Robert P. Renner

Four-year longitudinal study of the periodontal health status of overdenture patients

Seven patients with a total of 12 roots were treated with overdentures (maxillary, mandibular, or both) and recalled at 6-month intervals for a period of 4 years. A periodontist evaluated the periodontal health status of the abutment roots after complete periodontal therapy, immediately prior to placement of the overdentures, and at all recall visits. The gingival tissues around all the abutments were slightly erythematous and edematous and bled on probing. There were no statistically significant changes in pocket depth or in apparent width of attached gingiva on an intra-arch basis. However, statistically significant changes were found on comparison between the maxillary and mandibular arches. Over the 4-year period 50% of the roots remained immobile, 25% of the roots that were initially mobile exhibited no mobility, and 25% of the roots decreased in mobility. Five of 14 roots in eight patients (35.7% of the abutment roots) developed dental caries. Periodic recalls to reinforce plaque control measures, to provide adjunctive periodontal therapy, and to correct and adjust the prostheses of patients treated with overdentures are important factors in the longterm success of this treatment modality. Biomechanically, treatment of patients with overdentures is a valid practical alternative to complete dentures.

Osteoporosis in postmenopausal women

Eleven postmenopausal complete denture patients participated in a study to evaluate some possible predictors of osteoporosis. Most participants in the study reported a low caloric intake and consumed considerably less than the recommended daily allowances of sodium, cholesterol, calcium, fluoride, magnesium, zinc, and folic acid. Many participants in the study were taking additional daily vitamin and mineral supplements. The CCT as measured on radiographs of the second phalynx of the fifth digit of the right hand correlated linearly with the CBD corrected for soft tissue. Panoramic radiographs revealed that all individuals had severe residual ridge resorption. All serum calcium and phosphorus means were within the normal range, while more than 60% of the patients had below normal plasma levels of 25-hydroxyvitamin D. In conclusion, although based on a small sample, it appears that the diet of elderly women in New York is somewhat deficient for adequate skeletal homeostasis. Ideally, the vitamin D status of each patient should be determined and proper supplements prescribed. However, the high cost of analysis suggests that dietary analysis be used on a selected but more frequent basis. Radiation techniques for measuring skeletal porosity are also too complex to perform on a routine basis and should, like dietary analysis, be reserved for patients in whom other clinical signs and symptoms indicate metabolic bone disease.

Assessment of antimicrobial treatment of denture stomatitis using an in vivo replica model system: Therapeutic efficacy of an oral rinse

Five denture stomatitis patients demonstrating Candida albicans on both maxillary dentures and palates volunteered to test the effects of Peridex oral rinse in treating their oral disease. They used Peridex rinse both as a mouthrinse and as a denture soak for a period of 24 days. Agar replicas of the tissue-fitting surfaces of the maxillary dentures revealed elimination of C. albicans. Significant decreases in palatal inflammation were also noted, although some inflammation was still evident. Several weeks after the termination of Peridex oral rinses, inflammation increased as concentrations of C. albicans on the denture surface returned to pretreatment levels. A marked similarity in the site-specific localization of this yeast species on the denture was noted before and after Peridex rinse treatment.

An in vivo replica method for the site-specific detection ofCandida albicans on the denture surface in denture stomatitis patients: Correlation with clinical disease

A site-specific agar replica technique for detecting Candida albicans on the acrylic resin denture surface of denture stomatitis patients has been developed. The method is selective for C. albicans during a finite incubation period with a specific synthetic growth medium. C. albicans colonies can be geographically observed on the replica and their presence can be correlated with inflammatory lesions visible on the mucosa of the maxillary and mandibular residual ridges. In 12 denture stomatitis patients studied, a close clinical correlation of Newton type III patients was noted but this clinical correlation could not be observed in Newton type I and II patients. In general, the number of C. albicans colonies increased with the severity of the inflammation. The findings are discussed in light of lack of knowledge of the etiology of the stomatitis. The importance of the replica method is also discussed.

Mechanical evaluation of splint therapy in treatment of the edentulous patient

Many edentulous patients have temporomandibular joint (TMJ) dysfunction that affects the use of their complete dentures. During the diagnostic and treatment-planning phase an ordered series of procedures must be performed. An arbitrary axis mounting, needlepoint and pantographic tracings on stabilized record bases will aid the dentist in determining the functional state of the TMJ and associated muscles. If no pathosis is found, a conventional denture technique can be used. If TMJ dysfunction is noted on the basis of an analysis of the tracings, an interim mandibular denture can be modified to correct the TMJ and musculature before new complete dentures are made. The occlusal scheme chosen for each patient can be based on a careful analysis of the tracings over a period of months.

