The International Journal of Prosthodontics, 02/2012

Purpose: The aim of this systematic review was to analyze the evidence on the occurrence of denture stomatitis (DS) and potential risk factors in patients wearing partial removable dental prostheses (RDPs). Materials and Methods: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews were searched and complemented by manual searching. Outcome measures were the presence of DS in patients wearing partial RDPs and an assessment of associated risk factors. All types of experimental and observational studies investigating an association between DS and the wearing of partial RDPs were included. Methodologic quality and level of evidence were assessed using valid scales. Two authors performed study selection, data extraction, and quality assessment independently. Results: A total of eight studies met the inclusion criteria. The prevalence of DS in partial RDP wearers ranged from 1.1% to 36.7%. Data on the potential risk factors were not consistent. Despite the heterogeneity and methodologic quality of included studies, an association between DS and the wearing of partial RDPs was found. Conclusions: There is some evidence that the presence of DS is associated with the wearing of partial RDPs. However, because of methodologic limitations and cross-sectional designs of research studies, no cause-effect relationship could be inferred. Future research should provide higher levels of evidence to confirm the etiology of DS in partial RDP wearers.

Purpose: The aim of this study was to compare sensitivity differences and interpretative agreement for magnetic resonance imaging (MRI) and computed axiography (CA) tracings in a patient population group with temporomandibular disorder (TMD). Materials and Methods: A convenience sample of 173 patients (53 men, 120 women; mean age: 33.2 ± 2.6 years) diagnosed with TMD was selected for this study. Each patient underwent an evaluation as per the European Academy of Craniomandibular Disorders clinical form as well as MRI and CA. Results: Use of the MRI results as the gold standard for the planned comparison led to the following observations: a CA sensitivity of 68% for joints without morphologic changes (so-called normal temporomandibular joints [TMJs]), sensitivity of 27% for those with disc displacement, and sensitivity of 8% for those with osteoarthritis. The kappa index, or agreement between the two examination methods, was weak for normal TMJs (0.16), acceptable for anterior disc displacement with reduction (0.28), little for anterior disc displacement without reduction (0.10), and very little for morphologic alterations (0.01). Conclusion: The sensitivity and agreement of the two examination methods was generally low. It was even worse when pathologic changes in the TMJ were more severe. MRI and CA are different examinations that could both be considered for severe TMD diagnosis.

Purpose: The aim of this study was to evaluate the influence of complete or partial removable dental prostheses (RDPs) on the frequency of Candida albicans isolated from the mouth and the presence of oral candidiasis in human immunodeficiency virus-positive (HIV+) patients correlated with CD4 levels. Materials and Methods: One hundred ninety-three HIV+ patients were evaluated; 68 had RDPs and 125 did not. CD4 cell count was obtained after blood sampling and performed on the day of clinical examination. The material was collected from the buccal mucosa for isolation of yeasts with a sterile swab and seeded onto Sabouraud dextrose agar with chloramphenicol. C albicans strains were identified by testing germ tubes and chlamydospore formation and biochemical (zymogram, auxanogram) characteristics. The results were subjected to the Fischer exact test and chi-square tests. Results: C albicans were isolated from 45 (66.17%) patients who had RDPs and 48 (38.4%) who did not (P = .0003). The presence of oral candidiasis was observed in 14 patients (7.25%), and 10 of the 14 (71.43%) were RDP users. The absence of candidiasis occurred in 121 (67.59%) nonusers and 58 (32.40%) users of RDPs (P = .0065). The mean CD4 cell count was lower in patients with oral candidiasis regardless of the use of RDPs. Conclusion: The use of RDPs was an important factor in the isolation of C albicans among HIV+ patients, and CD4 level seems to play a role in the presence of oral candidiasis.

The aim of this study was to compare quantitatively the masticatory performance of patients with overdentures supported by two implants, conventional complete dentures, and natural dentitions. Each patient was asked to chew a gelatin cube. The collected remains of the test food (gelatine cube) were fractioned by a sieving procedure and weighed. Maximum mouth opening and masticatory area were measured using kinesiography. There were statistically significant differences among groups with respect to masticatory performance using a 3.15-mm-diameter sieve (P .001) and 0.5-mm-diameter sieve (P .001), masticatory area (P = .019), and maximum mouth opening (P .001). Increasing retention of a mandibular complete denture with two implants improved masticatory performance.

