Abstract
In countries with a high amount of geriatric patients, it is mandatory for a dental clinician to have working knowledge on complete denture (CD) procedures. The aim of this study was to troubleshoot the errors in denture fabrication by assessing the difficulties in clinical procedures. A questionnaire was distributed among dental undergraduates across the country in the present study. A total of 26 questions were included in the study. An online sharing medium was used for distribution and a total of 140 responses were received. SPSS for windows, version 20 was used for data tabulation. Descriptive statistics and Chi-square test were done. The results of this study revealed that jaw relation was the most difficult procedure followed by border molding. Multiple problems arise from the practitioner's end due to the lack of knowledge. One of the causes for these problems could be inability to learn the principles and procedures during the undergraduate program. This must be addressed at the base level so that better care can be given to patients.
Keywords: Clinical errors, clinical knowledge, clinical problems, complete denture fabrication, troubleshooting in complete denture
INTRODUCTION
Complete denture (CD) prosthodontics refers to the skills and knowledge required for the restoration of an edentulous arch with a CD.[1] It is a popular treatment option for the replacement of missing teeth in geriatric patients for a variety of reasons. In countries with a high amount of geriatric patients, it is mandatory for a dental clinician to have working knowledge on CD procedures. Therefore, it is included in the curriculum in all dental schools. It is one of the most technique-sensitive procedures taught to dental students throughout the course of their study with a high chance of errors in the final prosthesis.[2,3,4,5]
There are multiple textbooks from various authors as well as video tutorials available regarding the fabrication of CDs. Rapidly changing social, economic, scientific, and technical elements influence prosthodontic education to a great extent. Yet, students might have some difficulty in understanding and performing certain procedures.[6,7,8]
There is limited scientific evidence on procedural difficulties in fabricating a CD. Our research and knowledge have resulted in high-quality publications from our team.[9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29] Therefore, this study will help dental educators to improve the quality of training of dental graduates.
MATERIALS AND METHODS
The present study was conducted among undergraduate students, 3rd year, final year, and interns of various colleges. Ethical approval was obtained from SRB, Saveetha Dental College.
A total of 26 questions were included and an online sharing medium was used to distribute the questionnaire [Table 1] and a total of 140 responses were received. SPSS for windows, version 20 was used to analyze the data obtained (IBM, India). Data were analyzed using descriptive statistics and Chi-square test.
Table 1.
Represents the frequency of responses obtained from the survey
| Questionnaire | n (%) | |
|---|---|---|
| 1 | Gender | |
| Female | 46 (32.9) | |
| Male | 94 (67.1) | |
| 2 | Name of the institution | |
| 3 | How many complete dentures have you done? | |
| 1-3 | 45 (32.1) | |
| 4-6 | 75 (53.6) | |
| 7-9 | 7 (5) | |
| 10 or more | 13 (9.3) | |
| 4 | How many times did you have to repeat a particular procedure? | |
| 1-2 times | 97 (69.3) | |
| 3-4 times | 21 (15) | |
| >4 times | 4 (2.9) | |
| Never | 18 (12.9) | |
| 5 | What material did you use for making a primary impression? | |
| Impression compound | 68 (48.6) | |
| Alginate | 71 (50.7) | |
| Putty | 1 (0.7) | |
| 6 | How do you perceive making a primary impression? | |
| Very easy | 12 (8.6) | |
| Somewhat easy | 75 (53.6) | |
| Neither easy nor difficult | 39 (27.9) | |
| Somewhat difficult | 12 (8.6) | |
| Very difficult | 2 (1.4) | |
| 7 | What material did you use for border molding? | |
| Greenstick compound | 135 (96.4) | |
| Monophase | 0 | |
