Current Trends In Complete Denture Education In Undergraduate Dental Colleges Of Pakistan.

Objective: To determine the current trends in complete denture education in undergraduate dental colleges. METHODS: The survey-based study was conducted in April and May 2020 at undergraduate dental colleges of Pakistan, and comprised heads of the Prosthodontics Department at all dental colleges across Pakistan having at least one batch of final year dental students. Data was collected using an online predesigned questionnaire that explored theoretical and practical teaching patterns of complete denture prosthodontics in the undergraduate years, and the materials and practices of students when constructing complete dentures in the clinics. The participants were given the option of choosing more than one option where needed. Data was analysed using SPSS 23. RESULTS: Of the 49 subjects approached, 40(81.6%) returned the forms duly filled; 11(27.5%) from public-sector institutions and 29(72.5%) from the private sector. There were 26(65%) institutions which required that their undergraduate students fabricate 2-4 conventional complete dentures. In all 40(100%) colleges, faculty gave live clinical demonstrations before students fabricated conventional complete dentures in the outpatient departments. Teaching strategy included small group discussions in 25(62.5%) institutions. Green stick 40(100%), zinc oxide eugenol 40(100%) and impression compound 39(97.2%) were the materials of choice for various steps of impression making. In all the 40(100%) institutions, students fabricated conventional complete dentures during their prosthodontics rotation. Immediate, copy and overdentures were constructed by students in 8(20%), 3(7.5%) and 8(20%) institutions, respectively. Conclusion: Majority of the dental schools used similar impression materials and techniques for fabricating conventional complete dentures. Didactic teaching of conventional and unconventional complete dentures was being carried out at a huge majority of the dental institutions studied.

The effect of food supplements on completely edentulous women rehabilitated with complete dentures: A randomized controlled trial.

Aim: Neglected oral health is a major issue, especially in women of developing countries, leading to early loss of teeth which may further lead to malnutrition, degradation of overall health, and increased chances of osteoporosis. Thus, the aim of this study was to assess the effect of food supplement on masticatory performance, nutritional status, electromyography (EMG) (masseter and temporalis), and bone mineral density (BMD) among women rehabilitated with complete denture. Settings and Design: Hospital based randomized controlled trial. Materials and Methods: A randomized controlled trial with 106 women of 45-65 years rehabilitated with complete denture (56 received food supplement and 50 did not receive food supplement) and 52 healthy control was conducted. The outcomes were assessed at baseline and 3 and 6 months of follow up (after complete denture fabrication). Outcomes were measured via masticatory performance, nutritional status (hemoglobin, serum calcium, albumin, and Vitamin D level), EMG of masseter and temporalis muscles, and BMD. Statistical Analysis Used: Friedman's analysis of variance test was used as a nonparametric test, and the Statistical Package for the Social Sciences version 21.0 at a significance level of 0.05 was used for statistical analysis. Results: A statistically significant change was observed during follow up for the group with food supplement for BMD, EMG, and masticatory performance. When biochemical parameters were assessed during follow up, no statistically significant change was observed for both groups (with and without food supplement), except for serum calcium level in group which received food supplement. Conclusion: It was found that the magnitude of effect was remarkably meager in food supplement group which could be perhaps due to less time given for follow up period. Longer duration of trials would yield better results.

Dentist-reported differences in services provided to patients with public vs. private dental insurance.

INTRODUCTION: Variation in dentists' provision of types of dental services based on patients' insurance may impact population access to comprehensive care. The aim of this study was to describe differences in the types of services provided to adult patients with Medicaid versus private insurance among private practice general dentists. METHODS: The data source was a 2019 survey of private practice dentists in Iowa, and the study sample included general dentists with current or recent participation in Iowa's Medicaid program for adults (n = 264). Bivariate analyses were used to compare differences in the types of services provided to privately insured and publicly insured patients. RESULTS: Dentists reported the greatest differences in services provided to patients with public versus private insurance for prosthodontic procedures, including complete dentures, removable partial dentures, and crown and bridge services. Endodontic services were the least frequently provided category of services provided by dentists for both patient groups. Patterns were generally similar among both urban and rural providers. CONCLUSION: Access to dental care for Medicaid members should be evaluated not only on the proportion of dentists who see new Medicaid patients but also on the types of services dentists provide to this population.

A qualitative analysis of denture wearing experience affecting the quality of life of older adults.

OBJECTIVE: To explore how denture-related experiences affect older adults' quality of life using a qualitative assessment of the Oral Health Impact Profile for Edentulous individuals (OHIP-Edent). MATERIALS AND METHODS: Twenty elderly individuals were interviewed before and 3 months after delivering new complete dentures, using an open-ended interview guide based on the OHIP-Edent. Interviews were audio-recorded and transcribed. Data were open coded and thematically analyzed following a Grounded Theory approach. Findings were integrated and constantly compared to understand the interviewees' difficulties, beliefs, and perceptions. RESULTS: Three interconnected themes were developed: functional and psychosocial impairments, and coping strategies. Even when posed as an open-ended format, the wording of some OHIP-Edent items was confusing while others were not relevant to the respondents. New categories related to speaking, smiling, swallowing, emotional and functional coping emerged from the interviews. Interviewees adapted to chewing and swallowing difficulties through food avoidance, modification of food choice and preparation techniques, and changes in dietary behaviors. CONCLUSIONS: Denture wearing is a daily challenging experience that encompasses various functional and psychosocial aspects and sheds light on the need for addressing the coping strategies employed by patients, as the current OHIP-Edent items may not fully represent other deemed important aspects of the quality of life of individuals who wear dentures. CLINICAL RELEVANCE: Dentists must not solely rely on structured questionnaires to explore the impact of denture wearing and treatment outcomes. Clinicians can use a more holistic approach to comprehend older adults' experiences with dentures including advice about coping mechanisms, food preparation techniques, and meal planning.