Purpose: This retrospective study investigated the survival rate of 174 clasp-retained removable partial dentures (CR-RPDs) made at the Department of Prosthodontics of the Regensburg University Medical Center over a 25-year period (1984 to 2009). Materials and Methods: The study analyzed the frequency of and time to the fracture of clasps, connectors, or denture bases; the occurrence of caries or periodontal lesions; the loss of abutment teeth; and the necessity of maintenance procedures such as relining or treatment of pressure areas. Results: The median follow-up time of 3 years was calculated using the inverse Kaplan-Meier method. The 5-year survival rate (time to renewal) of all CR-RPDs was 96.4%; the 10-year survival rate was 89.8%. Fractures most frequently occurred in clasps (n = 28, 16.1%) followed by major connectors (n = 9, 5.1%) and minor connectors (n = 6, 3.4%). The 5-year event-free rate for clasp fracture was 80.4%; the 10-year event-free rate was 76.9%. Caries lesions on abutment teeth were seen in 31.6% of patients, and 35.6% showed inflammation of the periodontal tissue surrounding the abutment teeth. The 5-year event-free rate for caries was 58.4%; the 10-year rate was 39.6%. A frequent complication was loss of abutment teeth (n = 15), but this complication was not age-dependent. After insertion of their prostheses, one-third of patients (n = 53, 30.5%) showed pressure areas of the mucosa. Significantly more (P .001) pressure areas were caused by prostheses of the mandible (39.6%) than by those of the maxilla (12.5%). Conclusions: CR-RPDs showed a survival rate of approximately 90% after 10 years of oral service. The predominant complications during oral service were caries lesions, loss of abutment teeth, and fracture of clasps.

This study investigated factors associated with perceptions of complete dentures (CDs) among patients presenting at a university dental clinic. A retrospective chart review of all new edentulous patients presenting at the Athens University School of Dentistry Removable Prosthodontics Clinic between 1993 and 2002 (n = 2,526) was completed. More than half of CD-wearing patients were dissatisfied with their dentures at the initial visit. Dissatisfaction was correlated with current use of denture adhesives and less time spent edentulous and was more prevalent among females. Factors affecting patients' adaptation to and satisfaction with CDs should be considered at CD fabrication and follow-up.

Purpose: This report aimed to compare prosthetic aspects and patient satisfaction during a 3-year randomized clinical trial of bar- and implant-retained mandibular overdentures attached with either resilient liners or clips. Materials and Methods: Thirty edentulous male patients (mean age: 62.5 years) received two implants in the anterior mandible after being allocated into two equal groups (according to attachment type received) using balanced randomization. After 3 months, implants were connected with resilient bars. New maxillary complete dentures were then constructed, and mandibular overdentures were retained to the bars with either clips (group I) or silicone resilient liners (group II). Subjects indicated satisfaction with their prostheses using a questionnaire and visual analog scale. Patient satisfaction and prosthetic complications were recorded for both attachments at 6 months and 1 and 3 years after overdenture insertion. Results: Comfort and stability with the maxillary denture and ease of hygiene procedures were rated higher in group II, while ease of handling the dentures was rated higher in group I. No significant differences in other parameters of patient satisfaction between groups were noted after 3 years. The mean number of prosthetic adjustments and repairs in group I (11.9) was significantly higher (P = .00) compared to that in group II (4.8). The most common complication in group I was clip wear, while separation of the resilient liner from the denture base was the most common problem in group II. Hyperplasia under the bar and flabby ridge in the maxilla occurred significantly more often in group I compared to group II. Conclusions: Resilient liner-retained mandibular overdentures had comparable patient satisfaction, less prosthetic maintenance and costs, and less soft tissue complications when compared to clip-retained ones after 3 years.

The aim of this study was to evaluate the efficacy of experimental toothpastes for removing denture biofilm by means of a randomized crossover trial. Thirty volunteers brushed their dentures using a brush and four pastes: (1) Corega refreshing mint (control), (2) 0.2% chloramine T, (3) 1.0% chloramine T, and (4) 0.01% fluorosurfactant. Each paste was used for 7 days, and participants were randomized to use them according to one of four sequences. Biofilm was disclosed (neutral red) after each period, photographed, and quantified by means of a software program. All experimental toothpastes were similar to the control in terms of posttreatment biofilm coverage.

