Cairo Dental Journal (24) Number (2), 313:333 May, 2008

ClINICal EvalUaTION Of ThE EffICaCy Of SOfT aCRylIC DENTURE COmpaRED TO CONvENTIONal ONE WhEN RESTORINg SEvEREly RESORbED EDENTUlOUS RIDgE
gehan f. mohamed1

1.

Assistant Professor, Department of Prosthodontic, Faculty of Dentistry, Menia University

AbstrAct
The prosthodontist encounters increasing problems in the fabrication of a well functioning

complete denture over a resorbed edentulous ridge. The objective of this study was to clinically evaluate the efficacy of the soft acrylic denture compared to conventional one when used to restore a severely resorbed ridge. Both quantitative and qualitative parameters were assessed. Quantitative parameters were bite force and chewing efficiency (velocity), which was measured 1 week, 3 and 6 months follow-up period, as well as retention force. This latter was recorded after 6 months. Qualitative parameters included denture fit, tissue condition, denture satisfaction, denture complaint and chewing ability. These parameters were assessed after 1 week and 6 months. Eleven subjects were included in the study. They first received conventional dentures. These latters were then substituted with duplicate dentures processed from soft heat cured acrylic resin materials. Results revealed nonsignificant difference between both types of denture among chewing ability and efficiency of soft food, stability scores, tissue response and satisfaction rate. Chewing efficiency of hard food and bite force showed significant difference in favor to conventional type. Retention force differed significantly in favor to conventional type in mandibular dentures. Conversely, soft acrylic dentures recorded high significant value in maxillary dentures. Morover, they showed higher significant score of complaint among both conventional upper and soft lower dentures. It was concluded that soft acrylic denture had a better retention of the upper denture, good tissue response, acceptable chewing efficiency and ability, moderate stability scores and high rates of patients satisfaction. Therefore it could solve the problem of severely atrophic ridge especially in maxilla and should be considered a treatment option according to patients behavior and ridge nature and quality.

INTRODUCTION
Functional problems associated with edentulousness

consequences of edentulousness include disability to speak and eat, reduction of social contact and inability of the residual ridge and its overlying tissues to withstand masticatory forces(3,4). Loading of the mucosa overlying

such as loose dentures and diminished chewing

efficiency, had been reported by many authors(1,2). The

(314)

Gehan F. Mohamed

C.D.J. Vol. 24. No. (II)

the mandibular bone may occur during swallowing, mastication or clenching via the denture. The mucosa is sandwiched between the denture base and the underlying

adequate denture retention is less functional movement and better stability(17). Relative lack of sufficient retention of a complete mandibular denture, even if there anatomic and experienced practitioner(18). Occasionally, it is

bone so that all the forces generated by the mandible, during function and parafunction, are transmitted maxillary denture-bearing area may lead to problems with prosthetic rehabilitation(5). through this atrophic tissue(4). Extreme resorption of the

landmarks exist, can test the limits of the most skilled not possible to achieve optimal denture retention and

stability because of factors not influenced by adequate

denture fabrication alone(19). These factors include poor neuromuscular coordination, inadequate quantity and poor location of available bone and alveolar mucosa, and denture therapy and sound Prosthodontic principles result

complaints from their complete denture especially with

Almost one third of the edentulous patients have

jaw and ridge relationships, psychologic conditions,

regard to their lower one(6). The complaints include pain during mastication. With time, as the resorption of

insufficient stability and retention of the denture and the residual ridge was commenced, pain and difficult proper nutritional intake and the patients ability to

inadequate vestibular depth. When conventional complete in inadequate denture retention and stability, patient satisfaction, confidence and comfort commonly suffer(19). retention and stability when conventional denture therapy There are treatment alternatives that aid in increasing

oral functioning may even increase to an extent that communicate with ease and confidence are jeopardized. In addition, a less attractive facial appearance, difficulty with speech and avoidance of social contact may result

is inadequate. These include resilient denture liner materials or surgical intervention. The liner materials were applied to the intaglio surface of dentures to achieve

in psychosocial problems(7). From the patients point of view, denture satisfaction appears to be primarily related to aesthetics, retention and function.

more equal force distribution, reduce localized pressure and improve denture retention by engaging undercuts(20,21). destraction of the alveolar ridge(22,23) increase the vestibular depth (vestibuloplasty and lowering the floor of for implant supported/retained prostheses(25). The surgical intervention include, augmentation and

complete dentures, should be the primary goal in the factors; retention, stability and support, in the prescription

A high level of patient satisfaction, when fabricating

treatment of edentulous patients. There are 3 key principal and provision of successful complete dentures(8-10). It was

the mouth)(24) and dental implant to provide an anchorage These facts indicate that problems reported by

stated that complete denture are made up of 3 surfaces; the impression, the polished and the occlusal surfaces(11). The retention, stability and support of the dentures are governed by the design of these surfaces(8-10).

edentulous patients will continue to challenge dentists,

particularly as the ability to adapt to conventional complete dentures that decreases with age(26). The prospective aim of this study was to evaluate clinically soft acrylic denture used to restore a severely resorbed ridges in completely edentulous patients. Objectively, the chewing efficiency, the occlusal bite force and the and stability scores (denture fit), tissue conditions scores,

surface tension, atmospheric pressure, viscosity and volume of saliva, gravity, muscle posturing and occlusion on denture retention had been well documented
(12-15)

The influence of adhesive and cohesive forces,

Denture retention is understood to be a function of saliva surface tention, its viscosity, the thickness of the salivary angle. Therefore, Kikuchi et al., 1999
(16)

retention force were measured. Subjectively, the retention denture satisfaction rate and chewing ability scores were focusing problems with related complaints and problems with chewing different types of food(27-29).

film, the contact surface and the saliva denture contact that good adaptation of the denture to the tissues, could improve denture retention. A logical consequence of mentioned

assessed using validated self-administrated questionnaires

CliniCal Evaluation oF thE EFFiCaCy

(315)

maTERIalS aND mEThOD

Patient were selected with resorbed ridges in both arches but with firm Mucoperiosteum Fig. (1). 1 year. Patient selected who had been edentulous for at least Conventional complete dentures were identically

Eleven completely edentulous male patients were selected from the Prosthodontic Clinic, Faculty of Dentistry, Menia University.

Inclusion and exclusion criteria:

The patients were selected according to the following criteria: Age ranging from 45-55 years. Free from any systemic or neuromuscular disorder that might affect chewing efficiency of masticatory muscles. Free from any temporo-mandibular joint disorder. Class I Angles ridge relationship.

fabricated in compliance with a neutrocentric philosophy

of treatment. Alginate impressions (Alginate chroma ridges, poured into stone plaster. Acrylic special trays were

done, Ultradent products Inc. Jordan) were made for both constructed. Border molding with green sticky compound (Kerr Italia S.P.A. 1-84014 Scafti, Salerno-Italia) and final impression for upper and lower ridges were made by outline impression paste (eugenol free) cavex. Holland)

using zinc-oxide and eugenol impression material (Cavex to obtain the master cast. Occlusion blocks on the final mount the upper cast on a semiadjustable articulator(30) Fig. (2).

Patient with abnormal tongue behavior and/or size were excluded.