Effect of Ozonated Water on the Color Stability of Denture Teeth and Heat Polymerized Acrylic Base Resin

Abstract Objective: To determine the effect of ozonated water on the color stability of denture tooth and denture bases. Material and Methods: Thirty denture base discs consisting of 15 Acropars and 15 ProBase Hot specimens with the dimensions of 40 × 5 mm were prepared. Fifteen denture teeth in shade A1 (Ivoclar Vivadent, Schaan, Liechtenstein) were mounted in a specific acrylic jig. All specimens were immersed in three solutions (1% sodium hypochlorite, ozonated water, and distilled water) for four months (one year of clinical use). Color measurements were done with a spectrophotometer and assessed using the CIE L*a*b* colorimetric system (0, 4, 8, 12, and 16 weeks). Data were analyzed using the three-way ANOVA and Tukey test (α=0.05). Results: Tukey's post hoc test revealed a significant change in color in the Acropars denture base for the distilled water group compared to the ozonated water and 1% hypochlorite (p<0.05). Regarding the ProBase Hot denture base, significantly less color change was observed in the 1% hypochlorite group compared to the ozonated water and distilled water (p≤0.001). For the denture teeth, significantly less color change was seen in the distilled water group than in the ozonated water (p=0.015) and 1% hypochlorite (p<0.05) groups. Conclusion: The color change of denture bases and denture tooth in ozonated water are acceptable. Ozonated water can be considered a good disinfectant for cleaning dentures.

Immediately loaded single-implant mandibular overdentures compared to conventional complete dentures: A cost-effectiveness analysis.

BACKGROUND: In recent years, the single-implant mandibular overdenture (SIMO) has been proposed as an alternative to more complex overdenture designs as a simplified implant intervention for edentulous patients. OBJECTIVE: The aim of this study was to run a cost-effectiveness analysis alongside a randomized clinical trial comparing the SIMO and the conventional complete denture (CCD) treatment. Imediately loaded external hexagon implant and ball attachment were used for the overdenture goup. Direct costs related to therapies were identified and valuated throughout a 1-year period after delivery, in Brazilian currency (R$) and converted into international dollars (I$) using purchase power parity exchange rates. Treatment effectiveness was measured using the OHIP-Edent and satisfaction scores for calculation of incremental cost-effectiveness ratios (ICER). RESULTS: Outcomes were assessed at the 1-year follow-up for 65 patients (CCD=34; SIMO=31). Overall OHIP-Edent and satisfaction scores improved significantly in the SIMO group, while remained unchanged in the CCD group. The mean overall costs were R$1,179.04 (I$590.99) for the CCD group and R$2,127.91 (I$1,068.20) for the SIMO group - 80.7% incremental cost for SIMO. The ICER calculation for SIMO treatment showed a mean cost of I$48.20 for 1-point reduction in OHIP-Edent scores, and I$12.56 for 1-point increase in satisfaction score. CONCLUSIONS: Findings support the effectiveness of this simplified and low-cost implant intervention for edentulous patients. SIMO also seems a cost-effective alternative to the CCD and the relatively low incremental cost may potentially increase the utilization of dental implants among older subjects, especially those with limited financial resources. CLINICAL SIGNIFICANCE: The immediately loaded single-implant mandibular overdenture was superior to the conventional complete denture in terms of patient-reported outcome measures at a low incremental cost.

Management of denture-related traumatic ulcers using ozone.

STATEMENT OF PROBLEM: Management of denture-related traumatic ulcers using ozone may improve tissue healing and reduce patient pain and discomfort. PURPOSE: The purpose of this clinical investigation was to assess the efficacy of ozone in the treatment of denture-related traumatic ulcers. MATERIAL AND METHODS: Seventy-five participants (study group) with denture-related traumatic ulcers were evaluated in this blinded, controlled cohort observational investigation. A control group (n=75) of participants with denture-related traumatic ulcers who matched the study group in sex and age were also recruited. Ulcers were treated with ozone gas for 60 seconds in the study group and with air for 60 seconds in the control group. Pain levels were evaluated by means of a visual analog scale (VAS), and ulcer sizes were measured in each participant at experiment baseline and each day for 15 days. Ulcer duration was established by calculating the period it took to completely heal and disappear. Major outcome measurements were ulcer duration, ulcer size, and levels of pain. RESULTS: Ulcer size decreased from day 2 in the study group (after ozone application) (P≤.01) and from day 4 in the controls (P≤.001). Recorded pain levels decreased from the first day soon after ozone application in the study group (P≤.001) and from day 3 in the controls (P<.001). Ulcer duration, ulcer size from day 3 to day 10, and reported pain levels from day 1 to day 10 decreased more in the study group (P≤.004). CONCLUSIONS: Exposure of denture-related traumatic ulcers to 60 seconds of ozone gas was associated with better ulcer healing and decreased pain levels, ulcer size, and ulcer duration.

