REMOVABLE PROSTHODONTICS
SECTION EDITORS
LOUIS BLATTERFEIN S. HOWARD PAYNE
Clinical long-term study of complete
denture wearers
Bo Bergman, D.D.S., Odont.Dr.,* and Gunnar E. Carbon,
I!nivcrsitv of I‘rnea. Fealty of Odontolog~. and l.nlwrsitv ol (Zreborq. Faculty of Odontolog~, Giiteborg. Swwkn
A daptation to complete dentures is a complex pro-
cess, and conflicting results are presented in the litera-
ture regarding the etiology, frequency, and duration of
difficulties associated with the wearing of dentures.‘.”
Obviously, many important factors are involved, some of
which are related to the jaw changes that accompany
prosthetic treatment. Such changes have been studied
extensively, but longitudinal investigations that cover
more than 5 years are rare.‘-”
The purposes of this article are to present clinical
findings in a group of patients who received complete
dentures for one or both jaws 21 years ago and to put
forward some of their opinions.
MATERIAL AND METHODS
The study comprised 32 patients at the School of
Dentistry in Umea who had teeth extracted and com-
plete denture treatment in the maxilla or the mandible
21 years ago. Nineteen belonged to a series of 38 patients
who received immediate complete denture treatment in
the maxilla. This group has already been described in
detail, including clinical and cephalometric radiographic
findings over a S-year period.“’
Of the total sub.jects, 13 belonged to a series of 34
patients who had all residual mandibular teeth extracted
and complete dentures made. This group also was
described earlier with the morphologic changes of the
mandible over 5 years.”
Of the original 72 patients, 10 had died, 11 were no
longer included in the register (which could mean either
that they were dead or were living outside the county),
seven lived more than 200 km from Umei, and two were
not to be found at the addressesgiven in the register. The
remaining 42 subjects were invited to come to the Dental
School for an examination. Three were chronically ill
and institutionalized, one was temporarily ill, and three
were away at the time of the follow-up examination.
Three said they did not wish to participate. The
remaining 32 subjects came for the examination, which
consisted of a questionnaire and clinical and radiograph-
56
D.D.S., Odont.Dr.**
ic examinations. Age and sex distribution, as well as
some clinical data are given in Table 1.
The questionnaire included questions on denture
treatment and function, wearing habits, satisfaction with
the dentures, general and oral health including the
masticatory system, and chewing ability. In the clinical
examination, the following items were noted: the state of
the oral mucosa and the denture-wearing tissues, signs of
mandibular dysfunction, anatomic conditions for denture
wearing, and the condition of the dentures including
tooth wear. The observations were carried out according
to criteria used and described in the first stages of the
studies of these patients,‘? and after the functional
examination of the masticatory system the clinical dys-
function index was assessed.”
The cephalometric radiographic examination was
made in a cephalostat with exposure data and focus-film
distance corresponding to those used in the original
series to allow the same cephalometric analysis with
measurements made directly on the radiographs 1~):
means of reference points as defined before.”
RESULTS
Questionnaire
Nine of the 32 subjects (28%) said that they had
visited a dentist during the last 2 years, while 8 (25%)
said that they had not done so for more than 10 years.
Nine subjects said they still wore the original dentures
made 21 years ago; 8 had one, and 13 had two or more
new sets of dentures made. (Two said they did not
remember.) The questions that related to relining and
repair of the dentures were answered with “don’t know”
by approximately half the subjects. Two thirds of those
meant they had not received such treatment. The func-
tion of the dentures was in general assessedas very good
or fairly good by the patients themselves (Table 11). The
worst alternative (bad) was used only in evaluation of
the retention of the mandibular denture by two subjects.
Half the subjects, however, thought that something
needed to be done currently with the dentures. Most
patients wore their dentures day and night (84% of
maxillary and 72% of mandibular). Most patients
seemed to have adapted well to their dentures, but four
reported that they had not and six said that they
regretted the transition to the edentulous state (Table
JANUARY 1985 VOLUMF 53 NUMBER 1
COMPLETE DENTURE WEARERS

NUMBER OF El WOMEN
PATIENTS

Fig. 1. Distribution of assessment by 32 complete denture wearers of their chewing

ability. 100% = Full set of natural teeth; 0% = edentulous mouth without dentures.

Table I. Age and sex distribution of patients Table II. Patient evaluation of denture
qualities (percent distribution in 32 denture
41-59 60-76 Total Mean
years years No.
wearers)*
age
Very Fairly Not so
Edentulous in both jaws
Women 2 9 11 65.5 good good good Bad
Men 2 5 7 66.1 Retention of upper denture SO 44 6 -
Edentulous in upper jaw Retention of lower denture 32 36 24 8
Women 4 4 8 57.9
Estheticsof the dentures 37 53 10 -
Men 2 4 6 61.0
Phonetic ability with the 44 50 6 -
Total 10 22 32 62.9 dentures
Total denture function 34 59 6 -

