Syed Rashid Habib1 , Azad All Azad2
1. Department of Prosthodontics, Armed Forces Institute of Dentistry, Rawalpindi.
2. Assistant Professor, Department of Prosthodontics, Armed Forces Institute of Dentistry, Rawalpindi.
Corresponding author: “Dr. Syed Rashid Habib” firstname.lastname@example.org
J Pak Dent Assoc 2009; 18(1): 009 – 013.
To compare the level of patients satisfaction with replacement complete dentures fabricated by copy denture technique versus conventional technique.
This was a Quasi experimental comparative study (Phase 2 trial). Conducted from May 2005 to May 2006 at the Department of Prosthodontics, AFID, Rawalpindi. First 60 patients seeking replacement complete dentures were registered and divided into two groups. Group-A patients were given dentures fabricated by copy denture technique and Group-B patients were given dentures fabricated by conventional denture fabrication technique. The patients satisfaction level was assessed after 6 weeks of denture insertion with the help of a questionnaire. Questions about appearance, looseness of dentures, ability to chew food, ability to taste foods, speech and comfort of the patient were asked from each of the patients. Each of the questions had three answers (a) Good (b) Fair and (c) Poor. Good was given a scoring rate of 3, fair a scoring rate of 2 and poor a scoring rate of 1. The maximum scoring rate was 18 and minimum was 6. The patients who had a rate of 15 to 18 were categorized as highly satisfied, from 11-14 were categorized as fairly satisfied and from 06 to 10 were categorized as poorly satisfied.
In group A, 10 patients (33 %) were highly satisfied, 11 patients (36 %) were fairly satisfied and 7 patients (23 %) were poorly satisfied. Chi-square test was applied for the comparison of satisfaction level of the two groups. Differences in satisfaction scores between the subjects belonging to the two groups were statistically significant. The p value was 0.002.
Copy denture technique is a valid, biologically acceptable and cost effective treatment modality.
Copy dentures, duplicate dentures, patients satisfaction with dentures, replacement complete dentures, .
Complete dentures can be a great disappointment to edentulous persons.’ The wearing of even technically perfect complete dentures is
associated with a significant deterioration of most oral functions. Some of the patients will be dissatisfied, even if the dentures are fabricated according to all accepted criteria.2
Successful function with complete dentures depends Oral functions with complete dentures require skill from the patient. Clinical observation shows that such dexterity takes time to develop, can be of a very high order, and can readily be lost. For elderly patient’s development of new skills and modification of the old ones both present problems.4
Oral tissues may not accept the new complete denture immediately and may require some time to accommodate it.5 The success of conventional complete denture treatment is variable and depends on the patient showing sufficient adaptive capacity to overcome the many limitations of complete dentures by the process of habituation.6
Many people requesting new complete dentures will have worn dentures (often the same set) successfully for many years.’ Patients generally expect new dentures to fit, function and look better than their existing dentures. Those few who demand similar esthetics to the former denture may prove to be a difficult management situation. Careful patient education and preparation for replacement dentures is critically important.8
When replacement dentures become necessary, it is helpful if the new prostheses require as little adaptation as possible to the existing skills. This is generally considered to be particularly important for the older patients in whom not only many skills have been developed over a long period, but also the ability to relearn may be diminished.3
Copy denture technique provides a more reliable method for provision of replacement complete dentures.3 Copy templates are made which exhibit those features of the existing dentures which are satisfactory and are to be reproduced in the new dentures, while facilitating controlled and predictable modification of undesirable features.9 The aim should be to ensure that with the new prostheses, the patient feels the absence of strangeness. There are various factors which influence a patients ability to accept and use dentures. This ability has to be acquired and involves the process of learning neuro-muscular skills and habituation. Once a denture has been accepted and proved successful, there is every good reason to avoid changing its features unless there is a specific reason for it.io
The advantages of copying old dentures are to enhance neuromuscular adaptation to new dentures as they are basically of similar shape, reduced chair side time, reduced laboratory time, fewer patient visits, registration of jaw relationship is often simple, gives technician much more of a guide to tooth position and moulds, esthetics can be copied and also cost effective!’
No such comparison of patients satisfaction with the replacement complete dentures fabricated by copy denture technique versus conventional technique was done previously in Pakistan. This study helped in identifying in terms of patients satisfaction for old complete denture wearers when they seek for provision of their replacement complete dentures.
