ORIGINAL ARTICLE J Adv Prosthodont 2012;4:109-15 http://dx.doi.org/10.4047/jap.2012.4.2.

109

Complication rates and patient satisfaction with

removable dentures
Hakan Bilhan, DDS, PhD, Ozge Erdogan, DDS, PhD, Selen Ergin, DDS, PhD, Melahat Celik, DDS, PhD, Gokcen Ates, DDS, PhD,
Onur Geckili*, DDS, PhD
Department of Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey

PURPOSE. The purpose of this clinical study was to evaluate the frequency and type of prosthetic complications in relation to type and prop-
erties of removable dentures and to investigate the influence of these complications and several data about the existing dentures on patient
satisfaction. MATERIALS AND METHODS. Ninety nine patients (44 males and 55 females) wearing removable dentures have been
included in the study. The complications of the patients were recorded; patient satisfaction was determined with a Visual Analog Scale (VAS)
and the relationship of complications and patient satisfaction with several data about the dentures such as denture age, type of denture, cen-
tric relation and vertical dimension was investigated. Kruskal Wallis, Mann Whitney U and Chi square tests were used for statistical analyses.
The results were evaluated statistically at a significance level of P<.05. RESULTS. Need for addition of artificial teeth for dentures with correct
centric relations was found to be significantly lower than dentures with wrong centric relations (P<.01). Loss of retention, ulcerations and high
vertical dimension affected the VAS chewing ability scores negatively and ulcerations affected the VAS phonation scores negatively (P<.05).
CONCLUSION. Considering the results of this study, it can be concluded that loss of retention, ulcerations and high vertical dimension caused
patient dissatisfaction. Additionally, dentures with wrong centric relations caused need for addition of artificial teeth. [J Adv Prosthodont
2012;4:109-15]

KEY WORDS: Complete denture; Patient satisfaction; Partial denture

INTRODUCTION sequences of destructive action of bad designed and manufactured

dentures, since many clinicians delegate planning to technicians.
The loss of teeth can impair function, esthetics and phona- Dental technicians may have a key role in the success of
tion and is restored most of the time with prosthesis. Although dentures, but it should be pointed out that they do not have ade-
preventive dentistry helps protecting teeth, the demand for quate knowledge about biological structures and occlusion, which
prosthodontic treatment is expected to rise even in devel- is needed for distribution of masticatory forces adequately. For
oped countries as a result of a rapid increase in their elderly pop- this reason the final tooth setup is always checked clinically
ulation.1-3 Many countries are facing an aging population, by dentists. There is not enough research about the data such
which will cause a ratio of individuals over 65 years of age up as vertical dimension, centric relation, and position of the arti-
to 50% in the coming decades. The number of edentulous patients ficial teeth relative to the denture base underlying tissues
even in countries with a high standard of dental health care is and borders of dentures, giving information about the gener-
significant.1,3 According to the World Health Organization (WHO) al trend of quality of dentures delivered in general practice.4
Global Oral Data Bank the prevalence of edentulism older than There are several textbooks pointing out the importance of
65 years was shown as 58% in Canada, 41% in Finland and 46% precise denture base adaptation, setup of the artificial teeth in
in the United Kingdom.1 the right position, establishment of correct centric relation and
Removable dentures are an economic and easy treatment vertical dimension for the maintenance of stability and reten-
modality for edentulous or partially edentulous patients and are tion of removable dentures.4-7 It could also be expected that the
still widely used.4 However, these dentures can be associated above mentioned factors could influence the emergence of com-
with various complications. It is assumed that failures are con- plications. However, there are not enough clinical studies

Corresponding author: Onur Geckili ⓒ 2012 The Korean Academy of Prosthodontics

Department of Prosthodontics, 2nd floor, Istanbul University Faculty of Dentistry, This is an Open Access article distributed under the terms of the Creative Commons
34093 Capa, Istanbul, Turkey Attribution Non-Commercial License (http://creativecommons.org/licenses/by-
Tel. 90 212 414 20 20/30256: e-mail, [email protected] nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction
Received February 28, 2012 / Last Revison May 4, 2012 / Accepted May 9, 2012 in any medium, provided the original work is properly cited.

