Συγκριτική μελέτη του ρυθμού προσαρμογής και του βαθμού αποδοχής από τον ασθενή, ολικών οδοντοστοιχιών κατασκευασμένων με δύο διαφορετικά πρωτόκολλα κατασκευής

Abstract

Purpose: The aim of this clinical study was to register the patients’adaptation and acceptance to conventional complete dentures fabricated withtwo different construction protocols, through their responses to specificoutcome measures, as well as in relation with objective factors (occlusalscheme, number of recalls, total number and location of sore spots).Materials and Methods: Forty complete denture wearers, who soughtreplacement dentures because of complaints (material degradation orunsatisfactory repaired fractures) associated with them, were selected. Allparticipants in the study adhered to specific inclusion criteria, designated duringthe study design phase. All participants read and signed the consent form fortheir participation in the study. The two denture construction protocols wererandomly assigned to the study participants, which were initially divided intotwo groups. Experimental group A (n=20) included patients scheduled to receivereplacement complete dentures constructed using a duplication protocol.Control group B (n=20) included patients scheduled to receive replacementcomplete dentures constructed using a traditional protocol.Group A consisted of 8 males and 12 females with a mean age of 73.6years (6.4 SD), with existing complete denture age of 12.1 years (11.0 SD) and aclearance of 18.4 years (13.4 SD). Group B consisted of 14 males and 6 femaleswith a mean age of 73.9 years (6.3 SD), with existing complete denture age of17.3 years (12.8 SD) and a clearance of 20.8 years (10.6 SD).Every clinical stage of the new complete denture fabrication,irrespective of the construction protocol being utilized, was undertaken byunder-graduate students under diligent supervision. Experimental Group A was divided into two subgroups. Subgroup a1 (n=10), included patients scheduled toreceive Duplicate Complete Dentures utilizing bilateral balanced occlusion. Subgroup a2 (n=10), included patients scheduled to receive Duplicate CompleteDentures utilizing a lingualized occlusal scheme. The primary researcher was theclinical instructor supervising the treatment for both of these subgroups. GroupB was also divided into two subgroups. Subgroup b1 (n=10), included patientsscheduled to receive Traditional Complate Dentures with bilateral balancedocclusion and with the primary researcher being the clinical instructor.Subgroup b2 (n=10), included patients scheduled to receive TraditionalComplete Dentures with the same occlusal scheme as subgroup b1, but with theundergraduate students being supervised by different clinical instructors. Theseinstructors were blind to the undergoing clinical study.In the present study the patients’ acceptance of complete dentures wasmeasured using psychometric questionnaires based on two well established andvalid instruments, the Oral Health Impact Profile-20 and the McGill denturesatisfaction instrument. The OHIP-20 questionnaire targeted the OHRQoL ofcomplete denture wearers. It consisted of twenty questions which were dividedinto seven domains, consisting of functional limitation, physical pain,psychological discomfort, physical disability, psychological disability, socialdisability and handicap. Patients used a 5-point Likert-type scale to mark theirresponses, rating from 1 (never) to 5 (always).The Complete Denture Satisfaction questionnaire used in the presentstudy comprised of ten questions which included general satisfaction, ease ofcleaning, ability to speak, ability to chew, comfort (upper and lower CD),esthetics (upper and lower CD) and stability (upper and lower CD). In this casethe patients recorded their responses on a 100mm Visual Analogue Scale, with anchor words at both ends: ‘completely unsatisfied’ marked -0- and ‘completelysatisfied’ marked -100-.In order to record the patients’ adaptation to their complete dentures, acustomized data sheet, illustrating the anatomy of the denture bearing area ofthe maxilla and mandible was developed. The total number of adjustment visits, as well as the number and location of every sore spot observed during the initialadaptation/adjustment period was recorded, until the patients felt comfortablewith their newly constructed prostheses.The SPSS v.21.0 software (SPSS Inc., Chicago, IL, USA) was used for allstatistical tests performed. Descriptive statistics were performed usingfrequency measures for the participants’ responses to both questionnaires.Additionally, reliability analysis was performed using the Cronbach’s alpha test.Within group comparisons were performed using the nonparametric Friedmantest and the Wilcoxon signed-ranks test to assess differences that occurredwithin and between subject responses for the pre-treatment versus the 3 and 6-month post-treatment data. The Mann–Whitney and Kruskal-Wallis tests wereused to evaluate differences in the responses in both questionnaires betweentreatment groups at each time interval. Significance was set at p<0.05.Results: All forty patients that were included in the study completed thescheduled examinations up to the 6-month recall. There was no significantdifference between the two groups for gender (22 males and 18 females,p=0.637) or age distribution (group A: 73.6±6.4 and group B: 73.9±6.3, p=0.815).Reliability analysis in the responses of both questionnaires resulted in highinternal consistency, with Cronbach’s alpha index of α=0.912 for the OHIP-20and α=0.932 for the CDS questionnaires.There was no significant difference between group A and B for everyspecified time interval (pre-treatment, 3-month and 6-month recall), whencomparing the general satisfaction and the total OHIP-20 scores (p>0.05). Both groups registered a marked improvement in the mean score of the generalsatisfaction question, and also an equally marked reduction (improvement) inthe mean score of the total sum of the OHIP-20 index. The differences of scoreswithin the same group were statistically significant (p≤0.05) between pretreatmentand the 3-month recall, as well as between pre-treatment and the 6-month recall. The differences of scores was not significant between the 3-monthand the 6-month recall (p>0.05) (Table 1).There was a significant reduction of the scores in six out of the sevendomains (p≤0.05) in the Traditional Complete Denture group, when comparingeach individual variable of the OHIP-20 questionnaire between pre-treatmentand the 3-month recall. On the contrary the scores referring to the socialdisability domain did not present a significant difference (p>0.05). An equallysignificant reduction was registered in four out of the seven domains (p≤0.05) inthe Duplicate Complete Denture group over the same observation period. Thescores for the domains of psychological discomfort, physical disability and socialdisability were not statistically significant (p>0.05). There was a significantreduction of the scores in all seven domains (p≤0.05) for the TraditionalComplete Denture group, when comparing pre-treatment and the 6-monthrecall period. A non-significant reduction (p>0.05) for the functional limitation,pain and handicap domain scores for the Duplicate Complete Denture groupwas observed over the same time period.The comparison of general satisfaction and the total OHIP-20 scoresbetween group a1 (Duplicate Complete Denture with a bilateral balance occlusalscheme) and group a2 (Duplicate Complete Denture with lingualized occlusion),revealed no statistically significant difference (p>0.05) in all scheduledevaluation intervals (pre-treatment, 3-month and 6-month recall). The withingroup comparisons registered a statistically significant improvement (p≤0.05) inthe general satisfaction scores for group a2, but not for group a1, between pretreatmentand both recall intervals. Regarding the total OHIP-20 scores therewas a significant reduction (p≤0.05) for group a1, but not for group a2, between pre-treatment and both recall intervals. There was no difference in scores(p>0.05) between both groups, when comparing the 3 to 6 month recall period.There was no significant difference between groups b1 and b2 at pretreatmentand at both recall intervals, in relation to the general satisfaction and the total OHIP-20 scores (p>0.05). Both groups registered an improvement inthe mean score of the general satisfaction question and also a reduction(improvement) in the mean score of the total sum of the OHIP-20 index. Thedifferences of scores within the same group were statistically significant(p≤0.05) between pre-treatment and the 3-month recall, as well as betweenpre-treatment and the 6-month recall. There was no statistical difference(p>0.05) in scores between the 3-month and the 6-month recall for both b1 andb2 groups.The total number of sore spots recorded during the initialadaptation/adjustment period was almost double for the Traditional CompleteDenture group with bilateral balanced occlusion (n=52 sore spots), whencompared with the Duplicate Complete Denture group with the same occlusalscheme (n=28 sore spots). When comparing the two Duplicate CompleteDenture groups (a1 and a2) the total number of sore spots recorded was almostequal (group a1=28, group a2=30). Finally, the mean number of post-insertionadjustment visits for both groups (A and B) was two with no significantdifference between them (p>0.05).Conclusions: Patients’ overall acceptance of their newly constructed completedentures improved significantly for all groups. The adaptation and acceptance ofconventional complete dentures by the patients were independent of thefabrication protocol and the occlusal scheme used for the construction of theirprostheses. Duplicate dentures with bilateral balanced occlusion exhibitedsignificant less sore spots than those constructed with the same occlusalscheme but a conventional construction protocol.

