Art-5
PROSTHETIC DENTISTRY www.stomaeduj.com
DURATION AND LENGTH OF ADAPTATION TO NEW
Original Articles
COMPLETE DENTURES: A SURVEY BASED ON PATIENTS’
SELF-REPORTED OUTCOMES
Renata Poljak-Guberina1a* , Tina Poklepović-Peričić1b , Marko Guberina2c , Asja Čelebić3d*
1
Department of Dental Prosthodontics, School of Medicine, University of Split, Split, Croatia
2
Department of Oral Surgery, Dental Polyclinic Zagreb, Zagreb, Croatia
3
Department of Removable Prosthodontics, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
a
DMD, PhD, Assistant Professor; e-mail: rpoljak@mefst.hr; ORCIDiD: https://orcid.org/0000-0002-6081-8424
b
DMD, PhD, Assistant Professor; e-mail: tinapoklepovic@gmail.com; ORCIDiD: https://orcid.org/0000-0002-9686-5062
c
DMD; email: markoguberina@yahoo.com; ORCIDiD: https://orcid.org/0000-0003-3717-1324
d
DMD, PhD, Professor (tenured); email: celebic@sfzg.hr; ORCIDiD: https://orcid.org/0000-0001-5985-8966
https://doi.org/10.25241/stomaeduj.2022.9(1).art.5
ABSTRACT
Introduction We studied the duration of adaptation to new complete dentures (CD) and changes for 5 years
based on patients’ self-reported outcomes.
Methodology Sixty fully edentulous patients who received new CDs and wore them for 5 years were
included. A questionnaire (answers 0-10 VAS) related to self-perceived speech, chewing function, comfort of
denture wearing, denture retention, and orofacial esthetics was completed on the 1st, 3rd, 8th, 15th, and 30th
day after new CD delivery, and after 1, 3, and 5 years of denture wearing.
Results Self-perceived speech reached the highest scores on the 30th day; females and previous removable
denture (RD) wearers adapted faster during the first days. Chewing reached the highest scores on the 30th
day, remained unchanged over the 1st year, and decreased significantly afterwards; females gave higher
scores during the first 15 days and previous RD wearers from the 3rd till the 30th day. A comfort of denture
wearing first slightly decreased, but soon increased, reaching the highest values the 30th day, remained
unchanged after one year, then decreased gradually, with no significant difference between gender and
previous RD experience. Retention scores decreased after 3 and 5 years, without difference between gender
and previous RD experience. Orofacial esthetics scores decreased substantially after 3 years with no effect of
gender and previous experience (p>0.05).
Conclusion The highest scores were obtained for orofacial esthetics and speech, the lowest for chewing
function. Participants needed 30 days to adapt to new CDs. The adaptation lasted one year and decreased
significantly the 3rd and the 5th year.
KEYWORDS
Complete Denture; Adaptation; Chewing; Speech; Comfort Esthetics.
1. INTRODUCTION treatment options in cases of edentulism, especially
Edentulism represents a certain level of physical considering older patients [1,6-9]. Prosthodontic
impairment, which is regarded as a chronic disability, treatment using a complete denture (CD) aims to
causing many edentulous individuals to face obstacles achieve oral rehabilitation and reestablishment of the
in their everyday activities, such as eating or speaking lost function, namely speech, occlusion, aesthetics,
[1]. Furthermore, it may significantly impact an and masticatory function. It is considered one of
individual's psychological and social functioning the main challenges of prosthodontic treatment [9-
and the overall quality of life [2,3,4]. Global trends 15]. It is important to obtain satisfactory retention
have shown significant differences in the rates of and stability of CDs, crucial factors for successful
edentulism worldwide [1,2,3,5]. Recent data from adaptation to them [15,16]. The masticatory function,
developed countries demonstrated a slight but antagonistic contacts, and preservation of masticatory
encouraging decline in complete edentulism [6]. muscle reflexes in CD patients were negatively
However, although edentulism is becoming less correlated with the development of dementia in
frequent in developed, industrialized countries, it old patients [14,17]. The success of treatment with
remains prevalent in many parts of the world, and CDs is further influenced by many other factors that
a complete denture is still one of the most frequent are also important to secure optimal retention and
OPEN ACCESS This is an Open Access article under the CC BY-NC 4.0 license.
