INTRODUCTION

oss of a teeth leads to impairment of oral function,esthetics and phonetics, making prosthodonticinvolvement necessary1. Since there has been an

increase in the life expectancy of elderly individuals, anincrease in the demand of prosthetic restorations has alsobeen noted. Edentulism in Pakistan occupies an estimated4.1% of the total population aged 65 years and above,

with a projected increase to 9.3% by 20302. Due to anincrease in the life expectancy of elderly individuals,prosthetic treatment for edentulous patients shall neverlose importance3.

Removable partial and complete dentures are twocommonest treatment modalities that are simple and costeffective. However faults in prosthesis may arise due toimproper denture designing by the clinician and lack oftechnical skills. One of the most common reasons fordenture failure in Pakistan is the allocation of vital clinicaldenture work to the dental technician by the dentist3.Prosthodontic technicians have an important role insuccessful complete denture therapy however; denturefaults and subsequent failures may occur due to lack oftechnical skills of a laboratory technician. Thus, it ishighly recommended that a trial denture is always

JPDA Vol. 24 No. 01 Jan-Mar 201535

COMPLETE DENTURE COMPLICATIONS AMONGPATIENTS IN A TEACHING HOSPITAL OF KARACHI

BACKGROUND: Proshthodontic intervention has become a necessity, since loss of teeth leads to degeneracy oforal function, phonetics and esthetics. A trend in increase of the life expectancy of the elderly also demands anincrease in the prosthodontic restorations. The aim of the current study was to assess complications rates amongcomplete denture wearers in a teaching hospital of Karachi.STUDY DESIGN: A cross sectional analytical study was conducted at the Department of Prosthodontics, Dr. Ishratul Ebad Khan Institute of Oral Health Sciences (DIKIOHS), Karachi, Pakistan from March 2014 to May 2014.METHODOLOGY: A total of 65 patients were selected who had worn heat cured acrylic complete denturesfabricated by post graduates and undergraduates. Variables such as age gender and satisfaction were recorded on aVisual Analog Scale (VAS). Various parameters that have potential effects on patient satisfaction and denturecomplication were assessed using SPSS version 18. Descriptive statistics like percentage, mean and median wereused. Quantitative data were tested with student t-test to find the relation between different variables.RESULTS: The results obtained were as follows; Males were greater in number i.e. 52.3% as compared to femaleswho were 47.6% out of total number of patients. The complications seen were: Ulcer development: 44.6%, Fracturesin the denture base: 27.6%, Loss of retention: 84.6%, Loss of teeth: 30.7%, Denture-related stomatitis: 7.6%. Patientsatisfaction according to the Visual Analog Scale (VAS) was found to be Esthetics: 72.5, Chewing Ability: 50 andPhonetics: 90.CONCLUSION: Within the limitations of the current study, Loss of retention in complete dentures was found tobe the most prevalent complication amongst all.HOW TO CITE: Khan SA, Rashid H, Sukkurwalla A, Naz A. Complete Denture Complications among Patientsin a Teaching Hospital of Karachi. J Pak Dent Assoc 2015; 24(1):35-38.

1. Department of Prosthodontics Dr Ishrat ul Ebad Khan Institute of Oral Health SciencesDow University of Health Sciences, Karachi, Pakistan.2. Assistant Professor. Department of Prosthodontics, Ziauddin College of Dentistry,Karachi, Pakistan.3. Senior Registrar, Department of Community Dentistry,Fatima Jinnah Dental College,Karachi, Pakistan.4. Assistant Professor and Head, Department of Prosthodontics, Dr. Ishrat ul Ebad KhanInstitute of Oral Health Sciences - Dow University of Health Sciences, Karachi, Pakistan.Corresponding author: “Dr Sujhah Adil Khan ” < shujah.adil@gmail.com >

Shujah Adil Khan1 BDS, MDS

Haroon Rashid2 BDS, MDScAdnan Sukkurwalla3 BDS, MMedSci

L

Asma Naz4 BDS, FCPS (Prosthodontics)

ORIGINAL ARTICLE

JPDA Vol. 24 No. 01 Jan-Mar 2015 36

examined by the clinician in a meticulous manner4.Due to ridge resorption with time, retention and

stability of a denture is compromised leading tocompromised patient's function (mastication). Pain andinability to communicate properly due to reasons outlinedabove, may give rise to psychosocial problems5. Theaim of the current study was to evaluate satisfactionamong complete denture wearers while understandingspecific complaints regarding denture usage.