109
Complication rates and patient satisfaction with removable dentures Bilhan H et al.

evaluating removable dentures.8 Subsequently the dentures were examined by two experi-
The quality of complete dentures assessed by clinicians enced prosthodontists, blinded to the treatment, and data
does not always come to accordance with the subjective regarding retention, stability, the position of artificial teeth, con-
judgment of the patients. Although a number of studies failed dition of the dentures in terms of hygiene and coloring and tech-
to show statistically significant relations between the two nical problems have been collected.
variables,9-12 other studies could show weak or moderately sig- Following prosthetic complications have been recorded as
nificant associations.13-18 present or not present:
It can be assumed that the quality of the prosthetic treatment 1. Loss of retention
may also affect oral health, thus oral health is related to 2. Existence of any denture irritation or ulceration
quality of life, since prosthodontic as well as surgical treatment 3. Existence of any debonded/fractured artificial teeth
is performed to improve patients' satisfaction.19-25 A previous 4. Existence of any fracture in the denture base
denture quality assessment of 1306 removable partial dentures 5. Existence of fractured retaining clasps
(RPDs) in the United States had found that 65% of the RPDs 6. Existence of denture stomatitis
had various types of defects, indicating potential for quality 7. Existence of epulis fissuratum
improvement.26 Combined with the high prevalence of RPDs 8. Existence of inflammatory papillary hyperplasia
in the general US population,27 improvement of RPD quality The borders of the existing dentures which influence the periph-
could have a substantial effect on population oral health, eral seal as well as the denture stability have been evaluated
assuming a causal association between denture quality and Oral and classified as long, normal and short for each maxillary and
Health Related Quality of Life (OHRQoL). On the other mandibular denture separately.
hand, a very recent study has reported that the quality of Vertical dimension of all patients was determined as correct,
removable dentures had a minimal effect on OHRQoL.28 high or low, whereas the overlapping of centric occlusion with
This clinical study was designed to collect information centric relation evaluated as wrong or right. For the determi-
about the various complications such as fracture of denture base nation of the vertical dimension the closest speaking space was
or other components, the need for relining, the need for repair used as usually in the department. In order to be able to pre-
of artificial teeth, and to evaluate their possible relation with den- vent confusion, 3 patients with upper and lower partial dentures
ture type and several properties of the dentures. Additionally, and natural occlusion where a centric occlusion could not be
the influence of these complications and several data about the established, have been excluded from the study group. The
existing dentures on patient satisfaction was evaluated. patients in the study group wearing upper and lower partial den-
tures (RPD/RPD) had no natural occlusion (tooth to tooth con-
MATERIALS AND METHODS tact).
Conditions of the denture were evaluated in two categories:
Patients from regular circulation at a University Clinic for a) Hygiene (good/bad),
Prosthetic Dentistry having applied for new dentures during b) Wear of the artificial teeth and coloring (present/absent).
a 3 month period have been examined and interviewed. The A 100 mm Visual Analog Scale (VAS)29 was signed out by
criteria of selection were that patients had worn convention- the patients to assess their personal opinion based on three main
al partial or complete removable dentures for at least 3 years. factors including esthetics, phonetics and mastication.
99 patients (mean age: 63.26 ± 9.6 years; 44.4% male, Statistical analyses were used in this study to evaluate the influ-
55.6% female) who had met these criteria were included in the ence of various parameters on denture complications. For
present study. The study was approved by the institutional review the statistical analysis of the results the NCSS (Number
board. Cruncher Statistical System) 2007 & PASS 2008 Statistical
The removable dentures were divided into the following groups: Software (Kaysville, UT, USA) was used. Demographic
1. A maxillary complete denture vs. mandibular complete den- parameters (age and gender), denture types and complications
ture (CD/CD) were evaluated. Beside descriptive statistics (means and stan-
2. A maxillary complete denture vs. mandibular remov- dard deviations), Mann Whitney U test was used for the
able partial denture (CD/RPD) comparison of the parameters of two groups and Kruskal
3. A maxillary removable partial denture vs. mandibular com- Wallis test was used for the comparison of quantitative data of
plete denture (RPD/CD) more than two groups. For the determination of the group engen-
4. A maxillary removable partial denture vs. mandibular dering the difference, the Mann Whitney U test was used. The
removable denture (RPD/RPD) comparison of qualitative data was performed using a Chi square
Subjects' age, gender and dental status including number of test. The results were assessed at 95% confidence interval, at
former dentures and age of the present dentures, period of eden- a significance level of .05.
tulism, presence of prosthetic complications were recorded.

