The International Journal of Prosthodontics, 03/2006

Purpose: To investigate the optimization of multidisciplinary and interdisciplinary oral health care through the introduction of pathways. Materials and Methods: A prospective randomized clinical trial was carried out in a tertiary referral academic institution. Ninety-one patients admitted for multidisciplinary oral health care from January 1, 2001, to March 31, 2003, were randomized to the test group (n = 50) or to the control group (n = 41). Pathways were implemented by means of the Medical Patient Management program, a computerized planning and coordination system specifically developed for a population with multidisciplinary oral rehabilitation needs. The efficiency of pathways in interdisciplinary oral health care was assessed. Results: Statistically significant differences between test and control groups were found for variables regarding the process of care, such as "number of planned versus actual disciplines," "length of planned versus actual treatment," and "average length of a treatment session." For variables regarding patient satisfaction, significant differences between test and control groups were found for questions regarding patient involvement with the treatment and patient satisfaction with the outcome of multidisciplinary treatment. Regarding practitioner satisfaction, the results of the questionnaire indicate that implementation of pathways into everyday clinical practice is desired but remains difficult. Conclusion: The findings of this study show that the implementation of pathways in multidisciplinary oral health care improved some aspects of the process of care and increased patient satisfaction. The predictive capability of the Medical Patient Management program in managing oral health care has been demonstrated

Purpose: In the present cohort study, overdentures with a combined root and implant support were evaluated and compared with either exclusively root- or implant-supported overdentures. Results of a 2-year follow-up period are reported, namely survival of implants, root copings, and prostheses, plus prosthetic complications, maintenance service, and patient satisfaction. Materials and Methods: Fourteen patients were selected for the combined overdenture therapy and were compared with 2 patient groups in which either roots or implants provided overdenture support. Altogether, 14, 17, and 15 patients (in groups 1, 2, and 3, respectively) were matched with regard to age, sex, treatment time, and observation period. The mean age was around 67 years. Periodontal parameters were recorded, radiographs were taken, and all complications and failures were registered during the entire observation time. The patients answered a 9-item questionnaire by means of a visual analogue scale (VAS). Results: One implant failed and 1 tooth root was removed following longitudinal root fracture. Periodontal/peri-implant parameters gave evidence of good oral hygiene for roots and implants, and slight crestal bone resorption was measured for both. Technical complications and service performed were significantly higher in the first year (P .04) in all 3 groups and significantly higher in the tooth root group (P .03). The results of the VAS indicated significantly lower scores for satisfaction, speaking ability, wearing comfort, and denture stability with combined or exclusive root support (P .05 and .02, respectively). Initial costs of overdentures with combined or root support were 10% lower than for implant overdentures. Conclusion: The concept of combined root and implant support can be integrated into treatment planning and overdenture design for patients with a highly reduced dentition

Purpose: To investigate 6 dental statuses as risk factors for malnutrition in geriatric patients admitted to a convalescent and rehabilitation hospital. Materials and Methods: One hundred twenty (59 men and 61 women) geriatric patients admitted to a convalescent and rehabilitation hospital were recruited. Three biochemical and hematologic parameters (albumin, hemoglobin, and lymphocyte count) were used for analysis. Malnutrition was defined as Body Mass Index (BMI) below 18.5 and albumin level under 35 g/L. The number of natural or prosthetic teeth in the dentate patients, and the presence of one or both dentures in the edentate patients, were recorded. Risk factors associated with malnutrition were investigated, namely: (1) edentulism among all patients, (2) edentulism without a set of complete dentures among all patients, (3) edentulism without a set of complete dentures among the edentate patients, (4) decreased number ( 6) of occluding pairs of natural or prosthetic teeth among the dentate patients, (5) decreased number ( 5) of posterior occluding pairs of natural or prosthetic teeth among the dentate patients, and (6) absence of posterior occluding pairs of natural or prosthetic teeth among the dentate patients. One-way ANOVA and Bonferroni multiple comparisons were used to determine if significant differences in the anthropometric, biochemical, and hematologic parameters existed between the patients with different dental statuses. The odds ratio and significance of 6 dental statuses as risk factors of malnutrition were calculated (P = .05). Results: BMI, albumin, and hemoglobin levels of the malnourished patients were significantly lower than those of nourished patients (P .05). Lymphocyte count was not significantly different between the 2 patient groups (P > .05). The status of edentate patients without a set of complete dentures compared with other edentate and dentate patients was the only independent risk factor (P .05) in the 6 statuses studied. Conclusion: Primary healthcare workers caring for hospitalized geriatric patients should identify edentate patients without a set of complete dentures for the possibility of malnutrition

