Radiographic Screening of Patients in a Dental School using the Prosthodontic Diagnostic Index.

INTRODUCTION: Organization of the findings associated with various diagnostic aids plays a key role in formulating the treatment plan of the patients undergoing dental and medical treatment. Enhanced consistency in diagnosing and classifying prosthodontic patients is the basic purpose of various classification systems. Hence, we planned this study to classify partially edentulous patients and completely dentate patients at the undergraduate clinics using the prosthodontic diagnostic index (PDI). MATERIALS AND METHODS: This study included classification of 13,599 edentulous patients who attended the clinics of undergraduate students of all the levels. Screening of all the patients was done radiographically with a digital orthopantomograph (OPG), and the data were saved in the computer system. The intraoral periapical radiographs (IOPA) taken for all the affected areas were also saved in the system. Based on the OPG and IOPA, the patients were classified into various classes. All the data of the patients were recorded and analyzed. RESULTS: Total number of patients screened was 17,220, out of which 3,621 were under 18 years of age and were excluded from the study. Most of the patients belonged to the age group of 31 to 45 years: 5,360 (39.4%) patients (3,817 [43.0%] males and 1,543 [32.5%] females) were class I; 2,730 (20.0%) patients (1,729 [19.5%] males and 1,001 [21.1%] females) were class II; 4,576 (33.7%) patients (2,835 [32.0%] males and 1,741 [36.8%] females) were class III; and 933 (6.9%) patients (483 [5.5%] males and 450 [9.5%] females) were class IV. CONCLUSION: There is a need to introduce PDI as a screening tool during the initial examination of the patient and to achieve a proper distribution of the patients among various levels of students, interns, and postgraduates. CLINICAL SIGNIFICANCE: Introduction of PDI will improve the treatment planning and prognosis of edentulous patients.

Association Between Dentition Status and Malnutrition Risk in Serbian Elders.

PURPOSE: The aim of this study was to find the correlation between the number, type, and placement of symmetric functional tooth units and the nutritional status using body mass index (BMI) and Mini Nutritional Assessment (MNA) in patients with both maxillary and mandibular removable partial dentures. MATERIALS AND METHODS: A randomized study was conducted at the Clinic for Prosthodontics, School of Dentistry, University of Belgrade, Serbia, followed by determination of number of functional tooth units. After insertion of the prostheses, the nutritional status was assessed, using BMI and MNA form. Nutritional status was reviewed 12 months after prosthetic treatment. Number of teeth and age were analyzed using analysis of variance and t test. For other variables such as BMI baseline, BMI follow-up, MNA baseline, MNA follow-up, change in BMI, and change in MNA, Kruskal-Wallis Test or Mann-Whitney Test were used. RESULTS: The results on the MNA changes showed that patients with symmetric natural functional tooth units had significantly higher values (2.9 ± 0.8) compared with patients without natural functional tooth units (1.9 ± 0.6) or with asymmetric natural functional tooth units (1.6 ± 0.4). Patients with asymmetric artificial functional tooth units had significantly lower change in MNA (1.9 ± 0.4) than those with symmetric artificial functional tooth units (2.6 ± 0.9). CONCLUSION: The findings of this study suggest that adequate rehabilitation with symmetric positioning of the functional tooth units can improve the nutritional status of partially edentulous patients.

Finite Element Analysis of Implant-Assisted Removable Partial Denture Attachment with Different Matrix Designs During Bilateral Loading.