110 J Adv Prosthodont 2012;4:109-15

Complication rates and patient satisfaction with removable dentures Bilhan H et al.

RESULTS correct, whereas in 38.4% of the cases there was a discrepancy

between habitual intercuspal position and centric relation.
99 patients with removable dentures were evaluated in the pre- It was determined that only 2% of the dentures' vertical dimen-
sent study. The distribution of the dentures is shown in Fig. 1. sion was correct. 26.3% of the patients had a denture with a high
Patient's denture ages, the number of former dentures, the peri- vertical dimension where as 71.7% of the patients had a den-
od of edentulism are shown in Table 1. The number of com- ture with a low vertical dimension.
plications per denture varied between 0 and 2 (Table 1). The hygiene of dentures was found inadequate for 51.5% of
The type and occurrence frequency of complications are shown the subjects. 53.5% dentures had worn artificial teeth and 67.7%
in Table 2. No significance was noted between the complication showed coloration.
frequency and type of the prosthesis (P>.05). The esthetic, phonetic and masticatory performance VAS scores
Distribution of the assessed border lengths of the dentures are shown in Table 4.
are listed in Table 3. No statistically significant difference was found between den-
The evaluation of the centric relation of the patients' dentures ture and complication types (P>.05; Table 5).
revealed that in 61.6% of the subjects the centric occlusion was No statistically significant difference was observed between

Table 2. The incidence of complications

n %
Complications Loss of retention 64 64.6
Irritation or ulceration 47 47.5
Loss of artificial teeth 35 35.4
Fracture of denture base 26 26.3
Stomatitis 9 9.1
Epulis fissuratum 5 5.1
Fractured retaining clasps 4 4
Existence of inflammatory
2 2
papillary hyperplasia

Table 3. The evaluation of the borders of the denture bases

n %
Upper Long 50 50.5
Fig. 1. Distribution of denture types (n = 64 for CD/CD, n = 21 for CD/RPD,
Denture Normal 13 13.1
n = 8 for RPD/CD, and n = 6 for RPD/RPD).
Borders Short 36 36.4
Lower Long 17 17.2
Denture Normal 35 29.2
Borders Short 50 41.7
Table 1. Descriptive data about denture age, period of edentulism,
number of former dentures and number of complications
Min - Max Mean ± SD Median Table 4. The VAS scores
Denture age 3 - 30 9.71 ± 7.16 7 Patient satisfaction Min-Max Mean ± SD Median
Number of former dentures 1-6 1.97 ± 1.09 2 Esthetics 0 - 100 63.51 ± 32.45 70
Period of edentulism 3 - 63 16.34 ± 10.85 15 Mastication ability 0 - 100 57.70 ± 35.45 50
Number of complications 0-2 1.13 ± 0.35 1 Phonetics 0 - 100 76.16 ± 31.28 90

Table 5. Distribution of different denture types and complications

Denture type
P value
Complication CD/CD (n = 64) RPD/RPD (n = 6) CD/RPD (n = 21) RPD/CD (n = 8) (chi-square)
n (%) n (%) n (%) n (%)
Loss of retention 40 (62.5) 2 (33.3) 14 (66.7) 8 (100) .068
Irritation or ulceration 33 (51.6) 2 (33.3) 8 (38.1) 4 (50.0) .643
Loss of artificial teeth 17 (26.6) 3 (50.0) 12 (57.1) 3 (37.5) .069
Denture fracture 20 (31.3) 1 (16.7) 5 (23.8) 0 (0) .259
Stomatitis 6 (9.4) 1 (16.7) 2 (9.5) 0 (0) .746

