|Year : 2017 | Volume
| Issue : 3 | Page : 143-149
Comparison of patient satisfaction with acrylic and flexible partial dentures
Clara Arianta Akinyamoju1, Tunde Joshua Ogunrinde2, Juliana Obontu Taiwo3, Oluwole Oyekunle Dosumu2
1 Department of Family Dentistry, University College Hospital, Ibadan, Oyo State, Nigeria
2 Department of Restorative Dentistry, University of Ibadan, Ibadan, Oyo State, Nigeria
3 Department of Periodontology and Community Dentistry, University of Ibadan, Ibadan, Oyo State, Nigeria
|Date of Web Publication||30-Oct-2017|
Clara Arianta Akinyamoju
Department of Family Dentistry, University College Hospital, Queen Elizabeth Road, Oritamefa, PMB 5116, Ibadan, Oyo State
Source of Support: None, Conflict of Interest: None
Purpose: Restoration of partial edentulous mouth may be done using a variety of treatment options. Removable partial denture (RPD) is commonly used because of its availability. RPDs from flexible resins unlike those from acrylic engage hard and soft tissue undercuts and feel more comfortable in the mouth. The aim of the study was to compare satisfaction with dentures made from these two types of materials. Materials and Methods: It was a quasi-experimental study among thirty patients at the Prosthetics Clinic, University College Hospital, Ibadan. Patients aged 16 years or more, requiring RPDs with one to three missing teeth in the anterior region of either the upper or lower arch participated. A modified semi-structured interviewer-administered questionnaire was used to collect data on sociodemographics and oral health variables. The level of satisfaction was assessed using a visual analogue scale. Data were analysed using descriptive and multivariate statistics at a significance level of P < 0.05. Results: The participants' ages ranged between 16 and 51 years, mean age was 33.8 ± 10.01 years. Male: female ratio was 1:1 and mean duration of edentulousness was 11.37 ± 10.52 years (median - 9.50). Most 28 (93.3%) subjects delayed replacement of their missing teeth; reasons were indifference 13 (43.4%), financial constraint 10 (33.3%), ignorance 4 (13.3%) and fear of aspiration 1 (3.3%). Overall, 21 (70.0%) participants were more satisfied with the flexible dentures, 6 (20.0%) with acrylic dentures while 3 (10.0%) were equally satisfied with both types of dentures (P = 0.04). Conclusion: Subjects were more satisfied with the flexible RPD than the acrylic resin RPD.
Keywords: Acrylic denture, flexible denture, satisfaction
|How to cite this article:|
Akinyamoju CA, Ogunrinde TJ, Taiwo JO, Dosumu OO. Comparison of patient satisfaction with acrylic and flexible partial dentures. Niger Postgrad Med J 2017;24:143-9
|How to cite this URL:|
Akinyamoju CA, Ogunrinde TJ, Taiwo JO, Dosumu OO. Comparison of patient satisfaction with acrylic and flexible partial dentures. Niger Postgrad Med J [serial online] 2017 [cited 2017 Dec 16];24:143-9. Available from: http://www.npmj.org/text.asp?2017/24/3/143/217402
| Introduction|| |
Individuals seek replacement of their missing teeth to improve their appearance, speech, social confidence and self-esteem, ability to chew more comfortably and to preserve the remaining natural teeth. Among Nigerians (89.2%), aesthetics has been indicated as a major reason for replacing missing teeth. Functional and aesthetic restoration of partially edentulous mouth may be done using a variety of treatment options, each with its advantages and disadvantages. The options are removable partial dentures (RPDs), fixed partial dentures and dental implants. The factors that may affect the choice of prosthesis used are the periodontal status, aesthetic requirements, cost, anatomical constraints and patient's acceptability. RPDs outnumber conservative implant tooth replacements because of their accessibility to lower socioeconomic groups in whom the highest rates of tooth loss occur.,
RPDs may be made with cast metal, acrylic resin with or without wrought metal component and acrylic resin with some cast units and those made with thermoplastic resin., The use of all-acrylic RPDs in the replacement of missing teeth varies with countries, with more frequent use in developing countries. The prevalence of use of the all-acrylic RPD among adults across Europe is between 13% and 29%; while in Nigeria, it was placed at between 86.0% and 92.3%., This is because the all-acrylic RPD is more affordable and easier to fabricate. However, some disadvantages of using the all-acrylic resin dentures are increased risk of developing caries, gingivitis and periodontal disease relative to other RPD frameworks., There is also difficulty in choosing a suitable path of insertion while maintaining close adaptation to the tissues in the presence of soft and hard tissue undercuts. In addition, acrylic dentures are made in thicker sections to compensate for its low impact strength, and this makes them bulky.
