5th International Vilnius Conference

EURO Mini Conference Knowledge-Based Technologies and OR Methodologies for Strategic Decisions of Sustainable Development (KORSD-2009) September 30October 3, 2009, Vilnius, LITHUANIA

ISBN 978-9955-28-482-6 M. Grasserbauer, L. Sakalauskas, E. K. Zavadskas (Eds.): KORSD-2009 Selected papers. Vilnius, 2009, pp. 278283
Institute of Mathematics and Informatics, 2009 Vilnius Gediminas Technical University, 2009

Elena-Gabriela Despa1, Cornelia Bcleanu2, Gabriela Moise3

1, 2, 3

The Clinical and Statistic Study Model of Total Edentulous Prosthetic Field
Faculty of Dentistry, Titu Maiorescu University, 67.A, Ghe. Petrascu st., Bucharest, Romania E-mail: 1gabidespa@gmail.com

Abstract: The clinical study model of edentulous prosthetic field show favorable and unfavorable elements and arguments for a full denture depending on the etiological factor. Material and method: The elements of the prosthetic field are individual at each patient (from de study group). This particularity has a positiv and negative influence upon the sustainable development stability and the bedding of the full denture. The statistic analysis model carried out on the two groups (first group-212 patients and the second group-294 pacients), has tried to establish similarities and/or differences between the clinical aspects studied, a correlation between the characteristics of the prosthetic fields totally edentulous and the examined patient. The synthesis of the studys result is absolutely necessary, allowing to emphasise the causative connections and mechanisms specific to the evolution of the totally edentuluous prosthetic field. Results and discussions: The socio-economic conditions are an important factor involved in the great variability of the shape and size of the osseous underlayer, but especially on morphological structures represented by mucous-periosteum.. Conclusions: The statistic and clinical study model has proved that each totally edentuluos prosthetic field is unique, being influenced by the socio-economical standard, cultural conditions and hygienic habits. Keywords: clinical study model, favorable and unfavorable elements of the totally edentulous prostetic field, medical statistical study, normal distribution curve, polynominal distribution.

Prosthetic fields distinguish the qualities of prosthesis, due to unadjustments they have a result at the soft tissues level (the support area and suction area), morpho-histological modifications (microscopic and macroscopic). From the this point of view ( of the examined and treated patients over the last 3 years), the clinical study can represent a documentary or teaching material useful in order to enrich the notions connected to prosthetic fields variability as it shall be presented hereinafter. The analyse model (clinical study) has pursued the following clinical aspects: characteristics of maxillary edentuous crests from the height, atrophy, width point of view; the depth of the palatal arch; existence or not of the torus palatinus; shape of the palatal arch; atrophy type; anterio-posterior size of the palatal arch; characteristics of the mucous underlayer; characteristics of the edentulous mandibular crest from the point of view of the symmetry, height, atrophy, direction to the sagittal plane, shape; characteristics of the piriformis tubercle: direction to the crest, volume. 278

Introduction

THE CLINICAL AND STATISTIC STUDY MODEL OF TOTAL EDENTULOUS PROSTHETIC FIELD

From the theoretical and practical point of view, these aspects have been described also by Romanian authors: Ene and Popovici, Hutu, Preoteasa, Puna, Bratu. The clinical study has required time, patience and observation wit, that have sustainable developed gradually so that all morpho-structural features specific to the patients observation moment to be noticed.

The clinical study model (analysis of the totally edentulous prosthetic fields) has been carried out for about 8 years, on 506 patients. In the next three years, the number of the totally edentuluos patients has increased a lot because of those who benefit from social assistance. These patience have no financial possibilities, which reflects in the hygiene of the prosthesis that they have owned for 510 years, repaired many times or transformed from partial to total prosthesis. The cases studied have been classified according to the shape, size, aspects (symmetricalasymmetrical) and structure of the mucous-periosteum depending on the determining causes as follows: cases with different shapes and sizes, very large or very small which are constitutional; cases with shapes and sizes acquired as a result of extractions or surgeries; cases with the mucous-periosteum aspects determined by iatrogenic prosthesis that caused lesions due to unadjustments (basal areas, mucous or occlusal observed surfaces, overlapping IM with RC). Sizes of the palatal arch have been also measured by Johnson D.L, Holt R.A, Duncanson J.R.M in 1986, study published in J.A.D.A and cited by Bratu in 2005. The mentioned author has accomplised the following measures of a batch of totally edentulous patients. In the first period (20002005), the batch consisted of 212 patients and was analysed separately, the casuistry was homogeneous and there were no obvious particularities to create exceptions, because the patients requested only prosthesis without any special problems. The patients in this batch had a good socio-economic status, with an adequate dentistry education, they were wearing prosthesis that were periodically changed every 34 years, at each small change felt at the teeth-maxillary apparatus level (mastication, physiognomy, fonation) they used to ask for a specialty examination. Patients in the second batch (20052008) amounting to 294, due to poor financial possibilities and due to the incorrect treatments, associated with the old age of prosthesis were remarkable cases, useful to the very purpose of the study of analysing the variety of prosthetic fields. This batch was extremely interesting because the following issues were noticed: the treatments undergone represented by total prosthesis, had clinical-technical deficiencies; prosthesis were old, on average 810 years, repaired many times, the material used was old; the local hygiene, especially at the prosthesis level, did not constitute for sure a concernt; prosthetic fields through the mucous-periosteum aspect were the consequence of the mucousal and occlusal adjustment faults. The analysis model was carried out on the two batches (different as number of patients), trying to find similarities and/or differences in the studied clinical aspects, a correlation between the characteristics of the prosthetic field totally edentulous and the examined patient. The statistical analysis model begins by checking the theoretical aspects of the study, pointing out the structure and dynamics of the evolution of the totally edentulos prosthetic field characteristics. It was pursed to show the functional connections of causality, appearance rate and development, concentration or dispersal of certain characteristics of the totally edentulous prosthetic field. Within the analysis model the accuracy and efficiency of the research methods used were checked, choosing adequate models to the specific problems. 279