This comparative study was conducted at department of Prosthodontics, Armed Forces Institute of Dentistry, Rawalpindi. The duration of study was one year. Edentulous patients seeking for replacement complete dentures reporting to the OPD of department of prosthodontics were included in the study
Patients included were complete denture user’s who had worn dentures successfully for a significant period of time and now wanted to replace the dentures due to combined effects of oral tissue changes, wear of teeth, lost teeth, discoloration, chipped or cracked bases, breakage, decreased vertical, inability to eat with the dentures, patients who were extremely satisfied from the esthetics of the old complete dentures, patients who were able to understand and respond to the questionnaire, patients with satisfactory oral hygiene and patients who were available for follow up visits.
Patients excluded were those having vertical decrease of more than 5 mm, deficiencies in the polished surfaces, difference in centric relation and centric occlusion, patients with Temporomandibular disorders and patients having any intra oral / extra oral pathology.
It was a comparative study and first 60 patients, coming to the Department of Prosthodontics, seeking for replacement complete dentures were registered according to a proforma as given in Annex-A. The patients were divided into two groups of 30 each, i.e. Group A and Group B.
Group A patients received complete dentures fabricated by the copy denture technique, which served as the study group. Patients in Group-B received complete dentures fabricated by the conventional denture fabrication technique, and this constituted the control group. The sampling was done according to convenience non probability technique.
For Group A patients, in the first visit, first of all we had to record impressions of the existing dentures for copying. We used stock impression trays and alginate (CA 37, Cavex Inc., Holland). Alginate was mixed and loaded into the maxillary impression tray and then the complete denture (maxillary/mandibular) was placed in the tray to obtain impression of the occlusal and polished surfaces. When this alginate had set, grooves were cut into it on the impression periphery to serve as locks for the second set of impression. Now the impression surface of the denture was captured in a second mix of alginate supported on the reverse surface of another stock impression tray. Once this alginate had set, the two impression trays were separated and the denture removed. A thin mix of chemically curing acrylic resin was poured into the moulds. The trays were placed over each other with the help of the grooves that were cut before the placement of the second tray and were held tight with rubber bands. Once this cold cured acrylic had set, it was removed from the impression mould. This gave us a template of the patient’s denture
On the chair-side, the denture was returned to the patient. Face bow record was taken. For this, a wax wafer was used that incorporated the increase in vertical dimension of occlusion that was required in the new set of dentures.
The copied denture templates were then articulated with the face bow and wax wafer onto a semi-adjustable articulator. Centric relation record was recorded and the articulator was programmed. Arrangement of teeth was carried out by trimming and replacing a single tooth at a time, without disturbing the buccolingual position of the teeth in the template.
During the second visit, trial of the dentures was done and the functional impressions using closed mouth technique, were recorded in impression paste (Cavex Outline, manufactured by Cavex Inc., Holland). This gave the added advantage of having new impression surface in the copied dentures. Flasking and curing of the dentures was done in the laboratory. After finishing and polishing, in the 3rd and final visit, the dentures were inserted and minor occlusal adjustments were made. Patients were aimed for follow up on 3rd & 10th day.
For patients in Group B, the new set of complete dentures were fabricated by following the conventional denture fabrication techniques involving initial impression, final impression, bite registration, trial and insertion steps.
The patients satisfaction level was assessed after 6 weeks of denture insertion with the help of a questionnaire (Annex-A). Questions about appearance, looseness of dentures, ability to chew food, ability to taste foods, speech and comfort of the patient were asked from each of the patients. Each of the questions had three answers (a) Good (b) Fair and (c) Poor. Good was given a scoring rate of 3, fair a scoring rate of 2 and poor a scoring rate of 1. The maximum scoring rate was 18 and minimum was 6. The patients who had a rate of 15 to 18 were categorized as highly satisfied, from 11-14 were categorized as fairly satisfied and from 06 to 10 were categorized as poorly satisfied.
Out of the 30 Group A patients there were 17 male patients and 13 female patients. Group B consisted of 16 male patients and 14 female patients out of the total 30 patients (Table-I).
The minimum number of years the denture was used by a patient of Group A was 5 years and the maximum number of years the denture was used by a patient of Group A was 14 years. The minimum number of years the
Table-I. Gender Distribution in Group-A & Group-B Patients
denture was used by a patient of Group B patients was 3 years and maximum number of years the denture was used by a patient of Group B patients was 12 years (Table-II).