Patient with xerostomia or excessive salivation were excluded.

casts were constructed. A face bow record was made to

fig. (1): Completely edentulous patients with severe resorbed ridges. (a) mandibular ridge, (b) maxillary ridge

accurate vertical dimension of occlusion, using check bite

Centric occluding relation was recorded at the

technique to mount the lower cast on the articulator in centric relation.(30,31) Protrusive record was made to adjust horizontal conylar guidance of the articulator, while the lateral condylar guidance was adjusted according to

the equation L=H/8+12 (Hanan formula). Zero- degree posterior denture teeth (Acrylic cross-linked, Acrostone, Egypt) were set on a flat plane over the ridge crest and
fig. (2): face bow record

the anterior teeth were set without vertical overlap(27). Waxing-up of denture base was then performed. Try-in

(316)

Gehan F. Mohamed

C.D.J. Vol. 24. No. (II)

was made and the occlusion was carefully checked on the articulator as well as in the patient mouth. Occlusion was verified both in centric and eccentric positions. Face bow index for the waxed-up upper trial denture

or discomfort. Each patients was allowed to wear his denture for one weak during which complete settling and adaptation of the denture could occur. Hence,

duplication of the denture(34) was performed once the

base was done to be used for clinical remounting and latter on for soft acrylic denture construction(32) Fig. (3).

first set of dentures was seemed to be comfortable by the patient, producing another set of denture with soft acrylic resin type. The dentures had their intaglio, polished and occlusal surfaces were replicated as accurately as possible using the following method. The definitive casts were duplicated using reversible hydrocolloid (Polyflex;

dentsply, York, pa) and mounted in the same relationship used to produce matrices in vinyl polysiloxane (Sherasil,

as the original final casts. The original set of denture was Werkstoff. Technologic GmbH & Co KG, Lemforde, Germany). These matrices were used to fabricate maxillary and mandibular autopolymerizing acrylic resin bases (vertex; Dental BV, Zeist, the Netherlands) with
fig. (3): face bow index

wax teeth (Kemdent Anutex Associated dental products). prosthetic teeth using face bow index as a guide for tooth position. Once, the maxillary teeth were correctly The maxillary wax teeth were replaced with identical

conventional heat cured acrylic resin material (Acrostone WHW plastic England packed by Anglo Egyptian Lab). The conventional acrylic resin denture was processed in a water bath curing tank for 1 hour at 74c and another 1 hour at 100c. Then, the dental flask was cooled to finished and polished. remounting
(33)

Waxed up denture was flasked, packed and cured with

positioned, the face-bow stone index was removed from the articulator and replaced with the mandibular final cast. The mandibular autopolymerizing acrylic resin base with wax teeth was located on the mandibular final cast. mandibular prosthetic teeth. The duplicate dentures

room temperature. Denture was laboratory remounted, All patients routinely worn their prostheses. Clinical was done to refine the finished denture

The mandibular wax teeth were replaced with identical were processed by conventional compression molding technique(35,36) using soft acrylic resin type (Vertex softDental B.V., Zeist, the Netherlands). The soft acrylic resin material was mixed, flasked, packed and cured according were polymerized in a water bath curing tank for 1 hour cool down in the open air. to the manufacture instructions. The vertex soft acrylic at 70c and for another hour at 100c, then let to slowly Laboratory remounting was done to refine the

occlusion on the articulator. The upper cast was remounted by aid of face bow index, while the lower cast was remounted by making new centric relation record. Also, horizontal record. Subsequently lateral condylar path inclination was calculated from Hanan formula. condylar guidance was re-adjusted by wax-wafer protrusive

extension, retention and stability intra-orally. The patient

Then, the finished denture was checked for proper

occlusion. A pneumatic chisel was used to remove The denture was finished and polished using the vertex Zeist, Netherlands).

was given a proper program for denture insertion and

carefully the soft denture without split from the cast. finishing-polishing instruments (vertex Dental Academy,

oral hygiene measures. The patient was recalled after

48 hours to check for any pressure area causing pain

CliniCal Evaluation oF thE EFFiCaCy

(317)

Occasionally, each patient was allowed to wear first, his conventional acrylic denture for 6 months during which all the evaluation parameters were measured. Then the denture was removed from patients mouth for 2 weeks as a period of rest. Then soft acrylic denture was secondly delivered to the same patient Fig. (4). Monitoring and data collection continued for additional 6 months. Each patient was examined by three prosthodontists. Data were independently and concurrently recorded by them.

Evaluation methods:
The clinical evaluation of soft acrylic denture that used to restore a severely resorbed edentulous ridge in comparable with conventional acrylic denture (control type) was performed by both objective (quantitative) and subjective (qualitative) manner. All patients were allowed to familiarized with the measurement procedure and the instruments.

Objective evaluations: * Chewing efficiency

Chewing efficiency of the conventional acrylic resin denture (control) was evaluated firstly for 6 months (one week, three and six months) follow-up periods. Then, there was 2 weeks a period of rest. Chewing efficiency of the soft acrylic resin denture was done for another 6 months by the same schedule of follow-up that previously made. During each follow-up period, standard 1 cm cubes of two different foods (Carrot and cheese) were given to each patient. He was asked to chew each food cube, measurements of efficiency was recorded as number of chewing strokes until the patient swallowed. Then, time (in seconds) elapsed from the first chewing stroke until patient swallowing, was calculated. Each prosthodontist repeated this measurement for each patient at each test session 3 times. Records of the three prosthodontists were collected and values were reported to be statistically analyzed(37-40).

* Bite force measurements:

For each patient at each follow-up session, maximum bite force was recorded using occlusal force meter instrument (Model GM, NaGoNo Keiki Seisakusho, Ltd, J. Morita Coorporation, 33-18-3 Chomeo-Torumi-choSuita City, Osaka 564-8650, Japan) as shown in Fig. (5).
fig. (4): finished conventional and soft acrylic dentures. (a) maxillary conventional and soft denture. (b) mandibular conventional and soft denture

Bite force was measured for both denture types (conventional and soft) at one week, three, and six months follow-up periods. The recorded force during maximal clenching was obtained with one bite force meter placed between pairs of opposing teeth at one

(318)

Gehan F. Mohamed

C.D.J. Vol. 24. No. (II)

side and four, wood tongue depressor at the other side.

The meter and depressor were located at the area of

premolar/molar where there is more number of occlusal contacts with strong determinant of muscle action and subsequent great bite force.

chair with their head on the headrest and the occlusal plane

Each patient was asked to set comfortably in a dental

of the maxillary teeth parallel to the floor. The patients consistent manner with uniform digital pressure until minute was then allowed for the denture base to reach a a hook screw with its nut (Digital force Gauge device

were trained to manipulate the base in their mouth in a it occupied a comfortable and accurate position. One stable equilibrium position. With self-cure acrylic resin, Model 47544 Extech instrument, coorporation, Taiwan) upper denture and mid-lingual surface of each lower

was secured in the polished mid-palatal surface of each denture to detach it from the patient mouth and record the amount of the force required for dislodgment. The pull end of the digital force gauge device was connected to the
fig. (5): occlusal force meter

hook positioned at maxillary and mandibular dentures for dislodgement occurred. Fig. (6).

each acrylic type and was pulled vertically until denture

position. The tip of the dispocap that covered the arm of

During testing, the patient was seated in upright

the meter device was inserted into the patient mouth and

he asked to bite on it slowly. When the force has exceeded 70 KgF, the buzzer would be sound continuously and the

the set-point, the buzzer was sound. If the force exceeded biting should be stopped immediately. For each patient, the mean of at least 10 record of the right and left sides were collected from each prosthodontist and used in the statistical analysis. Random errors of maximum bite this value is calculated from the differences between the two assessments as follows force were assessed by computing Dahlberg(41) Statistics;
fig. (6): Digital force gauge device attached to the maxillary denture

[ (first measurement - second measurement) 2 Error = (2 x number of couples of repeated measurements)]

* Retention force measurements
the method proposed by Kikuchi et al., 1999(42), using Retention force measurement was made according to

before and after each test session and no error of any kind was noted in the testing system. None of the patients experienced any discomfort from the level of forces required to dislodge the dentures from their seats.

The device was always automatically calibrated

force measurement gauge (Digital force gauge device model 47544 Extech instrument, cooperation, Taiwan; measure tension & compression, pull and push).