Material and study method

E.-G. Despa, C. Bcleanu, G. Moise

The statistical analysis model used methods belonging to methematical statistics: averages, dispersal from averages, average error, standard deviation, correlation and regression of the obtained values, in order to compare the two batches as well as distribution on age, sex, etc. groups. The summary of the study results is absolutely necessary, allowing emphases of causal connections and specific evolution mechanisms of the totally edentulous prosthetic field. In the end, the statistical analysis and summary allow us a good practical application of the conclusions obtained by the study. Although the two batches are different as regards the number of examined patients, there were some similarities: total bimaxillary edentation was more frequent, one-maxillary edentations were in the upper jaw mostly, total edentation was more frequent in women, decay and its complications, as etiological factor appeared in more cases compared to parodontopathy. Increased frequency of total edentation in women compared to men was also quoted by Hutu (2005), subsequently by Bratu (2005). From the patients age point of view there were differences between the two batches: in the first batch, most patients were 6670 years old and in the second batch, most patients were 61 65 years old. This difference appeared as a result of different characteristics between the two batches. The patients in the first batch were extremely interested in prosthesis and in maintaining a healthy dental maxillary apparatus, having at the same time a higher socio-economical status; while the patients belonging to the second batch were a poorer cathegory, that had not had any medical constant treatments in order to allow them maintain a healthy dental maxillary apparatus state (socially assisted patients). The two batches were compared statistically by using the Fisher(9) test, resulting a calculated F of 2,510 compared to a chart F of 1,79. Because the calculated F > the chart F, we reject the null assumption H0, the two batches were different, unhomogeneous from the statistical point of view. This result corresponds to the unhomogeneous character of the two batches, the patients in the first batch having higher socio-economical and cultural conditions compared to the patients in the second batch. Within both batches the cases repartion on age groups curve was studied, being observed the correlation with the calculus in population tendency curve, the latter respecting the normal distribution. In case of batch 1, although there were differences in the number of patients divided on sexes, the distribution curve has no normal character (Gaussian), in both sexes, thing that was proved also by calculated tendencies curves (chart 1). Deviation from the normal distribution is again explained through the socio-economical status as well as through the high hygiene habits that estranged these patients from the natural total edentation evolution.
60 50 pac ients 'num bers 56

140 120 patients 'numbers 100 80 60 40 20 0 60 65 63 42 29 14 70 75 115

40 30 20 10 0 60

39 35

42

12 11 65 70 75

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Patients age

Chart 1 Patients age in batch 1

Chart 2 Patients age in batch 2

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THE CLINICAL AND STATISTIC STUDY MODEL OF TOTAL EDENTULOUS PROSTHETIC FIELD

In the case of batch 2, there are also differences regarding the number of patients reported on sexes, but the distribution curve has a normal character in both sexes, corresponding the descendant slant of the Gauss bell; the statement is confirmed by the remarkable correspondance between the measured curves and the tendency calculus curves (chart 2). This result suits the socio-economical, cultural status and poor hygienic-sanitation habits typical to the batch 2, total edentation evolving naturally under the action of the etio-pathogenic factors. In both batches the Fisher test was applied, in order to find out the differences significant from the statistical point of view between the females and males. Batch 1 showed a F calculated of 7,5086 compared to the chart F of 1,96 and batch 2 a F calculated of 6,623 compared to a chart F of 1,83. In both batches F calculated > chart F, thus we reject the null assumption H0 because the two batches had significant differences from the statistical point of view between the female edentulous patients and male ones, possible causes being coordinated to the beforementioned causes. Regarding the elements of the totally maxillary edentulous prosthetic field studied according to the clinical model it was noticed that: edentulous crest had more frequently the height of 56 mm in case of batch 1, and 34 mm in case of batch 2; from the atrophy point of view in both batches the crest was unevenly atrophied; from the width point of view, in batch 1 in most cases the crest was rounded and in batch 2 it was sharp; the palatal arch had a depth of 68 mm in case of batch 1 and of 35 mm in case of batch 2; from the atrophy point of view, there was a symmetrical one in case of patients belonging to batch 1 and asymmetrical in case of patients belonging to batch 2; regarding the shape, presence or lack of torus and anterio-posterior distance there were similarities although the number of studied fields was different between the two batches, thus the U shape of arch was rulling, without torus and an average anterio-posterior distance of 4 cm; maxillary tubercles in both batches were average as frequency, present; regarding the retension most frequently they were unilaterally retained. In both batches the statistical analysis of the anterio-posterior palatal arch dimension was realised and its repartition curve was studied. Charts 3 and 4 show a normal distribution, Gaussian type, because the anterio-posterior dimension of the palatal arch is the only parametre of the totally maxillary edentulous prosthetic field that did not undergo any changes as result of edentation, maintaining the normal morphology.
140 120
200 180