Purpose: Patients with hemifacial microsomia may have a missing ear on the deficient side of the face. The fabrication of an ear for such individuals usually has been accomplished by directly measuring the ear on the normal side to construct a prosthesis based on these dimensions, and the positioning has been, to a large extent, primarily operator-dependent. The aim of the present study was to compare three methods, developed from the identification of landmarks plotted on three-dimensional surface scans, to evaluate the position of an artificial ear on the deficient side of the face compared with the position of the natural ear on the normally developed side. Materials and Methods: Laser scans were undertaken of the faces of 14 subjects with hemifacial microsomia. Landmarks on the ear and face on the normal side were identified. Three methods of mirroring the normal ear on the deficient side of the face were investigated, which used either facial landmarks from the orbital area or a zero reference point generated from the intersection of three orthogonal planes on a frame of reference. To assess the methods, landmarks were identified on the ear situated on the normal side as well as on the face. These landmarks yielded paired dimensional measurements that could be compared between the normal and deficient sides. Mean differences and 95% confidence intervals were calculated. Results: It was possible to mirror the normal ear image on to the deficient side of the face using all three methods. Generally only small differences between the dimensional measurements on the normal and deficient sides were observed. However, two-way analysis of variance revealed statistically significant differences between the three methods (P = .005). Conclusions: The method of mirroring using the outer canthi was found to result in the smallest dimensional differences between the anthropometric points on the ear and face between the normally developed and deficient sides. However, the effects of the deformity can result in limitations in relation to achieving a precise alignment of the ear to the facial tissues. This requires further study.

The aim of this study was to quantify the strain development of screw-retained three-unit implant-supported Procera Implant Bridge restorations. Two groups of screw-retained implant-supported restorations (n = 10) were fabricated by means of casting or computer-aided design/computer-assisted manufacture (CAD/CAM) to fit an in vitro cast situation with two implants. During fixation of the restorations, the emerging strains were recorded using strain gauges attached to the cast material mesially and distally adjacent to the implants. Absolute mean strain development ranged from 29.35 µm/m to 2,665.80 µm/m at the different strain gauge locations. Fabrication method had a significant effect on strain development (multivariate analysis of variance, P = .000), with the cast restorations showing significantly higher strain levels compared to the CAD/CAM-fabricated superstructures. CAD/CAM fabrication of screw-retained implant-supported restorations provides greater passivity of fit compared to conventional fabrication methods such as casting.

This study evaluated the influence of two preparation types on the marginal fit of computer-aided design/computer-assisted manufacture (CAD/CAM) alumina copings. Two subgroups of four alumina copings each were fabricated using alumina master dies with either a chamfer or 90-degree shoulder preparation. Copings were scanned with an x-ray microtomographic scanner, and marginal fit was evaluated. The preparation types presented no statistically significant differences regarding marginal gap (P = .410) and absolute marginal discrepancy (P = .229). No correlation was found between marginal fit of CAD/CAM alumina copings and preparation type. Marginal fit could be considered within the limits of clinical acceptance.

Purpose: The aims of this study were to investigate the prevalence of tooth loss in Greek individuals aged 35 to 44 and 65 to 74 years in relation to sociodemographic parameters and to describe their prosthetic status and needs. Materials and Methods: A stratified cluster sample of 1,188 middle-aged adults and 1,093 senior citizens was selected according to World Health Organization (WHO) guidelines for national pathfinder surveys. Tooth loss and prosthetic status and needs were recorded according to WHO criteria. Sociodemographic data were collected through face-to-face interviews. Results: Complete edentulism affected 0.3% of individuals aged 35 to 44 years and 31.5% of those aged 65 to 74 years. Most middle-aged adults (92.1%) had >= 21 natural teeth, while the corresponding percentage for the senior citizens was 23.1%. The mean number of missing teeth was 5.2 in middle-aged adults and 21.6 in senior citizens. The multivariate analysis showed that education level was the only predictor of tooth loss in both age groups. Approximately 38% of those aged 35 to 44 years and 80% of those aged 65 to 74 years had dental prostheses, while 47.6% of middle-aged adults and 66.3% of senior citizens did not need any prosthetic treatment. The need for complete dentures was relatively low in both age groups. Comparisons of the present results with those of 1985 indicate that the dentate status of Greek adults aged 35 to 44 years has not improved. Furthermore, the prevalence of tooth loss in the elderly population was high compared with internationally reported findings. Conclusion: The replacement of missing teeth with fixed or removable prostheses will continue to be common in Greece for the foreseeable future.

Throughout the 1980s and '90s, a small core group of clinical scholars played a major and pivotal role in the combined surgical and prosthodontic dissemination of osseointegration scholarship. As professor of oromaxillofacial surgery at the University of Washington, Dr Philip Worthington was one such pioneering educator. His academic leadership was acknowledged via numerous academic honors and tributes, including his recent postretirement recognition as distinguished professor at his university. This invited paper is a personal assessment of the impact of clinical changes ushered in by the osseointegration technique and was recently presented at the University of Washington's unique celebratory tribute to Professor Worthington.