THE PROSTHODONTIC TREATMENT OF THE MANDIBLE EDENTULOUSNESS. CLINICAL CASE

The article presents a clinical case of the prosthodontic treatment of the mandible edentulousness. Edentulousness is a widespread pathology that depends on the social and economic situation in the country, the demographic situation, the level of dental care and prevention organization. The current worldwide trend of population aging leads to an increase in the number of the elderly, and this number is expected to increase in the future. According to the WHO, today about 600 million people are people over 60, and this number will have doubled by 2030 and will constitute 2 billion in 2050 mostly in developed countries. The situation in Ukraine is not better. Functional and aesthetic rehabilitation of patients with edentulousness requires a comprehensive approach to the prosthodontic treatment planning. Complete removable laminar dentures on the mandible have a number of disadvantages. Insufficient fixation, stabilization, diction problems, aesthetic problems, decreased self-esteem of the patient are among the key ones. Modern protocols of the prosthodontic treatment require the manufacture of dental prostheses based on intraosseous dental implants. Complete dentures based on intraosseous dental implants have a number of advantages over the fixed dentures. Compensation for deficient bone support of the facial soft tissues occurs by means of the basis. Patients’ possibility to remove a secondary restoration by themselves lead to proper hygiene of the oral cavity and peri-implant area in particular. The clinical research conducted by S. Wolfart (2016) showed the possibility of fixed/removable dental prosthesis fixation in 14-31 days (early loading) after the surgical stage of implantation provided that 4-6 intraosseous dental implants were installed. The maximum mobilization of the patient to comply with the recommendations and prescriptions is the main task considering the limited postoperative period before the dental prosthesis fixation. Our publication describes the treatment of a patient born in 1967, who was diagnosed with a mandible complete absence of teeth. Diagnosis, examination and treatment were performed on the basis of the Department of Dentistry Postgraduate Education of Ivano-Frankivsk National Medical University. The described prosthodontic treatment plan involves the manufacture of a complete denture with bar system based on four intraosseous dental implants according to the early loading protocol in a patient with primary treatment of mandible edentulousness. The choice of treatment plan was based on the results of past medical history, the patient’s disease, basic and additional methods of examination, analysis of individual indications and contraindications and readiness for the selected treatment plan. This treatment protocol has its advantages over the protocol of manufacturing a fixed prosthesis based on intraosseous dental implants such as a higher level of proprioceptive sensations, increased level of hygiene, lower complexity of clinical and laboratory stages, affordability. The term of clinical and laboratory stages of manufacturing (from the surgical stage of implant treatment to the fixation of the dental prosthesis) constituted 16 days. Additional opportunities for success in clinical and laboratory stages of treatment, the accuracy of manufacture and minimization of complications in the future were created as a result of the combination of digital and analog treatment methods in dental prosthesis manufacturing.

“If I have teeth, I can smile.” Experiences with tooth loss and the use of a removable dental prosthesis among people who are partially and completely edentulous in Karnataka, India

Objectives Tooth loss is a phenomenon associated with structural and functional changes, with a negative influence on the oral and general health of an individual. Removable dental prosthesis is commonly fabricated as treatment for tooth loss. However, the perceptions and experiences of individuals during the transition from a dentate to a partially or completely edentulous state and their acceptance of the denture are largely ignored. The objective of this study was to explore the perceptions and experiences during the transition from a dentate state to being partially or completely edentulous in the Indian population. Methods Fifteen individuals wearing partial or complete denture prosthesis were interviewed in depth using open-ended questions. These interviews were recorded using a voice-recording device. They were then transcribed, and a coding process was applied using the thematic framework approach to qualitative analysis. Findings Five themes emerged, namely: (i) Transition from dentulous to partially or completely edentulous state; (ii) Varying experiences with the use of dentures; (iii) Convenience and duration of wearing dentures; (iv) Attitude of dentists towards patients’ complaints; (v) Knowledge and preference of available treatment modalities. Conclusions The loss of natural teeth seemed to affect the psychological, functional, and social well-being of participants. Tooth loss was believed to be a natural aging process. Costs of treatment deterred the uptake of fixed denture treatment options. However, some participants preferred removable dentures to fixed prosthesis.

Hiperplasia Fibrosa Inflamatoria: Reporte de un caso

BACKGROUND: Inflammatory fibrous hyperplasia associated with the use of removable dental prosthesis (IFH) is an adaptive lesion caused by long-term trauma exerted by a poorly adapted removable prosthesis on the oral mucosa, usually in the vestibular sulcus. Its diagnosis and treatment is imperative, due to its potential to cause discomfort to the patient, altering aesthetics, phonectics and chewing. CASE REPORTS: A 41-year-old denture wearer woman was referred due to discomfort in the right lower vestibular sulcus, the clinical examination showed a bilobed enlargement with an invagination where the edge of the prosthesis fits, the patient has worn the prosthesis for 15 years. EVOLUTION: Resection with scalpel (conventional technique) was performed. The histopathological examination reported inflammatory fibrous hyperplasia and a new total removable bimaxillary prosthesis was made for the patient. CONCLUSIONS: HFI is one of the main oral lesions in older adults denture wearers and it causes aesthetic and functional alterations; it is produced by the constant irritation caused by the settlement of the prosthesis borders on the mucovestibular sulcus as a consequence of alveolar resorption. Treatment is meant to eliminate the injury and its etiology; the absence of lesions on the mucosa and the bottom of the sulcus is completely necessary.