*All had complete dentures in maxilla, 19 in the mandible also, and six
III). The state of their general health was reported to be of the rest had a removable partial denture.
good by 25 and not so good by 7, but none said it was
bad. Only three patients said they had frequent head-
aches: more than once a week. Three patients said that Table III. Comments on adaptation to dentures
they often had sore spots and nine reported pain under in 32 denture wearers*
the dentures when chewing. Two did not know, but 10
Statement No. %
said that they often clenched their teeth. One third felt
that they had to avoid some foods because they were too I don’t think about wearing a
difficult to chew. denture 23 72
Nobody notices that I wear a
Table IV shows details of the chewing difficulties denture 11 34
connected with some foods. When asked to judge their It’s fine-no problems with
present chewing ability and mark it on a scale ranging toothache or caries 16 50
from that of a full set of good natural teeth (=lOO%) to I think the denture is good on the
that of an edentulous person without dentures (=O%), whole 20 63
I haven’t really become used to
the mean value was 76% for men and 64% for women. wearing a denture 4 13
The distribution is shown in Fig. 1. No difference was I don’t feel very happy about the
found between those with complete dentures in both jaws dentures 4 13
and those with residual dentition in the mandible. I regret very much that I had the
Answers to the questions about symptoms of mandibular teeth extracted 6 19
dysfunction were used for determination of the anamnes- *Some patients marked more than one alternative.
tic dysfunction index. I3 The distribution in Fig. 2 shows
that two thirds reported no dysfunction symptoms, while
two individuals had marked symptoms (pain on maxi- (Table V). The vertical dimension of occlusion was
mal opening of the mouth). considered to be too low in almost two thirds of the
patients, and in one third the denture teeth were severely
Clinical examination worn. According to the overall judgment, 14 of the 32
The observations of denture quality and tissue health patients needed new dentures and an additional six
revealed frequent deviations from optimal conditions needed relining, occlusal adjustment, or repair.
THE JOURNAL OF PROSTHETIC DENTISTRY 57
 BERGMAN AND CARLSSON

Number of Number of
patients patients
ES4 men
@3i men
0 women I

I II Ai 0 I II Ili Di
Fig. 3. Distribution of 32 patients according to clinical
Fig. 2. Distribution of 32 patients according to reported dysfunction index, D,13.0 = No; I = mild; JJ = moderate;
symptoms of dysfunction of masticatory system, Ai13. JJJ= severe clinical signs of dysfunction.
0 = No; J = mild; II = severe symptoms.

Table V. Observations on denture quality

Table IV. Patient evaluation of foods listed
and tissue conditions assessed by examiners
according to chewing difficulty (percent
(percent distribution in 32 denture wearers)*
distribution in 32 denture wearers)
Not so
Easy Good good Bad
to Some chewing Difficult ImFible
Food chew difficulties to chew to chew Stability of maxillary denture 68 29
Stability of mandibular 51 42
Steak (tough) 16 42 26 16 denture
Raw carrot 28 44 22 6 Extension of maxillary H4 13
Chewing gum 35 30 13 22 denturr
Almonds 48 37 11 4 Extension of mandibular hU 26 i
Peanuts 55 27 14 5 denture
Apples 59 25 13 3 Occlusion hh 22 1;
Roast veal 66 25 9 - Eccentric contacts 1’) 50 31
Bread rolls 68 19 10 3 Slide in centric
Cooked barley 71 26 3 Saglttalt 6b I9 16
and potato t.ateral* 81 13 h
cakes Denture-wearing mucosa
Chocolate bar 81 16 3 - Maxilla 63 31 6
Soft bread 81 16 3 - _-
Mandible 74 26
Crisp bread 88 9 3 -
Firmness of ridge
Fried chicken 89 - 7 3 Maxilla 28 5h lli
Boiled fish 97 3 - -
Mandible II 3: i.3
Boiled potatoes 97 3 - -
Anatomic conditions for
denture wearing
Maxilla
The functional examination of the masticatory system Mandible
was used to assessthe clinical dysfunction indexi (Fig.
3). None was classified as having severe dysfunction
(DiIII), and most had mild or no signs of mandibular
dysfunction (DiO and DiI).