| Putty | 3 (2.1) | |
| Heavy body | 2 (1.4) | |
| 8 | How do you perceive border molding? | |
| Very easy | 10 (7.1) | |
| Somewhat easy | 47 (33.6) | |
| Neither easy nor difficult | 43 (30.7) | |
| Somewhat difficult | 33 (23.6) | |
| Very difficult | 7 (5) | |
| 9 | What material did you making a secondary impression? | |
| Zinc oxide eugenol | 70 (50) | |
| Light body | 69 (49.3) | |
| Medium body | 1 (0.7) | |
| 10 | How do you perceive making a secondary impression? | |
| Very easy | 30 (21.4) | |
| Somewhat easy | 50 (35.7) | |
| Neither easy nor difficult | 35 (25) | |
| Somewhat difficult | 22 (15.7) | |
| Very difficult | 3 (2.1) | |
| 11 | How do you perceive modifying occlusal rims during jaw relation? | |
| Very easy | 10 (7.1) | |
| Somewhat easy | 45 (32.1) | |
| Neither easy nor difficult | 31 (22.1) | |
| Somewhat difficult | 45 (32.1) | |
| Very difficult | 9 (6.4) | |
| 12 | Have you used a face bow? | |
| Yes | 36 (25.7) | |
| No | 104 (74.3) | |
| 13 | If yes, How do you perceive using a face bow? (Out of the 36 who said yes) | |
| Very easy | 4 (11.1) | |
| Somewhat easy | 6 (16.7) | |
| Neither easy nor difficult | 2 (5.56) | |
| Somewhat difficult | 12 (33.3) | |
| Very difficult | 12 (33.3) | |
| 14 | How do you perceive vertical jaw relation? | |
| Very easy | 12 (8.6) | |
| Somewhat easy | 59 (42.1) | |
| Neither easy nor difficult | 34 (24.3) | |
| Somewhat difficult | 32 (22.9) | |
| Very difficult | 3 (2.1) | |
| 15 | How do you perceive horizontal jaw relation (Centric relation)? | |
| Very easy | 6 (4.3) | |
| Somewhat easy | 43 (30.7) | |
| Neither easy nor difficult | 39 (27.9) | |
| Somewhat difficult | 45 (32.1) | |
| Very difficult | 7 (5) | |
| 16 | What method did you use to stabilize the occlusal rims in centric relation? | |
| Nick and notch method | 80 (57.1) | |
| Stapler pins | 44 (31.4) | |
| Fusing the wax | 16 (11.4) | |
| Zinc oxide eugenol | 0 | |
| 17 | What method do you use for teeth selection? | |
| Visual | 112 (80) | |
| Teeth molds | 5 (3.6) | |
| Using casts | 7 (5) | |
| Facial landmarks | 16 (11.4) | |
| 18 | Brand of teeth used | |
| Acryrock | 83 (59.3) | |
| Primadent | 42 (30) | |
| Ivoclar | 5 (3.6) | |
| Dentsply | 10 (7.1) | |
| 19 | Rate the difficulty in evaluating phonetics during try-in | |
| Very easy | 7 (5) | |
| Somewhat easy | 67 (47.9) | |
| Neither easy nor difficult | 42 (30) | |
| Somewhat difficult | 21 (15) | |
| Very difficult | 3 (2.1) | |
| 20 | Rate the difficulty in evaluating esthetics during try-in | |
| Very easy | 12 (8.6) | |
| Somewhat easy | 67 (47.9) | |
| Neither easy nor difficult | 39 (27.9) | |
| Somewhat difficult | 20 (14.3) | |
| Very difficult | 2 (1.4) | |
| 21 | Rate the difficulty in evaluating occlusion during try-in | |
| Very easy | 7 (5) | |
| Somewhat easy | 60 (42.9) | |
| Neither easy nor difficult | 39 (27.9) | |
| Somewhat difficult | 32 (22.9) | |
| Very difficult | 2 (1.4) | |
| 22 | Did you have errors in occlusion during try-in | |
| Yes | 90 (64.3) | |
| No | 50 (35.7) | |
| 23 | How do you perceive insertion? | |
| Very easy | 12 (8.6) | |
| Somewhat easy | 62 (44.3) | |
| Neither easy nor difficult | 47 (33.6) | |
| Somewhat difficult | 17 (12.1) | |
| Very difficult | 2 (1.4) | |
| 24 | How often is the patient satisfied with the denture? | |
| Every time | 60 (42.9) | |
| Half the time | 77 (55) | |
| Never | 3 (2.1) | |
| 25 | How often are you satisfied with the denture? | |
| Every time | 39 (27.9) | |
| Half the time | 92 (65.7) | |
| Never | 9 (6.4) | |
| 26 | What according to you is the most difficult procedure? | |
| Primary impression | 5 (3.6) | |
| Border molding | 44 (31.4) | |
| Secondary impression | 8 (5.7) | |
| Jaw relation | 78 (55.7) | |
| Try in | 2 (1.4) | |
| Insertion | 3 (2.1) |
RESULTS AND DISCUSSION
In the present study, 140 responses were obtained, of which 32.9% were males and 67.1% were females. About 32.1% had fabricated 1–3 dentures, 53.6% had fabricated 4–6 dentures, 5% had fabricated 7–9 dentures, and 9.3% had fabricated 10 or more dentures [Table 1].