Effect of Chemical Denture Disinfectants and Tree Extracts on Biofilm-forming Staphylococcus aureus and Viridans Streptococcus Species Isolated from Complete Denture.

AIMS: The present study aims at recording the antibacterial efficacy of various disinfectants used at different time periods against Staphylococcus aureus and viridans streptococcal species of bacteria isolated from complete dentures. MATERIALS AND METHODS: Fifty complete denture patients were selected for the study and swabs were collected from their complete denture surfaces. The isolated bacteria were subjected to six experimental groups which includes four groups of chemical denture disinfectants and two tree extracts groups. Isolation of the bacteria S. aureus and viridians streptococcal species was done by means of selective media and confirmed by means of biochemical tests. The bacteria were subjected to biofilm assays. The biofilm-forming bacteria with optical density (O.D.) values of more than 1.5 were selected for the study. About 150 acrylic specimens were fabricated and were contaminated by the 2 isolated bacteria mentioned above. The contaminated samples were disinfected by immersion for 10, 20, and 30 minutes in six disinfectants, namely: (1) 1% sodium hypochlorite, (2) 2% chlorhexidine, (3) 2% glutaraldehyde, (4) 3.8% sodium perborate, (5) 2% aalam extract, and (6) 2% neem extract. RESULTS: ANOVA test was performed for both S. aureus and viridans streptococcal species with regard to various synthetic and tree extracts as well as time duration of disinfection. F values for disinfection vs S. aureus is 205.4 (p < 0.001) and the relevant Scheffe post hoc test values is in the following order: 3 < 1, 4 < 6, 2 < 5. F values for disinfection vs viridans streptococcal species is 364.7 (p < 0.001) and the relevant Scheffe post hoc test values is in the following order: 3 < 4 < 1, 6, 2 < 5. CONCLUSION: For biofilm-forming S. aureus, 2% glutaraldehyde showed best antibacterial efficacy which was followed by 1% sodium hypochlorite and 3.8% sodium perborate. When it comes to biofilm-forming viridans streptococcal species, 2% glutaraldehyde showed best antibacterial efficacy. Next to 2% glutaraldehyde, 3.8% sodium perborate exhibited good disinfection potential. CLINICAL SIGNIFICANCE: Complete denture patients have a plethora of microorganisms habitating their complete dentures. Some bacteria are capable of causing systemic illness such as aspiration pneumonia and endocarditis. Hence, constant removal and disinfection of biofilms from the denture surface is vital to the local and systemic wellness of the patient. The most common bacteria capable of causing pneumonia and endocarditis that are isolated from complete dentures include S. aureus and viridans streptococcal species. The present study evaluates antibacterial efficacy of different disinfection agents especially against these biofilm-forming bacteria for different time periods. How to cite this article: Andonissamy L, Karthigeyan S, Ali SA, et al. Effect of Chemical Denture Disinfectants and Tree Extracts on Biofilm-forming Staphylococcus aureus and Viridans Streptococcus Species Isolated from Complete Denture. J Contemp Dent Pract 2019;20(11):1307-1314.

Effectiveness of immediately loaded single-implant mandibular overdentures versus mandibular complete dentures: A 1-year follow-up of a randomized clinical trial.

OBJECTIVE: This randomized clinical trial (RCT) aimed to assess the 1-year effectiveness of single-implant mandibular overdentures (SIMO) compared to conventional complete dentures (CCD). METHODS: In the first phase of the study, participants received new maxillary and mandibular CCDs. Then, they were randomly allocated to one of the study groups (CCD or SIMO). Participants in SIMO group received an external hexagon implant in the mandibular midline, with the immediate connection of an O-Ring/ball attachment. Oral health-related quality of life (OHIP-EDENT) and patient satisfaction in both groups were assessed before allocation and at 6- and 12-month follow-up visits. Both intention-to-treat (ITT) and per-protocol approaches were used for analyses. Statistical analyses were performed using the Wilcoxon Signed Ranks test and the Generalized Estimating Equations. RESULTS: Eighty-four participants (CCD n = 42; SIMO n = 42) were included, out of which 70 completed the 12-month follow-up (CCD n = 34; SIMO n = 36). ITT analysis showed no changes for the CCD group in the longitudinal assessment compared to baseline. Participants in SIMO group had a significant improvement in OHIP-EDENT scores and satisfaction with the mandibular denture. No changes for the maxillary denture were observed in either groups. Similar results were found when per-protocol analysis was performed. CONCLUSIONS: SIMO treatment resulted in a significant improvement in patient perceived outcomes compared to the CCD. SIMO may be considered as an alternative treatment modality for patients with poorly adapted and/or unstable mandibular dentures (ClinicalTrials.gov NCT03463174). CLINICAL RELEVANCE: The immediately loaded single-implant mandibular overdenture markedly improved patient satisfaction and oral health-related quality of life of conventional denture wearers after a 12-month follow-up.

