Psychometric Assessment of the Romanian Version of the Index of Dental Anxiety and Fear (IDAF-4C+).

BACKGROUND AND OBJECTIVES: The goal of this study was to assess the validity of the Romanian version of the Index of Dental Anxiety and Fear (IDAF-4C+) questionnaire. MATERIALS AND METHODS: This study was conducted on a convenience sample of past patients and their acquaintances through an online questionnaire administered on the Google Forms platform between May 2021 and September 2022. The sections of the survey were demographic characteristics, the dental anxiety scale questionnaire, the IDAF-4C+ questionnaire, a single question about dental fear, and previous dental treatments. RESULTS: In total, 239 participants were included in the study, and the mean age was 37. The IDAF-4C questionnaire had good internal validity (Cronbach alpha was 0.945). The IDAF-4C had good convergent validity, and it was positively correlated with the dental anxiety scale (r = 0.825, p < 0.001) and the question about the fear of going to the dentist (r = 0.738, p < 0.001). The questionnaire had good reliability, and the intraclass correlation was 0.985. Lower levels of dental anxiety were associated with scaling, orthodontic treatment, and dental implants. A confirmatory factor analysis was conducted after the removal of the first question from the phobia module, and residual covariance was added between items four and nine of the stimulus module, showing a good fit for the retained questions of the IDAF-4C+, grouped by module. CONCLUSIONS: The Romanian version of the IDAF-4C+ showed acceptable psychometric properties.

The Biomechanical Impact of Loss of an Implant in the Treatment with Mandibular Overdentures on Four Nonsplinted Mini Dental Implants: A Finite Element Analysis.

The aim of this study was to evaluate the biomechanical impact, in terms of stress and displacement, at the level of a mandibular overdenture, on four mini dental implants (MDIs) after the loss of an implant. A three-dimensional virtual model was obtained by scanning the overdenture, and a biomechanical analysis was carried out, using the finite element method (FEM). The displacements of the overdenture and the equivalent von Mises stresses were evaluated using logarithmic scales. In the case of a mandibular overdenture on four MDIs inserted in the interforaminal area, the frontal loading generated the lowest values for the von Mises stresses, and the bilateral loading generated the least displacement when two implants were inserted in the canine area and two in the molar area. The highest von Mises stress was observed during frontal loading in the situation of the mandibular overdenture on four MDIs, two of which were inserted in the canine area and two in the molar area, following the loss of an implant in the canine area. The largest displacement was noted in the mandibular overdenture on four interforaminal MDIs during unilateral loading, following the loss of a distally inserted implant. The FEM analysis showed aspects that correlated with clinical observations, with predictive value. The concentration of von Mises stresses, and the occurrence of some displacements of the prosthodontic restoration, can explain the emergence of some complications in the overdenture's biodynamics, and the increased risk of fracture. Complications can be prevented by choosing a certain number of implants and a topographical distribution correlated with biomechanical aspects, and by proposing a correct occlusal scheme with optimal functional loading.

Perception and attitudes of dentists regarding the complications of conventional acrylic dentures and overdentures supported by teeth or implants.

This study aimed to assess the perception of dentists on the complications associated with prosthodontic treatments with acrylic dentures and overdentures in partially or complete edentulous patients. The study analyzed the complications of acrylic dentures and overdentures using a questionnaire with 24 open or closed questions, with single or multiple answers. The participants were 63 dentists, mostly women (77.8%), aged between 30 and 39 years old (52.4%), more than half of them with a clinical experience of less than 15 years. The main complications encountered were: lesions of the oral mucosa (52.4%), lack of maintenance (44.4%) or stability of dentures (39.7%), fracture of acrylic bases (14.3%), and detachment of attachment systems (44.4%). The complete maxillary acrylic dentures fractured most often (38.1%), frequently on the midline (58.7%), the main causes being accidental fall, masticatory stress, or lack of stability of the dentures. The most common intervention to correct the complications of dentures was the repair of fractured acrylic bases (33.3%). The study exposed that dentists are aware of the possible complications of acrylic dentures, which they correlate with the peculiarities of oral structures, but also with some deficiencies of prosthodontic restorations, materials and technologies. Maxillary acrylic dentures, overdentures, and partial acrylic dentures have a high risk and fracture rate, but the use of new technologies and materials can reduce the complications rate of acrylic dentures and overdentures.

The perceived association of oral diseases and general pathology among doctors of different specialties.

