|Year : 2022 | Volume
| Issue : 4 | Page : 382-388
Clinical evaluation of complete denture fabricated using two different final impression techniques on masticatory efficiency and oral health-related quality of life
Uttkarsh Shah1, Neerja Mahajan2, Ninad Bhatt2
1 Private Practitioner, Mumbai, Maharashtra, India
2 Department of Prosthodontics and Crown and Bridge, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
|Date of Submission||22-Jan-2022|
|Date of Decision||24-Jun-2022|
|Date of Acceptance||08-Jul-2022|
|Date of Web Publication||03-Oct-2022|
Department of Prosthodontics and Crown and Bridge, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara - 391 760, Gujarat
Source of Support: None, Conflict of Interest: None
Aim: To compare the effect of complete denture fabricated using selective pressure impression and functional impression technique on masticatory efficiency and oral health-related quality of life (OHRQoL) in patients with resorbed ridges.
Settings and Design: A randomized two arm, parallel group study.
Materials and Methods: Forty-eight participants with set inclusion and exclusion criteria were randomly allocated into two groups. Complete denture was fabricated in Group A and Group B using selective pressure and functional impression technique, respectively. The follow-up was done at 3 months. Masticatory efficiency was measured by color-changing chewing gum, and OHRQoL was assessed using the Geriatric Oral Health Assessment Index (GOHAI) Hindi Version.
Statistical Analysis Used: The Wilcoxon signed-rank test was applied to check the intergroup analysis for the GOHAI scores of both impression techniques. The Mann–Whitney U test was applied to compare intragroup analysis for masticatory efficiency and the GOHAI scores of both the techniques.
Results: A total of 45 participants completed the follow-up. The mean age of the total participants was 62.7 ± 3.8. No statistically significant difference (P > 0.05) was observed between the masticatory efficiency and post-GOHAI scores of both the impression techniques.
Conclusion: Selective pressure and functional impression techniques may be successfully used to fabricate complete dentures for patients with resorbed ridges.
Keywords: Chewing gum, dental impression technique, dental prosthesis, quality of life
|How to cite this article:|
Shah U, Mahajan N, Bhatt N. Clinical evaluation of complete denture fabricated using two different final impression techniques on masticatory efficiency and oral health-related quality of life. J Indian Prosthodont Soc 2022;22:382-8
|How to cite this URL:|
Shah U, Mahajan N, Bhatt N. Clinical evaluation of complete denture fabricated using two different final impression techniques on masticatory efficiency and oral health-related quality of life. J Indian Prosthodont Soc [serial online] 2022 [cited 2022 Dec 7];22:382-8. Available from: https://www.j-ips.org/text.asp?2022/22/4/382/357797
| Introduction|| |
In India, 34.5% of the total population is urban, and the rest resides in a rural setup. Complete dentures would always remain a prime treatment modality for any resource-strained country. Complete denture rehabilitation aims to improve the patient's quality of life and masticatory efficiency. Therefore, research must be strengthened in this area to help the patients. The quality of the denture in relation to satisfaction, comfort, stability, and chewing ability is totally dependent on the final impression.
Selective pressure, and functional impressions are well-accepted techniques for edentulous patients. In their randomized controlled trial, Hyde et al. proved that patients preferred dentures fabricated using the selective pressure technique. They also emphasized the usage of silicone impression materials for final impressions. The oral health-related quality of life (OHRQoL) was also improved after wearing a denture made using addition silicone impressions. Another suggested technique is functional impressions which accurately record and register mucosal resiliency along with denture base and functional margins. The functional impression technique provides good results along with saving time. It is recommended for geriatric patients with old dentures, ill-fitting dentures, and clinically compromised conditions. Yadav et al. have also advised the use of the functional impression technique for better retention, stability, and support in Atwood's orders V and VI.
Although many authors recommend the functional impression, no study has compared it with an already established selective pressure impression technique in cases with resorbed ridges. Therefore, a gap exists in the literature. Many elderly patients with resorbed ridges in our day-to-day practice come for new denture fabrication, and their old dentures can be very well used for making a functional impression.
The study's primary objectives were to evaluate and compare the masticatory efficiency and OHRQoL of dentures fabricated with the selective pressure impression and functional impression techniques. The secondary objective was to evaluate the number of denture adjustment visits after a routine denture follow-up.