Do traditional techniques produce better conventional complete dentures than simplified techniques? A 10-year follow-up of a randomized clinical trial.

OBJECTIVES: The use of a simplified method (S) of fabricating complete dentures has been shown to be more cost-efficient than the traditional method (T), and there are no negative consequences that detract from the cost savings in the short term. However, it is not clear whether this remains constant over a decade. The objective of this study was to clarify patients' perspectives and determine any differences between the dentures fabricated with these two different techniques after a decade of use. MATERIAL AND METHODS: Edentate individuals participated in a randomized controlled clinical trial and completed a 6-month follow-up from 2001 to 2003 (T group n = 50; S group n = 54). For this 10-year follow-up, they were interviewed by telephone. The assessment included whether the denture was still in use or replaced, the condition of the dentures, patient satisfaction and oral health-related quality of life (OHRQoL). Between and within-group differences and the factors that cause deterioration of oral health-related quality of life (OHRQoL) were determined. RESULTS: Among 54 responders (25 T and 29 S), 14T and 21S kept the original dentures. Both groups were similar in ratings of satisfaction and OHRQoL (maxilla T: 80.0 S: 86.0, p = 0.36; mandibular; T: 66.1 S: 72.3, p = 0.48; OHRQoL T: 111.1 S: 108.5, p = 0.46). Irrespective of fabrication method, discomfort, chewing difficulty and esthetics were the factors that deteriorate OHRQoL (adjusted r = 0.76, p < 0.001). CONCLUSION: The results indicate that the simplified method remains more cost-efficient than the traditional method over a 10-year period. (IRB approval: A09-E71-12 B McGill University, trial registry: ClinicalTrial.org; NCT02289443).

Complete dentures for a patient after a stroke by means of orofacial myofunctional therapy: A clinical report.

After a stroke, patients frequently show compromised swallowing, mastication, and speech, as well as unfavorable motion and deviation of the tongue and mandible. The dentist can improve the oral rehabilitation of a patient with deteriorated facial and oral muscles after a stroke by incorporating orofacial myofunctional therapy. This report describes a method for tongue exercises and correction of mandible deviation in an edentulous patient after a stroke by using a pearl on a wire in the anteriomedian palatal part of the maxillary denture.

Cameo surface recording in complete denture fabrication using transcutaneous electrical nerve stimulation: A clinical report.

Severe bone loss in patients with complete edentulism poses a treatment challenge. In fabricating a denture, the stability of the prosthesis must be enhanced by recording the cameo surface within the confines of the physiological position of the cheek and tongue muscles (the neutral zone) and by shaping it accordingly. The treatment of a patient with a completely edentulous maxillary arch and severe maxillary anterior bone loss is described. The cameo surface was recorded within the physiological limits during the fabrication of a complete denture by using transcutaneous electrical nerve stimulation (TENS).

Análise in vitro do extrato de citronela (Cymbopogon nardus) e de enxaguatórios bucais comerciais sobre propriedades físicas e microbiológicas de materiais utilizados na confecção de prótese tipo protocolo / In vitro analysis of citronella extract (Cymbopogon nardus) and commercial mouthrinses on physical and microbiological properties on materials used in the manufacturing of protocol type prosthesis