PURPOSE: The aim of this study was to investigate the effect of different matrix designs on resilient attachment on an implant-assisted removable partial denture (IARPD) using finite element analysis (FEA). MATERIALS AND METHODS: A laser scanner was used to extract the geometrical data of a human partially edentulous mandible. A 12-mm-long and 4.8-mm-diameter-wide implant was modeled, and two types of intradental attachment of snap fastener principle (elliptical) and resilient attachment (titanium) matrices were modeled along with tooth roots and periodontal ligaments. The modeling was performed with a combination of reverse engineering and solid modeling. The model incorporated a removable partial denture and was loaded with realistic bilateral forces. The FEA was used to analyze the stress and strain distributions in the IARPD and in the metal framework. RESULTS: Stresses and deformations in the metal framework and resin denture base surfaces were analyzed for the elliptical and titanium matrix designs. The maximum von Mises stresses were 605.85 and 614.96 MPa in the metal framework surface and 10.35 and 10.63 MPa in the resin denture base surface, respectively, for the elliptical and titanium matrix designs. The maximum deformations (displacements) were 418.5 and 428.3 µm in the metal framework surface for the elliptical and titanium matrix designs, respectively. The corresponding values of displacements for the resin denture base surface were 325.52 and 249.22 µm for the elliptical and titanium matrix designs, respectively. The maximum displacements in the matrixes were, however, nearly the same (229.51 and 229.47 µm) for both the elliptical and titanium matrixes. CONCLUSION: The titanium matrix design was a more favorable design compared with the elliptical design, because it had lower lateral deformation as indicated by the maximum displacement.

Impact on Dietary Intake of Removable Partial Dentures Replacing a Small Number of Teeth.

The aim of this study was to clarify the impact of wearing removable partial dentures (RPDs) replacing a small number of teeth on dietary intake. Participants had at least 20 teeth and were classified as Eichner B1 or B2. The participants underwent dental and oral examinations, and their dietary intake was assessed. Analysis of covariance showed that RPD wearers consumed more vegetables, n-3 fatty acids, calcium, vitamin A, and dietary fiber than nonwearers after adjusting for possible confounding factors. It is concluded that RPDs are effective for improving dietary intake even in participants who have lost a small number of teeth.

Treatment Outcomes of Cantilever Fixed Partial Dentures on Vital Abutment Teeth: A Retrospective Analysis.

PURPOSE: This retrospective clinical study evaluated the long-term outcomes of cantilever fixed partial dentures (CFPDs) and the factors influencing their survival probability. MATERIALS AND METHODS: The study is based on a convenience sample of 57 patients who received 71 CFPDs on a total of 176 vital abutment teeth. The mean survival time of the CFPDs was calculated using a Kaplan-Meier estimate. The following variables were analyzed as covariates of the survival function (logrank test, P < .05): sex, denture location, number and distribution (Kennedy Class) of the abutment teeth, dentition in the opposing arch (removable dentures, fixed partial dentures, or natural dentition), position of the cantilever unit (mesial or distal), and participation in follow-up visits. RESULTS: The mean observation period was 3.2 ± 2.8 years (maximum 10.7 years). During the observation period, 22.5% (n = 16) of the CFPDs ceased functioning. The calculated outcome probability was 93.0% after 5 years and 84.5% after 8 years. The number of abutment teeth was the only parameter that significantly (P < .05) impacted this probability. CONCLUSION: The survival rate of CFPDs on vital abutment teeth is comparable to that of conventional fixed partial dentures. Thus, CFPDs on vital abutments are an acceptable alternative to removable dentures.

Shortened dental arch and body mass index in adults 45-65 years of age: results from National Health and Nutrition Examination Survey 2005-2008.

OBJECTIVE: Many people have dental arches with unrestored edentulous areas posterior to natural teeth. One dental pattern is the shortened dental arch (SDA). As a result of the lack of teeth, individuals with an SDA may eat a restricted diet, including soft, highly processed foods. Such diets may increase the risk of being overweight or of obesity. We examined whether there was an association between SDA and body mass index (BMI) in adults 45-65 years of age. METHODS: The data for this study were US National Health and Nutrition Examination Survey (NHANES) 2005-2008 merged files. There were 5,773 eligible participants. The data were examined for frequencies, and the results were analysed using the chi-square test and logistic regression. RESULTS: There were 69.3% participants with a shortened mandibular arch and a BMI of ≥25 compared with 71.8% of participants who had a complete mandibular dental arch and a BMI of ≥25 (P=0.7246). There were 70.6% of participants with a shortened maxillary arch and a BMI of ≥25 compared with 71.9% of participants who had a complete maxillary dental arch and a BMI of ≥25 (P=0.8859). The adjusted odds ratio for shortened mandibular dental arch was 0.70 (95% CI: 0.46-1.08) for a BMI of ≥25 as compared with individuals with a BMI<25. The adjusted odds ratio for shortened maxillary dental arch was 1.06 (95% CI: 0.63-1.78) as compared with individuals with a BMI<25. CONCLUSIONS: The research hypothesis that an SDA was related to higher BMI, and the corollary that restored or complete dentition had better odds of a lower BMI, were not supported.