On the other hand, RPDs made from flexible resins because of their inherent flexibility and ability to engage hard and soft tissue undercuts for retention are more natural and comfortable in the mouth., Also, because the material is translucent, it picks up underlying tissue tones, making it almost impossible to be detected in the mouth. No clasping is visible on tooth surfaces when used in manufacturing of clear clasps, thereby improving aesthetics. The flexibility of the material provides balanced masticatory forces over the entire supporting ridge instead of individual support points. In addition, flexible resin RPDs are seen to display a biocompatibility similar to that of the cast RPDs, and they do not engage the abutment teeth alone for support and retention hence the relative stresses on the abutment teeth are relieved. The laboratory fee for flexible dentures is higher compared to that for all-acrylic dentures but more affordable than that for cast metal dentures. However, a drawback is the high surface roughness of dentures made from these resins, which may contribute to microbial colonisation and biofilm formation., Despite the above shortcoming, metal-free restorations and prostheses are being considered as the future of dentistry. Therefore, the aim of the study was to compare patients' satisfaction with two types of denture base materials with the intention of providing a clinically satisfactory alternative in a developing country.
| Materials and Methods|| |
Ethical approval was obtained from the University of Ibadan/University College Hospital, Ibadan Ethical Review Board (UI/EC/14/0005) on the 19th June, 2014. Informed consent was obtained from the patients before inclusion in the study. Patients were recruited into the study between November 2014 and April 2015, study was completed in June 2015. Subjects in the study were patients aged 16 years or more requiring RPDs with one to three missing teeth in the anterior region of either the upper or lower arch (Kennedy Class IV and anterior class III).
It was a quasi-experimental study using a crossover design involving 32 consecutive patients from the Prosthetics clinic of the University College Hospital, Ibadan, Nigeria. Patients with good periodontal health to mild periodontal disease of standing teeth and those with mild-to-moderate Seibert's classes I and II edentulous ridge were recruited. Other inclusion criteria were patients with no previous history of denture use, who had lost their teeth for ≥3 months and gave assurance of their availability through the period of the study. Sample size calculation was done using the formula for comparison of paired means at a power of 90% based on mean satisfaction scores for two types of partial dentures. However, two subjects were lost to follow-up after delivery of the initial denture-one flexible and one acrylic denture. Thus, the analysis was done for the 30 remaining subjects that completed the study.
Participants were examined on a dental chair, the edentulous ridge of the subjects was assessed to ensure it was well formed and without anomaly. The clinical evaluation was done by a single examiner, appropriate infection control protocol using primary barrier method; disposable materials were used as needed. Subsequently, participants were randomly allocated into 2 groups using ballot papers coded 1 for acrylic and 2 for flexible dentures. Participants who picked ballot paper 1 began with an acrylic RPD while those who picked ballot paper 2 commenced with the flexible RPD. A modified semi-structured interviewer-administered questionnaire was used to collect data on subjects' sociodemographics such as age, sex, marital status, occupation, level of education and oral health variables which included clinical data such as missing teeth, replaced teeth, duration and cause of tooth loss, reasons for delayed replacement and wanting replacement of missing teeth. The subjects were categorised into upper, upper middle, lower middle and lower social classes using a standard occupational classification system.