METHODOLOGY

In this cross sectional analytical study, data from 65edentulous patients who were wearing complete dentureswas collected. The patients were wearing dentures for aperiod of 1 year and were recalled between March 2014to May 2014 at the department of Prosthodontics,Dr. Ishrat ul Ebad Khan Institute of Oral Health Sciences.Inclusion criteria only involved patients who had worncomplete dentures fabricated by post graduate residentsand undergraduate students of DIKIOHS. The dentureswere examined and patients were interviewed. Everypatient's age, gender, and variables for satisfaction wererecorded on a Visual Analog Scale (VAS)6. The VASscale was used to record the satisfaction of the patientsregarding the chewing ability, aesthetics of the dentureand the phonetics.

Each denture was examined for its vertical dimensionand graded as low, normal or high, whereas the centricrelationship was recorded as either correct or incorrect.Phonetic method as proposed by Silverman was used toestablish the vertical dimension7 and three-finger chin-point guidance method was used to assess the centricrelation8. Following complications associated withcomplete denture wearers were observed and recorded:

. Development of ulcers

. Teeth lost due to fracture of the denture teeth

. Fractures of the Denture base

. Denture related stomatitis

. Loss of denture retention

Various parameters that have potential effects onpatient satisfaction and denture complication wereassessed using SPSS version 18. Descriptive statisticslike percentage, mean and median were used. Quantitativedata were tested with student t-test to find the relationbetween different variables.

RESULTS

A total of Sixty-five patients with a mean averageage of 63.48 ± 8.42 years were included in this study.Amongst all, 31 were females (47.6%) while the remaining34 were males (52.3%). The complications observed inthe patients with regards to their frequency were:

. 84.6% - Loss of denture retention

. 44.6% - Developing of ulcers

. 30.7% - Loss of denture teeth due to fracture

. 27.6% - Fractures of the denture base

. 7.6% - Denture stomatitis

Age and gender distribution has been enumerated inTable 1 and Table 2 shows VAS scores of patient's dentureaesthetics, the phonetics and their chewing ability.

Denture's condition, vertical dimension and the centricrelation are the parameters that are enumerated inTable 3 while incidence of complications are shown in

Complete Denture Complications among PatientsKhan SA / Rashid H / Sukkurwalla A / Naz A

Table 1: Age Distribution among patientsn = 65

Table 2: Esthetics, chewing ability and phonetic VAS scoresn = 65

Table 3: Evaluation of parameters for vertical dimension, centricrelation and denture condition

n = 65

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Table 4. There is no significant relation between the

patient's satisfaction and complications in the procedures(P > 0.05); also the VAS scores or incidence ofcomplications. It was also found that centric relation orvertical dimensionhad no significance between them(P > 0.05).

DISCUSSION

The majority of the edentulous patients were morethan 65 years old and were using dentures for more than10 years. That had resulted in mucosal changes whichwas noticed in about 44-63% of cases. A clinical analysishas recommended that 40% of the dentures after a periodof 5 years and 80% of dentures after a 10 year periodmust be replaced9. Elderly individuals are more likelyto have difficulty in accepting a new denture speciallyif they face difficulty in chewing, or have noticed asignificant change in their facial appearance10,11.The mandibular dentures are more likely to showinstability and lack of retention due to presence of limitedsurface area. These problems become even moresignificant in cases where there is severe residual ridgeresorption in mandible. Major problem reported by suchpatients is unbearable pain during chewing possibly dueto denture trauma12,13,14.