This study aimed to highlight the perceived associations between general and oral pathology, among clinicians of different specialties. Data was collected through a questionnaire with 22 questions, with single or multiple answers, to 88 dentists, general practitioners, or pediatricians. The majority of participants were women (89.8%), aged between 30 and 39 years (52.3%), with a professional experience mostly under 10 years (61.3%). Many doctors considered that there was an association between oral and general pathologies (39.8%). The most common general pathologies associated with oral pathology were digestive disorders (n=21, 23.9%), followed by cardiovascular, genetic, endocrine and metabolic, neuropsychiatric, respiratory, hematological, immunological, and oncological pathologies. Tooth decay was mainly found in patients with digestive, respiratory, or neuropsychiatric disorders, and periodontal disease was more common in patients with obstetric disorders. Diseases of the oral mucosa, such as canker sores and gingivostomatitis, were more common in patients with digestive pathology, endocrine and metabolic, or reproductive disorders. The study pointed out that physicians, regardless of their medical training, often observed a relatively rich general pathology associated with oral conditions. It is important to differentiate between primary and secondary oral pathology, associated with general pathology and medication, establishing a correct diagnosis of the disease and treatment according to general or oral diseases and their manifestations.

Food Bolus Properties in Relation to Dentate and Prosthetic Status.

The objective of this study is to evaluate food bolus properties (mass, moisture content and food comminution) in patients wearing fixed or removable dental prostheses. Methods: A cross-sectional study was conducted on a convenience sample of patients aged at least 55 years old. Patients chewed a 10 g sample of fresh raw carrot until they felt ready to swallow. The mass of the food bolus was determined as collected and after drying. Food comminution was assessed by the multiple sieve method. Results: Patients with fixed prostheses compared to those with removable prostheses registered a similar mass of food bolus as collected (4.40 g vs. 4.60 g; p = 0.856); a higher mass of dried food bolus (3.46 g vs. 0.86 g; p < 0.001); lower moister of food bolus (24.65% vs. 82.35%; p < 0.001); and better food comminution (mass of smaller particles, of size below 2 mm, represented 65.93% vs. 20% of dried food bolus). In removable denture wearers, food comminution was slightly better in partially than in completely edentulous patients, and rather similar in completely edentulous patients with either implant overdenture or complete denture in the mandible, and complete denture in the maxilla. Conclusions: The current results suggest that food bolus properties are dependent on the dentate and prosthetic status.

Oral Health Related Quality of Life and Prosthetic Status among Institutionalized Elderly from the Bucharest Area: A Pilot Study.

The aim of the study was to assess the oral health related quality of life (OHRQoL) of elderly in care homes, one of Romania's most vulnerable social categories, to correlate it to sociodemographic, oral health parameters, and prosthodontic status. Therefore, a cross-sectional study was performed on 58 geriatrics divided into 3 age groups, who were clinically examined and answered the oral health impact profile (OHIP-14) questionnaire. Very high rates of complete edentulism in the oldest-old subgroup (bimaxillary in 64.3%; mandibular in 64.3%; maxillary in 85.7%), and alarming frequencies in the other subgroups (middle-old and youngest-old), statistically significant differences between age groups being determined. The OHIP-14 mean score was 14.5. Although not statistically significant, females had higher OHIP-14 scores, also middle-old with single maxillary arch, single mandibular arch, and bimaxillary complete edentulism, whether they wore dentures or not, but especially those without dental prosthetic treatment in the maxilla. A worse OHRQoL was also observed in wearers of bimaxillary complete dentures, in correlation with periodontal disease-related edentulism, in those with tertiary education degree, and those who came from rural areas. There were no statistically significant correlations of OHRQoL with age, total number of edentulous spaces or edentulous spaces with no prosthetic treatment. In conclusion, despite poor oral health and prosthetic status of the institutionalized elderly around Bucharest, the impact on their wellbeing is comparatively moderate.

Periimplant Bone Resorption at the Level of Tilted Implants in SKY Fast & Fixed Restorations.