Purpose: This study aimed to investigate the release of nickel, copper, zinc, cadmium, magnesium, and lead from prosthodontic base metal alloys into protein-containing biologic solutions. Materials and Methods: Dissolution experiments were conducted in either 3% Dulbecco's Modified Eagle Medium or 3% bovine serum albumin solutions for 7 weeks. Results: The protein-containing dissolution solutions and dissolution time did not have a significant effect on release of elements from the alloys (Kruskal-Wallis, P > .05). Conclusions: The amount of the released elements was well below the dietary intake levels of these elements. This study is important given the widespread use of the base metal alloys and the continuing public concerns/questions regarding the health benefits/risks associated with these materials.

Purpose: Eating, which includes chewing and swallowing, is an oral function that influences quality of life. Though the swallowing ability of maxillectomy patients was reported in our previous study, the chewing function has not been fully reported to date. Thus, the purpose of this study was to evaluate the chewing function of obturator prosthesis wearers by measurement of masticatory performance and occlusal force. The relationship of these 2 measurements was also investigated. Materials and Methods: Twenty maxillofacial obturator prosthesis wearers undergoing periodic checkup at the maxillofacial rehabilitation clinic in Kyushu University Hospital were recruited for this study. Additionally, 20 young, healthy individuals were recruited as controls. Data on masticatory performance, which was measured by a sieve method using hydrocolloid material, and maximum occlusal force, which was measured by the Dental Prescale System (Fuji Film), were obtained for each participant. Results: The mean of masticatory performance was 2.6 (SD 1.2) on a 1.40-mm mesh. There was no significant difference in masticatory performance between the patient group and the controls. The mean maximum occlusal force of the patient group was 625.9 N (SD 299.1 N), which was significantly lower than that of the control group. There was no significant correlation between masticatory performance and maximum occlusal force for the patient group in this study (P = .3726). Conclusion: Masticatory performance of obturator prosthesis wearers with dentate or partially edentulous maxillae was not different from that of young, healthy individuals, though maximum occlusal force of these patients was lower than that of controls.

Purpose: This paper is the first in a series that aims to identify the specification requirements for advanced digital technologies that may be used to design and fabricate complex, soft tissue facial prostheses. Materials and Methods: Following a review of previously reported techniques, appropriate and currently available technologies were selected and applied in a pilot study. This study uses a range of optical surface scanning, computerized tomography, computer-aided design, and rapid prototyping technologies to capture, design, and fabricate a bone-anchored auricular prosthesis, including the retentive components. The techniques are assessed in terms of their effectiveness, and the results are used to identify future research and specification requirements to direct developments. Results: The case study identifies that while digital technologies may be used to design implant-retained facial prostheses, many limitations need to be addressed to make the techniques clinically viable. It also identifies the need to develop a more robust specification that covers areas such as resolution, accuracy, materials, and design, against which potential technologies may be assessed. Conclusion: There is a need to develop a specification against which potential technologies may be assessed for their suitability in soft tissue facial prosthetics. The specification will be developed using further experimental research studies

Purpose: This study aimed to assess the dimensional alterations in the anterior region of the orbit after enucleation or evisceration. Materials and Methods: Analysis of orbital areas and perimeters of 17 patients with unilateral removal of the ocular bulb was performed, and posteroanterior radiographic examination was carried out by a single specialist, who had been previously calibrated. Results: Data obtained from measurements confirmed the clinically observed facial asymmetry. Conclusion: The observation of asymmetry in the anterior orbital area, confirmed by our results, indicates early treatment to prevent orbital disturbances and will aid in the planning of prosthetic rehabilitation

