Is a two-step impression mandatory for complete denture fabrication on the severely resorbed mandible? A randomized trial on mastication, patient satisfaction and adjustments.

OBJECTIVES: To compare one- vs two-step impression procedures for the provision of conventional complete dentures (CCDs) for edentulous individuals with severe mandibular resorption, in terms of (1) masticatory performance and ability; (2) satisfaction with mandibular CCDs; and (3) post-delivery adjustments. METHODS: Fifty-two patients requiring maxillary + mandibular CCDs were randomly divided into two parallel arms according to the impression method of the mandibular ridge: (SI) single impression with stock trays (irreversible hydrocolloid); (TI) two-step impression in custom trays, with border molding (impression compound) followed by the impression itself (polyether). Mastication performance was evaluated by a colorimetric test, whereas patients answered questions on masticatory ability and satisfaction with mandibular CCDs (100-mm visual analogue scale). The number of post-delivery sessions for adjustments were also quantified. Outcomes were assessed at 3 and 6 months after delivery. RESULTS: The masticatory performance was similar for both groups, regardless of time (3 months, P = 0.62; 6 months, P = 0.61). No significant difference was found for patient-reported (P > 0.05), i.e. masticatory ability (general ease of chewing and quality of grinding food; ability to chew specific foods), general satisfaction with the mandibular CCD (general satisfaction, comfort, aesthetics, ability to speak and to perform correct cleaning, retention and stability). Both methods resulted in a similar number of post-delivery adjustment sessions [SI: 3.8 (1.7); TI: 3.2 (1.4); P = 0.09]. CONCLUSIONS: Compared to a traditional approach, CCDs obtained from a single impression achieve similar masticatory performance/ability and patient satisfaction, even in patients with severely reabsorbed mandibular ridge. Both methods demand the same amount of post-delivery adjustment. CLINICAL SIGNIFICANCE: A simplified impression technique which eliminates the secondary impression can provide CCDs of good clinical quality, which influences the OHRQoL, and satisfaction in the same extent they would by a two-step procedure, even for patients with severely reabsorbed mandibular ridges (ClinicalTrials.gov: NCT02339194).

Is a two-step impression mandatory for complete denture fabrication on the severely resorbed mandible? A randomized trial on patient perception and denture quality.

OBJECTIVES: To evaluate the effectiveness of CCDs produced by two impression procedures for the mandibular ridge, in patients with severe mandibular atrophy. METHODS: Fifty-two completely edentulous patients with severely resorbed mandibles were randomly allocated into two groups according to the impression procedure of the mandibular ridge: SI - single impression (stock tray and irreversible hydrocolloid); TI - two-step impression (custom tray, border molding with compound, and polyether). Assessments of oral health related quality of life (OHRQoL, primary outcome) and denture satisfaction were performed by using validated questionnaires. Denture quality was evaluated by means of functional tests. RESULTS: Regardless of the technique, participants reported better OHRQoL (P < 0.001) in both follow-up periods (3 and 6 months after denture delivery), and groups resulted in similar OHIP-EDENT scores in its different domains (P > 0.05). Between-group differences were insignificant for general satisfaction (3 months, P = 0.699, 6 months, P = 0.392), as well as for aspects such as esthetics, comfort, mastication, speech, and prosthesis retention (P > 0.05). Overall clinical quality of the CCDs (P = 0.383) was similar between-group, as well as in specific aspects - interocclusal distance, occlusion, articulation, retention of the maxillary denture, and stability of both maxillary and mandibular dentures (P > 0.05). CONCLUSIONS: Mandibular CCDs based on a single impression technique showed quality levels comparable to those generated by a two-step impression, both from the patient and clinician perspective. CLINICAL SIGNIFICANCE: A simplified impression technique which eliminates the secondary impression can provide CCDs of good clinical quality, which influences the OHRQoL, and satisfaction in the same extent they would by a two-step procedure, even for patients with severely reabsorbed mandibular ridges. (ClinicalTrials.gov: NCT02339194).