Implant-prosthetic rehabilitation registers multiple variants, but their short- and long-term evolution has been a frequent concern. This study aimed to evaluate the peri-implant bone resorption at the level of the tilted implants in the SKY fast & fixed restorations, with reference to clinical and treatment parameters. An observational study was conducted on a convenience sample of patients with implant-prosthetic rehabilitation in one or both jaws, according to the SKY fast & fixed protocol (Bredent, Germany). Bone resorption was assessed on panoramic radiography. Other data were collected from the patient's medical records. Thirty tilted implants were analyzed, 12 of which were in the maxilla and 18 in the mandible. After the follow-up period, both bone resorption (maximum 7 mm) and bone apposition (maximum 8 mm) were observed. There was a tendency for the resorption to be more pronounced in the mandible, in patients where tooth loss was due to periodontal disease, and when implants with length less than 16 mm were used. Resorption was statistically significantly lower when bone addition materials and membranes were used at the extraction socket, and when SKY fast & fixed rehabilitation was performed in both jaws. SKY fast & fixed implant-prosthetic technique, which involves applying a small number of implants, and a fixed prosthesis corresponding to a shortened dental arch, is a viable method of treatment that outcomes the need for complex and expensive surgical interventions, and proves to be beneficial in maintaining the optimal parameters of bone support.

Masticatory function parameters in patients with removable dental prosthesis.

This study aimed to assess the masticatory efficiency in patients with a removable dental prosthesis, presenting different systemic, oral and prosthetic states while chewing different foods. The study was conducted on a convenient sample of patients aged 45 and above, with removable prostheses in at least one jaw. Patients were asked to chew samples of digestive biscuits, apple, and carrot, until the sensation of swallowing. The recorded masticatory function parameters were: chewing time, the number of mastication cycles, mean masticatory cycle duration, and chewing frequency. We found out that the masticatory functional parameters registered statistically significant differences according to the chewed food (e.g., generally the highest values were recorded for carrot and lowest for apple), most likely this being in relation to food's consistency, wetting, and adherence. High positive correlations were found between the chewing time and the number of mastication cycles for all three foods taken into consideration. Higher values for chewing time and number of mastication cycles were found for all foods in patients with complete dentures and overdentures, and while chewing carrot in patients with altered general status and of advanced age. Therefore, it that it takes a different time and number of mastication cycles to complete chewing, in relation to individual and food characteristics, to the systemic, oral and prosthetic patient's status. The residual teeth number and the type of prosthetic rehabilitation favor the adaptation and improvement of masticatory parameters and can have marker value for masticatory efficiency.

Compound odontoma - morphology, clinical findings and treatment. Case report.

Compound odontomas are benign tumors, composed of odontogenic tissue that has an orderly pattern. These are formed of unilocular conglomerate of multiple calcified structures, some resembling to mini-teeth. A case of a 9-year-old female patient with compound odontoma is reported, highlighting aspects of odontoma's morphology, clinical findings and treatment. The tumor, found in the anterior maxilla, included multiple calcified structures, some of them resembling to mini-teeth (the biggest were about 5 mm), arranged in a conglomerate. The mini-teeth presented a crown and root, different dental tissues, open apices (the root was incompletely formed), and root canal which was evidenced by usage of Kerr K-file needle No. 8. Their surface presented many irregularities. Odontoma associated impaction of maxillary central incisor, and eruption disturbances and malposition of adjacent teeth. In order to minimize side effects, especially when odontoma is localized in an area with great impact on facial esthetics, early diagnosis and proper treatment are of great importance.

Anatomical features and prosthetic considerations of edentulous patients with mandibular reconstruction with autograft performed more than 40 years ago.

In this manuscript there are presented two cases, both with mandibular reconstruction with autograft harvested from the iliac crest, performed more than 40 years ago, but with different bone defect etiology, i.e., mandibular dysplasia and mandibular fracture, both having currently extensive tooth loss in the mandible, being in need for prosthetic rehabilitation. These cases confirm that reconstructive surgery of mandibular bone defects with autograft from iliac crest has a satisfactory long-term outcome, providing acceptable conditions for prosthetic rehabilitation. Bone resorption in the grafted area seems to be related to the etiology of bone defect, and influenced by preservation of dental occlusion and masticatory function. Reconstructive surgery made decades ago has sequelae that increase the difficulty of prosthetic treatment of edentulous patient, that need to be proper evaluated and included in the treatment plan, in an individualized approach, in order to obtain an acceptable functional outcome.

Clinical study on thermography, as modern investigation method for Candida-associated denture stomatitis.