After recruitment, impressions of the subject's maxillary and mandibular arches were taken in sterile well-fitting stock trays using irreversible hydrocolloid impression material. The cast was poured with type III dental stone and duplicated to produce two working casts for the acrylic and the flexible dentures to ensure an exact dimension for both dentures. Tooth shade was selected and the teeth selected for the two dentures were of the same brand, shade, size and shape. To standardise the arrangement of the teeth for the dentures, an over-impression of the teeth on the working cast of the initial denture was made using putty impression material, which was used to locate the exact position of the teeth on the second denture. A try-in of the trial denture for both dentures was done; and found satisfactory before processing of the dentures. Valplast (Dentiflex-Roko, Poland) was used for the fabrication of the flexible dentures and acrylic resin for the acrylic dentures. All laboratory procedures were carried out by one dental technologist; sixty dentures were fabricated: thirty flexible and thirty acrylic RPDs. Oral prophylaxis was done for all the subjects before denture fitting was done. Post-insertion instructions were given to the subjects both in oral and written forms. The subjects were given review appointments at 24 h, 1 week and 1 month after insertion of dentures, reminders in the form of telephone calls and text messages were sent to all subjects a day before each appointment.
Subject satisfaction was assessed at 1 month of use of initial denture and the second one was fitted thereafter. The level of satisfaction with the second denture was done at the end of the following month. The 1 month period was considered sufficient for the subjects to make informed and largely unbiased judgements about the two dentures. Subjects specified their level of satisfaction by indicating a position along the continuous line of a 100 mm visual analogue scale (VAS). The VAS is a continuous graphical rating scale. It is a tool used in expressing or analysing a patient's feelings quantitatively, before and after seeking any kind of treatment or to rate the intensity of sensations such as pain., The VAS line represents a spectrum of feelings between two extremes, a vertical mark on the line represents their feelings at that time.
The VAS was interviewer-administered. The subjects rated their dentures in terms of appearance, ease of cleaning, ability to speak, comfort while eating and overall satisfaction. Rating of each category used key words “not at all satisfied” at 0 mm and “extremely satisfied” at 100 mm. A pencil mark was made across the horizontal line at a point corresponding to the subjective feeling of the subject. Satisfaction was then measured as the distance in millimetres from the left end limit to the point of the pencil mark representing the VAS score of the subject. The higher the score, the better the prosthesis as perceived by the subject. Satisfaction levels using the VAS scores were classified as: totally dissatisfied (0–31), slightly dissatisfied (>31–50), slightly satisfied (>50-79) and satisfied (>79).
Data were analysed using Statistical Package for Social Sciences version 19, Chicago, IL, USA. The normalcy of distribution was assessed using the Shapiro Wilk's test. The Wilcoxon signed-rank test was used to compare mean VAS scores, Kruskal–Wallis test for association between VAS scores, age and social class, Mann-Whitney U test for association between VAS scores and gender. The level of statistical significance was set at P < 0.05.
| Results|| |
Thirty-two partially dentate patients were recruited into the study but two were lost to follow-up after using the initial RPD given to them, thirty subjects participated fully in the study. The subjects were equally distributed by sex; their ages ranged between 16 and 51 years with a mean of 33.8 ± 10.01 years. Seventeen (56.7%) of them were married and most 27 (90.0%) were from the Yoruba tribe. Majority (60.0%) of the subjects were of lower social class, a little less than half (43.3%) had tertiary education and 27 (90.0%) of them resided in urban areas [Table 1].
The mean duration of edentulousness was 11.37 ± 10.52 years (median: 9.50 years); most (90.0%) lost their teeth on account of trauma while 3 (10.0%) did so secondary to periodontal disease. A greater number 28 (93.3%) of the subjects delayed replacement of their missing teeth, the main reasons for failure to replace the missing teeth were indifference 13 (43.4%) and financial constraint 10 (33.3%). The majority 41 (91.1%) of teeth replaced were maxillary teeth and almost all 26 (86.7%) subjects wanted to have their missing teeth replaced on account of aesthetics. After tooth replacement, majority 27 (90.0%) were satisfied with the appearance of the flexible denture [Table 2], and this was higher for those in 26–35 years age group (P = 0.67). Subjects aged 36–45 years (36.7%) were more satisfied with the appearance of the acrylic dentures (P = 0.56) [Table 3].
