the majority of patients do not require any active treatment and had resolution of their symptoms after conservative management.

[Influence of a maxillary complete denture on taste perception Patients regularly report an alteration in taste perception after the insertion]. / De invloed van een gebitsprothese op de smaakgewaarwording.

Patients regularly report an alteration in taste perception after the insertion of a maxillary complete denture. It is generally accepted that changes in temperature and texture perception of the food induced by covering the hard palate are the principalfactors contributing to this alteration. Besides temperature and texture, other factors contributing to taste perception are smell, age and saliva composition.

A randomized clinical study to evaluate the effect of denture adhesive application technique on food particle accumulation under dentures.

Food ingress under dentures is a common problem that may be reduced by denture adhesive use. The objective of this study was to explore the effect of the mode of application of a denture adhesive on reducing accumulation of food particles under dentures. This was a single-centre, controlled, single-blind, randomized, three-treatment, three-period, crossover study in participants with complete, removable well-fitting, well-made upper/lower dentures. Treatments were: 1) experimental denture adhesive application (test adhesive) applied with a precision applicator as continuous strips; 2) marketed denture adhesive (positive control) applied using a flat ribbon nozzle as dabs; 3) no adhesive. Food-occlusion testing was performed by assessing peanut particle migration under dentures with denture retention/stability evaluated using the Kapur Index (Olshan modification). Differences were assessed using an ANOVA model. Adhesive oozing and perceptions of the adhesives were assessed by questionnaire. All 83 randomized participants completed the study. There were no significant differences between positive control or test adhesives versus no adhesive, or between test adhesive and positive control, for mass of peanut particles recovered from dentures. Both adhesives had significantly higher retention and stability scores compared with no adhesive (all P < .01). Participants reported significantly higher scores for denture comfort, confidence, satisfaction and movement with both adhesives versus no adhesive (all P < .01). No differences in adhesive ooze were reported between adhesives. No adverse events were reported. In conclusion, there was no difference in performance, as measured by peanut particle mass recovered from upper/lower dentures, for the test adhesive, positive control and no adhesive.

Favoring trauma as an etiological factor in denture stomatitis.

The etiology of denture stomatitis remains controversial. Trauma due to unstable dentures has been suggested as an etiological factor. Therefore, we tested the hypothesis that the prevalence of denture stomatitis is reduced when mandibular dentures are stabilized by implants. Data were collected at a one-year follow-up from 173 edentulous elders who had randomly received mandibular implant overdentures or conventional dentures. The diagnosis of denture stomatitis was determined according to the Newton classification. Elders wearing conventional dentures were almost 5 times more likely to have denture stomatitis than those wearing mandibular two-implant overdentures (P < 0.0001, Fisher's exact test). Adjusted odds ratios showed that only the type of the prosthesis (AOR = 4.54, 95% CI 2.20 to 9.40) and nocturnal wear (AOR = 3.03, 95% CI 1.24 to 7.40) predict the frequency of denture stomatitis. Thus, implant overdentures may reduce oral mucosal trauma and control denture stomatitis.

Prosthetic complications in mandibular metal-resin implant-fixed complete dental prostheses: a 5- to 9-year analysis.

PURPOSE: The purpose of this study was to investigate the prosthetic complications of patients with a maxillary complete removable dental prosthesis opposing a mandibular metal-resin implant fixed complete dental prosthesis. MATERIALS AND METHODS: This study is a retrospective analysis of an ongoing prospective study. Dental records from 46 patients treated with a maxillary complete removable dental prosthesis and a mandibular metal-resin implant-fixed complete dental prosthesis were reviewed for 15 different prosthetic complications. The average recall time was 7.9 years. The percentage of patients exhibiting each complication and corresponding 95% confidence intervals was calculated. Logistic regression analysis determined the effect of recall period, age, and gender on each of the following major complications: tooth fracture, complete denture relines, screw complications, and tooth replacement. The recall period was divided into 3 parts: < or = 2 years, 2 to 5 years, and more than 5 years. RESULTS AND CONCLUSION: Statistical significance was exhibited for complete denture relines, posterior tooth replacement, and screw complications. No abutment or framework fractures were recorded for any of the time intervals. The most common complications were prosthetic tooth fracture, tooth wear, maxillary hard relines, and screw complications. Patients were 1.06 times more likely to require a heat-processed hard reline with each year increase of age. After 2 to 5 years and > 5 years, patients were 3.7 times and 8.5 times more likely to require a hard reline than at < or = 2 years. Patients were 52.5 times more likely to need posterior tooth replacement at > 5 years than at < or = 2 years, and 7.7 times more likely to encounter a screw complication at > 5 years than at < or = 2 years.