Peer-Reviewed Article
Citation: Poljak-Guberina R, Poklepović-Peričić T, Guberina M, Čelebić A. Duration and length of adaptation to new complete dentures: a survey based
on patients’ self-reported outcomes. Stoma Edu J. 2022;9(1):45-53.
Received: January 22, 2021; Revised: March 02, 2022; Accepted: March 30, 2022; Published: March 31, 2022.
*Corresponding author: Dr. Renata Poljak-Guberina, DMD, PhD, School of Medicine University of Split, Šoltanska 2, 21000 Split, Croatia.
Tel.: +385 21 55790 ; Fax: +385 21 21557895; e-mail: rpoljak@mefst.hr
Prof. Asja Čelebić, DMD, PhD, School of Dental Medicine, University of Zagreb, Gundulićeva 5, 10000 Zagreb, Croatia.
Tel.: +385 1 4802125; Fax: +385 1 4802159; e-mail: celebic@sfzg.hr
Copyright: © 2022 the Editorial Council for the Stomatology Edu Journal.
Stoma Edu J. 2022;9(1): 45-53 pISSN 2360-2406; eISSN 2502-0285 45
www.stomaeduj.com
stabilization of a denture, such as characteristics the respective dental school (No. 05-PA-26-6/2015).
Original Articles of the saliva, status of the alveolar bone, condition After 30 days, one patient was not available for the
of the mucosa and its resilience, relations between recall examination, after 12 months an additional 9
maxillary and mandibular residual alveolar ridges patients dropped out, after 3 years 5 more patients
and neuromuscular factors [7-11,16,18]. Besides, a dropped out, and another seven patients were not
new denture may cause difficulties during speaking, available after 5 years. Finally, 60 patients completed
and time is needed for patients to reach a satisfactory the prospective clinical study and were included in
level of speech [16,18]. Although the quality of a new the final analysis. The flowchart of the study protocol
denture depends mainly on technological, biological, and drop-outs is presented in Figure 1.
and physiological factors, it also depends on the
interaction between the patient and the therapist [7].
However, long time CD wearing elicits some
inherent problems, such as continuous residual
ridge resorption, injuries of underlying mucosa,
mucosal inflammation, flabby ridge development,
and even loss of a complete alveolar ridge bone with
consequent loss of denture retention and stability,
loss of vertical dimension of the lower third of a
face, and contra-clockwise rotation of the mandible
[19-24]. As the mandible is more prone to residual
alveolar ridge loss, recent recommendations of a
panel of experts led to McGill consensus proposing
that the minimum treatment needed for completely Figure 1. Flowchart of the study protocol and the participants'
edentulous subjects is a manufacture of maxillary availability at follow-up examinations.
complete denture and a mandibular two-implant
overdenture [25, 26, 27]. In subjects with narrow alveolar 2.2. Complete denture manufacture
ridges, rehabilitation with four mini implant retained All dentures were made following the same criteria.
mandibular overdenture is also an option. After alginate preliminary impressions, custom trays
Unfortunately, rehabilitation of the implant retained were made, and custom (individual) impressions were
overdenture is usually not available to many obtained for everyone. After registration of the vertical
patients due to economic, social, or general jaw relation in a centric position, the occlusal rims
health issues [7-15,27,28]. Consequently, the were transferred into a semi-adjustable articulator.
manufacture of conventional CDs is the only The semi-anatomical artificial teeth and a lingualized
treatment option for them. A certain amount of time occlusion scheme, with no attempt of occlusal balance
is needed for a patient to accept a new prosthodontic were applied. New CDs were processed after the
device, especially a removable denture [8-15]. artificial teeth set-up in a trial denture and verification
This study aimed to assess how long patients need of satisfactory esthetics and antagonistic contacts in a
to adapt to their new conventional CDs and how centric relation in the mouth. After the new dentures
long their satisfaction lasts. An additional aim was to delivery, during adaptation, the occlusion was
evaluate the association between gender, previous checked and adjusted if necessary, oral mucosa was
removable denture experience, and age with inspected for soreness, and the denture was trimmed-
adaptation to CDs and self-perceived satisfaction. off when necessary.
