Patient Satisfaction Clinical Trial
Official title:
Evaluation of Patient Satisfaction and Adaptation After Elevation of Vertical Dimension of Occlusion in Patients With Compensated Tooth Surface Loss Using Partial Overlay Denture or Fixed Temporary Crowns
Elevation of the vertical dimension of occlusion has always been a debatable issue specially using removable prosthesis. Fixed restorations have been a more predictable treatment modality in treating patients with tooth surface loss. A more conservative restoration, more retrievable, and cost effective option is proposed. Partial overlay dentures could provide a reversible and more conservative solution either by being used as a final restoration or teeth are provided with ceramic onlays instead of crowns.
Tooth surface loss and its prevalence:
Tooth surface loss is a process that describes loss of hard tooth structure due to reasons
other than caries, trauma, or developmental disorders. Lambrechts et al. in 1989 estimated
that the physiological tooth surface loss per annum to be approximately between 20-38
micrometers.
More than the average amount of TSL could be described as pathological tooth surface loss. A
systematic review of 186 prevalence studies reported an increase of tooth surface loss from
3% at the age of 20 to 17% at the age of 70. Another German study reported similar results.
Pathologic tooth surface loss:
Pathologic tooth surface loss can be classified into attrition, abrasion, erosion, and
abfraction.
These factors in addition to overloaded teeth due to partial edentulism can cause loss in the
vertical dimension of occlusion (non-compensated by alveolar bone) or loss of tooth substance
with dento-alveolar growth preserving the vertical dimension but with unsatisfactory
esthetics and sometimes dentine exposure and sensitivity. Vertical dimension of occlusion
according to the glossary of prosthodontics is defined as the distance measured between two
points when the occluding members are in contact.
Loss of vertical dimension:
Elevation of vertical dimension of occlusion has different modalities. The choice between the
treatment options depends mainly on the extent of tooth surface loss (which can be quantified
by different classification indices as the popular Smith and Knight classification and the
more recent BEWE classification described by Bartlett at 2010), and the aesthetic needs of
different patients.
Deciding to go for a restorative treatment can be subdivided into one of three lines which
are:
- Altering position of the mandibular closure while maintaining the existing vertical
dimension which can only be accomplished in teeth when no need to restore anterior teeth
and the rest of the posterior teeth are sound. This concept is based on the different in
position between the vertical dimension of occlusion and the centric relation.
- Increasing the vertical dimension of occlusion.
- axial tooth movement through orthodontic treatment of prosthodontic appliances inducing
orthodontic forces.
Compensated and non-compensated tooth surface loss:
Tooth surface loss can be either compensated where the freeway space remains within the
normal range due to overgrowth of the teeth with the alveolar bone into axial direction, and
non-compensated tooth surface loss leading to loss of occlusal vertical dimension and
increase in the average freeway space (2-3mm).
Need for esthetic and functional rehabilitation in addition to covering sensitive exposed
dentine in both cases urges treatment.
While non-compensated tooth surface loss presents a more predictable and easier modalities of
treatment where the freeway space exceeds the average of 2mm, so it is easy to quantify the
amount needed to be raised; compensated tooth surface loss based on available studies
reported establishment of a new postural position of the mandible and new interocclusal
distance obtained even when violating the freeway space.
Based on the previous findings we decided to study alteration of the vertical dimension of
occlusion in patients with compensated tooth surface loss.
One group temporized during adaptation period with partial overlay denture and the other
using fixed temporary crowns on the new vertical dimension of occlusion. This new vertical
dimension is determined according to a wax up where patients included require esthetic
alteration between 2-5mm.
Different techniques of alteration of the vertical dimension of occlusion differed between
fixed and removable prosthesis through temporization (adaptation period).
Removable prosthesis had the advantage of retrievability, while the fixed ones had the
advantage of ensuring patient adherence while symptoms persist.
The investigator's subject groups are fully dentate or partially edentulous patients (free
end or long bounded posterior) with at least a pair of occluding posterior teeth on each
side. Subjects have moderate to severe tooth surface loss requiring elevation of vertical
dimension of occlusion from 2-5mm.
Subjects will be restored using patial overlay denture or fixed temporary crowns.
