Professional Documents
Culture Documents
Asja »elebiÊ1
Melita ValentiÊ-PeruzoviÊ1
Classification, Partial Denture Josip PanduriÊ1
Robert ∆eliÊ1
Renata Poljak-Guberina2
Material and Construction on 1Department of
Patients’ Satisfaction Prosthodontics
School of Dental Medicine
University of Zagreb
2Private dental practice,
Zagreb
of Dental Medicine, and 55 patients were examined with the aesthetic appearance of their dentures, sat-
in the Geriatric Institution “Treπnjevka”, Zagreb. isfaction with speech, mastication and the comfort
The study included 59 males and 105 females. of wearing their partial dentures. With regard to
Patients were aged from 38 to 87 years. A ques- comfort assessment, if patients had any problems
tionnaire was devised for the purpose of the study, with their dentures, they were assessed from 1 to 5,
divided into two parts and completed by the patients where 5 indicated the greatest problems (Figure 1).
and the dentist. In the first part patients graded their For all of the assessed variables, distribution was
dentures, depending on the level of satisfaction with completely asymmetrical towards the highest grades
their partial dentures. They first graded their den- (5) with one or two small peaks in the lower grades
tures in total and then graded then separately with (Figure1), except for the comfort of wearing den-
regard to retention, aesthetics, speech, mastication tures, where values were asymmetrical towards the
and comfort of wearing dentures. Patients graded lowest grades (Figure 1). From the distributions of
their dentures by using a scale from 1 to 5, as it the patients’ evaluation of their partial dentures
common in our society and used in all schools and obvious by the great majority of the patients are
Universities. really satisfied with their dentures. More than half
of the patients assessed all the variables describing
In the second part the dentist determined Ken-
their satisfaction with their partial dentures as the
nedy classification and their modifications (exempt-
highest grade (grade 5) (Figure 1). For general
ing cases with very long saddles), material (metal/
/acrylic) and denture support, upper denture base satisfaction with the partial denture, 74% of the
shape (palatal plate-type/ U-shaped/ single palatal patients gave the highest grade (5) for the upper and
bar/ anterior and posterior palatal bar type), lower 76.2% for the lower partial denture (Figure 1). For
denture base shape (linguoplate/ half-pear-shaped retention of the upper partial dentures 64.6% of the
lingual bar) and the number of missing teeth (three patients gave the highest grades (5) and for retention
groups: 1. from 1 to 5 teeth missing, 2. from 6 to 10 of the lower partial dentures 60.8% of the patients
teeth missing and 3. more then 10 teeth missing). gave the highest grades, while 75.2% of the patients
The dentist also evaluated the denture construction assessed their speech with the upper partial denture
by using a scale from 1 to 5. as the highest grade and 67.7% of the patients
assessed the in speech with the lower partial denture
Statistical analysis was made by using the sta- as the best highest (Figure 1). Grade five was given
tistical software SPSS 3.0 for Windows with the for mastication with the upper partial denture by
following methods: 63.7% of the patients and for mastication with the
a) Distribution of frequencies for testing vari- lower partial denture by 51.5% of the patients. The
ables. highest percentage of the patients had no problem
b) Mean, standard deviation, median, mode. at all with the comfort of wearing the upper (89.5%)
c) Testing the normality of distribution by one- or lower (76.2%) partial denture (Figure 1).
way Kolmogorov-Smirnov test.
Histograms of the frequencies, as well as stan-
d) Testing the significance of the differences
dard deviations (SD), modes and medians for partial
between different variables by the Kruskal-
denture construction (scale 1-5) assessed by the
-Wallis test.
dentist are shown in Table 1, as well as deter-
mination of Kennedy classification, number of
missing teeth in the upper and /or lower jaw (divided
Results
in to 3 groups), type of denture material and support
Diagrams of the frequencies for the variables and denture base shape.
assessed by the patients (scale from 1 to 5), depend- The most frequent Kennedy Class was Class I
ing on how satisfied they had been with their partial (56% of upper and 74% of lower removable partial
dentures are shown in Figure 1. Patients assessed the dentures), followed Class II (30% of upper and 19%
following variables: their general satisfaction with of lower removable partial dentures), while the low-
upper and/or lower partial denture(s), satisfaction est percentage of partial dentures were of Class III
(10%). Considering Kennedy Classification subdi- According to the number of missing teeth in the
visions, the most frequent was subdivision 1 (70%), lower jaw, Kruskal-Wallis test revealed that there
followed by subdivision 2 (20%), while the lowest was significant difference between the number of
percentage of partial dentures were of subdivision missing teeth (p<0.05) (Table 1), indicating that
3 (7%). Subdivision 4 was not found. patients with a greater number of missing teeth had
With regard to the number of missing teeth in the more problems with denture comfort.
upper and/or lower jaw (divided in to 3 groups), Statistically significant difference also existed
most of the patients were in group 3 (more then 10 between the ability of speech with a lower partial
missing teeth) (60%). denture and the dentist’s evaluation of construction,
In the upper jaw, the most frequent was a palatal which shows that the dentures with lower con-
plate-type (44%) denture base, while U-shaped struction scores (given by the dentist) also had lower
connectors and single palatal bars occurred in the scores for ability of speech (given by the patient)
(p<0.05)(Table 2).
same percentage (27,4%).