Maxillary implant-retained partial overdenture with Dolder bar attachment: a clinical report.

This article describes a technique for maintaining a maxillary Kennedy III partial removable dental prosthesis design in a patient who had non-restorable failing abutments by replacing the abutments with dental implants. Two implants were placed immediately after extraction of the abutment teeth in the anterior maxilla. After the implants were fully integrated, a Dolder bar attachment was fitted onto the implants. A new maxillary partial removable dental prosthesis was fabricated using the implants and the remaining natural teeth as abutments to restore function and esthetics. With the aid of dental implants, this Kennedy III maxillary removable dental prosthesis design could provide additional retention and support by promoting cross-arch stability and tissue, implant and tooth support. The patient's satisfaction was significantly increased.

A tomographic study of the mandibular condyle position in partially edentulous population.

BACKGROUND AND OBJECTIVES: The Influence of the loss of teeth on the condylar position and on temporomandibular joint (TMJ) dysfunction syndrome remains a c ontroversial issue. This study analyses the condylar position by means of a tomogram in partially dentate subjects which serves as a guide to predict which of the partially dentate statuses is prone to develop TMJ dysfunction syndrome in personnel without symptoms of the same. METHODOLOGY: Eighty personnel were enrolled in this study consisting of Kennedy's class I, II, III, IV and control to analyze the condylar position by means of a tomogram. In all the five groups TMJ sectional tomogram programmed in a panoramic radiographic machine (PLANMECA PM 2002 CC PROLINE) was taken with the subjects at maximal intercuspal position and rest position. Tomograms were evaluated using linear measurements of the anterior and posterior intra-articular joint spaces on the basis of drawings and tracings. RESULTS: The results of the study revealed a predominance of reduced posterior condylar space in Kennedy's class I and II. A disparity was seen between the maximum intercuspal position and rest position, where the posterior joint space was reduced in the rest position. CONCLUSION: Within the limitations of this study, it has been revealed that in Kennedy's classes I and II, for partially dentate personnel, a posterior displacement of the c ondyles was seen. This predisposition would suggest towards the necessity of restoring the missing dentition in order to maintain the har mony of the stomatognathic system.

Accuracy of surgical guides made from conventional and a combination of digital scanning and rapid prototyping techniques.

STATEMENT OF PROBLEM: Surgical guides aid in accurately placing dental implants to achieve a predictable restorative outcome. Which surgical guide fabrication technique results in the most accurately fitting surgical guide is unknown. PURPOSE: The purpose of this investigation was to determine the internal fit of dental implant surgical guides on dentate and edentulous ridges by using implant surgical guides fabricated from conventional and computer-aided design/computer-aided manufacturing (CAD/CAM) techniques. MATERIAL AND METHODS: Eighty surgical guides were fabricated from conventional and CAD/CAM techniques; half were designed from Kennedy Class 2 (K2) casts, and half were designed from Kennedy Class 3 (K3) casts. Conventional surgical guides were fabricated from acrylic resin. The CAD/CAM surgical guides were scanned by using cone beam computed tomography (CBCT) or an optical scan (OS). The guides were printed with stereolithography (SL) or 3-dimensional digital printing (3DP). All surgical guides were cemented to their respective design casts, sectioned, and measured at standardized locations. A 2-way ANOVA and the post hoc Fisher least square difference t test was performed (α=.05). RESULTS: The 2-way ANOVA indicated that the difference between surgical guide groups and Kennedy class was statistically significant (P<.05) and the interaction between groups and Kennedy class was statistically significant (P<.05). The OS/3DP CAD/CAM guide was the best-fitting cast for the K2 cast group, and the conventional guide was the best-fitting guide for the K3 group. CONCLUSIONS: Conventionally fabricated and OS surgical guides have greater accuracy of fit than CBCT scanned surgical guides.

