The primary consideration for patients seeking prosthetic
treatment with missing anterior teeth is esthetics. The size and form of the
maxillary anterior teeth are of importance to both dental and facial aesthetics
(Vasantha Kumar et al, 2011). Several methods are available for the selection
of anterior teeth. Historically, it started with anthropometric measurements
such as the bizygomatic width, inter-alar distance, etc., and later advanced to
typal form theory, Berry’s biometric ratio method, Wright’s photometric method,
etc. (Chander, 2021).
In the present day, a variety of shade guides, mold sizes
and measurements are provided by the manufacturers to help aid the clinician in
selecting the anterior teeth. The patients cannot visualize the final outcome
of their dentures using these methods. Digital dentistry helps the patients in
viewing the final outcome of their dentures during a digital trial
registration. This method is quite expensive and may not be feasible in
developing countries (Varghese, 2022). The most common method used is the arbitrary selection of
anterior teeth with the help of mold sizes based on the patient’s opinion and
clinician’s experience. It is time-consuming to attach the different molds of
acrylic teeth on the occlusion rims by trial and error. In
a study conducted by LaVere, it was found that the anterior teeth sizes used in
dentures were smaller than the natural teeth sizes. (LaVere et al, 1994 and
Ceruti et al, 2013).
In a randomized case control clinical trial, a new
inexpensive method of anterior teeth selection was evaluated. With the help of
adhesive paper teeth (Major Moncalieri) available in all mold sizes and shapes,
the patients could visualize the final outcome comparatively better than the
arbitrary method. The adhesive plasticized papers of different teeth could be
placed together or separately. This allowed customization and is an advantage
of this new technique. The disadvantage is the necessity of remounting due to
operator error in attaching the adhesive teeth to the rims (Ceruti, 2013). A new technique of using life-size coloured print of teeth
molds has been developed. This helps the patients in the visualization of the
aesthetics of their final dentures. A major drawback was that the teeth could
not be arranged individually and the visibility of the background colour of the
denture base beyond the incisal edges of the teeth make it unaesthetic
(Varghese, 2022). There
are not many studies evaluating the patients’ satisfaction of the denture
esthetics related to the teeth size. In order to overcome the drawbacks of the
previous studies, a novel three-dimensional esthetic dental strip was designed
to help the patients visualize the final esthetic outcome of their
dentures. Research
Question: Is there any change in the patients’ satisfaction of denture
esthetics related to teeth size when the maxillary anterior teeth are selected
using novel esthetic strips or the conventional methods?
Null
Hypothesis: There is no change in the patients’ satisfaction of denture
esthetics related to teeth size when the maxillary anterior teeth are selected
using novel esthetic strips or the conventional methods.
Aim:
To
compare the patient satisfaction related to teeth size when the denture teeth
are selected using the novel esthetic strips or by a conventional method.
Objectives:
1. To
design and develop novel esthetic strips from the commonly used acrylic denture
teeth moulds
2. To
select the teeth size for edentulous patients with the help of the novel
esthetic strips and by a conventional method
3. To
compare the patient satisfaction related to the size of the artificial teeth
when the denture teeth are selected using either of the two methods Sample size determination: The sample size was estimated using the
G power software v.3.1.9.2. Analysis: A
priori: Compute required sample size Input: Tail(s) = Two Effect size d = 0.7 α err prob = 0.05 Power (1-β err prob) = 0.85 Allocation ratio N2/N1 = 1 Output: Noncentrality parameter δ = 2.7559028 Critical t = 1.6706489
Df = 60 Sample size group 1 = 31 Sample
size group 2 = 31 Total
sample size = 62 Considering the effective size to
be measured (d) at 0.7, power of the study at 85% and the margin of error at
5%, the total sample size needed is 62. The total sample size is divided into
two groups. Each group will consist of 31 samples (31x2 = 62 samples). Methodology for objective 1: The average sizes of the artificial teeth will be determined based on a
cross-sectional survey measuring the natural anterior teeth sizes amongst
people aged more than 45 years old. The commonly used acrylic maxillary
anterior teeth corresponding to the sizes commonly used in the institution will
be selected for both the genders. These acrylic teeth are then trimmed to a
thin shell measuring 1.5 mm in thickness. The sizes selected based on the survey are ArcyRock size 13,15,18 and 32; and Premadent sizes S1, M2, N2, A26. The novel esthetic strip will be
formed by attaching the thin shells of acrylic to a tissue tape with a
thickness of 0.05 mm. Methodology for objective 2: The patients will be randomly divided into two groups. For one group, the novel esthetic strips will be used for teeth selection. These strips are attached to the maxillary occlusion rim during the jaw relations appointment to aid teeth selection. Multiple strips can be tried until the patient and the clinician reach a mutual agreement. For the other group of patients, the anterior maxillary teeth will be slected based on a conventional method. This involves arbitrarily selecting anterior teeth with the help of teeth mold sizes based on the width of the ala of the nose which is equivalent to the inter-canine tip distances (Attokoran et al, 2018 and Pisulkar et al, 2022). Methodology for objective 3: A patient
satisfaction questionnaire related to the teeth size be designed and based
on a five-point Likert scale with points ranging from 0 to 4. The lowest point
will indicate the worst satisfaction while the highest point will indicate the
best satisfaction (0 – very dissatisfied, 1 – dissatisfied, 2 – neither
dissatisfied nor satisfied, 3 – satisfied, 4 – very satisfied) (Anastassiadou et al, 2004 and Ahmed et
al, 2019). The questionnaire will
be filled by both the groups of patients during jaw relations and after the
insertion of the dentures. Planned statistical analyses:
Statistical package for social sciences (SPSS) for windows version
21.0 released 2021, Armonk NY, IBM Corp was used to analysis the data.
Independent sample T test will be used to compare the mean patient
satisfaction scores using conventional method and novel esthetic strips after
jaw relation and insertion of complete denture.
Chi square test will be applied to compare the proportions of patient
satisfaction scores between using the conventional method and novel esthetic
strips after Jaw relation and after insertion of the complete denture.
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