O uso de soluções enxaguatórias é uma ferramenta no controle de patologias relacionadas ao uso de próteses. A efetividade antimicrobiana e citotoxicidade de alguns enxaguatórios comercialmente disponíveis ainda são questionadas, tornando a fitoterapia uma alternativa a ser pesquisada. Sendo assim, este estudo teve como objetivos: 1) avaliar in vitro a eficácia de formulações à base do extrato de citronela (CN) em biofilmes monoespécie em formação e formado, sobre amostras de resina acrílica ativada termicamente (RAAT) e liga de níquelcromo (LNC), contaminadas por S. aureus e C. albicans, simulando uma prótese protocolo em meio bucal, em comparação com dois enxaguatórios comerciais sem etanol (LT ­ Listerine Zero e CHX ­ Periogard sem etanol); 2) avaliar in vitro a citotoxicidade das soluções em células epiteliais HaCat, simulando o contato com os enxaguatórios por 1 min; 3) avaliar, in vitro, o efeito de enxaguatórios bucais comerciais e da solução teste à base do óleo de CN a 10,9%, na alteração de rugosidade e cor de materiais utilizados na confecção de prótese tipo protocolo, sendo eles: duas marcas de dentes artificiais (DA - Trilux e Vivodent), RAAT e LNC. A alteração de cor da LNC não foi avaliada. Para o primeiro objetivo, após a obtenção da concentração bactericida/fungicida mínima (CBM/CFM) da CN contra S. aureus e C. albicans, foram confeccionadas amostras de RAAT e LNC. A CBM/CFM da CN foi multiplicada por 5x e 10x para a formulação de dois enxaguatórios. As superfícies das amostras com o biofilme em formação (4 h de adesão) e formado (24 h) foram submetidas à ação das soluções à base de CN, Periogard sem etanol (CHX) e Listerine Zero (LT). A simulação dos bochechos foi realizada em dois momentos diferentes, sendo a primeira simulação logo após o tempo de adesão de 4 h (biofilme em formação) e 24 h (biofilme formado), e a segunda simulação, 6 h após a primeira simulação, para cada microrganismo. O ensaio de citotoxicidade das soluções foi realizado em células epiteliais HaCat, simulando o contato com os enxaguatórios por 1 min e quantificado pelo método de MTT. Para a análise das propriedades físicas, amostras dos três materiais foram distribuídas em 6 grupos (n=10), de acordo com a solução enxaguatória: GI - Saliva artificial; GII - Periogard sem etanol; GIII - Periogard com etanol; GIV - Listerine Zero; GV ­ Listerine Tartar Control; GVI - Solução teste à base do CN à 10,9%, sendo submetidas à imersão e agitação por 180 min, simulando bochechos diários por 6 meses. A alteração de superfície das amostras foi avaliada em rugosímetro, no qual um grupo sem imersão foi utilizado como controle (GC); e a alteração de cor, em espectrofotômetro. Como resultados da ação antibiofilme das soluções testadas, observou-se que independente da superfície, todas as soluções impediram o desenvolvimento dos biofilmes de S. aureus e C. albicans, quando aplicados no início de sua formação (4 h). Para os biofilmes formados (24 h), todas as soluções diferiram dos respectivos controles, em resina ou metal, mostrando atividade contra biofilmes de S. aureus e C. albicans. CN 5x CBM/CFM e CN 10x CBM/CFM tiveram os melhores efeitos antibiofilme, não diferindo estatisticamente entre si, independente da superfície da amostra. Ambas as concentrações de CN tiveram efeito superior à CHX e LT, independente da superfície. Para os ensaios de citotoxicidade, todas as soluções diluídas em 50 e 25% causaram citotoxicidade celular. A partir da diluição de 3,12%, todas as soluções permitiram mais de 70% de viabilidade celular. Como resultados da alteração de cor foi possível observar que todas as soluções promoveram um ∆E acima de 3,3 para RAAT, valor considerado clinicamente inaceitável. Para os DA não foi notada nenhuma diferença estatisticamente significante em relação ao grupo controle. Para a análise de superfície, a rugosidade da RAAT foi alterada somente no grupo GIV ­ Listerine Tartar Control, enquanto que não houve nenhuma alteração estatisticamente significante para os DA e LNC. Pode-se concluir que ambas as concentrações do enxaguatório à base de citronela tiveram os maiores efeitos antibiofilme, comparativamente às soluções comerciais sem etanol, contra S. aureus e C. albicans. Todas as soluções enxaguatórias foram citotóxicas nas suas concentrações iniciais, entretanto, após diluição seriada, considerando as concentrações dos princípios ativos dos enxaguatórios comerciais, CN teve o menor efeito citotóxico. A formulação teste à base de 10,9% de CN mostrou-se segura em seu uso como solução enxaguatória, no que se refere às propriedades físicas estudadas(AU)

