Stabilization of dental clasp in the construction of partial dentures.
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STATEMENT OF PROBLEM: Removable partial denture frameworks are complex castings fabricated from high-shrinkage alloys. This may result in difficulty in achieving accurate fit. PURPOSE: The purpose of this study was to evaluate which component(s) of the clasp assembly contact the abutment tooth clinically. MATERIAL AND METHODS: New and existing frameworks with at least 1 conventional prepared occlusal rest were evaluated for fit. The spacing between the bottom of each of the rests of the 50 clasp assemblies and the corresponding rest seat were recorded with vinyl polysiloxane. The fit of each rest was determined with the use of a dial caliper by measuring, in micrometers, the thickness of the record between the rest and the bottom of the rest seat. The Kennedy classification was also recorded. A 2-sample t test was used to evaluate the difference in fit between tooth-tissue supported and tooth-supported designs (alpha=.05). RESULTS: The average space between the rest and prepared rest seat was 193 +/- 203 microm, with a range of 0 to 828 mum. Twenty tooth-tissue frameworks had an average space of 136 +/- 160 microm and 30 tooth-supported frameworks had an average space of 230 +/- 222 microm. The 2-sample t test showed no significant difference for fit between tooth-tissue supported and tooth-supported frameworks (P=.1081). Twenty-four percent of rests had contact in the prepared rest seat. CONCLUSION: The majority of rests evaluated did not contact the intended surfaces.
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OBJECTIVE: A series of nasopharyngeal appliance designs is presented that represents our evolving experience over a 20-year period in the adjunctive use of prosthetic stents in the surgical correction of nasopharyngeal stenosis. DESIGN: Retrospective assessment of effectiveness of two nasopharyngeal stenosis hollow stent designs in a consecutive series of patients for relief of nasal obstructive symptoms. SETTING: Tertiary academic medical center, Craniofacial Program at Children's Hospital. PATIENTS: Four patients with nasopharyngeal stenosis were treated with a preoperatively fabricated stent made from a clasped palatal appliance onto which hollow acrylic conduits were extended through surgically re-created pharyngeal ports. A subsequent set of four patients with nasopharyngeal stenosis were treated with intraoperatively-fashioned silastic grommets, as opposed to palatal appliances. INTERVENTIONS: Postoperative intraoral stenting of nasopharyngeal ports. MAIN OUTCOME MEASURES: Maintenance of pharyngeal port opening after 1 year, improvement in nasal airway obstructive symptoms. RESULTS: The palatal appliance stents were less well tolerated and had a lower maintenance of port patency after device removal (4 of 8, 50%). The silastic grommets provided better retention into the ports and increased patient tolerance, as well as better 1-year port maintenance (6 of 8, 75%). CONCLUSIONS: The grommet stent appliance offers numerous advantages over a conventional dental-clasped appliance for prosthetic nasopharyngeal stenting, including obviation of extensive preoperative preparation, ease of insertion and removal, and exchange of air during the stenting period. Improved nasopharyngeal patency with this device may be due to greater patient tolerance and subsequent longer use.
BACKGROUND: When constructing complete dentures for edentulous patients, ultimately patient satisfaction is key. Complete dentures can be produced with different types of occlusal schemes (chewing surfaces) and it is widely accepted that the occlusal scheme for complete dentures has a direct influence upon their success. OBJECTIVES: To assess the relative effectiveness of differing occlusal schemes for complete dentures with regard to patient satisfaction. The null hypothesis is that there is no difference in terms of patient satisfaction between different designs of chewing surfaces for complete dentures. SEARCH STRATEGY: Several electronic databases were searched in order to identify relevant trials: Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2004), MEDLINE (1966 to week 2 April 2004), OLDMEDLINE (1953 to 1965), EMBASE (1980 to week 16 2004),Zetoc (1993 to December 2003), SIGLE (1980 to December 2003), SCI (Science Citation Index) (1945 to 04 April 2004 ). Reference lists of identified, relevant trials and review articles were scanned. Unpublished data were sought through personal contact with experts in the field. There was no language restriction. SELECTION CRITERIA: Randomised or quasi-randomised controlled clinical trials (RCTs), recruiting edentulous adults, and comparing complete dentures produced with different occlusal schemes with regard to patient satisfaction and masticatory function. DATA COLLECTION AND ANALYSIS: The quality assessment of the included trials was undertaken independently and in duplicate by two reviewers based initially on what was written in the articles. Data were extracted by two reviewers independently. Disagreements were discussed and a third reviewer consulted as necessary. Authors were contacted for clarification or missing information. Data were excluded until further clarification if agreement could not be reached. MAIN RESULTS: 1076 titles and abstracts were identified through the electronic searches. Thirteen trials were thought to be potentially relevant. Ten of these studies were subsequently excluded following further analysis. Two trials require further information from the author before being considered eligible for inclusion. Only one cross-over trial (n = 30), comparing lingualised teeth and zero-degree teeth, fully met the review's inclusion criteria. Twenty patients preferred the lingualised denture, five the zero-degree denture and five patients had no preference. There was a statistically significant difference in favour of the lingualised denture with an odds ratio of 10 (95% confidence interval 2.04 to 48.96). AUTHORS' CONCLUSIONS: There is weak evidence that it may be advantageous, for dentists providing a complete denture service, to prescribe prosthetic posterior teeth with cusps to improve patient satisfaction compared to providing cuspless teeth. However, this conclusion may only be made tentatively until further well conducted trials comparing different occlusal schemes for complete dentures are undertaken.
Although the altered-cast impression technique attains stability and controlled tissue support for distal-extension removable partial dentures, the procedure is time-consuming and technique-sensitive. This study clinically compared the vertical displacement of distal-extension removable partial dentures made from different impression techniques. The impressions studied were the altered-cast impression, an impression made from a border-molded custom tray, and a stock tray irreversible hydrocolloid impression that served as a control. A post hoc analysis, using a Tukey Q-test, exhibited significance (p less than 0.01) between the two impression techniques after intraoral loading was performed. Although statistically significant, the 0.19 mm difference between the impression techniques may or may not be clinically relevant. Additional research is required in this area.
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During the metal finishing phase of removable partial denture construction, metal is removed from all aspects of the casting. The amount removed from areas designed to contact prepared surfaces of abutments is critical to the resulting fit of the partial. Castings were evaluated before and during finishing procedures to measure metal loss at the tooth-removable partial denture interface. Finishing and fitting techniques for controlling the loss of metal are presented.
The implant-supported, maxillary anterior, fixed-detachable prosthesis is often fabricated with a gingival flange to enhance esthetics and phonetics. However, only the dentist can remove the prosthesis, and the esthetic labial flange invariably impedes patient access for cleaning. A two-piece, fixed-detachable prosthesis that incorporates a substructure retained with conventional set screws and a superstructure retained with precision attachments has been developed. The substructure is contoured to facilitate patient access for oral hygiene because it will be covered by the superstructure and neither esthetics nor phonetics is a concern. The superstructure is easily removed by the patient for routine cleaning and can be designed for favorable esthetics and phonetics. This article reviews and describes the procedures for fabrication of this precision attachment-retained, implant-supported prosthesis.
Removable partial denture frameworks must fit accurately to function properly and not cause injury to remaining teeth or soft tissue. This article presents a logical method and rationale for seating a removable partial denture framework and a review of several disclosing media used in the try-in procedure.
Direct procedures to make a crown under an existing partial denture are inconvenient for the patient. A process is described that uses an irreversible impression of both the crown preparation and the removable prosthesis to fabricate a crown indirectly. The process is efficient and inexpensive.