Two experienced specialists in Prosthodontics, who
2. METHODOLOGY were not involved in the CD manufacture assessed
the quality of new complete dentures in retention
2.1. Sample (quality of fit), flange extension, stability, esthetics,
The subjects recruited in this study comprised 82 fully and occlusion, as described in previous studies [8,9] .
edentulous individuals needing new CDs, unwilling The observers listed the dentures into low, average or
to undertake implant-supported mandibular high quality dentures. The weighted kappa statistics
overdenture treatment for different reasons, was calculated based on the number of matching
primarily due to a fear of a surgical procedure, categories between the two observes and showed
general health, or economic reasons. A total of 40 satisfactory agreement (κ= 0.808). Only patients with
participants received new CDs at the Department of high-quality new dentures were recruited in the study.
Prosthodontics, Dental Polyclinic, Split, Croatia, from
September 2015 to June 2016. The Ethics Committee 2.3. Study protocol
of the School of Dental Medicine in Split approved the After the new CDs delivery, the patients had to fill in a
study. Another 42 participants received new CDs at small questionnaire consisting of two parts. The first
the Department of Removable Prosthodontics, School part comprised data about gender, age, and previous
of Dental Medicine, Zagreb, Croatia, in the same dental status in their mouth [fixed partial denture or
period, with the approval of the Ethics Committee of natural teeth (FPD); removable partial denture (RPD)].
46 Stoma Edu J. 2022;9(1):45-53 pISSN 2360-2406; eISSN 2502-0285
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The second part comprised five questions with the removable denture wearers), while 53 patients (41
Original Articles
answers on the 0 to 10 visual-analog scale (VAS) for females, 12 males) (88.33%) already had experience
assessment of self-perceived speech ability, chewing with removable partial dentures.
function, comfort of denture wearing, denture The patients' self-perceived speech ability on the 1st,
retention, and orofacial esthetics. Assessments were 3rd, 8th, 15th, and 30th day after complete denture
repeated on the 3rd day after CDs delivery, 8th day, delivery, and after 12 months, 3 years and 5 years
15th day, and 30th day. Same assessments were again of denture wearing is presented in Table. 1. The
repeated after 9-12 months of denture wearing and in scores gradually increased till the 30th day after CD
a period after 3 and after 5 years of denture wearing. delivery, then remained almost unchanged at the
The checks were made in a dental office for the 1st, 3rd, 12 months and 3-year recall examinations and only
8th, and 15th day. If the patients needed any denture slightly decreased after 5 years of denture wearing.
adjustments, they also came to a dental office, and if Statistically significant difference existed between
not, they were assessed by telephone. The one-year, the observed periods (Friedman test; X2=116.04,
3-year and 5-year examination was performed in a df=7, (p=<0.001), mostly due to lower grades till the
dental office. The flowchart is presented in Figure 1. 30th day. However, participants without previous
removable denture experience gave lower scores
2.4. Statistical analysis during the first 15 days, but after 30 days and further
We used the IBM SPSS Statistics for Windows (Version on no significant difference was observed between
20.0.; IBM Corp, Armonk, NY, USA) to evaluate the previous CD and the first time CD wearers (Table 2,
descriptive statistics (medians, modal values, quartiles, Mann-Whitney test). Females gave better scores for
means and standard deviations for the patients’ self- speech than males during the first 15 days of denture
perceived assessments of their speech, chewing wearing (Tab. 2).
ability, denture retention, the comfort of denture The patients' self-perceived chewing ability on the
wearing, and their orofacial esthetics). Changes over 1st, 3rd, 8th, 15th, and 30th day after complete denture
time were estimated by the Friedman non-parametric delivery, and after 12 months, 3 years and 5 years of
test for related samples. Comparisons between gender denture wearing is presented in Table 1. The scores
and comparison between patients who previously were the lowest from the 1st to the 8 day, afterwards
th
wore removable denture and the first time removable increased, reached the highest values on the 30th day,
denture wearers were performed by non-parametric remained almost unchanged during the first year and
Mann-Whitney test. afterwards decreased (the 3rd year) and reached the
lowest values in the 5th year of follow-up examination
3. RESULTS (Friedman test; X2=223.45, df=7, p=<0.001). During
the first 3 days after new CDs’ delivery no significant
The patients’ age was between 66 and 81 years. There difference existed between the previous and the first
were 44 females (77.3%) and 16 males (26.7%). Seven time denture wearers, but after the 3rd day previous
patients (3 females, 4 males) (11.66%) had natural CD wearers gave significantly better scores than the
teeth or a fixed partial denture before treatment first time denture wearers; that remained unchanged
with new complete dentures (were the first time till the 3rd year.