num bers of c as s e

100 80 60 40 20 0 3,5 4

pac ients 'num bers

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160 140 120 100 80 60 40 20 0 3,2

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42 23
4,5

37
3,7 4,2

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antero-pos terior dimens ion of the palatal arc h

antero-pos terios dimens ion of the palatal arc h

4,7

Chart 3 Anterior-posterior dimension of the palatal arch in batch 1

Chart 4 Anterior-posterior dimension of the alatal arch in batch 2

Another morphological element in the totally maxillary edentulous prosthetic field that underwent the statistical analysis model was the maxillary tubercle from the retention point of view. 281

E.-G. Despa, C. Bcleanu, G. Moise

Batch 1 was characterised by a normal distribution curve (chart 5), identical to that one belonging to dentuous patients. Maintaining this feature in totally edentulous patients in batch 1 is explained by maintaining the trophicity status of the mucous-osseous support through correct prosthesis (transmiting the masticatory pressures that favour osteogenesis according to Jores studies), the maxillary tubercle maintaining the role of posterior pillar, pterigomaxillary in the resistance structure of the viscero skull. But the statistical analysis of the distribution curve in batch 2 shows a polynominal type (chart 6), the maxillary tubercle having random modifications that estranges it from the normal morphology belonging to dentulous patients. These osseous modifications are determined by using of inadequate prosthesis, unstable on the prosthetic field that transmit masticatory pressures, which, according to Jores studies, trigger osseous resorptions.
100 90 80 70 60 50 40 30 20 10 0 0

93
n um bers of c as s e

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N u m b e rs o f c a s s e

116 76 36

41

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1 2 3 4

1
-3 -2 -1

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-3 -2 -1

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21

-2 = unfavourable; 0 = neutral; 3 = very favourable

-2 = unfavourable; 0 = neutral; 3 = very favourable

Chart 5 Retention type of maxillary tubercle in batch 1

Chart 6 Retention type of maxillary tubercle in batch 2

Examination of the elements of the totally edentulous mandibular prosthetic field reveals certain differences and similarities: in batch 1 in most cases the mandibular edentuous crest was symmetrical while in batch 2, it was asymmetrical; in both batches most frequently the edentulous crest had an average height, even if the two batches were different from the examined mandibular edentuous fields point of view; it is worth mentioning that in batch 2 there is a slight difference between the number of crests of average height and the negative ones; another similarity regards the direction of the crest in sagittal plane and the shape of the crest, in both batches most frequently appeared crests with horizontal direction and U shape; connected to the piriformis tubercle, in both batches there were most frequently horizontal tubercles and with an average volume (allowing prothesis).

Conclusions

The statistical study model pointed out in case of these batches, differences regarding the number of examined patients, but also certain differences and similarities. The morpho-clinical variable of the totally edentulous prosthetic fields was demonstrated through the different features of the two batches. Thus, patients in the first batch were characterised by prosthetic fields with specific morphological elements that allow prosthesis, and maintaining the mucous-osseous trophicity with keeping these elements is determined by correct, repeated prosthesis, with a very good hygiene (corresponding to the socio-economical status of the studied patients). Between the two batches there were some similarities but they are not conclusive, the batches being different as number of patients. The clinical and statistical study model has demonstrated that each 282

THE CLINICAL AND STATISTIC STUDY MODEL OF TOTAL EDENTULOUS PROSTHETIC FIELD

totally edentulous prosthetic field is unique in its own way, being charactetised by certain morphological elements specific to each patient, elements that can be influenced by the socioeconomical status, cultural conditions and hygiene habits.

References
Bratu, D. 2005. Clinic and Tehnic Base of the Total Edentulous Treatment. Medical Editure, Bucharest. Despa, E. G.; Ionescu, T. and Hutu, E. 2004. Clinical study about total edentulous prosthetic field (first part), Romanian Journal of Stomatology I(1): 3840. Despa, E. G.; Ionescu, T. and Hutu, E. 2004. Clinical study about total edentulous prosthetic field (second part), Romanian Journal of Stomatology I(23): 7980. Despa, E. G. 2008. The Results of the Clinical and Statistical Study of Totally Edentulous Prosthetic Field, Romanian Journal of Stomatology LIV(3): 202210. Ene, L. 1989. Total Edentulous. Universitare Editure, Bucharest. Hutu, E. 2005. Total Edentulous. National Editure, Bucharest. Pauna, M and Preoteasa, E. 2002. Practice aspect of the total edentulous treatment, Cerma Editure, Bucharest.

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