Purpose: The Japan Prosthodontic Society has presented a classification system for teeth defects, and partial and complete edentulism. The classification system consists of two major sections and four divisions. Within each division there are four levels, which relate to degree of difficulty of treatment: Level I: ideal or minimally compromised; Level II: moderately compromised; Level III: substantially compromised; and Level IV: severely compromised. The purpose of this study was to evaluate the effects of the clinician's experience and the classification of degree of difficulty on chair time required for complete denture treatment by conducting a self-assessment survey of dentists. Methods: A questionnaire relating to clinician's experience (prosthodontic specialist certified or not) and the chair time required for each step of complete denture treatment was sent by post to clinicians. Results: The questionnaire was answered by 311 clinicians from 14 universities. Higher levels of difficulty required greatly increased chair time, whereas the treatment fee/hour decreased greatly. In addition, chair time required by prosthodontic specialist was short; however, chair time increased with higher levels of difficulty. Conclusion: Chair time and treatment number required by prosthodontic specialists (certified by Japan Prosthodontic Society) were shorter than those appertaining to non-prosthodontic specialist. However, chair time increased with Level III and Level IV by prosthodontic specialist.
Purpose: Mouthguards are available to provide protection from stomatognathic injury during sports. The aim of this study was to examine the thickness of each part of mouthguard sheet depending on the thickness of mouthguard sheet material. Methods: Cross stripes (10 × 10 mm) were printed in mouthguard sheets. We measured the thickness of each cross stripe area using a measuring-device®. Two mouthguard sheet materials were compared. The thickness of the mouthguard sheet materials were 2 and 4 mm. The difference in the thickness of the two mouthguard sheet materials was analyzed by Wilcoxon signed-rank test and t-test. Additionally, the relationship between the elongation and the thickness of the mouthguard sheets was investigated by regression analysis. Results: All parts of the sheet mounted on the cast decreased the thickness. The changes of the thickness in each part of mouthguard sheet were similar in both the 2-mm sheets and 4-mm sheets. In addition, the ratio of changes of the thickness in the part of the sheet fitted to the anterior teeth and palate on the 2-mm sheets was greater than that of the 4-mm sheets (p < 0.01). There was no statistically significant difference between the thicknesses of the sheet on the posterior teeth. The relationship between the elongation and the thickness of mouthguard sheet was modeled by quadratic equation. Conclusions: This study suggests that the ratio of changes of the thickness of the part of the sheet fitted to the anterior teeth and palate on the 2-mm sheets was greater than that of the 4-mm sheets. Furthermore the ratio of changes of the thickness of the part of the sheet fitted to the posterior teeth did not differ between the 2-mm and the 4-mm sheets.
Purpose: To assess whether body movement accompanying jaw movement exists even in sitting position, and, if so, to investigate differences of body movements in the sitting and standing positions. Method: The subjects were six men (age, 25-29 years, mean, 27.0 years) without stomatognathic problems. During the measurements, their Camper's planes were kept horizontal. One measurement sequence consisted of 20 s of tapping preceded and followed by 10 s of intercuspation. Mandibular movements (lower incisor point) were measured by referring to a coordinate system located on the maxilla, and head movements (upper incisor, condyle, etc) with TRIMETII (Tokyo Sizaisya) and body movements (sternum point) in sagittal plane were measured by referring to a coordinate system located on the floor with Proreflex (Qualisys). Results: Body movements accompanying jaw movements were detected even in sitting position. The ratio of body movements to jaw movements was significantly larger in standing position than in sitting position using Wilcoxon matched-pairs signed-rank test. Peak power of body movement at corresponding frequency to the open-close movement was significantly larger in standing position than in sitting position using Wilcoxon matched-pairs signed-rank test. On the other hand, there was no difference between sitting and standing position in probability of body movement detection by the original wave analysis using Wilcoxon matched-pairs signed-rank test. Conclusion: Body movements accompanying jaw movements were detected even in sitting position, and were smaller than in standing position. However, the probability of movements detected in original wave had no difference between the positions. Thus we concluded that we can analyze body movements during mastication in natural sitting position.
Purpose: The purpose of this study was to clarify the effect of different chewing rates on salivary cortisol levels as a stress indicator. Methods: The subject group consisted of 16 healthy males. They were required to rest for 30 min, and then given arithmetic calculations to perform for 30 min as stress loading. Immediately after, the first set of saliva specimens (S1) was collected over a period of 1 min to measure cortisol levels. Next, they were asked to chew a tasteless gum base for 10 min, and the second set of saliva specimens (S2) was collected in the same manner. They were then required to rest for 10 min, after which the third set of saliva specimens (S3) was collected. Chewing rates were set to slow, habitual, and fast in time with a metronome. Salivary cortisol levels were analyzed by radioimmunoassay. Changes in salivary cortisol levels comparing S1 with S2, and S1 with S3 were determined. Results: Changes in salivary cortisol levels between S1 and S2 showed a reduction of 4.7%, 14.6%, and 16.2% with slow, habitual, and fast chewing, respectively. A significant difference was observed between slow and fast chewing. Changes in salivary cortisol levels between S1 and S3 showed a reduction of 14.4%, 22.2%, and 25.8% with slow, habitual, and fast chewing, respectively. A significant difference was observed between slow and fast chewing. Conclusion: This study showed that differences in chewing rate affected salivary cortisol levels as a stress indicator, and suggested that the effect on stress release with fast chewing is greater than that with slow chewing.