(6 months), the force required to dislodge the conventional

For each patient, by the end of the follow up period

or soft acrylic dentures from the upper and lower ridges

CliniCal Evaluation oF thE EFFiCaCy

(319)

were recorded 10 times per each and the average value was taken as a record. The same was repeated with three inter-examiner colleagues. Records were measured by Newton. Then, they were gathered and calculated to obtain the mean retentive values for each ridge in both types of acrylic denture to be statistically analyzed.

Subjective evaluations; * Retention and stability scores

subjectively after 6 months for denture retention and stability using the scoring system described by Kapur, 1975(43) Fig. (7). The complete upper and lower dentures were evaluated

Retention and Stability Scoring Systems

Patient name: Evaluator: Date: Retention score: Stability score: Retention Criterion 0 No retention (when a denture is not seated in its place, its displaces itself) Minimum retention (when a denture offers slight resistance to vertical pull, and little or no resistance to lateral forces) Moderate retention (when a denture offers resistance to lateral forces) Good retention (when a denture offers maximum resistance to vertical pull and sufficient resistance to lateral forces) 0 Post convention denture: Post soft denture: Retention: conventional D: Soft D: Stability Criterion No stability (when a denture base demonstrates extreme rocking on its supporting structure under pressure) Some stability (when base demonstrates moderate rocking on its supporting structure under pressure) Sufficient stability (when a denture demonstrates slight or no rocking on its supporting structures under pressure)

fig. (7): Retention and stability data form

(320)

Gehan F. Mohamed

C.D.J. Vol. 24. No. (II)

* Tissue condition score:

both arches were evaluated with the criteria-based scoring The condition of the denture-supporting tissues in

the evaluation. The numbered criteria that best described the patients tissue condition were recorded. Higher scores indicated more favorable tissue conditions. The data obtained from the three prosthodontist were collected at one week and 6 months follow-up for each type of denture to be statistically analyzed.

system described by Rayson et al., 1971(44) Fig. (8). the tissue. Clinical observation along with pressure-

The evaluation consisted of four criteria that described indicating paste (PIP) patterns were recorded and used in

Tissue Condition Scores

Patient name: Evaluator: Date: Tissue score: 1 week conventional denture 6 months conventional denture 1 week soft denture 6 months soft denture

Criteria
1. Large general region of redness involving half or more of the denture bearing surface or a considerable amount of movable tissue not present before or both. 2. Some movable tissue on the crest of ridge not previously present or irritated regions covering one-third of the denture bearing area. 3. The tissues are generally firm and appear healthy except for small isolated regions. 4. Tissues are firm and appear healthy with no signs of abrasion or other injury caused by the dentures. All abnormal areas are to be scribed on the drawing and the following coding used: R: Redness (isolated) I: Inflammation (general) R Drawing and PIP record H: Hyperplastic tissue U: Ulceration L

fig. (8): Tissue condition data form

CliniCal Evaluation oF thE EFFiCaCy

(321)

* Denture complaints score, chewing ability score and overall denture satisfaction rate:
primarily focused on the subjective appreciation of Variables used for treatment outcome assessment

patient received one complete denture constructed by conventional heat cured acrylic resin (type I control) and another one constructed by soft heat cure acrylic resin

denture (type II). They were followed up clinically to force values (objective parameters). Additionally, the

the denture. Denture satisfaction was assessed with a

record the chewing efficiency, bite force and retention retention and stability scores, denture complaint and chewing ability problems scores, patient satisfaction rate parameters). and tissue condition scores were assessed (subjective

validated self-administered questionnaire at 1 week and 6 months for each type of denture(45,46). Twelve questions addressed problems with functioning with the lower The extent of each specific complaint could be expressed

denture and seven questions concerned the upper denture. on a four-point rating scale (0=no, 1=little, 2=moderate,

3=severe complaints). Five questions addressed chewing

Chewing efficiency (Masticatory performance):

patient as follows: 3 times periods for conventional acrylic denture (one week, 3 months, 6 months) and another 3 times periods for soft acrylic denture (one week, Six chewing efficiency records were made for each

ability problem of soft and hard food, each with a threepoint rating scale (0=good, 1=moderate, 2=bad). The patients overall denture satisfaction was expressed on

a 10-point rating scale (1=very bad to 10=excellent). On each factor, final scores were calculated as the mean of the item scores, ranging from zero to three for the

3 months, and 6 months). The data obtained from the prosthodontist for each type and at each time period were summarized and reported in the form of mean values of both the chewing times and number of chewing strokes.

complaints questionnaire and from zero to two for the subjective chewing ability. All data obtained (objective analyzed. and subjective) were gathered, tabulated and statistically

Then the number of chewing velocity (stroke/sec) were when chewing carrot and cheese.

calculated to compare between both types of denture

Data analysis
and conventional acrylic dentures, a two-way analysis To determine, significant difference between the soft

Chewing hard food:

types of acrylic denture; the mean values and standard deviations of chewing velocity (number of strokes/unit To compare between the chewing efficiency of both

of variance with repeated measures on two factors was efficiency. While, the other evaluated parameters as

used to analyze the values of bite force and chewing retention force measurements and scores, stability scores, denture complaint scores, chewing ability scores, denture satisfaction rate and tissue condition scores were P-value 0.05 were considered statistically significant. While those <0.01 were considered highly significant.

time) of both type were calculated throughout different

follow-up periods and tabulated (Table 1). The mean value conventional acrylic denture, while those for soft acrylic week, 3 and 6 months follow-up periods respectively.

of chewing velocity were 1 0.03, 10.03, 1.010.03 for denture were 0.930.12, 0.990.05 and 0.970.03 at one There was a significant difference of chewing

compared in both type of denture using signed rank test.

RESUlTS
Eleven completely edentulous male patients received

velocity between both types of acrylic denture infavor to difference in both types by time.

twenty-two success full complete dentures. Each

conventional (p<0.03). While; there was no significant

(322)

Gehan F. Mohamed

C.D.J. Vol. 24. No. (II)

TablE (1) Analysis of the chewing efficiency in both conventional and soft acrylic complete dentures when chewing hard food at different follow-up periods Conventional acrylic denture Time No of strokes MeanSD 26.913.51 25.553.36 24.553.39 Time in sec MeanSD 26.913.58 25.573.26 24.213.46 Stroke/time velocity MeanSD 10.03 10.03 1.010.03 No of strokes MeanSD 25.824.67 6.183.06 24.643.17 Soft acrylic denture Time in sec MeanSD 27.623.45 26.003.68 25.313.23 Stroke/time velocity MeanSD 0.930.12 0.990.05 0.970.03

1W 3M 6M

ANOVA results
Variable Time Type Time/type interaction
All values are mean standard deviation NS: Non significant

P-value 0.340 0.030 0.223

P-value 0.05 are considered significant Sig. Significant

Effect NS Sig NS

Chewing soft food:

chewing velocity were 0.950.09, 0.970.09 and During chewing soft food, the mean values of

1.050.10 for the conventional acrylic denture, while

for the soft acrylic denture were 0.960.09, 0.960.09

and 0.980.07 at one week, three and six months follow up period respectively Table (2). No statistical difference between the conventional and soft acrylic dentures when chew a soft food. However, there was a significant increase of chewing velocity by time in each type infavor to conventional acrylic denture.