Table 1. Medians, mods, means, and percentiles of self-assessed speech, chewing, the comfort of denture wearing, denture retention, and esthetics.
Speech 1st day 3rd day 8th day 15th day 30th day 1 year 3 years 5 years
Median 8.50 9.00 9.00 9.00 10.00 10.00 10.00 10.00
Mode 10 10 10 10 10 10 10 10
Mean 8.27 8.43 8.83 9.08 9.43 9.58 9.50 9.28
SD (mean) 1.89 1.84 1.28 1.09 0.81 0.67 0.70 0.96
Percentile 25 7.00 8.00 8.00 8.00 9.00 9.00 9.00 9.00
50 8.50 9.00 9.00 9.00 10.00 10.00 10.00 10.00
75 10.00 10.00 10.00 10.00 10.00 10.00 10.00 10.00
Chewing 1st day 3rd day 8th day 15th day 30th day 1 year 3 years 5 years
Median 7.00 7.00 7.00 8.00 9.00 9.00 7.00 6.50
Mode 7 7 7 8 9 9 7 6
Mean 6.87 6.73 7.45 8.02 8.87 8.95 7.48 6.57
SD (mean) 1.70 2.00 1.73 1.51 0.87 0.81 1.07 1.73
Percentile 25 6.00 5.25 7.00 7.00 8.00 9.00 7.00 6.00
50 7.00 7.00 7.00 8.00 9.00 9.00 7.00 6.50
75 8.00 8.00 8.00 9.00 10.00 9.00 8.00 8.00
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Original Articles Comfort of
1st day 3rd day 8th day 15th day 30th day 1 year 3 years 5 years
denture wearing
Median 9.00 8.00 8.00 8.50 9.00 9.00 8.00 6.50
Mode 10 10 10 10 10 9 9 9
Mean 8.03 7.60 8.27 8.43 9.03 8.77 7.53 6.40
SD (mean) 2.25 2.28 1.65 1.44 1.12 0.96 1.32 2.20
Percentile 25 7.00 6.00 7.00 7.00 8.00 8.00 6.00 5.00
50 9.00 8.00 8.00 8.50 9.00 9.00 8.00 6.50
75 10.00 10.00 10.00 10.00 10.00 9.00 9.00 8.00
Retention of
1st day 3rd day 8th day 15th day 30th day 1 year 3 years 5 years
complete dentures
Median 9.00 8.00 9.00 9.00 9.00 9.00 7.00 5.50
Mode 10 8 8 9 10 9 7 5
Mean 8.63 8.13 8.50 8.63 9.17 8.70 6.97 5.50
SD (mean) 1.83 2.05 1.56 1.39 0.98 0.94 1.66 2.13
Percentile 25 8.00 8.00 8.00 8.00 9.00 8.00 6.00 4.00
50 9.00 8.00 9.00 9.00 9.00 9.00 7.00 5.50
75 10.00 10.00 10.00 10.00 10.00 9.00 8.00 7.00
Esthetics 1st day 3rd day 8th day 15th day 30th day 1 year 3 years 5 years
Median 10.00 10.00 10.00 10.00 10.00 10.00 9.00 8.00
Mode 10 10 10 10 10 10 9 9
Mean 9.40 9.63 9.70 9.73 9.80 9.72 8.60 7.58
SD (mean) 1.09 0.66 0.65 0.58 0.48 0.58 1.12 2.05
Percentile 25 9.00 9.00 10.00 10.00 10.00 10.00 8.00 7.00
50 10.00 10.00 10.00 10.00 10.00 10.00 9.00 8.00
75 10.00 10.00 10.00 10.00 10.00 10.00 9.00 9.00
Table 2. Significance of the differences for the self-perceived speech ability between gender, and between participants with previous removable
denture experience and the first time complete denture wearers over the observed period.
