Status of Oral Prosthetic Rehabilitation of Edentulism at the University Clinics of Kinshasa (CUK), DR Congo

Objective: The present work aimed to identify the most common edentulousness and prosthesis type (prosthetic treatment), to improve the management in oral prosthetic rehabilitation in DR Congo. Material and Methods: It was a documentary, longitudinal, and retrospective study of the medical records of edentulous patients admitted to the prosthetic service of the Dental Department/Kinshasa University from January 1983 to December 2020. Age, sex, cause of teeth loss, and prosthetic treatment (partial removable prosthesis, complete removable prosthesis) were evaluated. The Chare square test was performed to compare significant differences between the variables and the P-value < 0.05 was set as significant. Results: One thousand six hundred and ninety patients in that 901 were men (47 ± 16 years) and 789 women (42 ± 15 years) had undergone prosthetic treatment. One thousand eight hundred and forty-four edentulous teeth were viewed according to the Kennedy classification. Kennedy class 1 was the most predominant (61.4%) followed by Kennedy class 3 (24.8%). Two thousand one hundred and ninety-one prostheses were performed. The removable partial prosthesis with plate (acrylic resin) was the most performed (78.8%;n = 1727) and followed by the joint (17.4%;n = 384). Dental caries (52.6%) and periodontitis (36.4%) were the main causes of these edentulous teeth. Conclusion: The present study showed that edentulism is becoming a concern for the implementation of a real oral health policy.

Fixed Bicortical Screw and Blade Implants as a Non-Standard Solution to an Edentulous (Toothless) Mandible

Aim This paper deals with the treatment of an atrophied toothless mandible with a fixing bridge carried by two nonstandard implant systems. Methodology Four bicortical screws were implanted into the frontal part of the mandible and one implant on each side was placed into the distal area of the mandible as a support for a fixing bridge. Results During the years 2002–2007 the authors placed a total of 256 bicortical screw and 84 blade implants. During this period only four bicortical screws and one blade implant failed. The primary and secondary surgical success rate was therefore above 98%, while the prosthetic success rate was 100%. （Bridges which had to be re-fabricated due to implant failure were not taken into account.） Conclusion This approach is recommended as a highly successful and affordable option for a wide range of patients.

Posterior partially edentulous jaws, planning a rehabilitation with dental implants

AIM: To discuss important characteristics of the useof dental implants in posterior quadrants and the rehabilitation planning. METHODS: An electronic search of English articles was conducted on MEDLINE(PubM ed) from 1990 up to the period of March 2014. The key terms were dental implants and posterior jaws, dental implants/treatment planning and posterior maxilla, and dental implants/treatment planning and posterior mandible. No exclusion criteria were used for the initial search. Clinical trials, randomized and non randomized studies, classical and comparative studies, multicenter studies, in vitro and in vivo studies, case reports, longitudinal studies and reviews of the literature were included in this review. RESULTS: One hundred and fifty-two articles met the inclusion criteria of treatment planning of dental implants in posterior jaw and were read in their entirety. The selected articles were categorized with respect to their context on space for restoration, anatomic considerations(bone quantity and density), radiographic techniques, implant selection(number, position, diameter and surface), tilted and pterygoid implants, short implants, occlusal considerations, and success rates of implants placed in the posterior region. The results derived from the review process were described under several different topic headings to give readers a clear overview of the literature. In general, it was observed that the use of dental implants in posterior region requires a careful treatment plan. It is important that the practitioner has knowledge about the theme to evaluate the treatment parameters. CONCLUSION: The use of implants to restore the posterior arch presents many challenges and requires a detailed treatment planning.

Single Nucleotide Polymorphisms and Haplotypes in Vascular Endothelial Growth Factor Gene and Residual Ridge Resorption of Mandible in Korean Population

The tooth extraction is a routine surgical procedure in the dental treatment where the healing process results in a saddle-shaped residual ridge in the edentulous jaw. There are substantial differences among individuals in the end result. In some cases, there is excessive bone atrophy, which complicates the dental restorative treatment. The alveolar ridge receives the mechanical load continuously from the periodontal ligament connected to the teeth and it diminishes dramatically as a consequence of dental extraction;thus it is believed the continuing pattern of the alveolar bone resorption is related to this change. The reduced partial pressure of oxygen is the most prominent event from the reduced mechanical load. Vascular Endothelial Growth Factor (VEGF), regulated by HIF-1, reported close association with angiogenesis and bone turn over, where partial oxygen pressure has changed. Therefore the genetic association between Single Nucleotide Polymorphsim (SNP) of VEGF gene and RRR was investigated. 120 subjects (70.93 ± 9.28 years) which were treated at Dental clinic of Yonsei University with edentulous mandible were recruited. Mandibular bone height was measured following the protocol of the American College of Prosthodontists. Three variants, rs1570360, rs25648, and rs3025039 in VEGF from previous study, were used as tag-SNPs and genotyping for the study. Student’s t-test and ANOVA were used for statistical analysis. There was a notable association with rs1570360 (P = 0.051) in dominant group and haplotype A-C-C showed a statistically significant association with RRR in dominant group (P = 0.042). Results of this study may be useful in developing novel genetic diagnostic tests and identifying Koreans susceptible to developing severe RRR after dental extraction.