Purpose: Although patients with temporomandibular disorders (TMD) often report impaired eating, the features of food intake difficulty have rarely been estimated. This study compared subjective difficulty in 4 categories of food intake situations among 3 subgroups of TMD patients. Materials and Methods: A total of 511 TMD patients (402 women, 109 men, mean age 36.4 ± 15.4, range 12 to 82) participated in this study. Subjects were divided into 3 TMD subgroups: myofascial pain (MFP), disc displacement with/without reduction (DD), and arthralgia or osteoarthritis (Arth). Patients' level of food intake difficulty was assessed using a visual analogue scale (VAS) for 4 categories of food intake situations: difficulty in putting food into mouth (PUT), difficulty in biting off foods (BIT), difficulty in grinding down foods (GRD), and overall difficulty in consuming a meal (OAL). Results: Nearly all patients (98.6%) exhibited food intake difficulty in at least 1 category. In the category of PUT, the DD group exhibited significantly more difficulty than the MFP and Arth groups (P .048), and the Arth group had a higher VAS score than the MFP group (P = .030). With regard to BIT and GRD, there was no significant difference among the TMD subgroups. In OAL, the DD group showed more difficulty than the MFP group (P = .046). Conclusion: TMD patients experienced impaired food intake ability. In particular, the DD group experienced more difficulty than the MFP group. Concerns about types of food and food intake behavior for each TMD subtype should be taken into account in the management of TMD patients.

Purpose: This 10-year prospective, randomized, clinical trial investigated the treatment outcome of edentulous patients treated with mandibular overdentures retained by 2 endosseous implants compared with conventional dentures in patients with or without vestibuloplasty. Materials and Methods: One hundred fifty-one edentulous patients (5 groups) with a symphyseal mandibular bone height between 8 and 25 mm participated. Sixty-two patients were treated with an overdenture retained by 2 implants (groups 1 and 3), 59 patients were treated with a conventional denture (groups 2 and 5), and 30 patients were treated with a conventional denture after preprosthetic vestibuloplasty (group 4). Patients who received conventional dentures but preferred implants later on could undergo implant surgery after 1 year of their initial treatment, but were analyzed in their original group. The prosthetic and surgical care and aftercare were scored during a 10-year evaluation period. Results: One hundred thirty-three patients completed the 10-year follow-up evaluations. Forty-four percent of patients treated with conventional dentures switched within 10 years to implant-retained overdentures, versus 16% of the patients who were treated with conventional dentures after vestibuloplasty. On average, a greater time investment and more treatment sessions were needed in patients treated with implant-retained overdentures compared to patients treated with conventional dentures. Conclusion: Patients treated with an implant-retained overdenture need more treatment interventions and treatment time than patients treated with conventional dentures.

Purpose: To assess the angles between craniofacial planes and the gravity horizontal plane (GHP). Materials and Methods: The plumb line was hung from the ceiling, the Fox plane (FoxP) was placed in the mouth, and 56 Angle Class I subjects were photographed in a natural head position. FoxP represents the extraoral view of the occlusal plane. Results: In frontal view, bipupilar plane (BP) and occlusal plane (FoxP) were almost parallel to GHP. In lateral view, FoxP was almost parallel to GHP, but Frankfort horizontal plane (FHP) and Camper's plane (CP) were not. FoxP and CP were not parallel. Conclusion: CP is not a reliable landmark for occlusal plane reconstruction. FHP does not represent GHP.