The null hypothesis stated that no difference exists in the masticatory efficiency and OHRQoL in complete dentures fabricated using selective pressure and functional impression techniques.
| Materials and Methods|| |
A randomized two-arm, parallel-group study was conducted after approval from the institutional ethical committee with approval no. SVIEC/ON/DENT/BNPG17/D18004. A participation information sheet was given to all the participants, and informed consent was taken. The research work was carried out by the Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans. All dentures were fabricated between the periods of January 2018 to June 2019.
Using data values from a study done by Wegner et al., the sample size was calculated by 80% power and 95% confidence interval. A total sample size of 40 was determined and divided equally into 20 in each group. Considering the dropout ratio of 20%, another eight patients were added, making the final sample size 48.
Following were the inclusion criteria
- Age 60 years or above reporting to the department of prosthodontics for complete denture fabrication
- Patients having a complete set of old dentures
- Having adequately extended peripheral borders and complaints of loosening due to resorption
- Able to chew adequately though having worn out teeth
- Patients with a resorbed ridge (American College of Prosthodontists (ACP) Class III and IV)
- Patients who could understand the questionnaire in Hindi.
Following were the exclusion criteria
Patients who refused to sign the consent form, had poor neuromuscular control, had pathological ridge defects, systemic problems, and patients with fractured or badly repaired old dentures were excluded from the study.
After assessment of eligibility, an orthopantomogram was taken. The least height of the ridge was measured to know the ridge status according to the ACP classification using Adobe Photoshop [Figure 1]. Then randomization was done by a computer-generated method, and two groups were formed. This study was based on the parallel design compared to the crossover design because, in this design, patients will not have to stay without dentures during the wash-out period.
Random allocation was done by computer-generated sequence for all 48 patients. A single operator did all the procedures. In this study, evaluator and statistician were blinded.
The participants were divided into two groups. Group A complete dentures were made using selective pressure impression, and Group B complete dentures were made using the functional impression utilizing the patient's set of old dentures. The CONSORT flow diagram is shown in [Figure 2].
The Hindi version of the Geriatric Oral Health Assessment Index (GOHAI) with a three-point Likert scale of “always-1,” “sometimes-2,” and “never-3” was used to assess the OHRQoL. Pre-GOHAI questionnaire was administered to both the groups before starting any procedure.
In Group A, a preliminary impression was made using alginate in the metal stock tray, and the diagnostic cast was poured with type 2 dental stone. The maxillary arch spacer of 1 mm was adapted to the cast within the outline borders except in the area of the posterior palatal seal to provide space for the final impression. In the mandibular arch, 1 mm of the spacer was given on the crest and the slope of the alveolar ridge except in the buccal shelf-area. The custom tray was fabricated using auto-polymerizing denture resin. Denture adhesive (Medicept LOT-10433) was applied on the border of the custom tray and kept aside for drying for 15 min as recommended by the manufacturer. Then a single-step border molding was done using heavy body silicone (Dentsply LOT-170925) in the upper arch and regular body silicone (Dentsply LOT-170329) in the lower arch. After giving relief holes, the final wash impression was made with light-bodied silicone Dentsply (LOT-170602) [Figure 3]a.
|Figure 3: (a) Selective pressure impressions and (b) functional impressions|
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In Group B, labial, buccal and lingual extensions of old dentures were trimmed 1-2 mm short, so that functional depth gets recorded in tissue conditioner material. The tissue surface of the old existing denture was also trimmed approximately 2 mm to create space for the material. Tissue conditioner (Dentsply LOT-1709000863) was mixed according to the manufacturer's instruction and carefully applied on the tissue surface of the denture to avoid any air bubbles entrapment. The denture was placed in the patient's mouth with firm pressure. The borders were molded by hand manipulation of the cheeks and lips. About 5 min were given for material to set in the old denture. The patient's tongue was directed to mold the lingual border in the mandibular ridge. The denture was removed, rinsed with water, and evaluated [Figure 3]b. Later, dentures were given to the patient for functional usage, and proper home care instructions of not to soak the denture in any denture cleaning solution and store it in the air were given. The patient was also instructed to clean the denture in plain running water after every meal and to use wet cotton or gauze to clean the fitting denture surface. The patient reported back after 1 day (within 48 h), and the denture was evaluated for well-rounded functional borders. Then the master cast was poured with Type 3 dental stone.