PREVIOUS RPD MEAN MEAN
SPEECH N P GENDER N P
EXPERIENCE RANK RANK
no 7 7.36 female 44 34.91
1ST DAY <0.001 ** 1ST DAY 0.001 **
yes 53 33.56 male 16 18.38
no 7 8.93 female 44 34.86
3RD DAY <0.001 ** 3RD DAY 0.001 **
yes 53 33.35 male 16 18.5
no 7 10.64 female 44 34.55
8TH DAY 0.001 ** 8TH DAY 0.002**
yes 53 33.12 male 16 19.38
no 7 12.36 female 44 32.98
15TH DAY 0.001 ** 15TH DAY 0.051 NS*
yes 53 32.90 male 16 23.69
no 7 19.64 female 44 32.98
30TH DAY 0.08 NS 30TH DAY 0.25 NS
yes 53 31.93 male 16 26.75
no 7 18.86 female 44 32.39
1 YEAR 0.061 NS 1 YEAR 0.09 NS
yes 53 32.04 male 16 25.31
no 7 20.86 female 44 31.66
3 YEARS 0.25 NS 3 YEARS 0.33 NS
yes 53 31.77 male 16 27.31
no 7 24.29 female 44 31.05
5 YEARS 0.33 NS 5 YEARS 0.66 NS
yes 53 31.32 male 16 29.00
**= p<0.01; *= p<0.05; NS=not significant. **= p<0.01; *= p<0.05; NS=not significant.
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Afterwards no significant difference existed (Table 3). X2=223.45, df=7, p=<0.001). There was no significant
Original Articles
Females gave better scores to chewing than males differences between males and females, and between
for the first 15 days and at the one-year observation those without or with previous removable denture
(Table 3). experience (Table 4).
Table 3. Significance of the differences for the self-perceived chewing Table 4. Significance of the differences for the self-perceived comfort of
ability between gender, and between participants with previous denture wearing between gender, and between participants with
removable denture experience and the first time complete denture previous removable denture experience and the first time complete
wearers over the observed period. denture wearers over the observed period.
