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.

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.

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).

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.

Prosthetic outcome, patient complaints, and nutritional effects on elderly patients with magnet-retained, implant-supported overdentures--a 1-year report.

PURPOSE: To study the changes in treatment outcomes of complete dentures and magnet-retained, implant-supported overdentures in a group of elderly patients. MATERIALS AND METHODS: In this nonrandomized trial, 43 edentulous patients (14 men and 29 women) were fitted with complete dentures followed by implant-supported mandibular overdenture in a sequential model. Treatment outcomes used for analysis included objective assessment of denture quality (Woelfel's index), patient satisfaction, nutritional status, body mass index (BMI), and serum albumin level. The McNemar test was used to determine if significant differences in the Woelfel's index and nutritional status existed at different treatment phases. Repeated measures ANOVA and multiple pairwise comparison tests were used to analyze patient satisfaction. BMI status and serum albumin level at different treatment phases were analyzed with one-way ANOVA and Tukey post hoc test. RESULTS: At the 1-year follow-up, significant improvements were recorded for the objective assessment of denture quality and patient complaints (P < .05). No subject was found to be malnourished at pretreatment and in subsequent treatment phases. BMI and serum albumin level were not significantly different at different treatment phases (P > .05) CONCLUSIONS: The present study demonstrated that in elderly patients with stable health and nutritional status, complete dentures made in a university clinic brought about overall improvement in denture quality and reduction in denture complaint score. Insertion of mandibular implant-supported overdentures further improved the mandibular denture quality and reduced the mandibular denture complaint score. In this group of patients, no improvement in BMI, serum albumin value, and nutritional status were documented.

Changes in the edentulous maxilla with ball and telescopic attachments of implant-retained mandibular overdentures: a 4-year retrospective study.

OBJECTIVE: This retrospective study investigated the clinical and radiographic changes in the edentulous maxilla in patients with either ball or telescopic attachments of implantretained mandibular overdentures. METHOD AND MATERIALS: Thirty-two completely edentulous patients (21 males and 11 females) received two implants in the canine region of the mandible. New maxillary complete dentures and mandibular overdentures were fabricated. Overdentures were connected to the implants either with ball (group 1, n = 16) or telescopic (group 2, n = 16) attachments. Retention and stability of the maxillary denture as well as mucosal changes of the maxillary ridge were recorded after 4 years of denturewearing. Traced rotational tomograms were used for measurements of maxillary alveolar bone loss. The proportional value between bone areas and areas of reference not subject to resorption was expressed as a ratio (R). Change in R immediately before (T0) and after 4 years (T4) of overdenture insertion was calculated for the anterior and posterior regions of the maxilla. RESULTS: After 4 years of denture-wearing, maxillary denture retention was significantly higher in group 1 than in group 2, while occurrence of flabby ridges was significantly higher in group 2 than in group 1. The change in R of the anterior region of the maxilla was significantly higher than the change in the posterior region in both groups. Group 2 showed significant anterior residual ridge resorption compared to group 1. CONCLUSION: Telescopic attachments for implant-retained mandibular overdentures are associated with increased maxillary ridge resorption and flabbiness, and decreased maxillary denture retention when compared to ball attachments.

Evaluation of satisfaction and complications in patients with existing complete dentures.

The aim of this clinical trial was to assess satisfaction, as well as the frequency and type of prosthetic complications in terms of several variables, in patients with complete dentures that had been supplied at private clinics. The study subjects were 64 patients with a mean age of 63.48 years wearing complete dentures provided at private clinics, and requesting new ones. The degree of patient satisfaction with their dentures was assessed, as well as complications and parameters related to the dentures such as the accuracy of vertical dimensions and centric relation, arrangement and possible malposition of the artificial teeth, and the border length of the denture bases. The most common complication was loss of retention (85.9%), followed by ulceration (44.2%). Mandibular dentures with long vestibular borders showed a significantly higher incidence of epulis fissuratum (P = 0.017), and denture-related sore spots influenced patients' speech ability (P = 0.023). Routine recalls seem to be important for wearers of complete dentures, as several insidious complications may develop and cause damage to the dentures as well as the patients' oral tissues.

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.

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.

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.

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.

Transposition of the mental nerve by piezosurgery followed by postoperative neurosensory control: a case report.

Transposition of the mental nerve is a preprosthetic procedure that is effective for patients with hyperaesthesia caused by the effect of a dental prosthesis on the alveolar ridge. We present the case of a 74-year-old woman with pain and hyperaesthesia of the right inferior alveolar nerve caused by a dental prosthesis. Caudal transposition of the right mental nerve by piezosurgery resulted in postoperative neurosensory controls of the lower lip showing normal nerve function 2 months later.

Frequency and location of traumatic ulcerations following placement of complete dentures.

PURPOSE: To determine the location of mucosal injuries that appear following placement of complete dentures, as well as the number of adjustments necessary to achieve patient comfort. The frequency of mucosal injuries in female and male patients and their connection with clinical anatomic features were also investigated. MATERIALS AND METHODS: Sixty-one completely edentulous healthy patients who wore dentures (47 women and 14 men) took part in the study; 122 newly fabricated complete maxillary and mandibular dentures were investigated. All patients were seen for a 1-week adjustment appointment. Areas where signs of denture-induced mucosal injuries appeared were marked on an anatomic illustration. The follow-up period was in 1-week increments as deemed necessary by the patient. Associations between variables were analyzed with analysis of variance. Results were recorded as mean + SD. Statistical significance was set at P < or = .05. RESULTS: Eighty-seven percent of the dentures required adjustment at week 1, 50% at week 2, and only 7% at week 3. No patients required a further visit. Most frequently injured maxillary areas were the vestibular sulcus (41%), maxillary tuberosity (21%), and hamular notch (12%). In the mandible, the most frequently injured areas were the retromylohyoid area (17%), lingual sulcus (14%), and vestibular sulcus (13%). Denture-induced irritations were detected in a higher ratio in the mandible (P < .001), especially in male denture wearers at the first adjustment (P < .05). Men had a higher ratio of lesions at the region of the maxillary vestibular sulcus between the labial and buccal frenum and at the mandibular vestibular sulcus of the buccal shelf region (P < .001). CONCLUSIONS: Denture-induced irritations appeared most often in the vestibular sulcus of the maxilla and mandible, indicating that it is necessary to evaluate the area of the facial seal of the prosthesis by applying a medium- or a heavy-pressure indicator paste to the borders, and to make adjustments at the delivery stage and subsequent adjustment appointments. Denture placement must not be the final patient-clinician encounter when treating with complete dentures. Denture adjustments are very important clinical phases of denture fabrication and essential in patient care.

[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.