COMPLETE PROSTHESES TREATMENT – PRESENT AND FUTURE PERSPECTIVES
common restorative procedures . Increased number of trips to see the dentist also adds to patient ’ s expenses . Reduced space for complete dentures in dental schools ’ curriculum 24 , 25 , 26 is likely to generate graduates less prepared for the treatment of edentulism . Under these circumstances , it appears that the need / demand of complete dentures exceeds the offer of prosthodontic care within the limitations of existing dental care delivery systems , even in developed countries . The purpose of this paper is to review data on prevalence and future projections on edentulism , also review treatment modalities for this condition . Possible ways to improve efficiency in complete denture treatment , and ameliorate access to care are also investigated .
2 . Edentulism and demographics The prevalence of edentulism in seniors observes a wide range internationally , from 11 % in China , to 23 % in Brazil , 24 % in Indonesia , and 26 % in the United
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States . In Europe , it varies from 15 % to 78 %. In the U . S ., the prevalence of edentulism registered a decline during past decades , 28 which can be approximated by a 10 % decline for each decade . 29 Using Census data and projections from 1996 ( indicating a significant increase in adult population , especially adults over 55 ), Douglass 30 estimated that the adult population in need for complete dentures will increase by 2020 to nearly 37.9 million , even considering a utilization rate of dentures of about 90 %. 29 , 31 It was predicted that even if the estimated decrease in the prevalence of edentulism will follow previous trends , it will likely be offset by the 79 % growth in the population over 55 , triggering an increase of the need for complete dentures from 53.8 million ( 1991 ) to 61 million in 2020 . 30 The fact that dentures need to be replaced periodically , in order to maintain reasonable function and the oral health related quality of life 32 is also to be considered . Newer data indicate that during the past half century covered by surveys , the prevalence of edentulism in U . S . adults decreased from 18.9 % to 4.9 %. 33 As socioeconomic disparities increased during the same period , edentulism is currently concentrated in the low-income population . 33 The relative decrease in edentulism prevalence in the U . S . by 74 % is comparable with data from other countries : 84 % relative decrease in the U . K . over four decades . 34 A 57 % relative reduction was noted in Finland , 35 84 % in Sweden , 36 and 61 % in Australia , 37 during twodecade periods . 33 In the U . S ., the rate of decrease in edentulism is expected to slow to 2.6 % by 2050 . Such decline is predicted to be partially offset by population increase and aging , indicating that the number of edentulous individuals will actually decrease by 30 %, from 12.2 million in 2010 to 8.6 million in 2050 . 33 In Europe , the prevalence of edentulism is also expected to decrease significantly during the next decades . The growth of the older segment of population is expected to counteract the trends in prevalence , but the effect is not expected to be as dramatic as in the U . S . 7 Prevention of edentulism is work in progress worldwide , with significant disparities , related mostly to access to care and education . Overall , it is likely that the elderly will lose teeth later in life , 38 contributing to an anticipated decrease in the need for tooth replacement , at least in some populations of the developed world .
3 . Treatment modalities for the edentulous patient Despite consistent advances in organ and tissue engineering , 39 , 40 their current impact on the dental profession and practice is rather limited at best . Dentistry remains predominantly restorative nowadays , and the time when re-growing teeth will become mainstream is probably decades away . The advent of dental implants more than half a century ago brought the hope to evade some of the shortcomings of conventional , tissue supported dentures . Constant development in materials and techniques enabled implant dentistry to become a predictable and lucrative enterprise . If cost were not a limiting factor , implant placement and restoration would be mainstream today , considering the excellent survival rates , even for implants being placed in predoctoral and residency programs . 41 Most studies on implant treatment and oral function demonstrated an improvement of chewing function in the mandible . 13 , 14 , 42 , 43 , 44 , 45 , 46 , 47 The implant restorations are well received within the stomatognathic system , with electromyographical activity values comparable to those of dentate subjects . 48 A systematic review by Fueki et al . 11 concluded that a mandibular implant-supported overdenture opposing a maxillary conventional complete denture provides significant improvement in the masticatory performance compared to the conventional upper and lower complete dentures for a limited population having persistent functional problems due to severely resorbed mandible . After implant treatment , patients report high levels of satisfaction regarding various aspects of their denture function and they are more satisfied than patients with similar problems who receive a
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conventional denture without implant support . Lindquist & Carlsson 50 , 51 found that treatment with implant-supported fixed prostheses , generated a significant improvement of the patients ’ assessment of their chewing ability , and of the results of chewing tests ( particle size reduction and masticatory force ). While implant-supported / retained prostheses demonstrated superiority in terms of retention , stability and patient acceptance , especially with fixed restorations , their cost remains prohibitive for a large majority of edentulous patients . During the past decades , using a reduced number of implants was proposed in order to provide the most value for money in such cases , and possibly define a standard of care . The McGill consensus statement proposed a standard of care for edentulous patients , including a maxillary conventional complete denture opposing a 2 implant overdenture . 15 The said standard was
Review Articles
Stomatology Edu Journal
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