PREVIOUS RPD MEAN PREVIOUS RPD MEAN
CHEWING N P COMFORT N P
EXPERIENCE RANK EXPERIENCE RANK
no 7 20.71 no 7 29.07
1ST DAY 0.119 NS 1ST DAY 0.822 NS
yes 53 31.79 yes 53 30.69
no 7 21.07 no 7 32.79
3RD DAY 0.113 NS 3RD DAY 0.718 NS
yes 53 31.75 yes 53 30.20
no 7 17.14 no 7 27.64
8TH DAY 0.030 * 8TH DAY 0.652 NS
yes 53 32.26 yes 53 30.88
no 7 18.21 no 7 21.93
15TH DAY 0.046 * 15TH DAY 0.171 NS
yes 53 32.12 yes 53 31.63
no 7 16.86 no 7 23.93
30TH DAY 0.026 * 30TH DAY 0.296 NS
yes 53 32.30 yes 53 31.37
no 7 14.79 no 7 22.50
1 YEAR 0.009 ** 1 YEAR 0.202 NS
yes 53 32.58 yes 53 31.56
no 7 21.50 no 7 27.57
3 YEARS 0.150 NS 3 YEARS 0.652 NS
yes 53 31.69 yes 53 30.89
no 7 22.29 no 7 29.93
5 YEARS 0.194 NS 5 YEARS 0.928 NS
yes 53 31.58 yes 53 30.58
**= p<0.01; *= p<0.05; NS=not significant. **= p<0.01; *= p<0.05; NS=not significant.
MEAN MEAN
GENDER N P GENDER N P
RANK RANK
female 44 34.55 female 44 32.23
1ST DAY 0.003 ** 1ST DAY 0.188 NS
male 16 19.38 male 16 25.75
female 44 35.58 female 44 30.45
3RD DAY <0.001 ** 3RD DAY 0.973 NS
male 16 16.53 male 16 30.63
female 44 34.31 female 44 30.77
8TH DAY 0.004 ** 8TH DAY 0.836 NS
male 16 20.03 male 16 29.75
female 44 33.43 female 44 31.14
15TH DAY 0.027 * 15TH DAY 0.629 NS
male 16 22.44 male 16 28.75
female 44 32.43 female 44 31.59
30TH DAY 0.134 NS 30TH DAY 0.392 NS
male 16 25.19 male 16 27.50
female 44 33.65 female 44 33.02
1 YEAR 0.011 * 1 YEAR 0.067 NS
male 16 21.84 male 16 24.75
female 44 31.88 female 44 31.09
3 YEARS 0.286 NS 3 YEARS 0.196 NS
male 16 26.72 male 16 28.88
female 44 32.39 female 44 28.86
5 YEARS 0.156 NS 5 YEARS 0.499 NS
male 16 25.31 male 16 35.00
**= p<0.01; *= p<0.05; NS=not significant. **= p<0.01; *= p<0.05; NS=not significant.
The results were similar with the self-perceived
The patients' self-perceived comfort of denture assessment of denture retention, with a more
wearing is presented in Table 1. It decreased after emphasized decrease after one year (Friedman test;
the 1st day till the 8th day, then increased till the 30th X2=218.65, df=7, p=<0.001) (Table 1) Also, no significant
day remained unchanged at the 1-year follow-up and differences were found between gender and previous
again decreased after 3 and 5 years (Friedman test; or the first time denture wearers (Table 5).
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Original Articles Table 5. Significance of the differences for the self-perceived complete Table 6. Significance of the differences for the self-perceived esthetics
dentures' retention between gender, and between participants with between gender, and between participants with previous removable
previous removable denture experience and the first time complete denture experience and the first time complete denture wearers over the
denture wearers over the observed period. observed period.