Oral rehabilitation for a geriatric population<br>—A voluntary experience in Ukraine report

Despite the outstanding progress in dentistry, there are still a great number of edentulous patients world-wide, what’s more, the dentists are not willing to inform the patients about their handicapped condition. Elderly people do not complain about this a lot, and also unfortunately the general public and government authorities do not concerne too much about gerodontic issues. The elderly people has suffered greatly from this. Dental implant is one way to figure this out. The Ukrainian Dental Implant Association has initiated a professional voluntary project entitled: “Quality of Life for our Parents”. This geriatric welfare program offers free implant and Prosthetic rehabilitation for the Elderly edentulous patients.

Association of type 2 diabetes mellitus with the reduction of mandibular residual ridge among edentulous patients using panoramic radiographs

Objective: To evaluate the association between type 2 diabetes mellitus and the reduction of mandibular residual ridge in completely edentulous patients wearing complete dentures and to investigate the ef-fect of gender, age and years of edentulousness / den-ture wearing on ridge resorption on both groups. Methods: Seventy-two (36 men and 36 women) with a mean age 63.5 years (range of 52 to 73 years) com-pletely edentulous denture-wearing patients were included in this study. Of these, there were 40 patients with type 2 diabetes mellitus and 32 control subjects participated in the study. Resorption in the mandibular residual ridges was assessed by using the mental foramen and the inferior border of the mandible, as they appear in panoramic radiographs, as reference points using Wical and Swoope Analysis method. Measurements were performed using “Dijite” Digital Caliper. The amount of mandibular ridge resorption was calculated and correlated with type 2 diabetes mellitus and the results were compared with control group. Differences in gender, age and years of edentulousness were investigated. Statistical analysis was performed using SPSS (V11.0). A 2-sample t-test was used to evaluate the differences in mean values of mandibular ridge resorption between diabetics and controls. Level of significance was set at 0.05. Results: The mean mandibular residual ridge resorption of all participants is 8.0 mm (26.9%), diabetic group significantly (P < 0.01) had two times more resorption compared with control group (35.8% versus 18.0%). Females recorded greater amount of resorption in diabetics 49.7% versus 21.8% (P < 0.001) and in controls 22.3% versus 13.7%, (P < 0.05) compared to males, respectively. There were no differences in both groups regarding the age of subjects and the length of time they have been edentulous and years of denture wearing. The amount of mandibular residual ridge resorption was directly related to the number of years of edentulousness. Conclusion: Completely edentulous, denture-wearing diabetics, women in particular, are at more risk to have ridge resorption than “nondiabetic” subjects. Reduced mandibular height is directly related to years of edentulousness and denture wear-ing with greater amount of resorption among diabet-ics.

Effects of Denture Removal on Expiratory Upper Airway Patency during Mask Ventilation in Complete Denture Wearers under General Anesthesia

Background: Some anesthetized patients present with expiratory airway obstruction (EAO) during mask ventilation (MV). EAO may occur more frequently among edentulous patients for whom a firmer grip of the mask and the mandible is needed to avoid gas leakage. We compared EAO grades before and after denture removal and identified predictors of EAO during MV in edentulous patients. Methods: One hundred and eight denture-wearing edentulous patients were anesthetized, their mouths were wrapped with film, their nasal masks and mandibles were held with two hands, and their lungs were ventilated in a pressure-controlled mode. Their dentures were subsequently removed, mouths were re-wrapped, and nasal MV was reapplied. EAO was graded based on capnography waveforms as follows: Grade I, normal waveform (no obstruction);II, loss of the alveolar plateau of the waveform (partial obstruction);and III, no waveform (total obstruction). EAO grades were compared before and after denture removal. Predictive demographic variables for occurrence of total EAO were identified using a multivariate analysis. Results: The proportions of Grades I, II, and III were 43.5%, 26.9%, and 29.6% when dentures were worn and 35.2%, 15.7%, and 49.1%, respectively, when dentures were removed. A significant difference was observed in EAO grades before and after denture removal (P = 0.000034). Age ≥ 75 years (adjusted odds ratio 3.41;95% confidence interval 1.31 - 8.87;P = 0.012) and body mass index ≥ 25 kg/m2 (adjusted odds ratio 2.61;95% confidence interval 1.07 - 6.40;P = 0.036) were independently associated with an increased incidence of total EAO in patients with their dentures removed. Conclusion: Denture removal impaired expiratory upper airway patency in edentulous patients, particularly in older or obese patients, during MV.