There was no significant difference between the
The lowest frequency (0.9%) was for the upper
denture base shape and the patients general sat-
anterior and posterior palatal bar type partial
isfaction or patients’ satisfaction with retention,
dentures.
chewing, speech, aesthetics and comfort (p>0.05).
In the lower jaw 64.6% were linguoplate types, There was also no significant differences for Ken-
and 35.4% half pear shaped lingual bars. nedy classification and subdivisions, type of mate-
Seventy percentage of the partial dentures were rial, denture support of the upper and lower partal
tooth supported. dentures and patient’s satisfaction with their partial
removable dentures (p>0.05).
The dentist evaluated the denture construction
by using a scale from 1 to 5, and scores 4 and 5 were
present in the same percentage (41%), while score
Discussion
3 appeared in 18.4% (Table 1).
Normality of the distribution for the assessed There are many factors which depend on the
variables was tested by the one-way Kolmogorov- patient, as well as on the therapist which can influ-
-Smirnov test, which indicated out that all of the ence patients’ satisfaction with their partial remov-
assessed variables differed from the normal dis- able dentures (1). Apart from psychologic factors,
tribution (p<0.05), which shows that with 95% other factors that depend on the patient are as
reliability, it could be concluded that distribution of follows: quality of the denture bearing area, quality
the assessed variables were different from the nor- of oral mucosa, influence of surrounding muscles on
mal distribution described by Gauss. denture flanges, viscosity of saliva, patient’s age
As the assessed parameters did not a have normal and ability to get used to thea denture, state of
distribution, non-parametric statistical test had to be abutments, state of other teeth in the mouth, relation
applied for further analysis, i.e. Kruskal-Wallis test, between the horizontal and vertical dimension of
which is the same as the one-way analysis of vari- occlusion, hygiene habits, diet, of chronic diseases,
ance in the parametric statistics. Kruskal-Wallis test position of patient’s teeth in the mouth, quality of a
compares categories of ranks for testing the sig- fixed prosthodontic appliance, etc. (3,4).
nificance of the differences. Denture quality depends on the knowledge and
Kruskal-Wallis test was used to determine if any skill of the therapist and technician (7).
significant difference exists between the examined From the results of this study, it is clear that the
variables. In Table 2 the variables and their ranks distribution of patients’ assessment of their partial
with significant differences are listed (p<0.05), dentures (on a scale from 1 to 5) are completely
while variables which had not showed any sta- asymmetrical towards the highest scores (grades),
tistically significant difference are only mentioned i.e. the most of the patients (more than 60%) gave
in the further text (p>0.05). the highest grades to their dentures (Figure 1). This
indicates that the most of the patients are completely There is also statistically significant difference
satisfied with their partial dentures. between the patients’ grades for speech and the
None of the factors, such as the Kennedy clas- dentists’ valuation of the lower denture construction
sification, denture base shape, type of material or the (p<0.05)(Table 2). In the denture constructions with
denture support, were statistically related to the lower dentist’s scores patients were also less sat-
patient’s satisfaction in general, satisfaction with isfied with speech with their partial dentures (Table
mastication, speech, aesthetics or retention (p>0.05). 2).
Although it was assumed that the patients with
a metal construction, tooth supported dentures and Conclusions
anterior and posterior palatal bar connectors would
be more satisfied, this was not confirmed by the From the statistical analysis the following con-
results. If the highest percentage of scores 4 and 5 clusions were made:
for the construction are considered (given by the
dentist) (Table 1), then this indicates that the correct 1. Patients were mostly satisfied with their par-
indication was set for almost all the patients. If it tial dentures (distribution of the scores of the
was possible to make the tooth-supported denture patients’ assessments was asymmetrical towards
and metal construction denture then it was done, the highest scores in all examined categories).
and where it was impossible, a larger acrylic denture 2. Kennedy classification, material, denture base
base, or mucosa-supported denture was made. An shape and denture support do not have an
adequate construction was made for almost all the influence on patients’ satisfaction with den-
patients, therefore there was no differences between ture retention, speech, mastication, aesthetics
their satisfaction. and comfort of wearing dentures (p>0.05).
According to the results of this study statistically 3. The number of lower missing teeth have an
significant difference (p<0.05) was found between effect on comfort of wearing lower dentures
the patients’ evaluation of lower denture comfort (p<0.05), more teeth missing, more problems
and the number of missing teeth in the lower jaw. with comfort.
It shows that the patients with a greater number of 4. Construction of the lower denture has an
missing teeth in the lower jaw (group 3- more then influence on patients’ satisfaction with speech
10 missing teeth) had more uncomfortable dentures with lower partial denture (p<0.05).
(scores 4 or 5 given by patients) in comparision with
patients with less missing teeth.