TablE (2) Analysis of the chewing efficiency in both comparison of conventional and soft acrylic complete denture when chewing soft food at different follow-up periods Conventional acrylic denture Time No of strokes MeanSD 11.822.09 11.092.21 10.452.25 Time in sec MeanSD 12.341.48 11.401.7 9.941.61 Stroke/time velocity MeanSD 0.950.09 0.970.09 1.050.10 No of strokes MeanSD 11.452.11 10.912.26 10.002.05 Soft acrylic denture Time in sec MeanSD 11.881.42 11.331.76 10.171.57 Stroke/time velocity MeanSD 0.960.09 0.960.09 0.980.07

1W 3M 6M

ANOVA results:
Variable Time Type Time/type interaction
All values are mean standard deviation NS: Non significant

P-value 0.030 0.189 0.052

P-value 0.05 are considered significant Sig. Significant

Effect Sig NS Sig

CliniCal Evaluation oF thE EFFiCaCy

(323)

Bite force measurement:

measurement for the maximum bite force was (7.9%) within the acceptable range <10% .
(37)

Retention force measurement

retention, were considered the primary measures of secondary. The objective measures, force gauge-measured

According to Dahlbergs equation, the error of the

efficacy and the subjective measures were considered The means ( standard deviations) and P-values from

conventional and soft acrylic dentures were 5.45 0.52 and 4.75 1.12 at one week, 8.82 1.02 and 7.81 1.28 months follow-up periods respectively Table (3).

The recorded mean values of biting force for

after three months and 8.18 1.20 and 7.49 1.29 at six Analysis of the result revealed a significant difference

the analyses for the measured retention data are listed in statistically significantly greater retention values than

table (4). Conventional acrylic mandibular denture had the soft acrylic ones (P=0.001). However, maxillary soft retention than the conventional acrylic one (P= 0.044).

between the two types of denture (P<0.001), where the

acrylic denture had a statistically significantly greater

conventional acrylic denture showed higher biting force values. There was also a significant increase in the bite time was the same in both types. force values by time in each type. Change occurred with

TablE (4) analysis of the retention force values in acrylic complete dentures at 6 months
Conventional acrylic denture (mean SD) 8.44 1.55 26.53 7.22 Soft acrylic denture (mean SD) 3.93 1.65 28.52 7.45

comparison of the conventional and soft

TablE (3) analysis of the biting force measured

(mean SD) in comparison of conventional and soft acrylic complete dentures at different follow-up period

Arch

P-value

Mandible

0.0010* 0.0449*

Time 1W 3M 6M

Conventional acrylic denture mean SD 5.45 0.52 8.82 1.02 8.18 1.20

Soft acrylic denture mean SD 4.75 1.12 7.81 1.28 7.49 1.29

Maxilla

All values were means standard deviation

*

P-value 0.05 are considered significant

Retention and stability scores

the retention and stability scores are seen in table (5). The results of the subjective measures which included; The data were demonstrated as median (range). It

ANOVA results:
Variable Time Type Time/type interaction P-value Effect

<0.001 <0.001 <0.111

Sig. Sig. Sig.

was clear that the conventional acrylic denture had a statistically significantly greater retention score for the

mandibular arch than soft acrylic denture. While, with maxillary denture, no significant difference were recorded for the both types of acrylic.

All values are mean standard deviation P-value 0.05 are considered significant NS: Non significant Sig. Significant

was observed between the conventional and soft acrylic dentures either in the mandible or the maxilla.

With respect to stability scores, no statistical difference

(324)

Gehan F. Mohamed

C.D.J. Vol. 24. No. (II)

TablE (5) analysis of the retention and stability scores in comparison of conventional and soft acrylic complete dentures at 6 months

Variables

Arch Mandible Maxilla Mandible

Conventional acrylic denture median (range) 2 (1-3) 2 (2-3) 2 (1-2) 2 (1-2)

P-value 0.05 are considered significant

Soft acrylic denture median (range) 1 (0-2) 3 (2-3) 1 (0-2) 2 (1-2)

P-value

Retention Scores

0.0156*

Stability Scores
All values are median ( range)

0.0625 0.5000

Maxilla
*

Tissue condition scores

( range) in Table (6). Values were equal for both the The tissue score data were represented as median

One week evaluation

The patient recorded significantly higher complaint scores for lower denture when wearing the soft acrylic type (P= 0.003). While, for upper denture, the reverse was observed where, the patient recorded high significant complaint score when wearing the conventional acrylic type (P=0.002). Difference in chewing ability problem scores between conventional and soft acrylic denture when chewing hard and soft food were not statistically significant. The overall denture satisfaction rating were equal in both types of acrylic denture. Table (7)

soft and conventional acrylic dentures at each follow-up conventional and soft acrylic dentures either for the (1 week 6 months).

period. No statistical difference were observed between mandible or maxilla at different follow-up periods

Denture complaint scores, chewing ability problem scores and denture satisfaction rate
the form of median ( range) at one week and 6 months follow-up periods respectively. All collected data were summarized in table (7&8) in

TablE (6) analysis of the tissue condition scores data in comparison of the conventional and soft acrylic complete dentures at 1 week and 6 months follow-up period.

Arch

Time 1W

Mandible 6M 1W Maxilla 6M
*

Conventional acrylic denture 3 (2-4) 3 (2-4) 3 (2-4) 3 (2-4)

Soft acrylic denture 3 (3-4) 3 (2-4) 3 (3-4) 3 (3-4)

P-value 0.5000 0.5000 0.0625 0.5000

All values are Median ( range)

P-value 0.05 are considered significant

CliniCal Evaluation oF thE EFFiCaCy

(325)

TablE (7) One-week post treatment scores (median range) of the denture complaint, chewing ability problem and overall denture satisfaction rating questionnaires. Variables Complaint of lower denture (Score 0-3) Complaint of upper denture (Score 0-3) Problem in chewing soft food (Score 0-2) Problem in chewing hard food (Score 0-2) Satisfaction rate (Score 1-10)
All values are median ( range)

Conventional acrylic denture 1.4 (0.9-1.7) 1.1 (0.8-1.3) 1.1 (0.9-1.4) 1.6 (1.1-1.8) 4.9 (4.1-7.5)

Soft acrylic denture 1.5 (1.1-1.8) 0.9 (0.7-1.1) 1.1 (0.9-1.4) 1.7 (1.1-1.8) 4.8 (3.9-7.2)

P-value 0.0039* 0.0020* 0.7969 0.2500 0.9941

* P 0.05 are considered significant

Six months evaluation

For lower denture, the patient were still recorded significant complaint score when wearing the soft acrylic type (P=0.002). Also, for upper denture the patient recorded high significant complaint score when wearing the conventional acrylic type (P=0.002). The chewing ability scores were not significantly, different between both types of acrylic denture when chewing soft food.

However, a significant difference was observed between where (P=0.002).

both types of acrylic denture when chewing hard food, Soft acrylic type had a higher chewing ability problem

than those of the control type. The overall denture satisfaction rate was increased by time in both types of acrylic with the same rate. Table (8).

TablE (8) Six-months post treatment score (median range) of the denture complaint chewing ability problem and overall denture satisfaction rating questionnaires. Variables Complaint of lower denture (Score 0-3) Complaint of upper denture (Score 0-3) Problem in chewing soft food (Score 0-2) Problem in chewing hard food (Score 0-2) Satisfaction rate (Score 1-10) All values are median ( range) Conventional acrylic denture 1.1 (0.7-1.5) 0.8 (0.6-1.1) 0.9 (0.6-1.1) 1.1 (0.9-1.6) 7.3 (5.1-8.5) Soft acrylic denture 1.2 (0.9-1.6) 0.6 (0.5-1.1) 0.9 (0.6-1.2) 1.4 (1.1-1.7) 7.6 (4.8-8.6) P-value 0.0020* 0.0020* 0.8594 0.0020* 0.3438

* P 0.05 are considered significant

(326)

Gehan F. Mohamed

C.D.J. Vol. 24. No. (II)

DISCUSSION
Wearing complete denture may have adverse effects

was adjusted according to the equation: L = H/8 + 12.