PREVIOUS RPD MEAN PREVIOUS RPD MEAN
RETENTION N P ESTHETICS N P
EXPERIENCE RANK EXPERIENCE RANK
no 7 32.64 no 7 25.93
1ST DAY 0.735 NS 1ST DAY 0.469 NS
yes 53 30.22 yes 53 31.10
no 7 30.79 no 7 33.50
3RD DAY 0.964 NS 3RD DAY 0.636 NS
yes 53 30.46 yes 53 30.10
no 7 29.93 no 7 31.79
8TH DAY 0.928 NS 8TH DAY 0.839 NS
yes 53 30.58 yes 53 30.33
no 7 23.93 no 7 31.64
15TH DAY 0.296 NS 15TH DAY 0.857 NS
yes 53 31.37 yes 53 30.35
no 7 23.64 no 7 30.64
30TH DAY 0.276 NS 30TH DAY 0.982 NS
yes 53 31.41 yes 53 30.48
no 7 21.21 no 7 37.00
1 YEAR 0.152 NS 1 YEAR 0.307 NS
yes 53 31.86 yes 53 29.64
no 7 29.71 no 7 32.57
3 YEARS 0.152 NS 3 YEARS 0.752 NS
yes 53 30.60 yes 53 30.23
no 7 21.50 no 7 34.00
5 YEARS 0.150 NS 5 YEARS 0.588 NS
yes 53 31.82 yes 53 30.04
**= p<0.01; *= p<0.05; NS=not significant. **= p<0.01; *= p<0.05; NS=not significant.
MEAN MEAN
GENDER N P GENDER N P
RANK RANK
female 44 28.59 female 44 29.55
1ST DAY 0.095 NS 1ST DAY 0.400 NS
male 16 36.50 male 16 33.13
female 44 29.23 female 44 28.82
3RD DAY 0.095 NS 3RD DAY 0.110 NS
male 16 34.00 male 16 35.13
female 44 28.86 female 44 29.55
8TH DAY 0.211 NS 8TH DAY 0.314 NS
male 16 35.00 male 16 33.13
female 44 29.18 female 44 29.59
15TH DAY 0.313 NS 15TH DAY 0.337 NS
male 16 34.13 male 16 33.00
female 44 28.41 female 44 30.00
30TH DAY 0.098 NS 30TH DAY 0.570 NS
male 16 36.25 male 16 31.88
female 44 28.68 female 44 29.41
1 YEAR 0.157 NS 1 YEAR 0.264 NS
male 16 35.50 male 16 33.50
female 44 28.77 female 44 29.81
3 YEARS 0.196 NS 3 YEARS 0.570 NS
male 16 35.25 male 16 32.41
female 44 29.59 female 44 29.30
5 YEARS 0.499 NS 5 YEARS 0.366 NS
male 16 33.00 male 16 33.81
**= p<0.01; *= p<0.05; NS=not significant. **= p<0.01; *= p<0.05; NS=not significant.
Self-perceived orofacial esthetics did not change 3. DISCUSSION
from the 1st day till the 3-year examination, when it
decreased and continued to decrease till the 5-year The treatment of complete or partial edentulousness
follow-up (Friedman test; X2=234.05, df=7, p=<0.001) has always been a major challenge. Although dental
(Table 1). Although females gave slightly lower scores, implants enable better and longer-lasting adaptation
no significant differences were found for any of the to removable dentures, they are still unavailable to
observation stages (Table 6). most of the population due to health issues and
The same results were seen with previous and the first economic reasons. Therefore, we aimed to study how
time removable denture wearers (Table 6). long it is necessary to adapt to new CDs considering
50 Stoma Edu J. 2022;9(1):47-55 pISSN 2360-2406; eISSN 2502-0285
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self-perceived speech function, chewing ability, influenced chewing function, as females and previous
Original Articles
the comfort of CD wearing, denture retention, and RPD wearers gave better scores. The results were the
orofacial esthetics. We also aimed to monitor the same for the self-perceived speech ability. Better
duration of the peak of patients’ satisfaction and sores obtained from female patients can be probably
the influence of gender, and previous dental status. explained by their happiness about esthetic outcome.
The study was designed as a longitudinal clinical Although males were also almost equally satisfied
prospective study in a cohort of edentulous patients with esthetics, the accepted cultural and personality
receiving new CDs. Most patients gradually adjusted standards probably played a role in the fact that
to complete dentures over 30 days. Self-perceived females scored some other domains better than men
chewing ability, speech and comfort of denture [6,37,38].
wearing reached the highest scores only after 30 The already experienced denture wearers adapted
days. However, self-perceived chewing function, and faster, which is in line with other studies [8,9,28,29,39],
the comfort of denture wearing, first decreased from although it has also been reported that greater overall
the 1st to the 8th day and then increased until the improvements after complete denture therapy were
30th day, then remained unchanged through the first observed in participants without than in those with
year, and decreased after 3 years. Orofacial esthetics previous denture experience [10,40]. First time CD
and denture retention did not change significantly wearers were probably uncomfortable with palatal
from the first day to the first year but the scores coverage, which could be a reason for their lower
decreased significantly after 3 years, and even more scores immediately after delivery. Previous CD
after 5 years of CD wearing. Speech significantly and wearers had already adapted to palatal coverage. It
gradually increased over 30 days. It seems that the has been reported that previous denture wearers also
period of 30 days can be considered sufficient for CD adapted faster as their discrimination of tactile ability
adaptation due to speech, chewing and comfort of significantly increased faster over the first 30 days than
denture wearing. However, this applies for patients in the first time denture wearers [39].
who received high-quality new CDs, as insufficient Orofacial esthetics scored highly as in other studies
denture quality has been one of the risk factors for
[8,9,38], but the score started to decrease significantly
non-adaptation to removable dentures [8,9,29].
after three years of denture wearing. There could be
It is not surprising that previous RPD wearing
many reasons. The vertical dimension of the lower
influenced a self-perceived speech function, as
third of the face decreases gradually over time due to
patients with previous RPD experience adapted
alveolar ridge atrophy and artificial teeth wear [19-22,
faster [8,9,29]. They had already adapted to speaking
30,31], accompanied by a counterclockwise rotation
with a palatal coverage. With first time CD wearers,
of the mandible and the appearance of emphasized
adjustment to new complete dentures took the
wrinkles and a decreased lip volume. The CD patients
longest. When analyzing speech, it is important to
probably noticed that problem. Moreover, artificial
have in mind that older patients are more likely to
suffer from xerostomia and have difficulty speaking teeth and denture materials also absorb colors from
clearly due to insufficient saliva flow, therefore they drinks and food and stain over time.
