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.

Temporomandibular disorder treatment in a patient wearing removable prostheses: A case report.

AIM: The purpose of this intervention was to treat the patient, a 51-year-old woman, who was wearing a maxillary denture and a mandibular bilateral distal-extension partial denture (both unfit) and was suffering from temporomandibular disorder (TMD). METHODOLOGY: The treatment suggested was to construct a superior repositioning splint (SRS), and after remission of the symptomatology, fabricate new dentures. RESULTS: The occlusal splint was effective and the symptomatology ceased after about five months of treatment. The new dental prostheses were made and followed up for 10 years with no return of the pain. CONCLUSIONS: SRS and subsequent construction of new dentures after remission of the symptomatology was an effective treatment for TMD in the case described.

Complications after use of elastomeric pressure-indicating media at 24-hour follow-up visit for immediate maxillary complete removable dental prosthesis: A clinical report.

Various pressure-indicating media are available to assess the adaptation of the intaglio surface of a removable dental prosthesis at the insertion and follow-up appointments. This clinical report describes the use of an elastomer that entered the maxillary sinus through an undetected oroantral communication at the 24-hour follow-up for an immediate maxillary complete removable dental prosthesis. A Caldwell-Luc sinusotomy procedure was required to remove the material, and the patient required over 1 year of healing time before his reported symptoms resolved.

Phase 1 clinical trial on the effect of palatal brushing on denture stomatitis.

PURPOSE: This study aimed to assess the efficacy of palatal brushing in the treatment of denture stomatitis. MATERIALS AND METHODS: After screening 143 individuals with a potential diagnosis of denture stomatitis, 48 patients (mean age: 66.0 ± 11.2 years) were enrolled in a two-center phase 1 clinical trial with a one-group pretest/posttest design. The intervention of interest was manual palatal brushing after each meal and before bedtime. Clinical and microbiologic examinations were performed at baseline and 1 and 3 months after treatment. Additional data were obtained using a validated questionnaire. The primary and secondary outcomes were the remission of denture stomatitis and diminution of Candida colony-forming units (CFUs), respectively. Descriptive and nonparametric statistical tests were conducted to analyze the data. RESULTS: At the 3-month follow-up, denture stomatitis was completely cured in 10.4% of the participants, and 70.8% of denture wearers showed improvement in the clinical signs of denture stomatitis. There was a significant reduction in the area and severity of the palatal inflammation (P < .0001). The effect size ranged from medium to large (0.34 to 0.54) depending on the classification used for the diagnosis of denture stomatitis. A significant reduction in the number of Candida CFUs isolated from the palatal mucosa and dentures (P ≤ .05) was observed. CONCLUSIONS: The results of this study suggest that palatal brushing is an effective treatment of denture stomatitis.

A nonsurgical approach to treating aggressive inflammatory papillary hyperplasia: a clinical report.

Preprosthetic interventions in patients with aggressive forms of inflammatory papillary hyperplasia have historically involved surgery. These procedures often involve significant postoperative discomfort and morbidity. Additionally, some patients who present with dental phobias, aversions to surgery, or underlying systemic disease may not be amenable to this type of surgical intervention. In this report, a patient with severe inflammatory papillary hyperplasia and phobias regarding the dentist and dental surgery was treated nonsurgically, following strict adherence to a clinical protocol. The methodology involved greater patient comfort during treatment, encouraged positive reinforcement to visiting the dentist for recall appointments, and effectively eliminated the underlying inflammatory papillary hyperplasia, allowing for the successful fabrication of the definitive removable prostheses.

The influence of the design of removable dentures on patient's voice quality.