After getting the master cast in both groups, all the further clinical and lab steps were kept the same. The maxillomandibular records were mounted on a mean value articulator. Nonanatomical teeth (Prestodent; New India Dental Products, India) were used for both the groups because, in poor ridge foundation, the least movement was observed with nonanatomic teeth. The denture insertion and routine postinsertion follow-ups were also maintained in both groups. The denture was used for 3 months, and the patient was recalled to fill out the post-GOHAI questionnaire and evaluate masticatory efficiency.
Denture alteration visits within these 3 months of the adjustment period of the patients after routine follow-up visits were also observed as a secondary objective, as there could be more chances of sore spots corrections in resorbed ridges.
Various tools are available to check the OHRQoL. Ikebe et al. concluded that the GOHAI was more sensitive than OHIP-14. The GOHAI consists of 12 questions, but the last 12th question cannot be applied to denture patients (How often were your teeth or gums sensitive to hot, cold or sweet foods?) was not included in the study. The same methodology of removing the last question was also applied by Shigli and Hebbal in their study.
After filling out the post-GOHAI questionnaire, the color-changing chewing gum (Gumxylitol; lotte co., Ltd) was used in the patients. The patient was told to chew 60 times, maintaining the rate of one per second. Afterward, chewing gum was wrapped in two polyethylene films and, with the help of two glass plates, flattened to 1.5 mm thickness. Color analysis was done by observing the changes before and after the mastication procedure. A spectrophotometer and the color scale [Figure 4] developed by Hama et al. were used to measure the values of color change. Halazonetis et al. and Tarkowska et al. stated that the masticatory efficiency could be evaluated safely using color-changing chewing gum.
Wilcoxon signed-rank test was applied to check for the significant difference between the pre- and postscores of the GOHAI questionnaire for both the groups. Mann–Whitney U test was applied to compare both groups' GOHAI questionnaire postscores and masticatory efficiency. The data was analyzed with Statistical Package for Social Sciences (SPSS) for Windows, version 26.0 (IBM Corp., Armonk, N. Y., USA). Confidence interval was kept at 95%, and values of P < 0.05 was taken as statistically significant.
| Results|| |
Out of 48 enrolled participants, 45 (23 participants in Group A and 22 in Group B) completed the study. One participant in Group A and two in Group B failed to report back after 3 months of the adjustment period.
The mean age of the total participants was 62.7 ± 3.8. Out of 45 participants, 88.9% of the patients were 61–65 years old. 4.4% and 6.7% of the patients belonged to the 66–70 and 71–75 years of the age group, respectively [Table 1]. Out of 45 patients, 26 were male and 19 were female. ACP class distribution of participants in Group A and B is shown in [Table 2].
|Table 2: American College of Prosthodontists class distribution in Group A and B|
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The primary and secondary outcomes were analyzed, keeping a 95% confidence interval. The primary outcome was to evaluate masticatory efficiency and OHRQoL. The pre- and postscores on OHRQoL using the GOHAI questionnaire show a statistically significant difference (P < 0.05) for all the questions except question no. 9, 10, and 11 for both Group A [Table 3] and Group B [Table 4]. No statistically significant difference (P > 0.05) was observed between the post-GOHAI scores between Group A and B [Table 5]. No statistically significant difference (P > 0.05) was also observed between masticatory efficiency in Group A and B [Table 6]. The secondary objective was also nonsignificant as for routine denture adjustments, only one patient of Group A (selective pressure impression technique) reported for denture adjustment of the sore spot.
|Table 3: Comparison of the pre- and post-geriatric oral health assessment index scores on oral health-related quality of life in Group A|
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|Table 4: Comparison of the pre- and post-Geriatric Oral Health Assessment Index scores on oral health-related quality of life in Group B|
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|Table 5: Comparison of post-Geriatric Oral Health Assessment Index scores on oral health-related quality of life in Group A and B|
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|Table 6: Comparison of masticatory efficiency using color-changing chewing gum in Group A and B|
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| Discussion|| |
As both masticatory efficiency and OHRQoL after fabrication of dentures using two different techniques showed no significant difference, the null hypothesis was accepted.
Items 1-4 in GOHAI are based on trouble related to functional problems in swallowing, speaking, and eating. Both groups found a significant difference between patients' pre- and post-GOHAI scores related to these questions. Item no. 5 and 8 are related to pain and discomfort, showing a significant difference in both groups' pre- and post-GOHAI scores. Other items 6, 7, 9, 10, and 11 are based on psychosocial characteristics.