need to adapt longer [29]. Decrease of a self-perceived All new complete dentures delivered in this study
speech ability after 5 years of CD wearing can be were made without balanced occlusion, as it has been
attributed to the loss of maxillary and mandibular proved that no occlusal scheme is superior regarding
denture retention, mainly due to alveolar bone chewing ability [11,41,42].
atrophy over time [19-22], which is significantly higher One article reported that 38.0% of patients
in CD wearers than in mandibular complete implant- showed non-adaptation to CDs. Non-adaptation
supported overdenture patients [20,31]. was significantly associated with the absence of
During the first days of wearing new CDs, dentures previous mandibular denture experience (p = 0.042),
may cause pain and discomfort. That was probably ulcerations after 15 days of rehabilitation (p < 0.001),
the reason why participants’ scores for chewing ability, and a reduced posterior mandibular ridge (p = 0.035).
the comfort of denture wearing, and denture retention After 6 months, this incidence decreased to 14.1%
first decreased after the 1st day and increased only [43]. Our study sample had in the most cases previous
after the 8th day. The scores peaked on the 30th day, CD experience, only 7 of them were the first time CD
when all occlusal and denture adjustments were wearers, which is also the limitation of the study. The
finished and patients learned how to speak more strength of the study is the duration of observation
clearly. These results remained throughout the 1st up to 5 years.
year of denture wearing. The results coincide with the Our longitudinal prospective clinical research
results of other studies [11,12,32,33]. No influence of confirmed that the process of adapting to new CDs
gender and previous denture status was observed is usually completed within a month. The patients’
on a self-perceived comfort of denture wearing and satisfaction remained unchanged during the first year
denture retention. This is in line with the results of and significantly decreases after 3 years of CD wearing
some previous research [33-36]. However, gender and in all domains: function, speech, comfort, retention,
previous removable denture experience significantly and esthetics, reaching the lowest scores after 5 years.
Stoma Edu J. 2022;9(1): 45-53 pISSN 2360-2406; eISSN 2502-0285 51
www.stomaeduj.com
AKNOWLEDGEMENTS for important intellectual content; administrative, technical, and
Original Articles A part of the research was funded by the Croatian Scientific material support; study supervision, writing some parts of article;
Foundation grant no. 1218. TP: acquisition of data, writing article’s draft, literature collection;
MG: drafting of the manuscript; AČ: study concept and design,
AUTHOR CONTRIBUTIONS analysis and interpretation of data, technical and material support,
RP: study concept and design; critical revision of the manuscript critical revision
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Renata POLJAK-GUBERINA
DMD, PhD, Assistant Professor
Department of Dental Prosthodontics
School of Medicine
University of Split
Split, Croatia
CV
Dr. Poljak-Guberina received her PhD (1998) and specialization in Prosthodontics (2001) from the School of Dental Medicine,
University in Zagreb, Croatia. Since 2017, she has been working as Assistant Professor at the Department of Prosthodontics at
the Faculty of Dentistry in Split, Split University, Croatia. Her research areas of interest are clinical projects and dental materials.
Questions
1. How long does a patient need to adapt to new complete dentures?
qa. One day;
qb. Two weeks;
qc. Four weeks;
qd. Six month.
2. How long does the adaptation to new denture last (based on the data in this
manuscript)?
qa. One week;
qb. One month;
qc. One year;
qd. 4-5 years.
3. Which two categories received the highest grades after one month of new complete
denture wearing, based on patients’ self-reported outcomes??
qa. Chewing and retention;
qb. Comfort of denture wearing and chewing;
qc. Retention and speech;
qd. Speech and esthetics.
4. Which category did not significantly change within one-month period of new denture
wearing?
qa. Comfort of denture wearing;
qb. Esthetics;
qc. Speech;
qd. Chewing ability.
Stoma Edu J. 2022;9(1): 45-53 pISSN 2360-2406; eISSN 2502-0285 53