The main condition for speech intelligibility is the specific anatomical characteristics of the human speech apparatus and harmonious work of all organs in the human vocal apparatus. The voice quality is characterized by speech intelligibility (relationship between the voice pitch, volume, timbre and speech speed). Improper functional quality (related to retention,support, stability), inappropriate design of the prosthetic base and disposition of artificial teeth are the basic reasons for dyslalia - impairment of utterance with abnormality of external speech organs. In the case of dyslalia a patient may suffer from a defective utterance of separate phonemes. When designing removable dental prostheses, it is important to evaluate the disposition of the artifical teeth (taking into account phonetic pronunciation), make a phonetically beneficial construction of the base of the dentures and restore the lost alveolar bone with the basis of removable prostheses. The aim of this study was to review literature on voice quality and the way it can be affected after the insertion of removable dental prostheses and to research the literature describing the ways how voice quality can be improved. The literature reviewed in the paper was retrieved from Science Direct, PubMed, MD Consult, Cochrane Libary databases and dates back to the period from 1990 to 2012.

Immediate loading of implants in the maxilla: survival and bone loss after at least 2 years in function.

PURPOSE: To compare survival and peri-implant bone loss around immediately loaded surface-enhanced implants in the maxilla supporting single crowns (SCs), fixed partial dentures (FPDs), and fixed full-arch dentures (FFDs). MATERIALS AND METHODS: The study included all subjects referred for implant treatment in the maxilla followed by immediate loading between November 2004 and 2007 with at least 2 years of follow-up. Smokers were excluded. Implant survival and bone loss were assessed by a calibrated external examiner who compared digital periapical radiographs taken during recall visits with baseline radiographs (day of loading = day after implant placement). An implant was considered successful when bone loss did not exceed 1 mm. Survival of implants supporting SCs, FPDs, and FFDs was compared using the log-rank test. A linear mixed-effect model analysis was used to evaluate bone loss because of clustering of implants in patients. RESULTS: Three hundred six implants were placed in 55 patients (31 women, 24 men; mean age, 57.5 ± 11.4 years; range, 19 to 77 years) and followed for a mean of 35 ± 10.2 months (range, 24 to 58 months). One implant failed, resulting in an overall survival rate of 99.7% on the implant level and 98.2% on the patient level. No statistically significant differences were observed in the survival rates for SCs (100%), FPDs (98%), and FFDs (100%). The overall mean bone loss was 0.27 ± 0.37 mm (range, 0.00 to 2.55 mm) and was not influenced by the prosthetic reconstruction. CONCLUSION: Immediate loading of fluoride-modified implants in the maxilla is a predictable and reliable treatment option with high survival rates and limited peri-implant bone loss after 2 years. No statistically significant differences were found between implants supporting SCs, FPDs, and FFDs.

Does the presence of anterior mandibular teeth increase the incidence of denture stomatitis?

PURPOSE: To compare the frequency of denture stomatitis (DS) under maxillary complete dentures (CDs) in patients with opposing mandibular distal extension removable partial dentures (RPDs) and CDs. MATERIALS AND METHODS: Participants included 365 maxillary CD wearers (241 women, mean age 70.5 ± 13.2 years; 124 men, mean age 71.5 ± 10.4 years) from 7 rest homes in Istanbul. A total of 268 had mandibular CDs; 97 had mandibular distal extension RPDs. Two independent, calibrated examiners performed oral examinations. Presence of maxillary denture-related stomatitis and the effect of risk factors on DS were evaluated and recorded. RESULTS: The frequency of palatal DS (Newton I-III) was 45.1% (n = 121) in the mandibular CD group and 49.5% (n = 48) in the mandibular distal extension RPD group, a statistically insignificant difference (p= 0.4). Factors significantly associated with palatal DS were maxillary denture age (p= 0.02), reduced occlusal vertical dimension (p= 0.04), and nocturnal denture wear (p= 0.03). CONCLUSION: In this study, DS beneath maxillary CDs did not differ between mandibular distal extension RPD and CD wearers. The presence of mandibular anterior teeth did not influence the occurrence of palatal DS.

Influence of two functional complete-denture impression techniques on patient satisfaction: dentist-manipulated versus patient-manipulated.

This preliminary clinical study aimed to identify the impact of two border-molding techniques (dentist-manipulated and patient-manipulated) on patient satisfaction, the occlusal force at denture dislodgment, and number of pressure sores. Salivary flow rate and residual ridge resorption were analyzed as covariates. Thirty-six edentulous patients in need of a relining of their existing maxillary denture were included. After relining, no significant influence of the border-molding technique on any of the variables investigated could be identified. It can be concluded that the impact of the border-molding technique on patient satisfaction and denture function probably has been overestimated in the past.