The statistically significant difference (P < 0.05) between the pre- and postscores of the GOHAI questionnaire was seen in all the questions except question no. 9, 10, 11. These items depict behavioral and psychological aspects. No significant difference was seen in these questions in the pre- and post-GOHAI scores of both the groups, probably because of the limitation of a complete removable prosthesis which will always persist and indirectly affect the patient's psychology. Patients' age, education, marital status, income, habits, attitudes, and the socioeconomic background will influence these responses.
There was no statistically significant difference (P > 0.05) between the masticatory efficiency and postscores of both the impression techniques for all the questions when evaluating the post-GOHAI questionnaire. Hence, both techniques may be equally acceptable for patients.
The result of this study suggests that the functional impression technique can also be seen as an effective alternative for making an impression in patients with resorbed ridges. The only prerequisite is the availability of an old set of dentures in acceptable conditions with peripheral borders and occlusion. If the extensions are improper, it will not lead to good results. Therefore, sound clinical judgment and skills are required regarding the existing condition of an old denture.
The functional impression has an added advantage of giving psychologic comfort to the patients as they can pre-experience the comfort and stability of dentures with tissue conditioning material. This technique even provides prior judgment to a clinician about the results.
As there are no previous direct comparative studies on the above-said techniques and materials, the association between previous works of literature is difficult. However, the results of this study follow randomized control trial by Komagamine et al., where the selective pressure impression technique was able to establish early stability of new dentures with fewer postinsertion dentures adjustments. Many studies,, and systematic reviews,, have also presented no difference in patient satisfaction, mastication, and quality of dentures fabricated by simplified or traditional/conventional methods.
Sociodemographic variables play a significant role in influencing patient denture satisfaction. In this study, all participants had the same socioeconomic background, as all visited an institute for their denture needs. 58% percent of Males and 42% of females were enrolled in the study. 89% of participants belonged to the 61–65 age group and 84% to ACP Classification III. Keeping all these variables into consideration, baseline balance was reasonably present. Nevertheless, comprehensive sociodemographic characteristics such as education, professional activity, marital status, socioeconomic status, and a span of edentulism along with patient's psychology can be addressed in future studies for better clinical applicability of results. Future studies can also report the minimal clinically significant difference associated with research involving patient denture satisfaction.
The limitation of the study is the small sample size. Longitudinal studies with more sample size can be conducted to support the results and reduce the baseline imbalances. Future studies can also assess the denture acceptance, adaptive skills, masticatory ability, and quality of life of a patient with poor neuromuscular abilities using the same or different impression techniques.
| Conclusion|| |
Selective pressure and functional impression techniques may be successfully used to fabricate complete dentures for patients with resorbed ridges.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Carlsson GE, Omar R. The future of complete dentures in oral rehabilitation. A critical review. J Oral Rehabil 2010;37:143-56.
Jayaraman S, Singh BP, Ramanathan B, Pillai MP, MacDonald L, Kirubakaran R. Final-impression techniques and materials for making complete and removable partial dentures. Cochrane Database Syst Rev 2018;4:CD012256.
Hyde TP. Case report: Differential pressure impressions for complete dentures. Eur J Prosthodont Restor Dent 2003;11:5-8.
Duncan JP, Raghavendra S, Taylor TD. A selective-pressure impression technique for the edentulous maxilla. J Prosthet Dent 2004;92:299-301.
Chase WW. Tissue conditioning utilizing dynamic adaptive stress. J Prosthet Dent 1961;11:804-15.
Hyde TP, Craddock HL, Blance A, Brunton PA. A cross-over Randomised Controlled Trial of selective pressure impressions for lower complete dentures. J Dent 2010;38:853-8.
Hyde TP, Craddock HL, Gray JC, Pavitt SH, Hulme C, Godfrey M, et al.
A randomised controlled trial of complete denture impression materials. J Dent 2014;42:895-901.
Kršek H, Dulčić N. Functional impressions in complete denture and overdenture treatment. Acta Stomatol Croat 2015;49:45-53.
Baslas V, Singh SV, Aggarwal H, Kaur S, Singh K, Agarwal KK. A technique for using short term soft liners as complete dentures final impression material. J Oral Biol Craniofac Res 2014;4:204-7.
Yadav B, Jayna M, Yadav H, Suri S, Phogat S, Madan R. Comparison of different final impression techniques for management of resorbed mandibular ridge: A case report. Case Rep Dent 2014;2014:253731.