The present study drives our attention to the mostcommonly encountered problem i.e. loss of retention(84.6%) closely followed by mucosal irritation (44.6%).Ongoing bone atrophy may have attributed to the abovementioned problems as it leads to a decrease in thealveolar crestal height14,15. According to the current study,27.6% patients have had fractures in their dentures, whichmay have been due to careless handling of the dentureduring maintenance and accidental droppings. Accidentaldamage or heavy occlusal forcees are found to be themain reasons behind the midline fracture of an acrylic

denture10,16.Rest vertical dimension (RVD) and occlusal vertical

dimension (OVD) become compromised when boneresorption occurs15,17. Generally, a relatively low OVDis preferred by the clinicians as it causes less discomfort.The results of the present study are consistent with thesefindings (69.2%). An increase in the OVD results indenture clicking sounds during speech or may causeunclear phonetics specially if the patient consciouslytries to stop the clicking sound14. Centric relation hasshown to effect denture's comfort12,19 however; no suchfindings were recorded in the present study.

Current study only focused on data collected fromthe department of prosthodontics DIKIOHS and waslimited. Studies have indicated that the results are differentif the data is collected from a larger general populationof complete denture wearers rather than a single teachinghospital1-3,5,12,13,14. A cross-sectional study involving largernumber of patients from different clinical centers isrequired to reach a more reliable conclusion in future.

CONCLUSION

Within the limitations of the current study, completedenture wearers in a teaching hospital commonlyencountered the problem of retention loss. Other problemsincluded development of ulcers, loss of denture teeth andfractures of the denture base.

REFERENCES

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Complete Denture Complications among PatientsKhan SA / Rashid H / Sukkurwalla A / Naz A

Table 4: Incidence of Complicationsn = 65

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417.6. Smith M. Measurement of personality traits and theirrelation to patient satisfaction with complete dentures. JProsthet Dent 1976; 35:492-503.7. Silverman MM (2001). The speaking method inmeasuring vertical dimension. J Prosthet Dent 85, 427-431.8. Celenza FV (1984) The theory and clinical managementof centric positions: II. Centric relation and centric relationocclusion. Int J Perio Rest Dent 4, 62-66.9. de Grandmont P, Feine JS, Tache?R, Boudrias P,Donohue WB, Tanguay R, Lund JP. Within-subjectcomparisons of implant- supported mandibular prostheses:Psychometric evaluation. J Dent Res 1994; 73:1096-104.10. Grant AA, Heath JR, McCord JF (1994) Complete prosthodontics: problems, diagnosis and management,C.V. Mosby, St Louis, 44-45.11. Zarb GA, Bolender CL, Eckert S, Jacob R, FentonA, Mericske-Stern R (2004) Prosthodontic treatmentfor edentulous patients: complete dentures and implant-supported prostheses. 12th ed. C.V. Mosby, St Louis, 298.12. Bergman B, Carlsson GE (1972) Review of 54

complete denture wearers. Patient's opinions 1 year aftertreatment. Acta Odontol Scand 30, 399-414.13. Heyink JW, Heezen JH, Schaub RMH (1986)Dentist and patient appraisal of complete dentures ina Dutch elderly population. Community Dent OralEpidemiol 14, 323-326.14. Van Waas MA (1990). The influence of clinicalvariables on patients' satisfaction with complete dentures.J Prosthet Dent 63, 307-310.15. Basker RM, Davenport JC (2002) Prosthetic treatmentof the edentulous patient 4th ed, Blackwell, Oxford, 1-2116. Van Waas MA (1990) Determinants of dissatisfactionwith dentures: a multiple regression analysis. J ProsthetDent 64, 569-57217. Atwood DA (1971) Reduction of residual ridges: amajor oral disease entity. J Prosthet Dent 26, 266-27918. Basker RM, Davenport JC (2002). The prosthetictreatment of the edentulous patient. 4th ed, Blackwell,Oxford, 269-311.19. Basker RM, Davenport JC (2002. The prosthetictreatment of the edentulous patient. 4th ed, Blackwell,Oxford, 260-269.

Complete Denture Complications among PatientsKhan SA / Rashid H / Sukkurwalla A / Naz A