RESULTS OF EVALUATION OF ORAL DYSBIOSIS AFTER ORTHOPEDIC TREATMENT WITH REMOVABLE DENTURES

В статье представлен анализ состояния и микробиоциноза слизистой протезного ложа под базисом съемной конструкции зубного протеза. Полость рта человека является индивидуальной экологической системой для разных микроорганизмов, которые формируют постоянную микрофлору. Нормальная микрофлора представляет собой главный критерий здорового состояния ротовой полости и указывает на патологические изменения, определяющие развитие стоматологических заболеваний твердых тканей зубов, тканей пародонта, слизистой оболочки и т.д. и влияния их на развитие патологических процессов. Видовое постоянство оральной микрофлоры включает представителей разных микроорганизмов. Превалируют бактерии анаэробного типа дыхания - стрептококк, лактобациллы, бактероиды, фузобактерии, вейллонеллы и актиномицеты. Кроме перечисленных представителей, встречаются определенного рода спирохеты, микоплазмы и разнообразные простейшие. Бактерии непостоянной микрофлоры полости рта выявляются, в большинстве случаев, в малых количествах и в небольшой промежуток времени. Долгому нахождению и деятельности их в полости рта мешают местные неспецифические факторы защиты - лизоцим слюны, фагоциты, постоянно находящиеся в полости рта лактобациллы и стрептококки, служащие антагонистами некоторых непостоянных обитателей микрофлоры полости рта. К непостоянным микроорганизмам ротовой полости относятся эшерихии, имеющая высокую ферментативную активность, аэробактерии, выступающие сильнейшим антагонистом молочнокислой флоры полости рта; протей, быстро колонизирующие при гнойных и некротических процессах в полости рта устойчивые ко многим антибиотикам и вызывающие гнойные процессы во рту клебсиеллы. При изменении обычного состояния полости рта бактерии непостоянной флоры могут задерживаться в ней и увеличиваться в численности и привести к дисбиозу полости рта, возникновение которого зависит от особенностей слюноотделения, консистенции и характера пищи, характера жевания и глотания, а также от гигиенического состояния твердых и мягких тканей, стоматологической культуры, наличия соматических заболеваний и ортопедических зубных протезов. Последний фактор стал предметом настоящего исследования. Микроорганизмы поступают в полость рта с водой, продуктами питания, с потоком воздуха, при наложении съемных зубных протезов. Рельеф в полости рта, инородная поверхность базиса зубных протезов, в которых остаются слущенный эпителий, остатки пищи, слюна, только благоприятствуют агрессивному размножению микроорганизмов патогенной и условно патогенной флоры. Сильные трансформации состава и функций микрофлоры, вызванные понижением реактивности организма, СОПР и многими лечебными мероприятиями, в том числе протезирование приводят к дисбиотическим сдвигам, ставящих под угрозу качество стоматологического здоровья и эффективность проводимого лечения The article presents the analysis of the status and microbiocenosis of the mucous prosthetic bed under the design basis removable dental prosthesis. The human oral cavity is an individual ecological system for different microorganisms that form a permanent microflora. Normal microflora is the main criterion for the healthy state of the oral cavity and indicates pathological changes that determine the development of dental diseases of the hard tissues of the teeth, periodontal tissues, mucous membrane, etc.and their influence on the development of pathological processes. The species constancy of the oral microflora is very stable and includes representatives of various microorganisms. Anaerobic respiration bacteria - Streptococcus, lactobacilli, Bacteroides, fusobacteria, veillonella and actinomycetes-predominate. In addition to these representatives, there are a certain kind of spirochetes, mycoplasmas and a variety of protozoa. Bacteria of the unstable microflora of the oral cavity are detected, in most cases, in small quantities and in a short period of time. Their long presence and activity in the oral cavity are hindered by local non-specific protection factors - saliva lysozyme, phagocytes, lactobacilli and streptococci that are constantly present in the oral cavity, which serve as antagonists of some non-permanent inhabitants of the oral microflora. Non-permanent microorganisms of the oral cavity include Escherichia, which has a high enzymatic activity, and aerobacteria, which act as the strongest antagonist of the lactic acid flora of the oral cavity; Proteus, rapidly colonizing with purulent and necrotic processes in the oral cavity resistant to many antibiotics and causing purulent processes in the mouth Klebsiella. When the normal state of the oral cavity changes, bacteria of unstable flora can linger in it and increase in number and lead to dysbiosis of the oral cavity. The occurrence of which depends on the characteristics of salivation, the consistency and nature of food, the nature of chewing and swallowing, as well as on the hygienic state of hard and soft tissues, dental culture, the presence of somatic diseases and orthopedic dentures. The latter factor was the subject of this study. Microorganisms enter the oral cavity with water, food, with the flow of air, when applying removable dentures. The relief in the oral cavity, the foreign surface of the basis of dentures, in which there are sloughed epithelium, food residues, saliva, only favor the aggressive reproduction of microorganisms of pathogenic and conditionally pathogenic flora. Strong transformations of the composition and functions of the microflora caused by a decrease in the reactivity of the body, SOPR and many therapeutic measures, including prosthetics, lead to dysbiotic shifts that threaten the quality of dental health and the effectiveness of the treatment