Laboratory remounting was done to overcome errors that might happen during processing(30). Also, clinical remounting was done to allow adjustment of occlusion.

on the health of both the oral and the denture supporting tissues. Although the prevalence of an edentulous condition is decreasing, the great number of edentulous people warrants the continuing efforts of basic and clinical with their age ranging from 45 to 55 (mean age of 50 years) to avoid muscle atrophy due to senility. There is research on removable prosthesis. Patients were selected

The oral cavity limits the visibility to accurate positioning

and examination of teeth. In addition the resiliency of

oral tissues precludes constant equalization of pressure. In various denture positions, the denture bases shift under incline plane stress without the operator being aware of it, dentures were tried in the patients mouth at the time whereas on a stone cast this can not happen(33). Finished of delivery to check for any occlusal discrepancies and border extensions that could impair denture stability as well as retention that might affect masticatory efficiency Then the dentures were kept in the patients mouth for

variation in muscle efficiency due to age, as the patients efficiency(47). The selected patients were male to avoid

in the same age group show almost the same muscle the difference in muscle efficiency between different

sexes(48). There are a variety of factors may contribute to preference of male selection(49), including hormonal alternations(50), blood pressure(51) and psychological rate of chewing efficiency than males(53). Patients with systemic disease or neuromuscular disorders were excluded to avoid any effect on the muscle tone and hence resultant masticatory efficiency(54). Patients with temporo-mandibular joint dysfunction

during the initial learning period after denture insertion. 48 hours to allow for interceptive settling and initial

factors(52). Furthermore, elderly females showed a lower

acclimization(59). The same patients received both types individual variation(34,60,61).

of denture alternatively to avoid bias resulting from The objective evaluation of masticatory efficiency

was made during chewing different types of food, either hard or soft (carrot and cheese)(62,63). Carrot and cheese were chosen as test food material, because of their

were also excluded to avoid any disturbance in muscle behavior(55). Moreover; patients with abnormal ridge relationship were avoided because dentate subjects with normal occlusion were found to have a better masticatory

reliable natural test and their suitability for complete them(64). Moreover, both carrot and cheese into small were cut

denture wearers who could easily crush and comminute and symmetrical pieces of about 1 cm to

efficiency than subjects with malocclusions(56). The abnormal tongue behavior or size and/or xerostomia or patients selection, as that may affect the dentures stability, rating(57). excessive salivation were exclusive factors during the retention and subsequent the patients satisfaction Incorporation of accurate centric relation was

eliminate the influence of different food size on muscular efficiency(64,65). Gunne et al., 1982(66), demonstrated that complete denture wearers often use more than 30 strokes before they feel ready to swallow. The number of strokes

was counted until swallowing to allow expression of the reproducibility of the method and the biological intraindividual variation; therefore providing small difference

important not only for mounting lower cast but also interference with mastication
(31,58)

to avoid jeopardization of retention, stability and bilateral balanced occlusal scheme, fully adjustable articulator should be used. However; it is not always available. Hanau model (H) semi-adjustable articulator was used and therefore the only eccentric record made was protrusive one. While lateral condylar guidance (L). . Ideally, to establish

for every patient between repeated record. Many authors(37,38,67) overcome the individual variation regarding counted number of strokes until swallowing, through obtained by sieving method to both number of strokes and time of chewing until swallowing. They concluded that the

correlating the masticatory performance percentage

number of chews as well as time of chewing taken before

CliniCal Evaluation oF thE EFFiCaCy

(327)

swallowing increase as the chewing efficiency decreases. Additionally, Gunne, 1985(38) had mentioned that the chewing efficiency could be calculated by velocity of chewing, i.e. number of strokes/second. It is worthy to mention that, the greater number of masticatory strokes and longer time were observed were during chewing

to examine objectively only because it is subjected to individual variations(72). There are several controversies for how to evaluate the masticatory efficiency. It was for accuracy of evaluation. recommended to use more than one interrelated methods The objective in any prosthetic restoration is not

carrot than that showed during chewing cheese in both types of acrylic denture evaluated in this study. This could be contributed to the hard fibrous nature of carrot necessitating much greater amount of force to grind it than that required for chewing cheese. This was in line with Horio and Kawamura, 1989(68), who reported that the fibrous and granulous nature of food seem to be more critical for determining chewing rate than hardness. Also,

only to have a good masticatory function, but also to

maintain the health of remaining structures among which between the occlusion and the neuro functional behavior

is the residual alveolar ridge. There is a good relationship of the masticatory muscles(73-75). Masticatory performance and ability were partly dependent on the occlusion(56). that the masticatory performance is based upon occlusal Additionally, Yamashita et al., 1999(76), have confirmed scheme, chewing pattern and force; as the ideal performance is dependant upon matching the chewing pattern to the occlusal scheme. Pietrokovski et al., 1995(77) reported that the lower

Karkazis and Kossino, 1998(64), showed that in complete denture wearers, the masseter muscle activity was higher should be emphasized that the comparison between the for chewing carrots than chewing apple. Additionally, it two acrylic dentures regarding either number of chewing strokes or time of chewing could be easily made and be more pronounced on level of hard food. The physical
(69)

complain scores given for maxillary denture can be attributed to the fact that most maxillary denture are easier to make and more comfortable to wear than mandibular dentures. In the present study maxillary conventional acrylic denture showed relatively higher complaint scores. This contradiction may be explained on the basis bone and denture as the result of denture movement over

and chemical characteristics of the food itself directly influence jaw and muscle performance . Also, Horio and Kawamiita, 1989(68), reported that in the majority of subjects, chewing forces and chewing movements were

influenced by the texture of food; as it is well known that the neuromuscular modulation plays a major role on on masticatory ability in removable prosthesis(70). Vegrune et al., 2007
(71)

that palatal mucosa may rubbed between the maxillary severely resorped ridge. Additionaly, the complaint scores were higher with the mandibular denture processed with al. 2007(78). The vast majority of the denture complaints concerns the lower denture. This is related to the more soft acrylic. This finding was in agreement with Fenlon et

denture retention, and stability which is directly reflected have reported that complete

denture wearers were able to adapt their mastication to

hardness of food substance by increasing the number of strokes and duration of masticatory sequence. A finding
(26)

severe resorption of alveolar bone in the mandible than

that goes in accordance with the result of the present problems related to the edentulous patient will continue to challenge the dentists particularly as the ability to adapt

in the maxilla. The reduced denture-bearing area, denture quality, dentist-patient interaction, previous denture experiences and the patients psychological well being personality are all determinants of the patients satisfaction with his dentures(79). The favourable short-term results of effect of the enlargement of the dental bearing area for means of retention(80) maxillary soft acrylic denture could be attributed to the denture support and clarification the effect of physical

study. Moreover, Allen et al., 2001 , mentioned that the

to conventional complete denture even having excellent prosthetic criteria. Hence, patients opinion can not be ignored, although it is a subjective result, but at the same

time can not be considered as a final result in view of the objective result. The masticatory function is difficult

(328)

Gehan F. Mohamed

C.D.J. Vol. 24. No. (II)

6 month only for analysis for two reasons. First, the three month to six months. Therefore, there was no

