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Awareness of occlusal concepts in complete dentures among general dental practitioners: A knowledge, attitude, and practice survey
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Background: Occlusion is an important factor which governs the retention and stability of the complete denture. The occlusal concepts should be selected carefully depending on the situation of the patient. Aim: The aim of this study focuses on evaluating the knowledge, attitude, and practice of occlusal concepts in complete dentures among general dental practitioners. Materials and Methods: A questionnaire containing questions on awareness of occlusal concepts in complete denture were given to a total of 100 general practitioners in Chennai. The data collected were computerized and analyzed statistically. The collected data were analyzed using IBM SPSS statistics software 23.0 Version. To find the significant difference between the bivariate samples in the independent groups the unpaired sample t-test was used. For the multivariate analysis, the one-way ANOVA with Tukey's post hoc test was used. Results: For patients with U-shaped arches, the majority of general dental practitioners preferred balanced occlusion and for V-shaped arches they preferred canine guided occlusion. For patients with increased interarch space, they preferred balanced occlusion followed by lingualized occlusion, and for patients with decreased interarch space, they preferred canine guided occlusion and monoplane occlusion. For patients with highly resorbed as well as well-formed ridges, balanced occlusion was the choice. For patients with Skeletal Class I, balanced occlusion was preferred, for Skeletal Class II, Balanced and Canine Guided were preferred, and for Skeletal Class III, lingualized occlusion, and canine-guided occlusion and Balanced occlusion were equally preferred. Conclusion: The knowledge and awareness about occlusal concepts among general dental practitioners should be improved, and the occlusal concept should be selected depending on the situation of the patient.
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... On a fixed partial denture, a pontic is an artificial tooth that substitutes a lost natural tooth, preserves its function, and typically fills the space left by the actual crown. 1 For pontics, a variety of designs that adhere to the fundamentals of pontic design have been put forth. 2 Pontics with mucosal contact and no mucosal contact are two subgroups of these designs. 1,2 Sanitary/hygienic and periodontal disease as well as caries. ...
... On a fixed partial denture, a pontic is an artificial tooth that substitutes a lost natural tooth, preserves its function, and typically fills the space left by the actual crown. 1 For pontics, a variety of designs that adhere to the fundamentals of pontic design have been put forth. 2 Pontics with mucosal contact and no mucosal contact are two subgroups of these designs. 1,2 Sanitary/hygienic and periodontal disease as well as caries. 4,5 A fixed prosthesis may make it more difficult to maintain dental hygiene, worsen plaque buildup, and raise the risk of periodontitis and dental cavities. ...
... These findings reflect those of another survey in which 34% of dentists chose a hygienic pontic design for posterior edentulous regions. 1 In one other survey, 28% out of 85 general dentists chose this design. 2 Anteriorly, designs allowing mucosal contact such as the ridge lap, modified ridge lap, ovate, modified ovate, and conical are favored because they provide a more aesthetic appearance. 12,22 Ridge lap/saddle-shaped pontic ...
A pontic is an artificial tooth that substitutes a lost natural tooth, preserves its function, and typically fills the space left by the actual crown. Sanitary/hygienic and modified sanitary/hygienic designs do not contact the alveolar mucosa. On the other hand, ridge lap, modified ridge lap, ovate, modified ovate, and conical are designs that maintain contact with the mucosa. The ideal biological properties to be taken into consideration while designing pontics are periodontal health, access for oral hygiene, no food trapping and occlusal harmony. Accumulation of dental plaque has been implicated in the onset of gingival and periodontal disease as well as caries in the vicinity of the fixed restoration. The connection of the pontic to the supporting crowns must be constructed in such a way as to make a flushable area in the direction of the gingiva, in order to ensure that this area can be cleaned by toothbrushing and flossing but not the large triangular spaces that make it easy for food particles to cling. Modified ridge lap and ovate types, out of all the pontic shapes described below, exhibit convex cleansable faces. Ovate pontics are most effective for use in anterior regions, while the modified ridge lap design can be utilized predominantly in fixed partial denture designs posteriorly. The important etiological factor for gingivitis, periodontitis and peri-implantitis is bacterial colonization which is impacted by the individual's immunologic response and genetic predisposition in addition to dental care practices and pontic design. It is believed that no matter what the material of the pontic is, it must provide a highly polished intaglio surface to help floss slide through and make contact with the full base of the pontic in order to minimize plaque accumulation.
... For the benefits of the patients, the dentist should be involved at the time of selection of pontic designs and its awareness should be improved on the pontic design selection for different situations, as it can reduce the harmful impacts of any food impaction [4]. ...
... Occlusal bases are used to record relation between the maxillary and mandibular edentulous alveolar ridges [10] . A proper occlusion helps in masticatory function and a successful treatment is mainly defined by occlusion [2] the forces that are transmitted to the residual ridge are influenced by the occlusal contact [11] a complete denture occlusion, is the closure of maxillary and mandibular teeth in centric relation throughout the extend of functional and nonfunctional movements of mandible [12] . Aesthetic arrangement, physiological tooth arrangement aids in maintaining the biocompatibility of the denture [13] . ...
SUMMARY Based on available investigations and current
trends in oral rehabilitation published in the
dental literature, an attempt is made to describe the
possible future role of complete dentures. For
edentulous patients, complete dentures have for
long been the only prosthodontic treatment option.