Denture stomatitis treated with photodynamic therapy: five cases.

OBJECTIVE: Photodynamic therapy (PDT) is an effective method for Candida spp. inactivation in vitro and in vivo, but as yet, no clinical trial has been conducted. This report describes 5 cases of denture stomatitis (DS) treated with PDT. STUDY DESIGN: Five subjects with clinical and microbiologic diagnosis of DS were submitted to 6 sessions of PDT 3 times a week for 15 days. In each session, patients' dentures and palates were sprayed with 500 mg/L Photogem, and, after 30 minutes of incubation, irradiated by light-emitting diode light source at 455 nm (37.5 and 122 J/cm(2), respectively). Cultures of Candida spp. from dentures and palates and standard photographs of the palates were taken at baseline (day 0), at the end of the treatment (day 15), and at follow-up time intervals (days 30 and 60). RESULTS: Four patients showed clinical resolution of DS (no inflammation) after PDT sessions, and only 1 subject demonstrated reduction in palatal inflammation. Recurrence of DS was observed in 2 patients during the follow-up period. CONCLUSIONS: PDT appears to be an alternative treatment for DS.

Combination syndrome symptomatology and treatment.

Combination syndrome (CS) is one of the most fascinating oral conditions yet is poorly understood and underappreciated in the literature and clinical practice. This article reviews the most important literature on this subject and analyzes the etiology, symptomatology, diagnosis, and current therapeutic modalities for treatment in an attempt to better understand CS. The syndrome represents an example ofa complex pathologic condition of the entire stomatognathic system with a multitude of hard-tissue, soft-tissue, and occlusal changes. These changes, initiated by a certain sequence of events, beginning with a prolonged period of tooth loss, can lead to severe bone atrophy in different regions of the jaws, loss of masticatory function, and the need for complex treatment. Implant rehabilitation of these patients in a preventative approach with cooperation of the entire dental team is emphasized.

Inflammatory papillary hyperplasia of the palate: quantitative analysis of candida albicans and its negative correlation with microscopic and demographic aspects.

Inflammatory papillary hyperplasia of the palate (IPHP) is a tissue-reactive overgrowth characterized by hyperemic mucosa with nodular or papillary appearance in the palate. The exact pathogenesis is still unclear. In this study, the presence of Candida albicans in the epithelial lining was evaluated using the indirect immunofluorescence staining technique. Strongly stained C albicans was observed only in the lesions of the IPHP group. Therefore, the detection of C albicans in almost all samples from IPHP tissue enabled a suggestion as to the microbial etiology of the disease, since the use of dental prostheses was reported.

Viscoelasticity of human oral mucosa: implications for masticatory biomechanics.

The dynamic behavior of oral soft tissues supporting removable prostheses is not well understood. We hypothesized that the stress and strain of the mucosa exhibited time-dependent behavior under masticatory loadings. Displacement of the mucosa on the maxillary residual ridge was measured in vivo by means of a magnetic actuator/sensor under vertical loading in partially edentulous individuals. Subject-specific finite element models of homogeneous bone and mucosa were constructed based on computed tomography images. A mean initial elastic modulus of 8.0 × 10(-5) GPa and relaxation time of 494 sec were obtained from the curve adaptation of the finite element output to the in vivo time-displacement relationship. Delayed increase of the maximum compressive strain on the surface of the mucosa was observed under sustained load, while the maximum strain inside the mucosa was relatively low and uninfluenced by the duration of the load. The compressive stress showed a slight decrease with sustained load, due to stress relaxation of the mucosa. On simulation of cyclic load, the increment of the maximum strain and the evidence of residual strain were revealed after each loading. The results support our hypothesis, and suggest that sustained and repetitive loads accumulate as surface strain on the mucosa.

[Only a denture sore? Causes of a possible denture sore from a maxillary complete denture]. / Nur eine Prothesendruckstelle? Ursachen einer möglichen Prothesendruckstelle bei Totalprothesen im Oberkiefer.