|Table 2: Oral features of subjects and their levels of satisfaction with the partial dentures (n=30)|
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|Table 3: Mean rank visual analogue scale scores of subjects by age and social class after acrylic and flexible partial denture use|
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There was a gender difference in the satisfaction of the subjects with the appearance of the dentures. Females gave a higher mean rank score (16.53) compared to males (14.47) for satisfaction with the appearance of the acrylic partial denture (P = 0.54). Similarly, they also reported higher mean rank score for satisfaction with the appearance of the flexible partial denture compared to males (P = 0.43) [Table 4]. In assessing satisfaction with the appearance of the dentures with respect to social class, subjects in the lower class were more satisfied with the appearance of the acrylic denture (P = 0.61).
|Table 4: Mean rank visual analogue scale scores of subjects by gender after acrylic and flexible partial denture use|
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Most subjects were satisfied with the cleanliness of the flexible 30 (100.0%) and acrylic 29 (96.7%) dentures. The mean rank scores for subjects' satisfaction with the cleanliness of the acrylic partial denture were not significantly different across the age groups (P = 0.18) and likewise for the flexible denture (P = 0.67). The mean rank scores for satisfaction with the cleanliness of the acrylic partial denture did not differ significantly between the upper middle (13.36) and the lower middle class (13.89) but was highest (16.61) for the lower class (P = 0.52). In addition, more subjects were satisfied with the flexible denture with respect to speech 25 (83.3%) and comfort while eating 25 (83.3%). Although those aged 16–25 years were equally satisfied with both types of dentures in relation to speech since they had the same mean rank score (14.56) for the acrylic and flexible dentures. Subjects in the lower class were more satisfied with the acrylic dentures for speech (P = 0.46) and comfort (P = 0.62). The mean rank scores for satisfaction with comfort while eating with the acrylic and flexible partial dentures were highest for the subjects in the 25–36 years age group, though satisfaction with the flexible denture was higher compared to that for the acrylic partial denture [Table 3].
A little above half of the subjects 16 (53.3%) were more satisfied with the flexible dentures while 4 (13.3%) preferred the acrylic denture for appearance (P = 0.06). Thirteen (43.3%) of them were more satisfied with the flexible denture with respect to speech while 6 (20.0%) preferred the acrylic partial denture. More subjects 19 (63.3%) indicated scores that showed comfort while eating with the flexible dentures while 6 (20.0%) had better comfort eating with the acrylic dentures (P = 0.06). Overall, 21 (70.0%) subjects were more satisfied with the flexible dentures, 6 (20.0%) with the acrylic dentures while 3 (10.0%) were equally satisfied with both types of dentures (P = 0.04) [Table 5].
|Table 5: Comparing subject's visual analogue scale scores for acrylic and flexible partial dentures|
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| Discussion|| |
Tooth loss is an irreversible condition and the end spectrum of the progression of oral diseases. Anterior maxillary tooth loss due to trauma has been found to be higher in males while tooth loss due to other reasons such as dental caries and periodontal disease is seen to be higher in females. However, there was an equal distribution of males to females in this study, in contrast to findings by Esan et al., in a study involving patients residing in Ile-Ife and Lagos, Nigeria, more female patients in the Ile-Ife group requested for dentures compared to those in the Lagos group. In addition, Osagbemiro et al., reviewing anterior tooth extraction and presentation for prosthetic replacement saw that more males (63.0%) presented compared to females (37.0%). The findings in the study by Osagbemiro et al., may be due to a wider study population age range (6–86 years).