The shortened dental arch concept: awareness and opinion of dentists in Victoria, Australia.

BACKGROUND: The occlusion of a complete dental arch is generally desirable but not necessary nor always achievable in many individuals. It is, however, relevant for dentists to consider what minimum number of teeth is required by individuals for oral function. This study investigated dentists' awareness and opinion of the shortened dental arch (SDA) concept in an Australian context. METHODS: A self-administered voluntary and anonymous questionnaire was mailed to a sample of 434 dentists, randomly selected from both rural and metropolitan locations in Victoria, Australia. The information collected included awareness of the SDA concept and its application as a treatment option. RESULTS: More than half of the respondents (61%) were aware of the SDA concept. All respondents 'agreed' or 'strongly agreed' with the seven criteria of SDA proposed in this study based on Käyser (1989). The majority (78.4%) believed that the SDA concept is useful in clinical practice. Dentists with <20 years of experience expressed more awareness compared to others (χ(2) test, p = 0.004). CONCLUSIONS: Most dentists who responded to this survey agreed that the SDA is a practical and useful treatment modality for older adults with limitations to complex restorative care. However, application of the SDA varied considerably among dentists.

Impact of periodontal maintenance on tooth survival in patients with removable partial dentures.

AIM: Removable partial dentures (RPDs) may have a negative impact on oral health and have the potential to cause further tooth loss, especially of abutment teeth. However, no evidence indicates the effective interval of regular periodontal maintenance after RPD provision. This practice-based cohort study aimed to examine the impact of regular periodontal maintenance visits on survival of RPD abutment teeth. MATERIALS AND METHODS: One hundred and ninety-two patients had been previously provided with 304 new clasp-retained RPDs at Osaka University Dental Hospital, Japan. Using the Kaplan-Meier method and log-rank test, 1094 abutments were analysed to illustrate survival curves and to compare each curve. According to the frequency of periodontal maintenance, study samples were divided into three groups; every 3-6 months (3-6M) group, 1-year (1Y) group and no-maintenance (NM) group. RESULTS: Seven-year cumulative survival rates were 83.7% (3-6M), 75.5% (1Y) and 71.9% (NM) respectively. Survival of abutment teeth in the 3-6M group was significantly better than both 1Y (p = 0.005) and NM (p < 0.001) groups. CONCLUSION: These longitudinal clinical data indicates that periodontal maintenance at least once in 6 months had the most favourable outcome. Frequent periodontal maintenance after RPD provision could be effective in preventing further tooth loss.

[Impact of the edentulousness on the quality of life related to the oral health of the Congolese]. / Impact de 'édentement sur la qualité de vie liée à la santé orale des congolais.

BACKGROUND: No studies on the perception of tooth loss effects in their daily lives of edentulous were performed in Congolese Bantu. OBJECTIVES: To assess the severity of the impact of edentulism on the quality of life of partially edentulous Congolese and analyze the influence of age, sex, missing teeth, the location of gaps and pairs of posterior dental occlusion in this impact. METHOD: This descriptive cross-sectional study was conducted in the University Clinics of Kinshasa (CUK) and the Centre Boyambi Army Hi Kinshasa/Gombe. One hundred and eighty one edentulous adults and non-denture wearers clinically examined were asked to complete the questionnaire OHIP 14. RESULTS: Average severity was 11.67 ± 8.74 on a scale of 0-56. Statistically missing teeth, location of gaps and pairs of posterior dental occlusion residual alter this severity. The poor quality of life was noted in patients who had lost more than 5 teeth (17.04 ± 7.26), anterior losses (17.32 ± 9.42) and less than 4 pairs of posterior occlusion (17.84 ± 6.13). Difficult chewing and concern were the most reported items. CONCLUSION: Severity of the influence of tooth loss on the daily life of Congolese people is low. All edentulous does not necessarily cause a very poor quality of life. Increasing the number of lost teeth, presence of anterior gaps and reduction of posterior occlusion pairs below 4 disrupt the quality of life of partially edentulous.

Theoretical role of adjunctive implant positional support in stress distribution of distal-extension mandibular removable partial dentures.