The retention and stability data were collected at

dentures regarding the chewing ability scores and stability scores. The better stability of the denture, the patient with less muscular effort(73). Shinkai et al., 2002(87) suggested stability) are not necessarily more likely to have better diets than people with poorly fitting or worm dentures. Bite force is reduced with risk for atrophy of the

mean and median did not change much from 1 week, reason to analyze the other two time periods. Second, even if the means had changed overtime, the 6 months
(81)

that people with good quality denture (good retention and

data as a measure of long-term efficacy, were more addition of weight to the mandibular complete denture dimensions and structure such as surface area length, depth, angulations of the palate and presence of undercut can also influence the ultimate retention of maxillary
(42)

appropriate . It has been suggested that gravity and the may aid in prosthesis retention(82,83). Variations in palatal

masticatory muscles especially, in the elderly complete with further opening in corresponding to the optimum

denture wearer(88). Furthermore, the bite force decreases length of the jaw-elevator muscle. This so called lengthtension relationship should be considered when assessing maximum bite force with a bite force meter that increases bite force measurement were done on both side of the

denture . The limit of effectiveness of the salivary film in retaining the denture base might depend on the nature of its adhesion to the fitting surface of the denture of soft acrylic denture may give better results than a conventional fitting surface of the denture base made

bite height and jaw separation(89). This explain why the same patient mouth. The number of occlusal contacts is a stronge determinant of muscle action and bite force than bite force meter posteriorly at the premolar-molar area the number of teeth(90). This support the insertion of the of the tested dentures. With respect to chewing pattern, on the other. The one side chewing produced a lever action with the ridge on the chewing side that becomes the fulcrum and causes vertical movement of the denture

base. It was hypothesized that an altered fitting surface

after routine processing procedures. There was increase in the surface area of the denture base and improved the the results of this study as conventional acrylic type had adhesion of saliva to the surface(42). This could support a higher retentive value for the mandibular denture than

patients were instructed to chew on one side and then

the soft acrylic type. The lower denture retention depend on the mechanical means which include the engagement denture processed from soft acrylic type showed a higher studies indicated that improvements in retention and stability result in no improvement in masticatory function or ability in conventional denture patients treated with This findings were observed in this study. Idowa et al., 1987
(86)

base on the controlateral side. This may contributed to trauma to the tissue of the supporting structure(91,92). This support the insertion of the bite fore meter on one side and tongue depressor on the other side to obtain a more symmetrical muscle contraction

of undercut at the lingual pouch. In contrast, maxillary retentive value than the conventional acrylic type. Recent

regarded successful. The real value of any treatment can

Patient satisfaction is important for a treatment to be

only be evaluated when it is compared to the outcome of a standard treatment (control type) as conventional denture in this study(93-96). Patients satisfaction with their

new conventional or implant-retained overdentures(84,85). mentioned that the objective

dentures were higher at 6 months after denture insertion than that at 1 week post insertion. This adaptation may be due to the neuromuscular control which is gradually and slowly generated by time, i.e. the longer the period gained(45,64).

masticatory performance has been predicted by denture stability but not by occlusal form of artificial teeth in elderly denture wearers. This explained why there was

no difference between the conventional and soft acrylic

of denture wearing, the better the neuromuscular control

CliniCal Evaluation oF thE EFFiCaCy

(329)

CONClUSIONS
Based on the results of this current study: The following can be concluded:

.
1. 2. 3. 4.

REfERENCES
Carlsson GE. Masticatory efficiency; the effect of age, the loss of teeth and prosthetic rehabilitation. Int Dent J; 1984, 34:93-7. Zarb GA. The edentulous milliew. J Prosthet Dent; 1983, 49:825-31. Todd JE, Lader D. Adult dental health 1988 United Kingdom. London: HMSO; 1991. Tyson KW, McCord JF. Chairside options for the treatment of complete denture problems associated with the atrophic (flat) mandibular ridge. Brith Dent J; 2000, 188:8-12.

Chewing efficiency showed marked increased by time infavor to the conventional acrylic denture. The higher value of efficiency obtained with chewing hard food. The chewing ability problems scores were observed significantly after 6 month with soft acrylic denture. The bite force values increased by time in both types of acrylic denture. The conventional acrylic denture had a higher biting force value than the soft acrylic ones. Mandibular conventional acrylic denture had a higher retentive value. In contrast, the maxillary denture had a higher retentive value when processed by soft acrylic material. Furthermore, the retention scores confirmed this result. Stability scores were approximately recorded same value for both types of acrylic denture. Denture complaint scores were higher with both mandibular soft and maxillary conventional acrylic dentures. Tissue responses were nearly the same in both types of acrylic denture. The patients were satisfied with both types of acrylic denture in favore to conventional type.

5.

Ohkubo C, Hosoi T. Effect of weight change of mandibular complete dentures on chewing and stability: a pilot study. J Prosthet Dent; 1999, 92:636-42.

6.

VanWaas HAJ. The influence of clinical variables on patients satisfaction with complete dentures. J Prosthet Dent; 1990, 63:307-310.

7.

Boerrigter EM, Geertman ME, VanQort RP, Bouma J, Raghoeban GM, Van Waas MAJ, Vant Hof MA, Boering G, Kalk W. patient Satisfaction with implant-retained mandibular overdentures. A comparison with new complete dentures not retained by implants. A multicentre randomized clinical trial. Br J Oral Maxillofac Surg; 1995, 33:282-288.

8.

Jacobson TE, Krol AJ. A contemporary review of the factors involved in complete denture retention, stability and support. Part I: retention J Prosthet Dent; 1983, 49:5-15.

9.

Jacobson TE, Krol AJ. A contemporary review of the factors involved in complete dentures. Part II: stability. J Prosthet Dent; 1983, 49:165-72.

RECOmmENDaTIONS

With respect to the previous observations and findings, a favorable treatment modality for severely resorbed ridges in completely edentulous patient, a combination of both types of acrylic resin is recommended. The mandible can receive denture processed from the conventional acrylic resin to engage mechanically the lingual undercut and to give a good retention, stability and function of the prosthesis. On the other hand, the maxilla can receive complete denture processed from the soft acrylic resin to gain more physical adhesion and cohesion of the saliva to a broader supporting area that achieve a high retentive value, stability and function of the prosthesis.

10. Jacobson TE, Krol AJ. A contemporary review of the factors involved in complete dentures. Part III: support J Prosthet Dent; 1983, 49:306-13. 11. Fish EW. An analysis of the stabilising factors in full denture construction. Br Dent J; 1931, 52:559-70 Citred from Sutton AF, McCord JF. A randomized clinical trial comparing anatomic, lingualized and zero-degree posterior occlusal forms for complete dentures. J Prosth Dent; 2007, 97:292-8. 12. Murray MD, Darvell BM. The evolution of the complete denture base. Theories of complete denture retention, a review part I: Aust. Dent J; 1993, 38:216-9.

(330)

Gehan F. Mohamed

C.D.J. Vol. 24. No. (II)

13. Murray MD, Darvell BW. The evolution of the complete denture base. Theories of complete denture retention a review parts II: Aust Dent J; 1993, 38:299-305. 14. Murray MD, Darvell BW. The evolution of the complete denture base. Theories of complete denture retention a review. Part III. Aust Dent J ; 1993, 38:389-93. 15. Murray MD, Darvell BW. The evolution of the complete denture base. Theories of complete denture retention a review part IV. Aust Dent J; 1993, 38:450-5. 16. Kikuchi M, Ghani F, Watanabe M. Method for enhancing retention in complete denture bases. J Prosthet Dent; 1999, 81:399-403. 17. Parel SM. Implants and overdentures: the osseointegrated approach with conventional and compromised applications. Int J Oral Maxillofac Impl; 1986, 1;93-100. 18. Epstein DD, Epstein PL, Cohen BJ, Pangillo, MK. Comparison of the retentive properties of six prefabricated overdenture attachment systems. J Prosthet Dent; 1999, 82:579-84. 19. Tarbet WJ, Boone M, Schmidt NF. Effect of a denture adhesive on complete denture dislodgement during mastication. J Prosthet Dent; 1980, 44:374-8. 20. Polyzois GL, Frangou MJ. Influence of curing method, sealer and water storage on the hardness of a soft lining material over time. J Prosthet. Dent.; 2001, 10:42-5. 21. Kawano F, Dootz ER, Koran A 3 Craig RG. Comparison of
rd