J Adv Prosthodont 2012;4:109-15 111

Complication rates and patient satisfaction with removable dentures Bilhan H et al.

denture type and vertical dimension results (P>.05; Table 6). The relationship between VAS phonetic scores and complication
Statistically significant difference was found between cen- types are shown in Table 9. Only ulcerations affected the
tric relation and need for addition of artificial teeth (P<.01). scores negatively (P=.011); whereas the other complications
Need for addition of artificial teeth for dentures which had a had no significant effect (P>.05; Table 9).
correct centric relation was found to be significantly lower than Significant difference was found between VAS esthetic,
dentures having a wrong centric relation (Table 7). No statistically phonetic and chewing ability scores and centric relation
significant difference was found between centric relation (P>.05). Vertical dimension didn't affect the VAS esthetic
and loss of retention, mucosal irritation/ulceration, denture frac- and phonetic scores (P>.05); whereas VAS scores for chew-
ture and stomatitis (P>.05; Table 7). ing ability of dentures were found to be statistically significantly
Significant difference was found between VAS esthetic different according to vertical dimension (P<.05). VAS chew-
scores and complication types (P>.05). The relationship ing ability scores with higher vertical dimension were found
between VAS chewing ability scores and complication types to be significantly lower than the dentures with lower (P=.012)
are shown in Table 8. Loss of retention and ulcerations affect- and correct vertical dimensions (P=.042; Table 10).
ed the VAS chewing ability scores negatively (P<.05; Table 8)

Table 6. Distribution of complications in relation to vertical dimension

Vertical dimension
P value
Complication Right (n = 2) Low (n = 71) High (n = 26)
(chi-square)
n (%) n (%) n (%)
Loss of retention 1 (50.0) 47 (66.2) 16 (61.5) .830
Irritaion or ulceration 1 (50.0) 33 (46.5) 13 (50.0) .951
Loss of artificial teeth 1 (50.0) 29 (40.8) 5 (19.2) .130
Fracture 1 (50.0) 21 (39.6) 4 (15.4) .276
Stomatitis 0 (0) 5 (7.0) 4 (15.4) .405

Table 7. Distribution of complications in relation to accuracy of the centric relation

Centric relation
P value
Complication Right (n = 61) Wrong (n = 38)
(chi-square)
n (%) n (%)
Loss of retention 39 (63.9) 25 (65.8) .851
Irritation or ulceration 30 (49.2) 17 (44.7) .667
Loss of artificial teeth 15 (24.6) 20 (52.6) .005**
Fracture of denture 12 (19.7) 14 (36.8) .060
Stomatitis 7 (11.5) 2 (5.3) .296

Table 8. The relation between occurring complications and VAS chewing ability scores
Chewing ability P value
Complication Mean ± SD Median (Mann Whitney U)
Yes 51.44 ± 34.54 50
Loss of retention .017*
No 69.14 ± 34.67 85
Yes 49.04 ± 34.09 50
Irritation or ulceration .011*
No 65.51 ± 35.13 77.5
Yes 62.86 ± 34.73 70
Loss of artificial teeth .348
No 54.87 ± 35.78 50
Yes 55.57 ± 31.31 50
Denture fracture .539
No 58.45 ± 36.98 60
Yes 54.44 ± 37.45 50
Stomatitis .820
No 58.02 ± 35.44 60

112 J Adv Prosthodont 2012;4:109-15

Complication rates and patient satisfaction with removable dentures Bilhan H et al.