This preliminary study evaluated the adjunctive supporting role of diverse implant positions on stress distribution in a Class I removable partial denture (RPD) design. Nine three-dimensional finite element models were prepared to simulate mandibular RPD designs with three different loading conditions applied. Implant supported designs demonstrated lower stress value concentrations and mucosal displacement.

Minimal intervention dentistry and older patients part 2: minimally invasive operative interventions.

UNLABELLED: As described in the first paper of this two part series, the expansion of our older population and the concomitant reduction in levels of edentulism will result in an increase in the number of patients presenting in general practice with complex restorative challenges. The application of the concepts of minimal intervention dentistry and minimally invasive operative techniques may offer a powerful armamentarium to the general dentist to provide ethical and conservative treatment to older patients. CLINICAL RELEVANCE: When it is unavoidable, operative intervention should be as minimally invasive as practicable in older patients to preserve the longevity of their natural dentition.

Vertical microgap and passivity of fit of three-unit implant-supported frameworks fabricated using different techniques.

PURPOSE: This study compared the vertical microgaps of milled zirconia and cobalt-chromium (Co-Cr) implant-supported fixed dental prosthesis frameworks to those seen in one-piece frameworks cast with different techniques. MATERIALS AND METHODS: Two threaded implants were used to simulate the rehabilitation of a maxillary partially edentulous space from the second premolar to the second molar. Three-unit screw-retained prosthetic frameworks were fabricated and divided into the following groups (n = 10 in each group): 1 = cast in Co-Cr using burnout cylinders; 2 = cast in Co-Cr using cast-on Co-Cr cylinders; 3 = one-piece cast in Co-Cr using a passive fitting technique; 4 = milled Co-Cr framework; 5 = milled zirconia framework. The microgap was measured under an optical microscope at ×25. Readings were made with one screw tightened and with both screws tightened. Data were submitted to statistical analysis to enable comparison between groups (α = .05). RESULTS: All frameworks presented microgaps less than 70 µm under all reading conditions, except for group 1 with the readings made on the side opposite the tightened side (124.22 µm). With one screw tightened, the microgap on the tightened side was significantly smaller in groups 2, 3, and 4. On the opposite side, groups 3, 4, and 5 presented significantly smaller microgaps compared to the other groups. When both screws were tightened, the microgap was significantly smaller in groups 2, 3, and 4. CONCLUSION: One-piece cast frameworks associated with a passive fitting technique and milled Co-Cr frameworks presented smaller microgaps than the other fabrication methods and materials that were tested.

[Rehabilitation by composite prosthesis combining milling of embedded bilateral edentulous: a clinical report]. / Prothèse composite et fraisages. A propos d'un cas clinique de réhabilitation d'un edentement encastré bilateral au maxillaire.

The treatments with composite prosthesis require the completion of milling. These precision preparations in the fixed prosthesis promote the integration of removable partial denture with metallic framework in mechanical (prosthetic balance), physiological, aesthetical and psychological point of view. Their conception and realization are always subordinated to the balance principles of the removable partial denture. The precision they require need the use of a dental milling machine working along the predetermined insertion axis of the partial denture casting and require an excellent communication and a close collaboration between dentist and experienced technician of laboratory. In this paper, after a recalling about the milling (definition, description, interests), we will detail the steps to achieve clinical and laboratory needs for a rehabilitation by composite prosthesis combining milling, and it will be illustrated through a clinical case with a bilateral tooth-supported edentulous in the maxilla.

A hinged two-part partial denture used in conjunction with severely tilted teeth: a case report.

A two-part sectional denture can be a useful treatment option when the presence of severe hard tissue undercuts compromises the provision of a satisfactory conventional prosthesis. This article presents a case report illustrating the effective use of a hinged two-part denture in restoring a mandibular Kennedy Class IV edentulous area. A sectional denture approach was selected because of severe proximal and lingual undercuts.

Partial Edentulism based on Kennedy's classifcation: an epidemiological study.