The patients who were given dentures fabricated by copy denture technique was our study group and out of those 30 patients, 2 patients did not reported for follow up. Six week follow up of the total patients showed 10 patients (33 %) were highly satisfied, 11 patients (36 %) were fairly satisfied and 7 patients (23 %) were poorly satisfied (Table-III).
In the Group A out of the 10 highly satisfied patients 8 were males and 2 were females, out of the 11 fairly satisfied patients 5 were male and 6 were female and out of 7 poorly satisfied patients 3 were males and 4 were females (Table IV).
The patients who were given dentures fabricated by conventional denture fabrication technique was our control group and out of those 30 patients, 2 patients did not reported for follow up. Six week follow up of the total patients showed 1 patient (3.3 %) was highly satisfied, 9 patients (30 %) were fairly satisfied and 18 patients (60 %) were poorly satisfied(Table-III).
Test of Significance: Chi-Square P-value = 0.002
In the Group B there was only 1 highly satisfied female patient, out of 9 fairly satisfied patients 2 were males and 7 were females and out of the 18 poorly satisfied patients 13 were males and 5 were females (Table-IV).
Statistical Package for Social Sciences (SPSS) version 10 was used to analyze the data. Satisfaction level of the patients was compared for the two groups by applying the Chi-square test at a confidence interval of 95%. P<0.05 was considered to be significant. The P value was 0.002 which showed that the result of this study was significant.
A dentist can make a technically correct denture, however, unless the patient accepts the work, the treatment can be a failure. Laird et. al. found that, although the technical aspects of denture fabrication are important, it was more critical to evaluate the patients motivation and adaptation ability for the new dentures to be successful.12′ 13 One example may be when a patient wants a new denture exactly like the old existing one. It can be difficult with conventional methods to get the denture teeth in exactly the same position. This may be necessary not only for the exacting patient but also for the physically impaired patient, as both might have difficulties adapting to a new arrangement of teeth, for different reasons, psychologic or physical
The clinical value of a method enabling reproduction of selected features of old dentures in replacements is no longer in doubt. The success of the present and earlier methods in overcoming problems arising from disparities between new dentures and old appliances, in both patients referred from general practice and from student clinics, has been gratifying, and constitutes a powerful argument for more widespread application of such a method in the first instance, rather then only when difficulties arise following application of conventional methods!’
Small percentage of copying in dentures is essential. In particular, this applies to elderly patients where after years of denture wearing complex skills associated with a particular denture form have been developed. Copying may not produce appliances which conform to the clinician’s normal criteria with regard for instance to tooth position, but by retaining many of the familiar characteristics and minimizing the changes the learned abilities may be used rather than having not only to be unlearned but also replaced. For such cases even badly deteriorated old dentures can justifiably be used as the basis for new appliances. Frequently it is wise to limit the corrections applied; for instance it may be advisable to reverse only partly mandibular over closure permitted by the old dentures:8
In contrast there are cases where the use of a copying technique is contraindicated by errors or deficiencies in the existing dentures even if the latter have been considered satisfactory by the patient. Perpetuation of design faults is not justifiable where adaptability to change is judged higher, with the patient able to learn to take advantage of improved mechanical features. The difficulty arises of assessment of the ability to adapt to change. It is felt that age 55 is a good general guideline; above this age an increasing proportion of patients are best presented with minimum change.
In addition to these patients there are younger patients whose dentures are basically correct, requiring replacement because of developing deficiencies in the accuracy of fit, increasing over closure through wear of occlusal surfaces and resorption of alveolar bone. For such patients the present method may provide a preferable but not essential procedure.19
Although there are many situations which could be benefited from the use of the copy denture technique, one has to remain careful in few cases. The method should not be used if there are obvious errors and deficiencies in the dentures even if they have been considered satisfactory by
the patient. Perpetuation of the design faults is not justifiable in cases where adaptability to changes in higher, with the patient able to learn to take advantages of the improved mechanical features. They have further suggested that patients above the age of 55 years should be best presented with minimum changes in their old dentures. However, it should be noted that the speed of aging varies from one individual to another and that in some cases the chronological age of a patient is not necessarily his biological age.”
At the outset the intention was to develop a method appropriate for general application. As outlined, at least some of those for whom copying of old dentures holds the most advantages are the elderly. For these the financial implications should not be a deterrent. Copy denture technique presents savings in clinical time, offsetting an increase in material costs, and no penalty in laboratory expenses. Copy denture technique does provide a reduction in discomfort during treatment, and during adaptation to the completed appliances. The latter is important. A period of even a few months of difficulty is hard to justify in an old person, who may resent the interference with what they may regard as a significant part of their remaining life.’