Whereas a large number of edentulous patients
report satisfaction with denture usage, a smaller
number are unable to adapt; for such patients,
sophistication of clinical and technical processes or
quality of denture-supporting tissues, appear to
have little influence on patient-perceived outcomes.
Since the 1980s, osseointegrated dental implants
have dramatically improved the therapeutic possibilities,
especially so for maladaptive patients. Those
able to access such treatment can expect significant
improvements in oral functional status and quality
of life. While there is a downward trend in edentulism
in several countries, it is region-specific, confirming
the overriding influence of socio-economic
factors on health status. In most societies, despite
ageing populations, the need for complete dentures
is not likely to reduce in the near future. Whereas a
two- or even a one-implant overdenture for the
edentulous mandible is increasingly regarded as a
minimum standard of care in many developed
countries, its routine prescription for the majority
in the world who are disadvantaged is unrealistic;
for them, even ‘low-tech’ therapies like conventional
dentures are beyond their reach. Improving
the conventional management of edentulous patients
is a necessity and requires a keener focus by
researchers, educators and clinicians in the developed
world on the needs of populations with fewer
resources.
KEYWORDS: decision-making, dental implants, edentulism,
epidemiology, implant overdentures, prevalence,
quality of life, treatment choice
Accepted for publication 14 November 2009
Purpose:
The aim of this study was to qualitatively review the literature regarding occlusal schemes for complete dentures.
Materials and methods:
An electronic search was executed using PubMed (MEDLINE) with the aid of Boolean operators to combine the following terms: "complete denture," "occlusion," "balanced," "lingualized," "anatomic," "flat," "monoplane," and "canine." The search was limited to English peer-reviewed articles published up to January 2012. The literature search was supplemented by manual searching of relevant journals and the reference lists of selected articles.
Results:
A total of 565 articles were retrieved; however, only 12 articles met the inclusion criteria. The included studies evaluated the effects of posterior tooth morphology/arrangement and lateral occlusal guidance. In relation to morphology, the posterior teeth were either anatomical or flat. The posterior tooth arrangements showed conventional bilaterally balanced occlusion (CBBO), lingualized bilaterally balanced occlusion (LBBO), or monoplane occlusion (MO). The lateral occlusal guidance involved either balanced occlusion or anterior tooth-guided occlusion (ATGO).
Conclusions:
Within the limitations of this review, it can be concluded that anatomical teeth arranged in CBBO or LBBO are preferable to flat teeth arranged in MO. This is primarily related to patient acceptance. ATGO can also be considered for complete dentures.
The occlusion for complete dentures discussed in this article is based on basic principles and concepts that have been studied, tested, refined, and applied successfully by dentists for years. This should simplify rather than complicate the selection of the proper posterior tooth form for each patient's edentulous condition, the the modification of the teeth, and the use of the many occlusal schemes. The problem of occlusion is the dentist's responsibility and cannot be shared or relegated to nonprofessionals. The motivation for this article has been the hope that it will help the dentist recognize, analyze, and apply sound procedures in managing the problem. Only after this has been skillfully accomplished has the dentist assumed his full professional responsibility to the patient.
1. 1. Test denture bases with interchangeable inserts with "balanced" and "nonbalanced" types of occlusion were made for 12 patients. Both types of occlusion were constructed to the same centric relation record. Subjective observations of the 12 patients were recorded along with objective observations of chewing efficiency tests and a correlation with the ridge conditions. 2. 2. The subjective responses indicated that 7 had no preference for either the balanced or the nonbalanced occlusion. Three preferred the dentures with the nonbalanced occlusion. Two preferred the balanced occlusion (one of these stated his preference for the balanced occlusion with reservation). 3. 3. Neither type of occlusion produced soreness which could be attributed directly to the type of occlusion being used. 4. 4. There was slightly more complaint about the relative "looseness" of the dentures with the nonbalanced occlusion than there was with the balanced occlusion. 5. 5. For 9 patients, there was greater efficiency of chewing with the balanced occlusion. In 3, the chewing efficiency was greater with the nonbalanced occlusion. The balanced occlusion showed a greater efficiency based on fineness of chew when carrots were being chewed. When peanuts were chewed, the difference in efficiency between the balanced and nonbalanced occlusions was not so clearly defined. This indicates that the chewing efficiency of both forms of occlusion varies with the types of food. The balanced occlusion showed a greater chewing efficiency for 9 patients, but the degree of difference was decisive only in 2 of them (5, 14 per cent; 11, 15.4 per cent). In the other 7, the percentage of difference was between 2.5 and 5.0. This slight difference could be attributed to experimental error and can be considered valid only because of the relatively large number of subjects in which it occurred. In the 3 patients whose nonbalanced occlusions showed greater chewing efficiency, the difference was also slight (from 1.5 to 5.8 per cent).
Two methods for establishing effective occlusal contacts on dentures for patients who have had Class II malocclusions of their natural teeth have been described.
Lingualized occlusion provides a useful combination of several occlusal concepts. Many advantages of anatomic and nonanatomic occlusions are retained. Adjustment to compensate for minor changes in vertical and centric relation is readily accomplished. Satisfactory occlusion is easily obtained, and balanced occlusion can be accomplished. The lingualized occlusal concept is not a panacea, and all other procedures still must be carefully executed.