Treatment of painful post-traumatic peripheral neuropathy with capsaicin in an edentulous patient with extreme resorption in the mental region: a case report.

AIM: The aim of this report is to present a clinical case of extensive alveolar resorption in the mental region of the mandible of a complete denture wearer for which capsaicin was used for alleviation and remission of post-traumatic painful peripheral neuropathy. BACKGROUND: Resorption of the residual ridge occurs in a chronic and progressive manner, altering the configuration of the ridge and the mucosa covering it and subsequently compromising the stability of the complete denture prosthesis. Individual variability associated with such factors as gender, age, edentulous period, nutrition, excessive load and compression on the ridge, parafunctional habits, occlusal instability, and maladaptation of the prosthesis may have a role in the rate and manner of bone loss. REPORT: A 62-year-old woman, edentulous at the age of 30, presented with complaints of pain and spontaneous "electrical shocks" in the mucosa under her mandibular complete denture. The pain increased while chewing approximately two years ago due to the pressure of this denture on her supporting tissues. The patient indicated the level of pain corresponded to a score of ten out of ten on the Visual Analogical Scale (VAS). Treatment included denture replacement and topical application of capsaicin gel using a custom tray technique. SUMMARY: The review of the literature and the results obtained from the management of this case have served to emphasize how much neuropathic pain research has demonstrated the complexity of its neurophysiologic mechanism due to the lack of association with any somatic manifestation. During the fabrication of a new lower denture the topical application of capsaicin was shown to be effective in the relief and remission of the painful symptoms of the neuropathy as of this writing.

[Malnutrition in the elderly--a interdisciplinary problem for the dentist]. / Malnutrition im Alter--Eine interdisziplinäre Problemstellung auch für den Zahnarzt.

Success in dental treatment and long-term care of elderly persons requires an interdisciplinary consideration of aging. Medical knowledge, which is far beyond specific dental expertise, is assumed. A typical example is that of malnutrition, which in spite of its high frequency in the elderly, has not yet been considered to be important in dentistry. Missing diagnosis and therapy of malnutrition lead to increasing morbidity and mortality. Clarifying the nutritional conditions of aging persons therefore should also become a part of dental diagnosis to guarantee early medical diagnosis and therapy as well as to avoid oral complications.

Spontaneous fracture of genial tubercles: case report.

A case is presented of fractured genial tubercles, revealed by occlusal radiography, in a 63-year-old edentulous woman. Isolated fractures are a rare event that may present with pain and edema in the floor of the mouth. It occurs mainly in patients wearing a complete denture when the mandible is atrophied and the genial tubercles are hypertrophied. Only 11 case reports have been found in the English literature.

Denture hyperplasia with areas simulating oral inverted ductal papilloma.

Denture hyperplasia is a reactive lesion of the oral mucosa, usually associated to an ill-fitting denture. This lesion is easily diagnosed and in some cases distinct microscopic variations such as osseous, oncocytic and squamous metaplasia may be found. These metaplastic alterations probably are associated with the lymphocytic infiltrate usually present in denture hyperplasia. We present a case of denture hyperplasia containing salivary gland tissue with ductal alterations mimicking an oral inverted ductal papilloma.

Mini vs. Standard Implants for Mandibular Overdentures: A Randomized Trial.