The purpose of this study is to troubleshoot the errors in denture fabrication by assessing the difficulties in clinical procedures. CD fabrication is one the most common treatments done in patients, especially in the geriatric community for a variety of reasons. It is also the only noninvasive method of tooth replacement.[30,31,32]
In countries with a high percentage of geriatric patients, it is mandatory for a dental clinician to have working knowledge on CD procedures. Therefore, it is included in the curriculum in all dental schools. It is one of the most technique-sensitive procedures taught to dental students throughout the course of their study, with a high chance of errors in the final prosthesis.[3]
In the present study, 50.7% reported using alginate for taking primary impressions. This is in accordance with Harrison et al. and Hyde and McCord who found alginate to be the most favored material for primary impression.[33,34] This is due to ease of manipulation, low cost, hydrophilic nature, and ease of pouring alginate.[35]
From this study, it is found that the green stick compound is commonly used for border molding. This is in accordance with surveys done by Levin and Sanders and Jaggers et al.[4,36] This preference is due to the ease of manipulation, reversible property, and low cost of the material.[37]
Fifty percent of the population used ZOE and 49.3% used light body as secondary impression material. A study done by Jaggers et al. stated that 62% preferred ZOE as the first choice material and 50% preferred light body as a second choice material.[36] Another study by Petropoulos and Rashedi, most of the population used elastomeric impression materials and nobody preferred ZOE.[38]
In the present study, 55.7% of the graduate students replied that jaw relation is the most difficult procedure and 31.4% replied that border molding was the most difficult procedure [Figure 1 and Table 2]. This could be a result of the technique-sensitive procedures done during border molding and jaw relation. This is in accordance with Bembalgi, who found that 85.42% found difficulty in recording horizontal jaw relations.[39]
Figure 1.
Bar chart represents the association between No. of dentures fabricated by the participants and the most difficult procedure according to them. The X-axis represents No. of dentures fabricated by the participants and Y-axis represents the most difficult procedure according to them. Jaw relation is reported as the most difficult procedure in all the groups. However, it is not statistically significant. (Pearson's Chi-square = 14.522, df = 20, P = 0.803 [P > 0.05])
Table 2.
Represents the association between the number of dentures fabricated by the participants and the most difficult procedure according to them
| Number of dentures fabricated by the participants | |
|---|---|
| Most difficult procedure | |
| χ2 | 14.522 |
| df | 20 |
| P | 0.803 |
Eighty percent of the population preferred visual methods for teeth selection in the present study. This is in accordance with Bembalgi, where the majority used Sex, personality and age factors (SPA) factors to select teeth. However, in a study done by Harrison et al., the majority used old dentures for teeth selection.[33,39]
McCord and Grant and Kumar et al. reported various problems encountered with the dentures.[40,41] Duncan and Taylor describe an abbreviated impression technique for the undergraduate curriculum.[42] Dodge discussed the problems encountered by the patient with the use of overdentures.[43] Woelfel talked about the technical procedures frequently overlooked during denture processing that causes denture failure.[44]
According to Fenlon and Sherriff, satisfaction was influenced significantly by the accuracy of jaw relations, which in turn is significantly influenced by mandibular denture security and mandibular anatomy.[45]
Adequate knowledge on the procedure and causes of failure would ensure that the graduate students can retain and recall the knowledge as and when needed. Problems encountered with these procedures may lead to problems in the denture. Sometimes it might even lead to denture failure. If these problems are addressed at a graduate level, the quality of treatment given to the patient can be improved.
Limitations of this study include a small sample size. Future studies can be done with a larger sample size to assess the uniformity of the problems.
CONCLUSION
The objective of this study was to troubleshoot the errors in denture fabrication by assessing the difficulties in clinical procedures. Principles and procedures that a practitioner learns in school form the base of his knowledge and confidence. Students should also give more feedback information. This should further be used to identify the problematic areas which should be rectified. However, from the practitioner's end, there is insufficient knowledge on the problems faced. More surveys and skill development programs need to be conducted among dental graduates in different regions to assess the uniformity of the problems. This will, in turn, improve dental education in various institutes.
Financial support and sponsorship
The present study is funded by the
Saveetha Institute of Medical and Technical Sciences
Saveetha Dental College and Hospitals
Saveetha University
Satyam Enterprises, Chennai.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
The authors acknowledge Saveetha University for all the help and support.
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