A study of comparison of patients satisfaction with replacement complete dentures fabricated by copy denture technique versus conventional denture fabrication technique was conducted at Department of Prosthodontics, Armed Forces Institute of Dentistry Rawalpindi.
The hypothesis of the study was that the patients satisfaction level is higher with the replacement complete dentures fabricated by copy denture technique as compared to replacement complete dentures fabricated by conventional technique. Paired sample T test was applied for the comparison of the satisfaction level of the two groups. The P value was 0.003 which showed that the result of this study was significant. Thus the hypothesis of this study was supported by the results.
Copy denture technique is a simple and cost effective treatment for elderly patients who have used dentures successfully for a significant period of time. The new dentures will have better adaptability with reduced time at the chair side and in the laboratory.
Copy denture technique is a cost effective treatment modality both in terms of clinical time, laboratory time and which is also cost effective. Moreover the established adaptation of the patient to the dimensions of complete dentures is exploited for an early satisfaction. Patients with poor adaptive capability, due to multifaceted causes are the real beneficiaries.
This study supports that copy denture technique should be used when a patient requests for replacement of his / her existing dentures that has performed satisfactorily.
1. Wass MAJV. The influence of clinical variables on patients satisfaction with complete dentures. J Prosthet Dent 1990; 63: 307¬310.
2. Berg E. Acceptance of full dentures. Int Den J 1993; 43: 299-306.
3. Mitchell DA, Mitchell L. Prosthetics and gerodontology. In: Oxford handbook of clinical dentistry. 2nd ed. New York: Oxford University Press, 1995: 366-367.
4. Yemm R. Replacement complete dentures: no friends like old friends. Int Den J 1991; 41: 233-239.
5. Memon D. Complaints associated with new complete denture. Pak Oral Dent J 2003; 23:63.
6. Thomason JM, Lund JP, Chehade A, Feine JS. Patients satisfaction with mandibular implant overdentures and conventional dentures 6 months after delivery. Int J Prosthodont 2003; 16: 467-473.
7. Davis DM. Copy denture technique: a critique. Dent Update. 1994; 21:15-20.
8. Kelly E. Changes caused by a mandibular removable partial denture opposing a maxillary complete denture. J Prosthet Dent 2003; 90: 213-219.
9. Treasure P. The copy denture technique. N Z Dent J. 1992; 88: 56¬59.
10. Ghani F. The provision of new dentures by duplicating the existing plates: report of a case. Pak Oral Dent J 1993; 13: 29-34.
11. Paterson AJ. Removable Prosthodontics. In: Churchill’s Pocket Book of Clinical Dentistry. 2nd ed. London. Elsvier. 2002; 201-260.
12. Langer A, Michmann J, Seifert I. Factors influencing satisfaction with complete dentures in geriatric patients. J Prosthet Dent 1961; 11: 1019-1031.
13. Etiinger RL, Jakobsen JR. A comparison of patient satisfaction and dentist evaluation of over denture therapy. Community Dent Oral Epidemiol 1997; 25: 223-227.
14. Yemm R. Analysis of patients referred over a period of five years to a teaching hospital consultant service in dental prosthetics. Br Dent J 1985; 159: 304-306.
15. Lechner SK, Champion H, Tong TK. Complete denture problem solving: a survey. Aust Dent J 1995; 40: 377-380.
16. Friedman N. Landerman HM. Wexler M. The influences of fear, anxiety and depression on the patients adaptive responses to complete dentures. Part I. J Prosthet Dent 1987; 58: 687-689.
17. Basker RM, Davenport JC. Relevance of existing dentures. In: Prosthetic treatment of the Edentulous Patient. 4th ed. Cornwall. Blackwell Publishing Company. 2002; 97-122.
18. Chamberlain JB, Basker RM. A method of duplicating dentures. Br Dent J 1967; 120: 347-349.
19. Grant AA, Heath JR, McCord JF. Template dentures. Complete Prosthodontics: Problems, diagnosis and management. 1st ed. London. Mosby. 1994; 119-122.
20. Anderson JN, Storer R. Denture copying. In: Immediate and replacement dentures. 2nd ed. London. Blackwell. 1973; 239-246.
21. Duthie N, Lyon FF, Sturrock KC, Yemm R. A copying technique for replacement of complete dentures. Br Dent J 1978; 144: 248-252