A mandibular implant-retained overdenture is considered a first-choice treatment for edentulism. However, some aspects limit the use of standard implants-for example, the width of edentulous ridges, chronic diseases, fear, or costs. This randomized trial compared mandibular overdentures retained by 2 or 4 mini-implants with standard implants, considering oral health-related quality of life (OHRQoL), patient satisfaction, and complications such as lost implant. In sum, 120 edentulous men and women (mean age, 59.5 ± 8.5 y) randomly received 4 mini-implants, 2 mini-implants, or 2 standard implants. Participants provided data regarding OHRQoL and satisfaction until 12 mo. Clinical parameters, including implant survival rate, were also recorded. Both 2 and 4 mini-implants led to better OHRQoL, compared with 2 standard implants. Treatment with 4 mini-implants was more satisfying than 2 standard implants, with 2 mini-implants presenting intermediate results. Implant survival rate was 89%, 82%, and 99% for 4 mini-implants, 2 mini-implants, or 2 standard implants, respectively. Overdentures retained by 4 or 2 mini-implants can achieve OHRQoL and satisfaction at least comparable with that of 2 standard implants. However, the survival rate of mini implants is not as high as that of standard implants (ClinicalTrials.gov NCT01411683).

Differences two years after tooth extraction in mandibular bone reduction in patients treated with immediate overdentures or with immediate complete dentures.

In a randomized controlled clinical trial, 74 patients who required immediate dentures were randomly treated with immediate overdentures on two lower canines or with immediate complete dentures. Mandibular bone reduction was measured by use of oblique lateral cephalometric radiographs made at baseline and the results compared with those of one year and two years after denture treatment. Analysis of the data showed that the average bone reduction in the lower canine regions in the first year was 0.9 mm in the immediate-overdenture group and 1.8 mm in the immediate complete-denture group. In the posterior parts of the mandible, the bone reductions were, respectively, 0.7 mm and 1.9 mm. The differences were statistically significant in all measured regions. During the second year, no significant differences in bone reduction were found. The sums of differences in the first two years were significant in all regions except the molar region, preserving the initial difference. Retention of roots of canines beneath a mandibular denture in immediate denture patients, even when they were in poor condition, reduced the collapse of the alveolar processes in all regions of the mandible.

Treatment of edentulous patients with temporomandibular disorders with implant-supported overdentures.

Treatment of edentulous patients who have temporomandibular disorders is difficult because of the poor stability of their conventional complete dentures. With an implant-supported bar and a clip-to-bar overdenture, mandibular dentures can be stabilized. The results of a prospective clinical study of 10 edentulous patients with temporomandibular disorders and treatment with implant-supported overdentures in mandibles are presented. Before and after 3 years of wearing the implant-supported overdentures, patients were interviewed and a clinical functional analysis was taken. Patients with displacement of the articular disc or bone destruction of the joints had a decrease in pain, an enhanced mobility of the mandible, and a decrease in temporomandibular joint sounds. Patients with pain of muscular genesis as a result of bruxism suffered after 3 years from the same pain and did not show an improvement of muscle or joint sensitivity.

Atypical cartilage in reactive osteocartilagenous metaplasia of the traumatized edentulous mandibular ridge.

Eighteen cases of reactive osteocartilagenous metaplasia of the edentulous mandibular alveolar ridge forming clinical masses that mimic neoplasms are reported. Although most of these lesions appeared histologically benign, three exhibited atypical microscopic features suggestive of chondrosarcoma. Of those cases that were followed, none of the lesions recurred after simple surgical excision. Because many investigators consider all cartilagenous lesions of the jaws potentially malignant, the importance of recognizing this benign condition is stressed.

Managing and treating the atrophic mandible.

Changes in age and disease patterns suggest that in the near future complete denture wearers will be older and have worn dentures for a longer time, but will also be more physically fragile. Some diagnostic issues related to support problems for mandibular complete dentures are evaluated and treatment modes suggested.