Influence of procedural variations during the laboratory phase of complete denture fabrication on patient satisfaction and denture quality

Abstract

Objectives: To compare subjective and objective outcomes of complete dentures fabricated with standard clinical protocols, but omitted selected steps during the laboratory phase.

Materials and methods: Forty-three edentulous patients (mean age 58.1 years, SD 9.9, range 35-78), were consecutively recruited and randomly assigned to one of four groups according to selected variations of laboratory steps: Group 1 (n=10), omission of secondary casts obtained from impressions in border moulded custom trays; Group 2 (n=10), omission of secondary casts and face-bow articulator mounting; Group 3 (n=10), omission of face-bow mounting; Group 4 (n=13), no steps omitted (control). Clinical procedures for all groups were identical, and performed by senior dental students under supervision of prosthodontists, all of whom were blinded to the Group. At 1-, 4- and 12-weeks after delivery, patients rated their overall satisfaction, as well as a range of functional factors using visual analogue scales. An independent blinded prosthodontist similarly rated four domains of denture quality at the 1-week follow-up.

Results: No significant differences were noted among the groups in all aspects of patients' assessments at all the time points (P>0.1). There were no significant differences in prosthodontists' ratings of denture quality in any of the domains examined (P>0.1).

Conclusion: Selected omissions of steps (face-bow mounting and/or secondary casts) during the laboratory phase of complete denture fabrication has only a minor role, if any, in subjective and objective outcomes, contrasting with the common belief that such omissions will adversely affect outcomes.

Clinical significance: General practitioners provide most complete dentures. Many do not follow all the procedures they were taught at dental school. Our finding that omitting frequently advocated steps made no difference to patient satisfaction or to denture quality suggests that cost-effectiveness through simplifications be considered in practice and in education.

Keywords: Border moulding; Complete denture; Denture quality; Education; Face-bow; Patient satisfaction.