Partial overlay denture is similar to temporary partial dentures with occlusal extension of
teeth where the existing posterior teeth can reach the newly reorganized occlusal plane.
A systematic review conducted in Germany reported symptoms collected from different articles
associated with elevation of the vertical dimension of occlusion. These symptoms included
headache, tenderness in the masseter and temporalis muscle area upon palpation, clenching,
grinding muscle and joint fatigue, soreness of teeth, cheek biting and difficulty in chewing
and swallowing.
Studying the two different groups is intended to monitor whether or not these symptoms
appear, severity of these symptoms, time taken for alleviation of these symptoms if it does
and overall patient satisfaction. Adaptation period will be up to 3 month through which a
weekly recall will be done to evaluate adaptation. Patients satisfaction is reported weekly
until adaptation occurs or at the end of the time limit using OHIP questionnaire.
Fixed restorations has the benefit of comfort and adherence of the patient over removable
options while it might need full crowning with less conservatism and more cost. The partial
overlay denture as a removable prosthesis is also less comfortable for the patient but could
be proposed as a retrievable, more conservative and a cheaper option.
;
| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Not yet recruiting |
NCT04079543 -
NPO and Patient Satisfaction in the Cath Lab
|
N/A | |
| Enrolling by invitation |
NCT05053958 -
Using Superimposition of Intra-Oral Scan and CBCT in Single Implant Restorations in Aesthetic Zone.
|
N/A | |
| Completed |
NCT04204785 -
Noise in the OR at Induction: Patient and Anesthesiologists Perceptions
|
N/A | |
| Completed |
NCT04774562 -
The Effect of Video-Assisted Discharge Education After Total Hip Replacement Surgery
|
N/A | |
| Terminated |
NCT04604340 -
Radial Versus Femoral Arterial Access for Cerebral Angiography in Adolescents
|
N/A | |
| Recruiting |
NCT04539210 -
Screw-retained Maxillary Complete Denture With Electric Welded Metal Framework Versus Cast One, Patient Satisfaction Assessment.
|
N/A | |
| Completed |
NCT02924974 -
Spinal Morphine in Robotic Assisted Radical Prostatectomy
|
Phase 4 | |
| Completed |
NCT01052415 -
POL and Access Intervention to Reduce HIV Stigma Among Service Providers in China
|
N/A | |
| Recruiting |
NCT06044103 -
Patient-controlled Sedation During Repair of Obstetric Perineal Lacerations
|
Phase 4 | |
| Not yet recruiting |
NCT05670080 -
Does MI Have a Therapeutic Role in Arthroscopic Rotator Cuff Repair?
|
N/A | |
| Completed |
NCT06114524 -
Effect of Binaural Beats on Level of Anxiety and Toleration in Patients Undergoing Upper Gastrointestinal Endoscopy Without Sedation
|
N/A | |
| Completed |
NCT06141122 -
The Colonoscopy Booklet:Effect of a Recipe Resource on Quality of Colonoscopy Bowel Preparation and Patient Experience
|
N/A | |
| Not yet recruiting |
NCT04534868 -
Patient Acceptance And Satisfaction of Teledermoscopy In General Practice In a Belgian Rural Area
|
N/A | |
| Completed |
NCT04823390 -
Anesthetist Controlled Versus Patient-controlled Sedation: Risks and Benefits
|
Phase 1 | |
| Recruiting |
NCT05884684 -
What is the Potential Impact of Reviewing Post-procedure Images With Patients Following Interventional Spine Procedures.
|
N/A | |
| Recruiting |
NCT05613439 -
The Fast-track Centre for Hip and Knee Replacement Database
|
||
| Withdrawn |
NCT04625842 -
Focus Group Interview Study on Patient Experiences and Satisfaction
|
N/A | |
| Completed |
NCT04420000 -
Effects of Mindfulness Therapy in Patients With Acromegaly and Cushing
|
N/A | |
| Recruiting |
NCT04842240 -
Comparison of Patient Reported Outcome Measures Using the BREAST-Q Questionnaire in Patients Undergoing Pre Versus Sub-pectoral Implant Based Immediate Breast Reconstruction.
|
||
| Completed |
NCT04048538 -
Preoperative Patient Education Via Animated Videos to Improve Patient Satisfaction and Reduce Complications in Head and Neck Surgery
|
N/A |