Table 9. The relation between occurring complications and VAS speech scores
Speech scores P value
Complication Mean ± SD Median (Mann Whitney U)
Yes 74.29 ± 32.60 90 .498
Loss of retention No 79.57 ± 28.86 90
Yes 68.83 ± 33.43 80 .011*
Irritation or ulceration No 82.79 ± 27.89 100
Yes 79.14 ± 27.82 90 .866
Loss of artificial teeth No 74.53 ± 33.11 90
Yes 74.04 ± 28.56 77.5 .418
Denture fracture No 76.92 ± 32.34 90
Yes 87.78 ± 33.08 100 .060
Stomatitis No 75.00 ± 31.05 90

Table 10. The relation between vertical dimension and VAS esthetic, chewing ability and speech scores
Esthetic Chewing Speech
Mean ± SD (Median) Mean ± SD (Median) Mean ± SD (Median)
Correct 85.00 ± 7.07 (85) 87.50 ± 3.53 (88) 85.50 ± 3.02 (86)
Low 66.45 ± 31.25 (75) 63.38 ± 34.23 (70) 78.51 ± 27.88 (90)
Vertical Dimension High 53.84 ± 35.10 (55) 39.88 ± 33.92 (40) 66.15 ± 38.89 (85)
P (Kruskal Wallis) 0.164 0.011* 0.612

DISCUSSION the consequential pain and impairment of patients' ability to

communicate may cause dissatisfaction.
Although a major part of the population in many coun- The most frequent complication in the present study was
tries has an incomplete dentition, a substantial number of the loss of retention which is in agreement with previous
patients remain either not prosthetically restored30 or functioning reports.1,41,42 Most of the patients in the present study complained
with a shortened dental arch without any need for treat- about the looseness and misfitting of their dentures. This
ment.31 Nevertheless, the restoration of oral function and complication is the main reason of need for replacement of their
esthetics especially in higher economic groups is preferred. The dentures. Additionally, loss of retention caused dissatisfaction
replacement of missing teeth can be achieved by fixed or remov- of patients related to function. The loss of retention of the den-
able appliances, but generally it is accepted that removable den- tures may have impaired the patients' ability to chew. A den-
tures deteriorate in a shorter time period,32 even though there ture sore spot which is the second frequent encountered com-
are studies indicating more favorable results by careful plan- plication might also be related to the misfitting of the dentures.
ning, regular recall appointments, patient instruction and Sheppard et al.43 revealed denture looseness as the main
prosthetic adjustments.33-35 cause of complaints of denture wearers, followed by pain which
Although conventional metal frame removable partial or com- corroborates the results of our study. Furthermore, with the pres-
plete dentures are not the ideal solution, this option is wide- ence of denture sore spots, patients reported lower phonetic and
ly used for the treatment of partial or complete edentulism. The chewing satisfaction scores. The low phonetic VAS scores may
number of studies evaluating the success, complication rate and be due to the overextension of the upper dentures onto the soft
patient satisfaction related to removable prosthesis is relatively palate which generally results in speech difficulties and the low
scarce. There are rather studies dealing with the fate of the abut- chewing VAS scores may be the reason of the sore spots in buc-
ment teeth,36,37 periodontal status of the remaining teeth38 or the cal surfaces of the maxillary tuberosities, buccal and lingual
comparison of the influence of different denture types on surfaces of mandibular crest because of instability or frenulum
patient satisfaction and patients' quality of life.39 impingements. An interesting finding of this study was the
Lack of stability and retention of the mandibular dentures, insignificant difference between the complication number, com-
increasing in time with ongoing residual bone resorption, plication type and type of the prosthesis. It is usually estimated
the impaired chewing ability are the main complaints of for the removable partial dentures to show fewer complications
complete denture wearers.40 These handicaps combined with than complete dentures due to the presence of teeth which con-

J Adv Prosthodont 2012;4:109-15 113

Complication rates and patient satisfaction with removable dentures Bilhan H et al.