Retention force of polyetheretherketone and cobalt-chrome-molybdenum removable dental prosthesis clasps after artificial aging

Objectives To examine the retention force of removable dental prosthesis (RDP) clasps made from polyetheretherketone (PEEK) and cobalt-chrome-molybdenum (CoCrMo, control group) after storage in water and artificial aging. Materials and methods For each material, 15 Bonwill clasps with retentive buccal and reciprocal lingual arms situated between the second pre- and first molar were manufactured by milling (Dentokeep [PEEKmilled1], NT digital implant technology; breCAM BioHPP Blank [PEEKmilled2], bredent), pressing (BioHPP Granulat for 2 press [PEEKpressed], bredent), or casting (remanium GM 800+ [CoCrMo], Dentaurum); N = 60, n = 15/subgroup. A total of 50 retention force measurements were performed for each specimen per aging level (initial; after storage [30 days, 37 °C] and 10,000 thermal cycles; after storage [60 days, 37 °C] and 20,000 thermal cycles) in a pull-off test. Data were statistically analyzed using one-way ANOVA, post hoc Scheffé and mixed models (p < 0.05). Results Initial, PEEKpressed (80.2 ± 35.2) and PEEKmilled1 (98.9 ± 40.3) presented the lowest results, while PEEKmilled2 (170.2 ± 51.8) showed the highest values. After artificial aging, the highest retention force was observed for the control group (131.4 ± 56.8). The influence of artificial aging was significantly higher for PEEK-based materials. While PEEKmilled2 and PEEKpressed showed an initial decline in retention force, all other groups presented no impact or an increase in retention force over a repetitive insertion and removal of the clasps. Conclusions Within the tested PEEK materials, PEEKmilled2 presented superior results than PEEKpressed. Although CoCrMo showed higher values after artificial aging, all materials exhibited sufficient retention to recommend usage under clinical conditions. Clinical relevance As RDPs are still employed for a wide range of indications, esthetic alternatives to conventional CoCrMo clasps are sought.

Is the high-performance thermoplastic polyetheretherketone indicated as a clasp material for removable dental prostheses?

Objectives To investigate the retention force of polyetheretherketone (PEEK) removable dental prosthesis clasps in comparison with a cobalt-chrome-molybdenum control group after storage in artificial saliva. Materials and Methods Clasps were milled (Dentokeep (PEEKmilled1), NT digital implant technology; breCAM BioHPP Blank (PEEKmilled2), bredent), pressed (BioHPP Granulat for 2 press (PEEKpressed), bredent), or cast (remanium GM 800+ (cobalt-chrome-molybdenum), Dentaurum); N = 60, n = 15/subgroup. Retention force was examined 50 times/specimen in a pull-off test using the universal testing machine (Zwick 1445), where pull-off force was applied with a crosshead speed of 5 mm/minute until the maximum force dropped by 10%, at different aging levels: (1) initial, after storage in artificial saliva for (2) 90 and (3) 180 days. Statistical analysis was performed using one-way ANOVA followed by post hoc Scheffé-test and mixed models (p < 0.05). Results Cobalt-chrome-molybdenum presented the highest retention force. No differences were observed between polyetheretherketone materials. Cobalt-chrome-molybdenum showed a significant decrease of its values after artificial aging, while polyetheretherketone materials presented similar results over the course of aging. Regarding a repetitive insertion and removal, even though PEEKmilled2 and cobalt-chrome-molybdenum showed an initial increase, ultimately, a decrease in retention force was observed for all tested groups. Conclusions Although the control group showed significantly higher results, the retention force of polyetheretherketone materials indicate a potential clinical application. Neither the manufacturing process nor artificial aging showed an impact on the retention force of polyetheretherketone clasps. Clinical relevance Mechanical properties of novel removable dental prosthesis clasp materials devised to meet the growing esthetic demands of patients need to be investigated to ensure a successful long-term clinical application.