The use of mouthrinses is a tool in the control of pathologies related to the use of prostheses. The antimicrobial effectiveness and cytotoxicity of some commercially available mouthrinses are still questioned, making phytotherapy an alternative to be researched. Therefore, this study aimed: 1) to evaluate in vitro the efficacy of formulations based on the citronella extract (CN) in monospecific biofilms, in formation and formed, on samples of thermally activated acrylic resin (RAAT) and nickel-chromium (LNC), contamineted by S. aureus and C. albicans, simulating a protocol prosthesis in buccal medium, compared to two alcohol free commercial mouthrinses (LT - Listerine Zero and CHX - Periogard alcohol free); 2) to evaluate in vitro the cytotoxicity of solutions in HaCat epithelial cells, simulating contact with the mouthrinses for 1 min; 3) to evaluate in vitro the effect of commercial mouthrinses and the test solution based on the extract of CN at 10.9%, in the alteration of roughness and color of materials used in the manufacturing of protocol type prosthesis; i.e. two tooth marks (DA - Trilux and Vivodent), RAAT and LNC. The color change of the LNC was not evaluated. For the first objective, samples were prepared after obtaining the minimum bactericidal / fungicidal concentration (CBM / CFM) of CN against S. aureus and C. albicans, RAAT and LNC. The CN's CBM / CFM was multiplied by 5x and 10x for the formulation of two mouthrinses. The surfaces of the samples with the biofilm in formation (4 h of adhesion) and formed (24 h) were subjected to the action of solutions based on CN, Periogard alcohol free (CHX) and Listerine Zero (LT). The simulation of mouthwashing was performed at two different moments; the first simulation after the time of adhesion of 4 h (biofilm in formation) and 24 h (formed biofilm), and the second simulation, 6 h after the first simulation, for each microorganism. The cytotoxicity assay of the solutions was performed on HaCat epithelial cells, simulating contact with the mouthrinse for 1 min and quantified by the MTT method. For the analysis of the physical properties, samples of three materials were distributed in 6 groups (n = 10) according to the mouthrinse: GI - Artificial saliva; GII - Periogard alcohol free; GIII - Periogard with alcohol; GIV - Listerine Zero; GV- Listerine Tartar Control; GVI - Test solution based on CN at 10.9%, and submitted to immersion and agitation for 180 min, simulating daily mouthwashing for 6 months. The surface change of the samples was evaluated in a rugosimeter and the color change in a spectrophotometer. A group without immersion was used as control (GC). As a result of the antibiofilm action of the tested solutions, it was observed that, regardless of the surface, all solutions prevented the development of the biofilms of S. aureus and C. albicans, when applied at the beginning of its formation (4 h). For the formed biofilm (24 h), all solutions differed from the respective resin or metal controls, showing activity against biofilms of S. aureus and C. albicans. CN 5x CBM / CFM and CN 10x CBM / CFM had the best antibiofilm effects, not statistically different from each other, regardless of the sample surface. Both CN concentrations presented a superior effect than CHX and LT, regardless of the surface. For cytotoxicity assays, all solutions diluted at 50 and 25% caused large cell cytotoxicity. From the 3.12% dilution, all solutions allowed more than 70% cell viability. From the results of the color change, it was possible to observe that all solutions promoted a ΔE above 3.3 for RAAT; a value considered clinically unacceptable. For DA, no significant statistical difference was observed in relation to the control group. For the surface analysis, RAAT roughness was altered only in the GIV - Listerine Tartar Control group, whereas there were no significant statistical alterations for the DA and LNC. It can be concluded that both concentrations of citronella-based mouthrinse had the highest antibiofilm effects compared to commercial alcohol free solutions against S. aureus and C. albicans. All commercial mouthrinses were cytotoxic at their initial concentrations, however, after serial dilution, considering the concentrations of active principles of commercial mouthrinses, CN had the lowest cytotoxic effect. The test formulation based on 10.9% CN was safe in its use as a mouthrinse solution in respect of the physical properties studied(AU)

Evaluation of correlations between frequencies of complete denture relines and serum levels of 3 bone metabolic markers: A cross-sectional pilot study.

STATEMENT OF PROBLEM: Continuous bone resorption is the primary reason for complete denture relines. Because resorption rates vary, the frequency at which individuals require relines also varies. Currently, there are no predictors to identify individuals at risk of frequent relines or to guide clinicians in decisions related to relines. PURPOSE: The purpose of this cross-sectional pilot study was to determine the utility of measuring bone metabolic markers (C-terminal telopeptide, osteocalcin, 25-OH hydroxy vitamin D) to predict the frequency of complete denture relines. MATERIAL AND METHODS: One hundred adult participants with complete dentures (either maxillary, mandibular, or both) participated in 1 dental clinic visit involving a dental examination and brief interview to obtain relevant medical and dental history, information on medication/supplement use, and 1 laboratory blood draw for the measurement of bone metabolic markers. Data were analyzed by using the Pearson correlation, independent Student t test, or analysis of variance (α=.05). RESULTS: Significant correlations were found between the frequency of relines and C-telopeptide and osteocalcin levels but not with vitamin D or age. No significant associations with reline frequency and other factors (sex, ethnicity, presence or absence of diabetes, use of calcium and vitamin D supplements) were observed. CONCLUSIONS: Elevated levels of bone turnover markers in individuals with edentulism were associated with increased frequency of denture relines.

Evaluation of methods for stain removal in acrylic resin denture teeth: in vitro study / Avaliação de métodos de remoção de manchas em dentes de resina acrílica para prótese total: estudo in vitro

Introduction: The staining of artificial teeth can be related to the acrylic resin abrasion caused by brushing, resulting in higher deposition of dyes from the beverage, and consequently higher aesthetic damage. Objective: The aim of this in vitro study was to evaluate methods for removal of stains from acrylic denture teeth using spectrophotometric analysis. Material and method: Artificial teeth were divided into twelve groups (n=10) according to the type of treatment (re-polishing - Re or immersion in Corega Tabs - Sp), staining solutions, coffee (Cf) and Coca-Cola® (Cc) or water (W) and with/without toothbrushing (B). The Sp specimens were submitted to seven immersion cycles (5 min each). The Re specimens were polished with pumice stone followed by Spain white paste. Color differences (ΔE) were captured by a spectrophotometer: T0 (baseline), T1 (after brushing/immersion in solutions) and T2 (after Re or Sp). Result: Statistically significant color change between T1 and T2 (paired T-test; α =.05) was observed for the group CfSp (p=.032); and for the groups BWRe (p=.000), BCfRe (p=.049) and CcRe (p=.042). Higher color changes were observed for the specimens submitted to toothbrushing (ANOVA two way; p<.001). Conclusion: It could be concluded that the immersion in sodium perborate (Corega Tabs) can be used for removal of coffee stains from denture teeth, and re-polishing for removal of Coca-Cola® stains. Still, toothbrushing produced greater color changes on denture teeth, regardless of the immersion solution.