ΣκοπόςΣκοπός της Διδακτορικής Διατριβής ήταν η καταγραφή του ρυθμούπροσαρμογής και του βαθμού αποδοχής από τους ασθενείς συμβατικώνολικών οδοντοστοιχιών (Ο.Ο.), που κατασκευάστηκαν με δύο διαφορετικάπρωτόκολλα.Υλικά και μέθοδοιΧρησιμοποιήθηκε δείγμα αποτελούμενο από σαράντα ολικά νωδούςασθενείς με προϋπάρχουσες Ο.Ο. Βάση του πρωτοκόλλου κατασκευής,διαχωρίστηκαν τυχαία, σε δύο ομάδες των είκοσι ατόμων και στη συνέχεια,κάθε ομάδα σε δυο υποομάδες. Στην αρχή της μελέτης, στον 3μηνο και στον6μηνο επανέλεγχο διανεμήθηκαν ερωτηματολόγια για τους δείκτες OHIP-20και τον δείκτη ικανοποίησης των ασθενών. Κατά την αρχική περίοδοπροσαρμογής των Ο.Ο. σημειώθηκε η εντόπιση των επώδυνων σημείων στονστοματικό βλεννογόνο.ΑποτελέσματαΠαρατηρήθηκε αύξηση του δείκτη γενικής ικανοποίησης και αντίστοιχαμείωση του συνολικού δείκτη OHIP-20 και στις τέσσερις υπό εξέταση ομάδες.ΣυμπεράσματαΟ ρυθμός προσαρμογής και ο βαθμός αποδοχής των ασθενών τουδείγματος στις νέες Ο.Ο. δεν επηρεάστηκε αρνητικά από το διαφορετικόπρωτόκολλο κατασκευής τους, ούτε από τον διαφορετικό τύπο αποδιδόμενης σύγκλεισης.