sequently result in more retentive dentures. This finding may The major limitation of this study is that the sample group
be because of the unequal distributions of patients into denture consists of patients having sought prosthodontic treatment or
groups which can be regarded as a limitation of this study. repair service at a university prosthodontic clinic. The results
In the first year following tooth extraction a loss of bone width may vary in the general population wearing removable den-
by 25% and a loss in bone height of 4 mm can be expected.44 tures. To be able to generalize the results, more studies in dif-
With the use of removable dentures, bone loss continues ferent centers with higher case numbers which would provide
over the years. It was observed that half of the evaluated valuable information should be accomplished. The evaluation
dentures had long borders in the present study. This might be of recently delivered dentures in various clinics would addi-
explained as the ongoing process of bone resorption with tionally elicit valuable data.
removable denture use of the patients and inability of the pre-
sent dentures to compensate this resorption as well as the overex- CONCLUSION
tended impressions taken often by inexperienced clinicians.
The establishment of a correct centric occlusion is very Within the limitations of the present study following conclusions
important for the success of removable dentures; especially when may be drawn:
the removable denture is a complete denture.45 Dawson had 1. The most frequently encountered complication in association
defined centric relation as the relationship of mandible to with removable dentures is the loss of retention, followed
the maxilla when the properly aligned condyle/disc assemblies by ulcerations.
are in the most superior positions against the eminence irre- 2. Complications do not affect the esthetic patient satis-
spective of tooth positions or vertical dimension,45 which is the faction scores, whereas loss of retention causes dissatis-
best repeatable position of the mandible. In the present study faction of patients related to chewing ability.
it was found that need for addition of artificial teeth for den- 3. Ulcerations affect patients' speech and chewing ability sat-
tures which had a correct centric relation was significantly low- isfaction scores negatively.
er than dentures having a wrong centric relation. This might 4. It was seen that a vast majority of the dentures had a wrong
be explained as the result of an occlusal disharmony with the vertical dimension and especially the high vertical dimen-
presence of a wrong centric occlusion. The artificial teeth may sion caused a significant decrease in patient satisfaction
have encountered unequal forces and therefore been broken. concerning chewing ability.
Vertical dimension of occlusion is defined as ''the distance
measured between two points when the occluding members are REFERENCES
in contact''.46 Actually vertical dimension can be accurately deter-
mined in the clinic with various methods and its value has diag- 1. Petersen PE, Yamamoto T. Improving the oral health of older
people: the approach of the WHO Global Oral Health Programme.
nostic validity.47 In all circumstances, an adequate interocclusal Community Dent Oral Epidemiol 2005;33:81-92.
rest space must be developed in the range of 2 to 4 mm. 2. Felton DA. Edentulism and comorbid factors. J Prosthodont
Faults in the development of the appropriate individualized 2009;18:88-96.
3. Turkyilmaz I, Company AM, McGlumphy EA. Should edentulous
dimension can result either an increased or decreased vertical patients be constrained to removable complete dentures? The use
dimension of occlusion.48 It was reported that improper vertical of dental implants to improve the quality of life for edentulous
dimension of occlusion with inadequate interocclusal clearance patients. Gerodontology 2010;27:3-10.
as the most common error found in patients with removable 4. Grant AA, Heath JR, McCord JF. Complete prosthodontics: prob-
lems, diagnosis and management. 1st ed. Manchester; Mosby Inc.;
dentures.49 However, the results of the present study were not 1994. p. 33-115.
in agreement with a previous study.49 Only 26.3% of the 5. Basker RM, Davenport JC. Prosthetic treatment of the edentu-
patients with existing dentures had a high vertical dimension; lous patient. 4th ed. Berlin; Wiley-Blackwell; 2002. p. 71-80.
6. Zarb GA, Bolender CL, Eckert SE, Fenton AH, Jacob RF,
whereas a majority (71.7%) dentures with low vertical dimen- Mericske-Stern R. Prosthodontic treatment for Edentulous
sion. This result is in accordance with the findings of Carlsson Patients: Complete Dentures and Implant-supported Prosthesis.
and Persson44 and caused a significantly lower patient satisfaction. 12th ed. St. Louis; Mosby; 2004. p. 268-329.
7. Devlin H. Complete dentures: A clinical manual for the general
It has been shown that removable denture wearers with high dental practitioner. Berlin; Springer; 2002. p. 33-59.
vertical dimension generally complain of uncertain pains 8. Dorner S, Zeman F, Koller M, Lang R, Handel G, Behr M. Clinical
involving both maxilla and mandible and a feeling of tiredness performance of complete dentures: a retrospective study. Int J
of the jaws.48 This may be the reason of low VAS chewing abil- Prosthodont 2010;23:410-7.
9. Langer A, Michman J, Seifert I. Factors influencing satisfaction
ity scores in patients with high vertical dimension. The trend with complete dentures in geriatric patients. J Prosthet Dent
between clinicians during denture fabrication though seems to 1961;11:1019-31.
be towards establishment of low vertical dimension, since den- 10. Smith M. Measurement of personality traits and their relation to
patient satisfaction with complete dentures. J Prosthet Dent
tures with low vertical dimensions are expected to cause 1976;35:492-503.
less dissatisfaction. 11. Manne S, Mehra R. Accuracy of perceived treatment needs among