Cepkalometric findings
Tracings of some of the radiographs are presented to
show the great individual variations in bone resorption
during the observation time (Figs. 4 to 6). Analysis of
measurements and various background factors will be
presented in a future article.
DISCUWON
The loss of participants in this long-term study can be
explained by unavoidable inability to attend the exami-
58
nation. (Only three said that they did not wish to come.)
While it is true that possible effects of this loss on the
results cannot be assessed, there seems no reason to
suspect a consequent bias.
The adaptation to denture wearing was excellent for
more than 70% of the patients, and only 69’0assessedthe
total denture function as less than good. These figures
were in contrast to the examiners’ evaluation that 20
patients (63%) needed new dentures or -substantial
JANUARY 1985 VOLUME 53 NUMBER 1
COMPLETE DENTURE WEARERS
Fig. 4. Tracings of symphysis region of mandible from cephalometric radiographs in 13
patients 2 days, 5 years, and 21 years after extraction of all remaining teeth in mandible
and insertion of immediate complete denture. All patients had complete maxillary
dentures.
adjustment to their present dentures. This discrepancy
between the patient’s satisfaction with the dentures and
the dentist’s assessmentof their quality has been demon-
strated in previous studies.ls3The small group of patients
who said that they had been unable to adapt to wearing
dentures even after 21 years or regretted that their teeth
had been extracted deserves special attention. The indi-
cations for complete denture treatment have certainly
changed during the last two decades in Scandinavia.
Newly published long-term studies over ten yearsI do
not support the opinion that removable partial dentures
will cause periodontal and carious lesions. On the
contrary, the conclusion can be drawn that a removable
partial denture is a valuable treatment procedure for
patients with a markedly reduced number of teeth.
There is a stronger emphasis on alternatives that avoid
extraction of all the teeth and on attempts to maintain
some as abutments for removable and fixed partial
dentures, or as supports for overdentures (tooth-sup-
ported dentures). It is probable that some patients in the
present study who had not adapted well could have been
offered such alternative treatment, which might have
postponed or eliminated the transition to complete
dentures. The functional state of the masticatory system,
both according to patient reports and clinical signs,13was
good in general compared with the results of epidemio-
THE JOURNAL OF PROSTHETIC DENTISTRY
logic studies of mandibular dysfunction in dentate and
edentulous subjects.‘6-‘8This low frequency of mandibu-
lar dysfunction was probably related to the good adapta-
tion to wearing dentures found in most of this group.
The denture quality was far from optimal according to
prosthodontic criteria, but most patients were satisfied
with the function of their dentures. In a series of patients
waiting for treatment because of unsatisfactory complete
dentures, Magnusson la found a high frequency of
marked clinical signs of mandibular dysfunction and
recurrent headaches. He reported a statistically signifi-
cant reduction of dysfunction and headaches 6 months
after treatment with new complete dentures.‘”
It is interesting to see the patients’ high evaluation of
their chewing ability (Fig. 1). It should be contrasted to
the extremely reduced chewing efficiency for denture
wearers compared with dentate persons found in clinical
studieszOand laboratory tests.21~22 The finding that those
with dentures in both jaws made similar assessmentsto
those with a denture in only one jaw and natural teeth in
the other also emerged from an epidemiologic study
using a questionnaire. 23 It is a surprising result when
compared with the substantial improvement in chewing
efficiency found among a group of poorly adapted
complete-denture wearers after treatment with a fixed
restoration on osseointegrated oral implants in the
59
 BERGMAN AND CARLSSON

Fig. 5. Tracings of anterior part of maxilla from cephalometric radiographs selected

from 19 patients who received immediate denture treatment in maxilla. A and 6, Two
patients with little resorption following first period after extraction. C and D, Two
examples of continuing resorption during follow-up period of 21 years.

A 6 C D
Fig. 6. Different patterns of resorption in maxilla in relation to status in mandible
during 20-year observation period. Solid line = 1 year; dotted line = 21 years after original
denture treatment. A and B, Large and small maxillary resorption, respectively, with
remaining teeth in mandible. C atid D, Variations of resorption in both jaws.

mandible while the complete denture was retained in the analyses of the cephalometric part of the study in a
maxilla.24 subsequent article.
The tracings of the cephalometric radiographs show
the extremely wide variation in hone resorption. The cc?pscLus~u~s
long-term results thus corroborate earlier results among The discrepancy found in the present study between
the same patients. *’ It is our intention to present further the patients’ satisfaction with the dentures and the
60 JANUARY 1985 VOLUME 53 NUMBER 1
COMPLETE DENTURE WEARERS
dentist’s assessmentof their quality is in agreement with
results of previous studies. This fact underlines the need
for regular check-ups even for complete denture patients
to avoid maladaptation and/or biologic injuries.
The low frequency of mandibular dysfunction was
probably related to good adaptation to denture-wearing
found in most of the patients.
The patients’ high evaluation of their chewing ability
is in contrast to the extremely reduced chewing efficiency
found in clinical and laboratory tests.
An extremely wide individual variation of bone
resorption was found from tracings of cephalometric
radiographs.
Before teeth are extracted and patients are provided
with complete dentures, alternatives such as removable
partial dentures and overdentures should be considered
seriously.
SUMMARY
Thirty-two patients initially treated with a complete
denture in the maxilla or mandible were examined after
21 years. The examination included a questionnaire plus
clinical and radiographic examinations.
Denture function was assessedin general as very good
or fairly good by the patients, but about half of the
subjects also felt that the dentures needed some attention.
The patients generally had a high evaluation of their
chewing ability. The functional state of the masticatory
system, both according to patients’ reports and the
clinical signs, was generally good compared with previ-
ously published epidemiologic studies.
The denture quality and tissue health were far from
optimum according to prosthodontic criteria. By overall
judgment, 14 patients needed new dentures and six
needed relining, occlusal adjustment, or repair.
Tracing of cephalometric radiographs showed wide
variations in bone resorption among patients.
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Re,tmnt requea lo:
DR. Bo BERGMAN
UNIVERSITY OF UMEA
FACULTY OF ODONTOLOCY
S-901 87 UMEbr
SWEDEN
61