This case presentation documents the treatment sequence of a 74 years old patient who complained about a sore spot of the palatal mucosa underneath the complete denture. The intraoral examination revealed a dark spot, redness and swelling of the mucosa around this spot and halitosis. The mucosa exhibited a perforation of 3 x 10 mm in diameter. A radiographic 3-D picture showed an impacted canine tooth, which was partly covered by the palatal bone. Firstly the denture base was relieved and the swelling gradually disappeared. Then a biopsy was taken for histological analysis to exclude any malignant process. In local anesthesia the tooth was extracted, which exhibited a deep carious lesion of the entire crown. After surgery a visible collapse of the jaw crest was observed. During a period of two months the denture was relined with a soft material to improve its fit and to enhance the healing process. With a final rebasement, the existing denture could be adapted again and the patient continued to wear it.

Oromandibular dystonia following dental treatment: case reports and discussion.

Oromandibular dystonia (OMD) is a movement disorder characterised by involuntary, repetitive, and patterned muscle contractions of varying severity, affecting the jaws, tongue, face, and pharynx. It is most commonly idiopathic or medication-induced, but peripheral trauma sometimes precedes the condition. There have been several reports of OMD following dental treatment, and this paper discusses two cases which occurred following extractions and full dentures.

Bone resorption processes in patients wearing overdentures. A 6-years retrospective study.

OBJECTIVES: 1. - To measure the alveolar resorption processes that occur in patients wearing mandibular overdentures on 2 implants and fully-removable maxillary dentures, and to evaluate the same process on patients wearing fully-removable dentures on both arches. 2.- To verify whether Kelly's Combination Syndrome occurs in the group of patients wearing overdentures. METHOD AND MATERIAL: Forty patients were evaluated, of which a "cases" group was formed by 25 patients wearing mandibular overdentures on 2 lower jaw implants and fully-removable dentures on the opposite arch. The other 15 patients formed a control group that wore fully-removable dentures on both arches. Each one of the patients underwent orthopantograms from the moment the dentures were inserted until an average of 6 years later, which were assessed based on the Xie et al. method to estimate vertical bone loss. Once the data was collected, it was subjected to statistical analysis. RESULTS: In terms of the maxillary midline, we observed a greater loss in patients wearing overdentures, which was statistically significant, as it registered 0.32 mm/year. Mandibular bone loss was 2.5 times less in patients in the cases group. The rest of the clinical criteria for Kelly's Combination Syndrome were not observed. CONCLUSIONS: Kelly's Combination Syndrome did not occur in the patients in the cases group. In spite of the greater bone loss on a premaxillary level in this group, the placing of the overdenture on the implants significantly reduced mandibular bone resorption.

Bone resorption processes in patients wearing overdentures. A 6-years retrospective study

Objectives: 1. – To measure the alveolar resorption processes that occur in patients wearing mandibular overdentures on 2 implants and fully-removable maxillary dentures, and to evaluate the same process on patients wearing fully- removable dentures on both arches. 2.- To verify whether Kelly’s Combination Syndrome occurs in the group of patients wearing overdentures. Method and Material: Forty patients were evaluated, of which a “cases” group was formed by 25 patients wearing mandibular overdentures on 2 lower jaw implants and fully-removable dentures on the opposite arch. The other 15 patients formed a control group that wore fully-removable dentures on both arches. Each one of the patients underwent orthopantograms from the moment the dentures were inserted until an average of 6 years later, which were assessed based on the Xie et al. method to estimate vertical bone loss. Once the data was collected, it was subjected to statistical analysis. Results: In terms of the maxillary midline, we observed a greater loss in patients wearing overdentures, which was statistically significant, as it registered 0.32 mm/year. Mandibular bone loss was 2.5 times less in patients in the cases group. The rest of the clinical criteria for Kelly’s Combination Syndrome were not observed.
Conclusions: Kelly’s Combination Syndrome did not occur in the patients in the cases group. In spite of the greater bone loss on a premaxillary level in this group, the placing of the overdenture on the implants significantly reduced mandibular bone resorption (AU)