BACKGROUND: The aim of this study was to determine the incidence of different Kennedy's classes of partial edentulism during 18 months period. MATERIALS AND METHODS: Patients were clinically examined for various Kennedy's classes of partial edentulism in the outpatient department (OPD), prosthodontics, GPRDCH, Kurnool (Andhra Pradesh). RESULTS: Of the total 1,420 OPD patients, Kennedy's class III was the most frequent classification encountered (62%) and followed by Kennedy's class I (18%), class II (11%), and class IV (9%) in decreasing order. CONCLUSION: The patients with various Kennedy's classes of partial edentulism can be offered various treatment modalities like removable cast partial dentures, fixed partial dentures, over dentures and implant supported dentures. This study can be crucial for screening the population for incidence of tooth loss as a factor of gender and age. Clinical significance: Tooth loss appears to have an important role in the loss of esthetics and mastication. Study of incidence of various classes of partial edentulism provides clinically useful information for dental training and continuing education.

Oral health-related quality of life in partially edentulous patients treated with removable, fixed, fixed-removable, and implant-supported prostheses.

PURPOSE: This study investigated changes in oral health-related quality of life (OHRQoL) in partially edentulous patients treated with removable dental prostheses (RDPs), fixed dental prostheses (FDPs), fixed-removable (combined) restorations (COMBs), and implant-supported fixed prostheses (ISFPs). MATERIALS AND METHODS: A total of 200 patients (30 to 50 years old) were enrolled: 45 received RDPs, 32 received FDPs, 66 received COMBs, and 57 received ISFPs. OHRQoL was measured using the shortened version of the Oral Health Impact Profile (OHIP-14) before treatment and 6 weeks and 6 months after treatment. Treatment groups were sex-neutral; however, significant differences were found relative to age and Kennedy classification. A general linear model was used to explore the interaction of age and Kennedy classification with treatment modality. RESULTS: Pretreatment analysis revealed that the psychologic discomfort domain showed the greatest negative impact on OHRQoL, while functional limitation had the smallest effect. Within-group comparison revealed a significant decrease in OHIP scores throughout the study in all groups except the younger age group treated with RDPs after 6 weeks. Between-group comparison revealed significant differences among the treatment groups. The least amount of OHRQoL improvement was recorded for RDPs for both age groups at 6 weeks and for the younger age group at 6 months. There were no significant differences between FDPs and ISFPs. CONCLUSIONS: All treatments produced significant improvement in OHRQoL. The least amount of improvement was observed in patients with RDPs. OHRQoL changes in patients treated with FDPs and ISFPs were comparable. The same treatment can have different impacts on the OHRQoL of partially edentulous individuals depending on their age and Kennedy classification.

Finite element analysis of an implant-assisted removable partial denture during bilateral loading: occlusal rests position.

STATEMENT OF PROBLEM: When implants are incorporated into an existing partial removable dental prosthesis, the acrylic resin base can fracture. It is therefore essential to study the mechanical behavior of partial removable dental prostheses by using stress and deformation analysis. PURPOSE: The purpose of this study was to analyze the effect of the occlusal rest position on the implant-assisted partial removable dental prosthesis by finite element analysis. MATERIAL AND METHODS: A Faro Arm scan was used to extract the geometrical data of a human partially edentulous mandible. A standard plus regular neck (4.8×12 mm) implant and titanium matrix, tooth roots, and periodontal ligaments were modeled by using a combination of reverse engineering in Rapidform XOR2 and solid modeling with the Solid Works CAD program. The model incorporated a partial removable dental prosthesis and was loaded with standard bilateral forces. A uniform pressure was applied on the occlusal surface so as to generate an equivalent net force of 120 N for both the left and right prosthesis. The finite element analysis program ANSYS Workbench was used to analyze the stress and strain distributions in the implant-assisted partial removable dental prosthesis. RESULTS: Maximum stresses were significantly high for the metal framework compared to the acrylic resin surface, and these stresses were different for the mesial and distal arm designs. The maximum stress in the metal framework for the mesial arm design was 614.9 MPa, and it was 796.4 MPa for the distal arm design. The corresponding stresses in the acrylic resin surface were 10.6 and 8.6 MPa. CONCLUSIONS: Within the limitation of this study, it was found that moving the position of the occlusal rest from the mesial to distal side of the abutment teeth improved the stress distribution in the metal framework and acrylic resin denture base structures.