Wegner K, Zenginel M, Buchtaleck J, Rehmann P, Wostmann B. Influence of two functional complete-denture impression techniques on patient satisfaction: Dentist-manipulated versus patient-manipulated. Int J Prosthodont 2011;24:540-3.
McGarry TJ, Nimmo A, Skiba JF, Ahlstrom RH, Smith CR, Koumjian JH. Classification system for complete edentulism. The American College of Prosthodontics. J Prosthodont 1999;8:27-39.
Mathur VP, Jain V, Pillai RS, Kalra S. Translation and validation of Hindi version of Geriatric Oral Health Assessment Index. Gerodontology 2016;33:89-96.
Zarb GA, Bolender CL. Prosthodontic Treatment for Edentulous Patients. 12th
ed. USA: Mosby; 2004. p. 225-45.
Hara S, Shimodaira O, Sato Y, Kitagawa N, Yamagata T. Facilitated method of mixing tissue conditioner to minimize the formation of air bubbles. Prosthodont Res Pract 2005;4:111-4.
Hong G, Li Y, Maeda T, Mizumachi W, Sadamori S, Hamada T, et al.
Influence of storage methods on the surface roughness of tissue conditioners. Dent Mater J 2008;27:153-8.
Woelfel JB, Hickey JC, Allison ML. Effect of posterior tooth form on jaw and denture movement. J Prosthet Dent 1962;12:922-39.
Ikebe K, Hazeyama T, Enoki K, Murai S, Okada T, Kagawa R, et al.
Comparison of GOHAI and OHIP-14 measures in relation to objective values of oral function in elderly Japanese. Community Dent Oral Epidemiol 2012;40:406-14.
Shigli K, Hebbal M. Assessment of changes in oral health-related quality of life among patients with complete denture before and 1 month post-insertion using Geriatric Oral Health Assessment Index. Gerodontology 2010;27:167-73.
Tarkowska A, Katzer L, Ahlers MO. Assessment of masticatory performance by means of a color-changeable chewing gum. J Prosthodont Res 2017;61:9-19.
Hama Y, Kanazawa M, Minakuchi S, Uchida T, Sasaki Y. Reliability and validity of a quantitative color scale to evaluate masticatory performance using color-changeable chewing gum. J Med Dent Sci 2014;61:1-6.
Halazonetis DJ, Schimmel M, Antonarakis GS, Christou P. Novel software for quantitative evaluation and graphical representation of masticatory efficiency. J Oral Rehabil 2013;40:329-35.
Komagamine Y, Kanazawa M, Sato Y, Iwaki M, Jo A, Minakuchi S. Masticatory performance of different impression methods for complete denture fabrication: A randomized controlled trial. J Dent 2019;83:7-11.
Cunha TR, Della Vecchia MP, Regis RR, Ribeiro AB, Muglia VA, Mestriner W Jr., et al.
A randomised trial on simplified and conventional methods for complete denture fabrication: Masticatory performance and ability. J Dent 2013;41:133-42.
Girundi FM, Marcello-Machado RM, Girundi AL, Gonçalves TM, Del Bel Cury AA, da Silva WJ. Performance of complete dentures fabricated with the simplified and the traditional technique: A randomized clinical trial. J Prosthet Dent 2021:S0022-3913(21)00495-9. doi: 10.1016/j.prosdent.2021.08.024. Epub ahead of print.
Ereifej NS, Oweis YG, El Manaseer W, Al Omoush S, Abu Awwad M, Sartawi S. Simplified versus conventional complete dentures: A randomized crossover clinical trial. J Prosthet Dent 2022:S0022-3913(22)00084-1. doi: 10.1016/j.prosdent.2022.02.002. Epub ahead of print.
Fernández E, Rivero MG, Díaz-Yokens M, Padilla P. Traditional versus simplified impression methods for complete dentures: Critical appraisal of evidence. Odontol Vital 2021;34:57-64.
Sanjeevan V, Rajagopal P, Venkitachalam R, Aras M. Efficiency of simplified versus traditional denture fabrication methods: A systematic review and meta-analysis. J Prosthet Dent 2021;126:377-85.
Singh BP, Pradhan KN, Tripathi A, Tua R, Tripathi S. Effect of sociodemographic variables on complete denture satisfaction. J Adv Prosthodont 2012;4:43-51.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]