Candida-associated denture stomatitis is an infectious inflammatory condition of the oral mucosa, with frequent recurrences. The aim of this study was to assess the use of infrared thermography as investigation method for Candida-associated denture stomatitis (as inflammatory disorder of the maxillary denture bearing area), by comparing disease and non-disease groups. An observational study was conducted on maxillary edentulous patients treated by acrylic dentures, with and without Candida-associated denture stomatitis. Diagnostic test methods used were clinical examination for denture stomatitis and conventional microbiological culture method for oral candidiasis. Thermography analysis of the maxillary denture bearing area was made using the ThermaCAM PM350 infrared camera (Inframetrics, Flir Systems) and ThermaGram Pro 95 software, data being acquired by usage of standard protocol of thermographic registrations. The sample included 52 patients, 21 with and 31 without Candida-associated denture stomatitis. The temperature of the maxillary mucosa corresponding to the denture bearing area was found to be statistically significantly higher in Candida-associated denture stomatitis (mean 36.20°C), compared to healthy oral mucosa (mean 34.85°C). The thermal threshold value of 35.44°C was identified as best differentiating a pathological from normal state of the maxillary mucosa corresponding to the denture bearing area. In conclusion, infrared thermography, a rapid non-invasive investigation method, has the premises to bring valuable data in inflammatory disorders of the maxillary denture bearing area, as Candida-associated denture stomatitis that may be used for screening, diagnostic or monitoring purposes.

DENTAL STUDENTS' PSYCHOLOGICAL WELL-BEING DURING EXAMINATION PERIOD AND HOLIDAY.

INTRODUCTION: Psychological well-being is recognized as an important health component, which influences the behavior, ability to cope with stressful events, work performance, and generally the ability to achieve one's full potential. AIM: To comparatively assess the psychological well-being of dental students during the summer semester examination period and summer holiday. MATERIAL AND METHODS: A single-arm, prospective study was conducted in second year dental students from the Faculty of Dental Medicine, Bucharest. The psychological well-being was assessed using the WHO-Five Well-being Index. RESULTS: Students' psychological well-being was statistically significantly better during the summer holiday (median=19) than during the summer semester examination period (median = 11.5), Z = 3.69, p < .001. The perceived satisfaction regarding financial means, faculty colleagues, home, family and overall life satisfaction was the same during summer semester examination period and summer holiday, but it was significantly correlated with the WHO-Five Well-being Index score corresponding to the summer holiday, and no association was observed with the WHO-Five Well-being Index score corresponding to the summer semester examination period. CONCLUSIONS: Within the limits of this study, psychological well-being is likely to be negatively influenced, on a fairly large scale, by the semester examination period. Therefore, it is recommended to identify the most appropriate methods of examination with regards to the psychological load that might be a threat to the validity of students' evaluation. Additionally, training students about adequate coping strategies, designed as interventions at individual or group level, may be required.

Microscopic morphological changes of the tooth surface in relation to fixed orthodontic treatment.

Orthodontic treatment has, as any other medical intervention, in addition to its benefits, side effects, some of them being perceived as unavoidable. The aim of this case series was to microscopically evaluate the changes of the tooth surface in relation to fixed orthodontic treatment. A case series study was implemented by the usage of four extracted first maxillary premolars, from patients with previous orthodontic treatment, of 12 and 23 months. Analysis was performed using the high precision stereomicroscope (Axiovert, Carl Zeiss, Germany), at magnifications from 10× to 50×. The tooth surface corresponding to the bracket bonding area registered numerous disorderly grooves and cracks, with various directions and depths, and was flattened, having lower convexity compared to teeth surfaces where brackets were not bonded. Root resorption lacunae were more frequently observed in teeth under orthodontic treatment, these having various depths, and sizes considerably larger than those observed in teeth without orthodontic treatment. Following orthodontic treatment, teeth exhibit changes that can be perceived as being directly linked to this medical intervention. These teeth changes usually have low or moderate severity, which can be influenced at some degree by the clinical conduct of the orthodontic treatment. The stereomicroscope proved to be a high sensitivity tool for the analysis of morphological changes of teeth in relation to the fixed orthodontic treatment.

Patients' satisfaction with conventional dentures and mini implant anchored overdentures.