Introdução: O manchamento dos dentes artificiais pode estar relacionado à abrasão da resina acrílica provocada pela escovação, resultando na maior deposição de corantes provenientes de bebidas, e consequentemente maior prejuízo estético. Objetivo: O objetivo do presente estudo foi avaliar métodos de remoção de manchas extrínsecas por meio de analise com espectofotômetro. Material e método: Dentes artificiais foram divididos em 12 grupos (n=10), de acordo com o tipo de tratamento (repolimento – Re ou imersão em perborato de sódio, Corega Tabs – Sp), tipo de solução de manchamento, café (Cf) ou Coca-Cola® (Cc) ou água (W) e com/sem escovação (B). Os métodos de remoção de manchas propostos (Re e Sp) foram realizados de acordo com protocolos pré-estabelecidos. Os espécimes Sp foram submetidos a 7 ciclos de imersão (5 minutos cada). O repolimento foi realizado com pastas de pedra pomes e branco de espanha, utilizando escovas de cerdas macias e rodas de feltro. As leituras de estabilidade de cor (ΔE) foram realizadas por meio de um espectrofotômetro: T0 (baseline), T1 (após escovação/imersão em bebidas), e T2 (após Re ou Sp). Resultado: Alterações de cor entre T1 e T2 (teste T pareado; α=0,05) foram observadas para o grupo CfSp (p=.032); e para os grupos BWRe (p=.000), BCfRe (p=.049) e CcRe (p=.042). Os dentes artificiais submetidos à escovação mostraram maior alteração de cor (ANOVA 2 fatores; p<0,001). Conclusão: Conclui-se que a imersão em perborato de sódio (Corega Tabs) pode ser utilizada para remoção de manchas de café e o repolimento para remoção de manchas de Coca-Cola®. Ainda, a escovação produziu as maiores alterações de cor nos dentes artificiais, independentemente da solução de imersão.

Application of Ce-TZP/Al2O3 nanocomposite to the framework of an implant-fixed complete dental prosthesis and a complete denture.

PATIENT: A 69-year-old Japanese male visited Nihon University Dental Hospital for refabrication of his mandibular implant-supported complete fixed prosthesis (ISCFPD) and maxillary complete denture, which had been fabricated 15 years previously. In this case, Ce-TZP/Al2O3 nanocomposite (Ce-TZP/A) was applied to the framework of the mandibular ISCFPD and maxillary complete denture. Three years after deliver of the framework, no particularly notable biological or prosthetic complications were observed, and a high level of patient satisfaction had been achieved. DISCUSSION: Conventional ISCFPD frameworks were fabricated by casting gold alloys; however, with the recent advancement of CAD/CAM technology, titanium (Ti) or yttria tetragonal zirconia polycrystal (Y-TZP) frameworks have become more common. In contrast, the main fabrication method for Ti or Co-Cr frameworks of removable dental prostheses has shifted from the conventional casting method to CAD/CAM fabrication. Ce-TZP/A, which was chosen as the framework material this time, shows higher strength and greater toughness than Y-TZP. However, since it has a low light-transmitting property and exhibits an opaque white color, the range of its application in fixed prostheses, particularly in the esthetic area, is limited. CONCLUSION: We described a case in which Ce-TZP/A was applied to the frameworks of a mandibular ISCFPD and a maxillary complete denture. No particularly notable biological or prosthetic complications were observed in the mandibular ISCFPD or the maxillary complete denture, and a high level of patient satisfaction was achieved. Medium- and long-term observations with a greater number of cases are essential to obtain information concerning various phenomena related to this procedure.

Impact of Different Prosthodontic Treatment Modalities on Nutritional Parameters of Elderly Patients.

PURPOSE: To assess dietary and nutritional changes among the elderly following pros-thodontic rehabilitation. Another objective was to study the relationship, if any, between diet and nutrition, with extent of edentulism and different types of prosthodontic treatment. MATERIALS AND METHODS: One hundred and thirty-five patients who satisfied the inclu-sion and exclusion criteria and agreed to be a part of the study after informed consent were recruited to this longitudinal study. Following selection, they were investigated on four aspects: dental examination, dietary assessment, anthropometric assessment, and serum biochemical assessment. All measurements were collected twice, first at baseline and then 6 months following prosthodontic rehabilitation. Treatment modalities included were complete denture (CD), removable partial denture (RPD), and fixed partial denture (FPD). The RPD group was of two types: distal extension prosthesis (RPDD) and tooth-supported prosthesis (RPDT). Change (post-pre) in outcome measures was compared by one-way ANOVA, and significance of mean difference between the groups was done by Tukey's honestly significance difference post hoc test. RESULTS: The improvement in diet was found to be: CD > RPDD > RPDT > FPD. Significant improvement in weight (p < 0.001), BMI (p < 0.001), protein (p < 0.001), carbohydrate (p = 0.021), calorie (p < 0.001), iron (p = 0.002), and vitamin B (p < 0.001) in group CD as compared to partially edentulous patients (group RPDD + RPDT + FPD) was noted. The protein and calorie intake increased significantly in group RPD as compared to group FPD in partially edentulous patients. CONCLUSION: Prosthetic rehabilitation becomes increasingly important as the level of edentulism increases to improve dietary, anthropometric, and biochemical parameters.