114 J Adv Prosthodont 2012;4:109-15

Complication rates and patient satisfaction with removable dentures Bilhan H et al.

geriatric denture wearers. Gerodontology 1983;2:67-71. mandibular dysfunction in shortened dental arches. J Oral
12. Magnusson T. Clinical judgement and patients' evaluation of com- Rehabil 1988;15:413-20.
plete dentures five years after treatment. A follow-up study. Swed 32. Wetherell JD, Smales RJ. Partial denture failures: a long-term
Dent J 1986;10:29-35. clinical survey. J Dent 1980;8:333-40.
13. Salonen MA. Assessment of states of dentures and interest in im- 33. Bergman B, Hugoson A, Olsson CO. Caries, periodontal and
plant-retained prosthetic treatment in 55-year-old edentulous Finns. prosthetic findings in patients with removable partial dentures:
Community Dent Oral Epidemiol 1994;22:130-5. a ten-year longitudinal study. J Prosthet Dent 1982;48:506-14.
14. Bergman B, Carlsson GE. Review of 54 complete denture 34. Rissin L, Feldman RS, Kapur KK, Chauncey HH. Six-year
wearers. Patients' opinions 1 year after treatment. Acta Odontol report of the periodontal health of fixed and removable partial
Scand 1972;30:399-414. denture abutment teeth. J Prosthet Dent 1985;54:461-7.
15. Heyink J, Heezen J, Schaub R. Dentist and patient appraisal of 35. Drake CW, Beck JD. The oral status of elderly removable
complete dentures in a Dutch elderly population. Community Dent partial denture wearers. J Oral Rehabil 1993;20:53-60.
Oral Epidemiol 1986;14:323-6. 36. Saito M, Notani K, Miura Y, Kawasaki T. Complications and
16. van Waas MA. The influence of clinical variables on patients' failures in removable partial dentures: a clinical evaluation. J Oral
satisfaction with complete dentures. J Prosthet Dent 1990;63:307- Rehabil 2002;29:627-33.
10. 37. Vermeulen AH, Keltjens HM, van't Hof MA, Kayser AF. Ten-
17. van Waas MA. Determinants of dissatisfaction with dentures: year evaluation of removable partial dentures: survival rates based
a multiple regression analysis. J Prosthet Dent 1990;64:569-72. on retreatment, not wearing and replacement. J Prosthet Dent
18. Kalk W, de Baat C, Kaandorp A. Comparison of patients' 1996;76:267-72.
views and dentists' evaluations 5 years after complete denture 38. Wagner B, Kern M. Clinical evaluation of removable partial den-
treatment. Community Dent Oral Epidemiol 1991;19:213-6. tures 10 years after insertion: success rates, hygienic prob-
19. Firtell DN, Finzen FC, Holmes JB. The effect of clinical remount lems, and technical failures. Clin Oral Investig 2000;4:74-80.
procedures on the comfort and success of complete dentures. J 39. Geckili O, Bilhan H, Bilgin T. Impact of mandibular two-implant
Prosthet Dent 1987;57:53-7. retained overdentures on life quality in a group of elderly
20. Jennings DE. Treatment of the mandibular compromised ridge: Turkish edentulous patients. Arch Gerontol Geriatr 2011;53:
a literature review. J Prosthet Dent 1989;61:575-9. 233-6.
21. Jooste CH, Thomas CJ. The influence of the retromylohyoid 40. van Waas MA. The influence of psychologic factors on patient
extension on mandibular complete denture stability. Int J satisfaction with complete dentures. J Prosthet Dent 1990;63:
Prosthodont 1992;5:34-8. 545-8.
22. Kalk W, van Waas MA, Engels SE. A comparison of different 41. Hobkirk JA, Abdel-Latif HH, Howlett J, Welfare R, Moles
treatment strategies in patients with atrophic mandibles: a clin- DR. Prosthetic treatment time and satisfaction of edentulous
ical evaluation after 6.5 years. Int J Prosthodont 1992;5:277-83. patients treated with conventional or implant-supported complete
23. Harper GW. Posterior base repair to maximize complete denture mandibular dentures: a case-control study (part 1). Int J
retention. Compendium 1993;14:454, 456, 458. Prosthodont 2008;21:489-95.
24. Sykora O, Sutow EJ. Posterior palatal seal adaptation: influence 42. Hobkirk JA, Abdel-Latif HH, Howlett J, Welfare R, Moles
of processing technique, palate shape and immersion. J Oral DR. Prosthetic treatment time and satisfaction of edentulous
Rehabil 1993;20:19-31. patients treated with conventional or implant-stabilized complete
25. Garrett NR, Kapur KK, Perez P. Effects of improvements of poor- mandibular dentures: a case-control study (part 2). Int J
ly fitting dentures and new dentures on patient satisfaction. J Prosthodont 2009;22:13-9.
Prosthet Dent 1996;76:403-13. 43. Sheppard IM, Schwartz LR, Sheppard SM. Oral status of eden-
26. Hummel SK, Wilson MA, Marker VA, Nunn ME. Quality of re- tulous and complete denture-wearing patients. J Am Dent
movable partial dentures worn by the adult U.S. population. J Assoc 1971;83:614-20.
Prosthet Dent 2002;88:37-43. 44. Carlsson GE, Persson G. Morphologic changes of the mandible
27. Douglass CW, Watson AJ. Future needs for fixed and remov- after extraction and wearing of dentures. A longitudinal, clini-
able partial dentures in the United States. J Prosthet Dent cal, and x-ray cephalometric study covering 5 years. Odontol Revy
2002;87:9-14. 1967;18:27-54.
28. Inoue M, John MT, Tsukasaki H, Furuyama C, Baba K. Denture 45. Dawson PE. Evaluation, diagnosis and treatment of occlusal
quality has a minimal effect on health-related quality of life in problems. 2nd ed. St. Louis; Mosby; 1989. p. 41-6.
patients with removable dentures. J Oral Rehabil 2011;38:818- 46. The glossary of prosthodontic terms. J Prosthet Dent 2005;94:
26. 10-92.
29. de Grandmont P, Feine JS, Tache′R, Boudrias P, Donohue 47. Hobkirk JA. Loss of the vertical dimension of occlusion and its
WB, Tanguay R, Lund JP. Within-subject comparisons of im- management implications. Int J Prosthodont 2009;22:520-1.
plant-supported mandibular prostheses: psychometric evaluation. 48. Jeganathan S, Payne JA. Common faults in complete den-
J Dent Res 1994;73:1096-104. tures: a review. Quintessence Int 1993;24:483-7.
30. Battistuzzi P, Käyser A, Kanters N. Partial edentulism, prosthetic 49. Yemm R. Analysis of patients referred over a period of five years
treatment and oral function in a Dutch population. J Oral to a teaching hospital consultant service in dental prosthetics. Br
Rehabil 1987;14:549-55. Dent J 1985;159:304-6.
31. Witter DJ, van Elteren P, Käyser AF. Signs and symptoms of

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