management of the atrophic mandible, London. Quintessence Publishing Company; 1984, 155-157. 25. Burns DR, Unger JW, Elswick RK, Bech DA. Prospective clinical evaluation of mandibular implant overdentures: Part I retention, stability and tissue response. J Prosthet Dent; 1995, 73:354-63. 26. Allen PF, McMillan AS, Walshaw D. A patient based assessment of implant-stabilizied and conventional complete dentures. J Prosthet Dent; 2001, 85:141-7. 27. Shetly NS. Comparative observations of the use of cusp and zero-degree posterior teeth. J Prosthet Dent; 1984, 51:459-60. 28. Fenlon MR, Sherriff M. Investigation of new complete denture quality and patients satisfaction with and use of dentures after two years. J Dent; 2004, 32:327-333. 29. Celebic A, Knezovic-Zlataric D. A comparison of patients satisfaction between complete and partial removable denture wearers. J Dent; 2003, 31:445-51. 30. Winkler S. Essentials of complete denture Prosthodontics and 2nd ed., PSG Publishing Co Inc, WSA; 1988; 217-249. 31. Fenlon MR, Sherriff M and Jhon Walter JD. Association between the accuracy of intermaxillary relations and complete denture usage. J Prosthet Dent; 1999, 51:520. 32. Basso MFH, Nogueira SS, Ariolifilho JN. Comparison of the occlusal vertical dimension after processing lingualized balanced occlusion and conventional balanced occlusion. J Prosthet Dent; 2006, 96:200-4. 33. Firtell DN, Finzen FC and Holmes IM. The effect of clinical remount procedures on the comfort and success of complete dentures. J Prosthet Dent; 1987, 57:53. 34. McCord JF, Grant AA. Registration stage III selection of teeth. Br Dent J; 2000, 24:660-6. 35. Zarb GA, Bolender CL, Carlsson GE. Bouchers Prosthodontic treatment for edentulous patients. 11th ed. St. Louis: Elsevier Health Sciences; 1997, 37:337-73. 36. Reeson MG, Nicholas GG, Jepson JA. Achieving an even thickness in heat-polmerized permanent, acrylic resin denture bases for complete dentures. J Prosthet Dent; 199, 82:359-361.

bond strength of six soft denture liners to denture base resin. J Prosthet Dent; 1992, 68:368-71. 22. Cheng AC, Tee-Khin N, Siew-Luen C, Lee H, Wee AG. The management of a severely resorbed edentulous maxilla using a bone graft and a cad/cam-guided immediately loaded definitive implant prosthesis: A clinical report. J Prosthet Dent; 2008, 99:85-95. 23. Pelo S, Baniello R, Gasparini G, Longobardi G, Amorosop F. Horizontal and vertical ridge augmentation for implant placement in the aesthetic zone. Int J Oral Maxillofac Surg; 2007, 36:944-948. 24. Stoeligna PJW. Concensus achieved during conference. In: Stoeligna PJW, ed. Proceedings. Consensus conference. The relative roles of vestibuloplasty and ridge augmentation in the

CliniCal Evaluation oF thE EFFiCaCy

(331)

37. Luke, DA and Lucas PW. Chewing efficiency in relation to occlusal and other variations in the natural human dentition. Brit Dent J; 1985, 159-401. 38. Gune HS. Masticatory efficiency and dental state. Acta Odontol Scand; 1985, 43:139. 39. Emmell J, Maskawi K, Feine JS Lund JP. Validation of methods for the analysis of masticatory function. J Dent Res; 1990, 69:334. 40. Feine JS, De Grandmont P, Boudrias P, Brien N, La Marche C and Tach R et al. Within subject comparison of implant supported mandibular prosthesis;choice of prosthesis. J Dent Res; 1994, 73L1105. 41. Dahlberg G. Statistical methods for medical and biological students. George Allen and Unwin Ltd, London; 1940, 222-132.Cited from Ferrario F, Sforza C, Zanotti G, Tartaglia GM. Maximal bite forces in healthy young adults as predicted by surface electromyography. J Dent; 2004, 32:451-457. 42. Grasso J, Gay T, Rendel J. The effect of the denture adhesive on retention of mandibular and maxillary dentures during function. J Clin Dent; 2000, 11:98-103. 43. Kapur KK. A clinical evaluation of denture adhesives. J Prosthet Dent; 1967:18:550-8. Quitted from Burns DR, Unger JW, Elswick RK, Bech DA. Prospective clinical evaluation of mandibular implant overdentures: Part I retention, stability and tissue response. J Prosthet Dent; 1995; 73:354-63. 44. Rayson JH, Rahn AO, Ellinger CW et al. The value of Subjective evaluation in clinical research. J Prosthet Dent; 1971, 26:111-8. Cited from: Burns DR, Unger JW, Elswick RK, Beck DA: Prospective clinical evaluation of mandibular implant overdentures: Part I retention, stability and tissue response. J Prosthet Dent; 1995, 73:354-63. 45. Awad MA. Patients ratings can be used to measure the satisfaction of different mandibular implant-retained overdentures. J Evid-base Dent Pract; 2005, 5:154-5. 46. Awad MA, Lund JP, Dufresne E, Feine JS. Comparison of the efficacy of mandibular implant-retained overdenture and conventional dentures among middle-aged edentulous patients: Satisfaction and functional assessment. Int J Prosthodont; 2003, 16:117-122.

47. Pancherz H. Temporal and masseter muscle activity in children and adults with normal occlusion. An electromyographic investigation. Acta Odontol Scand; 1980, 38:343. 48. Henriksson KL. Distribution, number and size of different types of fibers in whole cross sections of female anterior tibias. An enzyme histochemical study. Acta Physil Scand; 1985, 123:229. 49. Bingefors K, Isaccon D. Epidemiology, com-morbidity and impact on health-related quality of life of self-reported headache and musculoskeletal pain- a gender perspective. Eur J Pain; 2004, 8:435-50. 50. Kuba T, Quirones-Jenab V. The role of female gonadal hormones in behavioral sex difference in persistent and chronic pain: clinical versus preclinical studies. Brain Res Bulletin; 2005, 66:179-88. 51. Fillingim RB, Maixner W. The influence of resting blood pressure and gender on pain responses. Psychosomatic Medicine; 1996, 58:326-32. 52. Logan HL, Gedney JJ. Sex differences in the long-term stability of fore head cold pressor pain. J Pain; 2004, 5:406-12. 53. Pan S, Awad M, Thomson JM, Dufresne E, Kabayashi T, Kimoto S, Wallin SD, Feine JS. Sex differences in denture satisfaction. J Dent; 2008, 36:301-308. 54. Wyngoarden JB, Smith LH and Bennett JC. Cxecils test book of medicine. 19th ed., Philadelphia, WB, Sanders Co; 1992, 1401. 55. VonGonten AS, Palik JE, Oberlader BA and Rugh JD. Nocturnal electromyographic evaluation of the master activity in complete denture patient. J Prosthet Dent; 1986, 56:624. 56. Henrikson T Ekberg EC and Nilner M. Masticatory efficiency and ability in relation to occlusion and mandibular dysfunction in girls. Int J Prosthodont; 1988, 11:125. 57. Basker RM and Watson CJ. Tongue control of upper complete dentures: a clinical hint. Br Dent J; 1991, 170:449. 58. Dawson PE. A classification system for occlusions that relate maximal intercuspation to the position and condition of the temporo-mandibular joint. J Prosthet Dent; 1996, 75:60. 59. Jankelson B, Haffman GM and Hendron JA. The physiology of the stomatognathic system. JADA; 1953, 46:375.