Antimicrobial activity of complete denture cleanser solutions based on sodium hypochlorite and Ricinus communis: a randomized clinical study

ABSTRACT To preserve oral health and to maintain the prosthetic devices, it is important not only to improve the properties of commonly known hygiene products, but also to investigate new materials with antimicrobial action. Objectives This study evaluated the antimicrobial activity of sodium hypochlorite (0.25% and 0.50%) and 10% Ricinus communis’ solutions against specific microorganisms. Material and Methods Sixty four maxillary complete denture wearers were instructed to brush their dentures three times a day and to soak them (20 min/day) in the solutions: SH1: 0.25% sodium hypochlorite; SH2: 0.5% sodium hypochlorite; RC: 10% R. communis oil; and C: 0.85% saline (control). The solutions were used for 7 days in a randomized sequence. Following each period of use, there was a 1-week washout period. Antimicrobial activity was determined by Colony Forming Units (CFU) counts of Streptococcus mutans, Candida spp., and gram-negative microorganisms. For collecting biofilm, the internal surface of maxillary dentures was brushed with saline solution, and biofilm suspension obtained. After dilutions (100 - 10-3), aliquots were seeded in Mitis salivarius, CHROMagar Candida®, and MacConkey agar for detecting S. mutans, Candida spp., or gram-negative microorganisms, respectively. After incubation, colonies were counted, and CFU/mL values were calculated. Then, transformation - log10 (CFU+1) - data were analyzed using the Friedman test (α=0.05). Results showed significant differences between the solutions (p<0.001). Results All three solutions showed antimicrobial activity against S. mutans. Against Candida spp., RC and SH1 solutions showed similar effect while SH2 showed superior activity. SH1 and SH2 solutions showed antimicrobial action against gram-negative microorganisms. The Candida species most frequently isolated was C. albicans, followed by C. tropicalis and C. glabrata. Conclusions The 0.5% sodium hypochlorite solution was the most effective and might be used to control denture biofilm. C. albicans was the most frequently isolated Candida sp.

Implementation of a patient-centered approach to clinical dental education: a five-year reflection.

The intent of the redesign of the clinical component of the Harvard School of Dental Medicine (HSDM) curriculum from a traditional numerical procedures-based system to a patient-based comprehensive care system was to improve both patient care and student learning. The aim of this retrospective cohort study was to evaluate the outcomes of and students' perspectives on this patient-centered comprehensive care model introduced in 2009. Data were obtained from the school's Office of Dental Education for a study sample consisting of 205 fourth-year dental students in the graduating classes of 2009 through 2014 at HSDM. The results showed that students were completing more than the required number of comprehensive patient cases on average. A survey given to the Class of 2014 found that the respondents (35 of 36 students) were generally satisfied with the new curriculum and the clinical experience in relation to continuation of care and perceptions of comprehensive care. The results of this study suggest that the redesigned patient-centered assessment model of the clinical component of the curriculum helped improve patient care and student learning.

Antimicrobial activity of complete denture cleanser solutions based on sodium hypochlorite and Ricinus communis - a randomized clinical study.

UNLABELLED: To preserve oral health and to maintain the prosthetic devices, it is important not only to improve the properties of commonly known hygiene products, but also to investigate new materials with antimicrobial action. Objectives This study evaluated the antimicrobial activity of sodium hypochlorite (0.25% and 0.50%) and 10% Ricinus communis' solutions against specific microorganisms. MATERIAL AND METHODS: Sixty four maxillary complete denture wearers were instructed to brush their dentures three times a day and to soak them (20 min/day) in the solutions: SH1: 0.25% sodium hypochlorite; SH2: 0.5% sodium hypochlorite; RC: 10% R. communis oil; and C: 0.85% saline (control). The solutions were used for 7 days in a randomized sequence. Following each period of use, there was a 1-week washout period. Antimicrobial activity was determined by Colony Forming Units (CFU) counts of Streptococcus mutans, Candida spp., and gram-negative microorganisms. For collecting biofilm, the internal surface of maxillary dentures was brushed with saline solution, and biofilm suspension obtained. After dilutions (100 - 10-3), aliquots were seeded in Mitis salivarius, CHROMagar Candida, and MacConkey agar for detecting S. mutans, Candida spp., or gram-negative microorganisms, respectively. After incubation, colonies were counted, and CFU/mL values were calculated. Then, transformation - log10 (CFU+1) - data were analyzed using the Friedman test (α=0.05). Results showed significant differences between the solutions (p<0.001). RESULTS: All three solutions showed antimicrobial activity against S. mutans. Against Candida spp., RC and SH1 solutions showed similar effect while SH2 showed superior activity. SH1 and SH2 solutions showed antimicrobial action against gram-negative microorganisms. The Candida species most frequently isolated was C. albicans, followed by C. tropicalis and C. glabrata. CONCLUSIONS: The 0.5% sodium hypochlorite solution was the most effective and might be used to control denture biofilm. C. albicans was the most frequently isolated Candida sp.