Determinants Factors for the Choice of the Width Prosthetic Upper Central Incisor: Review of the Literature

Materials and Methods: The authors conducted a review of the literature around the theme, determinants of the choice of the width of the upper central incisor (WUCI), through search web including Pub Med, Inari and Google. Fifteen of the most recent publications since 2005 have been selected from twenty publications. Sample size (n), age range (AR), average bi zygomatic distance (BZD), choice determinants, type of study, and mathematical formula between WUCI and BZD were the study’s interest variables. Sociodemographic characteristics, facial anatomical marks and the size of the patient’s teeth for anterosuperior were the main factors to be assessed. Results: Out of 22 included articles, the Asian continent represents 59% in which India is the leading country with 27.3% followed by American 22.8%. The most Determinants choice for the width upper central incisor in craniofacial and anterior teeth method from the published papers were BZD (100%;n = 22) and WUCI (81.8%;n = 18). Conclusion: Application of mathematical formulation maybe help to predict the exact width of the upper central incisor.

Measurement of Mucosal Thickness in Denture-bearing Area of Edentulous Mandible

Background： The thickness of the alveolar mucosa influences the probability of the occurrence of denture-induced irritations. Thick denture-supporting tissues offer relief from mucosal tenderness and ulcers; however, the uniformity of the thickness across the entire mandibular alveolar mucosa cannot be accurately determined in edentulous patients. This study aimed to assess the mucosal thickness of the denture-bearing area in the edentulous mandible. Methods： Twenty-seven edentulous patients underwent cone-beam computed tomography scanning, wherein the patients wore a record base to retract soft tissues away from the alveolar mucosa. The measured regions were the central incisor （1C）, lateral incisor （1L）, canine （Ca）, first premolar （P 1）, second premolar （P2）, first molar （M 1）, and second molar （M2） regions. The thickness was measured in the alveolar ridge crest （T）, buccal （B1-B4）, and lingual （L I-L4） alveolar ridge mucosa. The average thickness of the mucosa at buccal sides （B） and lingual sides （L） were also assessed. Results： The differences in the mucosal thickness between the left and right sides were not significant. In the Ca-M2 regions, T was the thickest, and L3 was the thinnest of all the measured points in the same regions. L was significantly less than B in posterior regions （P 〈 0.01 ）. On the other hand, M2 at L4 was thinnest of all the measured regions from Ca to M2 （P 〈 0.01）, and was thicker than IC, IL, P1, and P2 at B2. Conclusions： Since the mucosal thickness of denture-bearing area in the edentulous mandible is not uniform; the tissue surface of the denture base or custom tray should be selectively relieved, which may reduce the risk of denture-induced irritations.

The need for a complete dental autopsy of unidentified edentulous human remains

In December 2017,a decomposed unidentified body was found near the river Tronto in Teramo,Italy.The corpse was found without any identifying documents or specific personal belongings,except for a packet of cigarettes.The medical examiner determined a gastric perforation from the intake of hydrochloric acid to be the cause of death.A jar of muriatic acid found near the body led to suicide being considered the manner of death.The Penal Court in Teramo appointed two forensic odontologists to complete the postmortem assessment and collect dental data for personal identification.The corpse was found wearing a complete set of upper and lower dentures.The dental autopsy and 42 periapical X-ray images helped generate a biological profile of a man totally edentulous with upper and lower dentures,as well as an osteosynthesis with two plates and screws in the left ascending ramus of the mandible.In March 2018,the sister of a missing person reported the disappearance of her brother,and a presumptive identification was performed through visual recognition of the decomposed body.The sister confirmed the presence of two dentures and the location of the maxillo-facial surgery for the treatment of the fractured mandible.A complete dental autopsy was able to establish his identity without any DNA comparison needed.This case highlights the importance of performing a complete dental autopsy inclusive of dental radiographs,and its value in the identification of all unknown human remains even when totally edentulous.A complete dental autopsy should be performed in all cases of human identification.