(332)

Gehan F. Mohamed

C.D.J. Vol. 24. No. (II)

60. Sutton AF, Glenny AM, McCord JF. Interventions for replacing missing teeth denture chewing surface designs in edentulous people. Cochrane Database Syst Rev; 2005: CD 004941. 61. Clough HE, Knodle JM, Leeper SH, Rudwill ML, Taylor DT. A comparison of lingualized occlusion and monoplane occlusion in complete dentures. J Prosthet dent; 1983, 50:176-9. 62. Kapur KK. Studies of biologic parameters for denture design. Part I. comparison of masseter muscle activity during chewing of crisp and soggy wafers in denture and dentition groups. J Prosthet Dent; 1975, 33:242. 63. Kapur KK, Soman SD. Masticatory performance and efficiency in denture wearers. J Prosth Dent; 2004, 92(2): 107-111. 64. Karakazis HC and Kossion AE. Surface EMG activity of the masseter muscle in denture wearers during chewing of hard and soft food. J Oral Rehabil; 1998, 25:8. 65. Slagter AP, Olttof LW, Steen WHA and Bosman F. Communication of food by complete denture wearers. J Dent Res; 1992, 71:380. 66. Gunne HS, Bergman B, Ebnorm L and Hogstrm J. Masticatory efficiency of complete denture patients. A clinical examination of potential changes at the transition from old to new dentures. Acta Odontol Scand; 1982, 40:289. 67. Hayakawa I, Hirano S, Takahashi Y and Keh ES. Changes in the masticatory function of complete denture wearers after relining the mandibular denture with a soft denture liner. Int J Prosthodont; 2000, 13:227. 68. 68. Horio T and Kawamura Y. Effects of texture of food on chewing patterns in the human subjects. J Oral Rehabil; 1989, 16:177. 69. Shi CS, Gman QY and Guo TW. Masticatory efficiency determined with direct measurement of food particles masticated by subjectes with natural dentition. J Prosthet Dent; 1990, 64:723 70. Fujimori T, Hirano S and Hayakawa I. Effect of a denture adhesive on masticatory functions for complete denture wearers. J Med Dent Sci; 2002, 49:151.

71. Vegrune JL, Lassauzay C, Nicolas E, Peyron MA, Woda A. Mastication of model products in complete denture wearers. Archiv Oral Biol; 2007, 52:1180-1185. 72. Tzakis MG, Karlsson S and Carlsson GE. Effects of intense chewing on some parameters of masticatory function. J Prosthet Dent; 1992, 67:405. 73. Gruibwieser G, Flatz A, Grmnert I, Kofler M, Ulner H, Gausch K and Kulmer S. Quantitative analysis of masseter and temporalis EMG: a comparison of anterior guided versus balanced occlusal concepts in patients wearing complete dentures. J Oral Rehabil; 1999, 26:731. 74. Gurnert L, Koffler M, Gausch K and Kronenberg M. Masster and temporalis surface electromyography in patients wearing complete dentures comparing anterior and posterior occlusal concepts. Pilot Study J Oral Rehabil;1994, 21:337. 75. Grunert L, Koffler M, Gausch K and Satteiri L. Elektromyographische untersuchung von kaumusklenbei prothesentragern mit anteriorem und posterierm okklusion. Skonzept Pilostsudie Zeitschrift fur Stomatologie; 1992, 55:451. 76. Yamashita S, Hacht JP and Rugh JD. Does chewing performance depend upon a specific masticatory pattern. J Oral Rehabil; 1999, 26:547. 77. Pietrokovski J, Harfin J, Mostavoy R, Levy F. Oral findings in elderly nursing home residents in selected countries: Quality of and satisfaction with complete dentures. J Prosthet Dent; 1995, 73:132-5. 78. Fenlon MR, Sherriff M, Newton JT. The influence of personality on patients satisfaction with existing and new complete denture. J Dent; 2007, 35:744-748. 79. VerVoon JM, Duinkerke ASH, Luteijn F, Van Der Pool ACH. Assessment of denture satisfaction. Community Dent Oral Epidemiol; 1988, 16:364-367. 80. Raghoebar GM, Meijer HJA, Vant Hof M, Stegenga B, Vissink A. A randomized prospective clinical trial on the effectiveness of three treatment modalities for patients with lower denture problem. A 10 year follow-up study on patient satisfaction. Int J Oral Maxillofac Surg; 2003, 32:498-503.

CliniCal Evaluation oF thE EFFiCaCy

(333)

81. Burns DR, Unger JW, Elswick RK, Beck DA. Prospective clinical evaluation of mandibular implant overdentures: part I retention, stability and tissue response. J Prosthet Dent; 1995, 73:354-63. 82. Jacobson Te, Krol AJ. A contemporary review of the factors involve in complete denture retention, stability and support part I: retention. J Prosthet Dent; 1983, 49:5-15. 83. Wormley JH, Brunton DA. Weighted mandibular dentures. J Prosthet Dent; 1974, 32:101-2. 84. Garrett NR, Kapur KK, Hamada MO, Roumanas ED, Freymiller E, Han T, Dienner RM, Levin S, Chen T. A randomized clinical trial comparing the efficacy of mandibular implant-supported overdentures and conventional dentures in diabetic patients. Part III: comparisons of masticatory performance. J Prosthet Dent; 1998, 79:632-40. 85. Hamada MO, Garrett NR, Roumanas ED, Kapur KK, Freymiller E, Han T, Dienner RM, Chen T, Levin S. A randomized clinical trial comparing the efficacy of mandibular implant-supported overdentures and conventional dentures in diabetic patients part IV: comparisons of dietary intake. J Prosthet Dent; 2001, 85:53-60. 86. Idowa AT, Handelman SL, Graser GN. Effect of denture stability, retention and tooth form on masticatory function in the elderly. Gerodontics; 1987, 3:161-4. Cited from. 87. Shinkai RSA, Hatch JP, Rugh JO, Sakai S, Mobley CC, Sauners MJ. Dietary intake in edentulous subjects with good and poor quality complete dentures. J Prosthet Dent; 2002, 87:490-8. 88. Miyawaki S, Araki Y, Tanimoto Y, Katakyama A, Fujii A, Jiani M, Takano-Yamamoto T. Occlusal force and condylar

motion in patients with anterior open bite. J Dent Res; 2005, 84:133-137. 89. Bakke M. Bite force and occlusion semi Othod; 2006, 12:120126. 90. Bakke M, Hom B, Jensen BL et al. Unilateral, isometric bite force in 8-68 years old women and men related to occlusal factors, Scand J Den Res; 1990, 98:149-158. 91. Rendell J, Grasso JE, Gay T. Retention and stability of the maxillary denture during function. J Prosthet Dent; 1995, 73:344-7. 92. Vardimon AD, Beckmann S, Shpack N, Sarne O, Brosh T. Posterior and anterior components of force during bite loading. J Biomech; 2007, 40:820-827. 93. Barnes DE. The state of science of patient outcome research. J Oral Implantol; 1990, 16:245-247. 94. Beorrigter EM, Geertman ME, VanOort RP, Bouma J, Rachoebar GM, VanWaas MAJ, Vant Hof MA, Boering G, Kalk W. Patient satisfaction with implant-retained mandibular overdentures. A comparison with new complete dentures not retained by implants. A multicentre randomized clinical trial. Br. J Oral Maxillofac Surg; 1995, 33:282-288. 95. Boerrigter EM, Stegenga B, Raghoebar GM, Boering G. Patient satisfaction and chewing ability with implant-retained mandibular overdentures: a comparison with new complete dentures with or without preprosthetic surgery. J Oral Maxillofac Surg; 1995, 53:1167-1773. 96. Raghoebar GM, Mener HJA, Stegenga B, Vant Hof MA, Van Oort RP, Vissin KA. Effectiveness of three treatment modalities for the edentulous mandible. A five-year randomized clinical trial. Clin Oral Impl Res; 2000, 11:195-201.