A clinical study of the periodontal status of abutment teeth supporting swinglock removable partial dentures—A pilot study

Eleven patients wearing mandibular swinglock bilateral distal extension removable partial dentures opposing maxillary complete dentures were studied for a period up to 2 years. They had moderate to advanced periodontal disease with retrograde mobility patterns. Periodontal therapy, as well as treatment of dental carious lesions, was completed before fabrication of the prosthesis. Recordings of the gingival status, pocket depth, plaque score, tooth mobility, and dental caries were made at the time of the placement of the prosthesis and thereafter at 6-month intervals. Final results were obtained at the end of 2 years in six patients (group A) and at 1 1/2 years in five patients (group B). Our findings show that both groups had a statistically significant increase in gingival inflammation. However, no differences in degree of inflammation were observed between the two groups with regard to the status of gingival tissues that were covered and uncovered by the components of the swinglock removable partial denture. Also, no statistically significant differences in pocket depths and plaque scores were found between the time of placement of the swinglock removable partial denture and the final recall visit. Of the 61 abutment teeth, 85.2% had no significant change in mobility, 11.5% showed a substantial decrease in mobility, and 3.3% showed a considerable increase in mobility. The patients were able to successfully wear the swinglock removable partial denture without clinically significant changes in the supporting structures of the abutment teeth. This report is part of an ongoing study to determine the efficacy of swinglock removable partial dentures.

The swing-lock partial denture: An approach to conventional removable partial denture service

There are many common problems associated with the use of conventional clasp removable partial dentures. An alternative modality in many instances is the swing-lock removable partial denture. Its advantages, disadvantages, indications, and contraindications are discussed. The procedures of fabrication, placement, and adjustments are described.

In vivo antifungal efficacy of salivary histidine-rich polypeptides: Preliminary findings in a denture stomatitis model system☆

Six denture stomatitis patients, all found to have Candida albicans on their maxillary denture and palatal tissue surfaces, volunteered in this preliminary study to test the in vivo efficacy of human salivary antifungal histidine-rich polypeptides (HRPs) in treating their oral disease. The patients were equally divided among the Newton types classification and, as expected, the severity of the inflammation was greatest in the Newton type III patients and least in the Newton type I patients. Patients received sterile solutions of either HRP-3 or HRP-4, which they used both as a mouthrinse and as a denture soak for a period of 1 week. Agar replicas of the tissue-fitting surface of the maxillary dentures revealed HRP reduction and/or elimination of C. albicans from the denture; in one Newton type II individual, this finding directly correlated with a site-specific reduction in palatal inflammation. In the Newton type II and type III individuals alike, there was a significant generalized decrease in inflammation suggesting the therapeutic efficacy of the HRPs. Killing of this yeast species by the HRPs, as determined by scanning electron microscopy (SEM), was probably responsible for the observed clinical benefits noted in this investigation. In the SEM, HRP-treated blastospores appeared severely deflated, as if they had been emptied of significant quantities of intracellular material.

Model system for the in vitro testing of a synthetic histidine peptide against Candida species grown directly on the denture surface of patients with denture stomatitis

The denture surface provides a nidus for the growth of microbial species that act to initiate, aggravate, and maintain clinical disease. The present investigation describes the development of a model system for the testing of the effectiveness of agents against these microbial species inhabiting the denture surface. It was observed through in vitro growth patterns that the model permitted the testing of representative samples of the microbial flora. Poly-L-histidine was observed to inhibit both Candida albicans and C. glabrata from growing from the denture surface into nutrient broth. Scanning electron microscopy of control and treated denture disks revealed that poly-L-histidine had either eliminated most microbial flora from the denture surface or had effected a noticeable distortion of those Candida blastospores still present on the surface. From microbiologic studies, it appeared that poly-L-histidine had inflicted direct but not lethal damage to the still-attached distorted blastospores because the latter were still able to promote growth in agent-free broth. The antifungal effects of poly-L-histidine were observed to be dependent on the concentration of the polypeptide. The data obtained were consistent for all of the patients regardless of their denture stomatitis classification.

A survey of temporomandibular disorder conducted by the greater New York academy of prosthodontics

The results of a temporomandibular joint survey sent to 167 members of the Greater New York Academy of Prosthodontics indicated a great variation in the diagnosis and treatment of patients with temporomandibular joint dysfunction. Although most indicated that their background in temporomandibular joint disorders was from clinical experience and/or textbooks and the dental literature, only 59% treated patients for these disorders. The most common diagnostic procedures were occlusal evaluation; joint evaluation for tenderness, crepitus, and click; evaluation of range of motion of the mandible; and a muscular evaluation. Only 35% used a formal temporomandibular joint dysfunction questionnaire. The percentage of complete denture patients with these symptoms was 5% or less. Thirty-three percent of clinicians sometimes treated asymptomatic patients who were without pain but had a click. Two thirds of the respondents believed that surgery was sometimes indicated for disk degeneration and displacement. More recent graduates are more likely to treat patients who have temporomandibular joint dysfunction than are older more experienced practitioners.