Purpose: To evaluate the effect of 2 postpolymerization treatments on toothbrushing wear (weight loss) and surface roughness of 3 autopolymerized reline resins-Duraliner II (D) (Reliance Dental), Kooliner (K) (Coe Laboratories), and Tokuso Rebase Fast (T) (Tokuyama Dental)-and 1 heat-polymerized resin, Lucitone 550 (L) (Dentsply International). Materials and Methods: Specimens (40 3 10 3 2mm) of each material (n = 24) were prepared and divided into 3 groups: control (no postpolymerization treatment); water bath (immersion in water at 55°C); and microwave (microwave irradiation). Specimens were dried until constant weight was achieved and the surface roughness (Ra) was measured. Tests were performed in a toothbrush machine using 20,000 strokes of brushing at a weight of 200 g, with the specimens immersed in 1:1 dentifrice/water slurry. Specimens were reconditioned to constant weight and the weight loss (mg) and surface roughness were evaluated. Data were analyzed by 2-way analysis of variance and followed by Tukey test (a = .05). Results: In the control group, the weight loss of materials D and T was lower (P .05) than that of L. No differences among materials were found after postpolymerization treatments (P > .05). The weight loss of material T (control = 0.5 mg) was significantly increased (P .05) after postpolymerization treatments (water bath = 1.9 mg; microwave = 1.8 mg). For materials K and T, the toothbrushed surface roughness was higher (P .05) after microwave and waterbath postpolymerization treatments. Material L showed increased surface roughness after microwave postpolymerization treatment. Conclusion: The toothbrushing wear resistance of L was not superior to the reline resins. The postpolymerization treatments did not improve the toothbrushing wear resistance of the materials and produced an increased surface roughness for materials L, K, and T

Purpose: The purpose of this study was to evaluate the effectiveness of microwave irradiation on the disinfection of simulated complete dentures. Materials and Methods: Eighty dentures were fabricated in a standardized procedure and subjected to ethylene oxide sterilization. The dentures were individually inoculated (10⁷ cfu/mL) with tryptic soy broth (TSB) media containing one of the tested microorganisms (Candida albicans, Streptoccus aureus, Bacillus subtilis, and Pseudomonas aeruginosa). After 48 hours of incubation at 37oC, 40 dentures were individually immersed in 200 mL of water and submitted to microwave irradiation at 650 W for 6 minutes. Forty nonirradiated dentures were used as positive controls. Replicate aliquots (25 µL) of suspensions were plated at dilutions of 10-3 to 10-6 on plates of selective media appropriate for each organism. All plates were incubated at 37oC for 48 hours. TSB beakers with the microwaved dentures were incubated at 37oC for 7 more days. After incubation, the number of colony-forming units was counted and the data were statistically analyzed by Kruskal-Wallis test (α = .05). Results: No evidence of growth was observed at 48 hours for S aureus, B subtilis, and C albicans. Dentures contaminated with P aeruginosa showed small growth on 2 plates. After 7 days incubation at 37˚C, no growth was visible in the TSB beakers of S aureus and C albicans. Turbidity was observed in 3 broth beakers, 2 from P aeruginosa and 1 from B subtilis. Conclusion: Microwave irradiation for 6 minutes at 650 W produced sterilization of complete dentures contaminated with S aureus and C albicans and disinfection of those contaminated with P aeruginosa and B subtilis.

Purpose: The purpose of this study was to determine denture cleanliness of a population sample, as well as to investigate denture cleaning habits and attitudes. Materials and Methods: Two hundred thirty-four denture-wearing patients were surveyed via a questionnaire to identify types and frequency of use of denture cleaning methods. Patients were also clinically examined to determine denture cleanliness. Dentures were classified as clean, dirty, or extremely dirty based on the level of debris and stain present. The oral mucosa was also examined and rated. Results: The most common regimen employed was brushing with toothpaste (40.59% of patients), while only 1 patient reported soaking the denture in mouthwash. Results showed that 38.9% of patients were not satisfied with their cleansing methods, and 82.9% of patients claimed their dentists did not inform them how to clean their dentures. Only 11.9% of patients had clean dentures. Older dentures tended to be dirtier than newer ones (P = .0001) and had a higher incidence rate of accompanying denture stomatitis (P = .0001). Conclusion: In this population sample, most denture wearers did not clean their dentures satisfactorily.