UNLABELLED: The aim of this study was to assess complete edentulous patient satisfactionwith two treatment alternatives--conventional dentures and mini implant anchored overdentures. MATERIALS AND METHODS: Study sample comprised 36 patients--18 treated with newly made conventional prosthesis and 18 with mini implants anchored overdentures, with a ball attachment system (from IMTEC Corporation). RESULTS: Patients treated with mini implant anchored overdenture presented a higher satisfaction regarding chewing ability (all of them reported satisfactory mastication, 50% accusing occasionally discontent) compared with the conventional denture group (28% reported impaired masticatory function and 39% occasionally discontent). Denture's retention was better in the mini implant overdenture sample (only 17% reported occasional problems, none of them feel the need to use denture adhesives), compared to the conventional treatment alternative (28% were dissatisfied about this issue). Both treatment alternatives were seen as being highly satisfactory regarding the aesthetic restoration of facial appearance and for performing phonation. Still, in the complete denture group 22% of patients claimed difficulties in articulating certain phonemes. The main reasons why patients refused implant treatment were its higher cost and fear of surgery. CONCLUSIONS: Patients treated with mini implant anchored overdentures were more satisfied than those treated conventionally, due to the increased retention and stability of dentures, mastication efficiency and improved comfort, these having probably a positive effect on the quality of life.

Undesirable dental hard tissue effects hypothetically linked to orthodontics - a microscopic study.

Like any other medical intervention, the orthodontic treatment may have, besides the positive effects, also unwanted secondary consequences. The aim of this study was to evaluate the changes present in dental hard tissue associated with orthodontic treatment. The stereo-microscopic ex vivo analysis was performed on two sets of maxillary first premolars undergoing orthodontic treatment for a long period of time (12 and 23 months); five teeth with other clinical situations were used as controls. By analyzing the teeth undergoing orthodontics, enamel color alterations were mainly found adjacent to the bracket, more pronounced in the gingival area, suggesting the need for a correct oral hygiene around it. Roughness was higher on the enamel surface corresponding to the bracket's base, aspect linked to the resign impregnation during bonding procedures. At the apical part, changes regarding contour, appearance and surface roughness were noticed. These modifications were suggestive for the presence of apical root resorption. The severity of root resorption was not correlated with the duration of treatment. In conclusion, through microscopic analysis changes that may be associated with orthodontic treatment have been observed in both crown and apical level.

Aspects of oral morphology as decision factors in mini-implant supported overdenture.

AIM: Evaluation of some morphological oral aspects perceived as decision factors in complete edentulism treatment by mini-implants overdenture. PATIENTS, MATERIAL AND METHODS: An observational study was conducted on a sample of 24 patients (average age of 61 years), through clinical and imagistic methods. The variables taken into consideration were: age, gender, alveolar mucosa status, bone offer, mini-implants characteristics, insertion torque and loading type. RESULTS: 117 mini-implants were applied, 59% to the lower jaw and 41% to the upper jaw. On average, there were inserted 5.33 implants to maxilla and 4.6 to mandible. Fifty-seven percent of implants were applied in the interforaminal area. The implants used had 10 mm (28.2%) and 13 mm (71.8%). In only 41% patients, the ridge width was higher than 5 mm (value necessary for conventional implant application). Diameters of implant used were: 1.8 mm (2.56%), 2.1 mm (25.64%) and 2.4 mm (71.8%). Smaller diameters were used in mandible. Only in 16.67% of patients was possible the transmucosal insertion. Bone density was D2 and D3 for men, and D3 and D4 for women. Immediate loading was achieved in 20.5% patients. CONCLUSIONS: Mini-implant supported overdenture can be an alternative to conventional denture and conventional implant overdenture. Its advantages derives from implants' characteristics (smaller diameter, variable length, O-ring retention system), which adapts better to the particular edentulous conditions. Insertion technique implies less surgical trauma. Choosing implants' size, number, topography, and the loading method have a great variety, depending on anatomical feature (bone offer, mucosa and relationship with the nearby anatomical structures), functional features and patients' wishes.

Orthodontically induced root resorption correlated with morphological characteristics.

UNLABELLED: Orthodontically induced root resorption is an irreversible process that can have medical, ethical and legal implications. AIM: The objective of this research was to identify morphological risk factors, in order to prevent it. MATERIAL AND METHODS: We realized a retrospective study on 50 patients and made correlation between the prevalence and gravity of radiological identified root resorption and multiple biological and anatomical features. RESULTS AND CONCLUSIONS: We found that, when removable orthodontic appliances were used, there were not found root resorption (0%), and in cases in which fixed appliances were used, the root resorption was found, and it generally presented a high prevalence (96%) and low severity. Prevalence of root resorption is influenced by the sex and age of the patients (is greater for males than for females and higher in older patients). Topographically, differences were found in prevalence of root resorption (79.33% in mandibullary frontal teeth and 74% in the maxillary ones). The highest prevalence of root resorption was found in the lower central incisor (86%). Prevalence of root resorption is higher when there are alterations of the normal anatomy (facial hypo- or hyperdivergence, Angle class II and III malocclusion, angulated roots). Some anatomical aspects may present a fact of prevision of the appearance of root resorption within the orthodontic treatment.