On the other hand, individuals with poorer socioeconomic conditions have been found to have a higher prevalence of teeth mortality. Similarly, most of the subjects (60.0%) presenting for RPDs in this study were in the lower social class, comparable to findings (53.3%) by Esan et al., in their study relating sociodemographic factors and edentulism in Nigeria. Pertaining to events that led to tooth loss, a good number (90.0%) of subjects in this study lost their teeth on account of trauma. Osagbemiro et al. observed a similar occurrence in another group of Nigerians. The reason for this may be due to the fact that majority of the individuals involved in this study lost their teeth as adolescents, which is a very active period in a child's life with increased predisposition to traumatic events. In addition, nearly, all of the participants (91.1%) in this study, replaced maxillary teeth and wanted their teeth replaced because of aesthetics, and this is consistent with observations in other studies in which a large number of teeth replaced were the anterior maxillary teeth and for aesthetic reason.,, More often than not, anterior maxillary teeth are most commonly affected when there is trauma to the oral and maxillofacial region.
Furthermore, studies have shown that patients initiate replacement of their missing teeth if it involves the anterior segment., Conversely, findings from this study revealed that most subjects (93.3%) had not sought immediate replacement of their missing anterior teeth. This proportion is higher than that observed in other Nigerians (53.3%). The main explanations given for delayed replacement of missing anterior teeth in this study were indifference (43.3%) and financial constraint (33.3%), in contrast to report of a study by Okoje et al., that stated financial constraint (88.8%) as the primary reason for deferring replacement of lost anterior teeth and indifference to their edentulous state (15.9%) was stated by fewer patients. Low oral health awareness, poor attitude to oral health and poverty among Nigerians may account for patients not seeking immediate replacement of their missing anterior teeth irrespective of the reason.
In this study, almost all (96.7%) the subjects were satisfied with the appearance of their flexible denture; similar satisfaction was seen in a study by Hundal and Madan, where all (100.0%) the patients were satisfied with the appearance of the flexible partial denture because of its aesthetic superiority. In addition, female subjects had a higher mean satisfaction score compared to the males for comfort while eating with both types of dentures which is consistent with findings by Kamber-Cesir et al. In contrast, Wakabayashi et al. reported a lower female satisfaction for comfort eating with their RPDs while Abouelkomsan et al., in their study comparing the difference between male and female patients, observed no significant difference in satisfaction between the sexes., However, females have been found to have more complaints with regard to eating with RPDs, but the flexible partial dentures are lighter and more comfortable and may be responsible for the findings in this study., Subjects aged 16–25 years were least satisfied with the appearance of the flexible denture; similar observations were noticed in a group of Japanese patients. On the contrary, VAS satisfaction scores for partial dentures were seen to decrease with increase in patients' age. Furthermore, patients in the upper middle and lower social classes were more satisfied with the flexible partial denture while those in the lower middle class were more satisfied with the acrylic partial denture. Likewise, Singh et al. observed that high-income Indian patients were more satisfied with the clinical variables of appearance, speech, denture care and comfort. Their results differed for those in the lower middle and lower social classes who were less satisfied with all the clinical variables assessed with respect to denture use. However, Knezović Zlatarić et al., said there was no difference in patient satisfaction with partial dentures by socioeconomic status, though the type of partial denture assessed for satisfaction was not stated. On the whole, more subjects were satisfied with the flexible denture (aesthetics 53.3%, speech 43.3% and comfort 63.3%) compared to the acrylic partial denture (aesthetics 13.3%, speech 20.0% and comfort 20.0%) in this study. This is akin to the levels of satisfaction reported by patients who used both types of dentures in a study by Dhiman and Chowdhury; satisfaction with the flexible denture with respect to aesthetics 34.5%, speech 34.5% and comfort 32.8% and acrylic denture-aesthetics 6.9%, speech 5.2% and comfort 1.7%. The thermoplastic material enhances aesthetics by blending with surrounding tissue and may be more comfortable to use as it can be made in thinner and smaller sections. Literature on thermoplastic denture base materials is scarce in this environment, so adequate comparison with other studies could not be done. With increase in use of thermoplastic denture base materials, studies on the long-term satisfaction of patients with these denture base materials are necessary.
| Conclusion|| |
Subjects were more satisfied with the flexible partial denture for all clinical variables assessed. Subjects should be informed on the availability of thermoplastic materials as an alternative to acrylic resin base material.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]