[Acrylic resin reinforcement with metallic and nonmetallic inserts]. / Ranforsarea acrilatelor prin inserturi metalice si nemetalice (cu fibre de sticla).

In the current use of acrylic resin for removable dentures and orthodontic treatments we are frequently facing the fact of base fracture. The repairing of this, determine most of the time, discomfort of the patient, by excluding the prosthetic device, affecting the treatment, loosing patient's time, doctor's time, implying the dental laboratory and extra expenses. The causes of fractures are many, from clinical cases with some specific anatomic and functional particularities, or parafunctional, to the incorrect designing, manufacturing or wearing of the prosthetic part, being connected with the materials characteristics. The consequences and costs of these fractures are leading to unsatisfying results in some of the clinical cases, in presence of parafunctions like bruxism or clenching and specifically for the new types of prosthetic rehabilitation, on natural teeth or implants.

[Considerations regarding the treatment with total dentures for patients with hyposalivation. A clinical case]. / Consideratii terapeutice privind protezarea totala în prezenta Hiposialiei. Caz clinic.

The reduction of the saliva volume leads to a number of difficulties in wearing the total dentures and favours the appearance of the denture stomatitis. For this reason, the treatment of edentulous patients with xerostomia must begin with a complete clinical examination, in order to evaluate the conditions for prosthetic replacement and the amount of the saliva volume. One can appreciate the aetiology and the degree of the saliva volume's alteration trough subjective methods (questionnaires) and objective methods (a few clinical tests, i.e. the mirror test, the pH evaluation, the examination of the saliva). During the treatment, we must pay attention to the preprosthetic measures (the oral rehabilitation), to the treatment stages (special types of impressions, the correct determination of the occlusal and intermaxillary relationships, the aspect of the internal denture's surface), and to the after-treatment phase (the patient's instructions regarding denture's wearing and hygiene, the patient's monitoring). Respecting this rules we may increase the quality of total dentures for patients with xerostomia.

[Epidemiologic aspects of the edentulous mouth (II). General and local features of the totally edentulous mouth]. / Aspecte epidemiologice privind edentatia totala (II). Aspecte generale si locale asociate edentatiei totale.

UNLABELLED: PREMISES AND AIM: The study wants to reveal the general and local clinical aspects, which may accompany the completely edentulous mouth and create difficulties in treatment. MATERIAL AND METHOD: The clinical and statistical study was carried out on 40 edentulous patients; we analyzed general aspects (the present medical status, the patient's medication and its effects) and local aspects (the etiology, the type of previous denture treatment, the type and number of denture's repairs, the extent of the residual ridge resorption, the relationship between residual ridges), the total difficulty of the treatment. RESULTS AND DISCUSSIONS: 80% of the edentulous patients suffered from general diseases, more frequent from cardiovascular, digestive, metabolic, renal, rheumatic diseases. 73% of the edentulous patients received daily medication, which generated in 30% of cases a decrease of the saliva volume. The demand for prosthetic treatment was greater for the recent edentulous patients (less then 1-2 years of edentulousness) or for those who lost their teeth more then 6 years ago. The majority of patients over 70 years are completely bimaxillary edentulous patients, 68% of them had previous bimaxillary dentures. We found the bone resorption moderate (50% of cases) and severe (33% of patients), the relationship of the residual ridges inverse in the anterior and posterior zones (60% of patients) and normal in the anterior zone and inverse in the posterior zone (28%). The difficulty of the treatment was frequently 3Pd degree for the maxilla and 4t' degree for the mandible (the maximum degree of difficulty). CONCLUSIONS: The completely edentulous patient presents a number of general and local modifications, which increase the difficulty of the treatment, demand supplementary therapeutic procedures, and increase the total cost. The modifications of the oral structures demand specific therapeutic procedures, and in some cases the frequent renewal or adaptation of dentures (every 3-5 years); all those costs must be took over by the insurance company, because of their social status (pensioners).