Purpose: The purpose of this study was to investigate the influence of mandibular residual ridge shape on the masticatory ability in complete denture wearers. Methods: The subject group consisted of 199 complete denture wearers. The mandibular residual ridge of each subject was evaluated using a replica of the ridge which was obtained with heavy-body silicone impression material. The basal area of each replica was measured with a digitizer. The volume and the height of each replica were also calculated. The masticatory ability of each subject was evaluated using a-25-item food intake questionnaire method by authors. The masticatory score of each subject was calculated to represent the masticatory ability. Furthermore, all subjects were divided into three groups (S, M, L group) according to the value of the basal area. Results: There were statistically significant correlations between the basal area of the residual ridge and the masticatory score (r = 0.366, p < 0.01), and also the volume of the residual ridge and the masticatory score (r = 0.314, p < 0.01). The basal area of the residual ridge, the volume of the residual ridge, and the masticatory score of the L group (29 persons) were statistically larger than those of the M group (136 persons) and the S group (34 persons) (p < 0.05), and those values in the M group were statistically larger than those of the S group (p < 0.05). Conclusion: It was confirmed that the basal area of denture foundation of the mandible had an influence on the masticatory ability in complete denture wearers.
Purpose: Neck pain is one of the main symptoms of temporomandibular disorder. Muscle activity of the sternocleidomastoid muscle during occlusion has been clarified in recent years. We reported that when healthy individuals were instructed to chew rapidly, the activity of the sternocleidomastoid muscle responded to activity of the masseter muscle, however, during voluntary jaw opening, activity of the sternocleidomastoid muscle did not respond, but worked actively due to motor programming. The objective of the present study was to investigate the learning effects of repetitive training, that is, changes in activity mode of the neuromuscular system. Materials and Methods: The sternocleidomastoid and the anterior belly of digastric muscles in 8 healthy male adults were analyzed. In response to acoustic stimulation, each subject was instructed to open their mouth as quickly and widely as possible a total of 30 times with a break between measurements. EMG-reaction times (RT) of the sternocleidomastoid and anterior belly of digastric muscles were measured, and the length of time from the start of EMG activity of agonist to the start of actual movement was measured. Results: In all subjects, at first measurement, EMG-RT of the sternocleidomastoid muscle did not precede that of the anterior belly of digastric muscle. With each measurement, the difference in EMG-RT between the sternocleidomastoid and the anterior belly of digastric muscles decreased, and in 6 of the 8 subjects, EMG-RT of the sternocleidomastoid muscle preceded that of the anterior belly of digastric muscle. Conclusion: Repetitive task movement alters the start times of muscular activities, and from the perspective of EMG kinesiology, motor learning effects were confirmed with maximum ballistic voluntary jaw opening.
Purpose: The purpose of this study was to investigate the ion release from titanium casts in solutions of mixed organic acids and to reconsider the possibility of allergic reactions to titanium. Methods: Cast specimens were made from commercially pure titanium. For the immersion solutions, we prepared two types of organic acid solutions, one mixed with organic acids contained in whole stimulated saliva at two different dilutions, and the other, a lactic acid solution. Following immersion, the amounts of dissolved titanium ions, weight loss of the casts, and micrographs of the specimen surfaces were examined. Results: There were significantly larger amounts of dissolved titanium ions in the mixed organic acid solutions than in the lactic acid solution. There was also a significant difference in the weight loss values between the immersion solutions (p < 0.0001), but the significance level was different from that of the difference in the quantity of ion elution. Conclusion: The results suggested that a much larger quantity of ions is released from titanium casts attached in the oral cavity than has been reported previously, and that it is necessary to consider the possibility of allergic reactions to titanium casts.
Purpose: The purpose of this study was to establish an evaluation method using a Nasometer, with several monosyllabic test words, to reveal the level of air leakage in maxillectomy patients without limitations due to language or ability to read. Methods: 20 normal Japanese (Group 1) and 20 international adults (Group 2), were asked to read 7 monosyllables, (5 vowels and 2 combined vowels, /a/, /i/, /u/, /e/, /o/, /am/, /aj/), 6 times each and 12 Japanese maxillectomy patients (Group 3) were asked to read only 3 monosyllables (/a/, /am/, /aj/) 6 times each. The “Nasalance Score” was calculated using a Nasometer (Nasometer II, model 6400 KayPentax, Lincoln Park, NJ, USA). Results: Coefficient of variations (CVs) of three monosyllables /a/, /am/, /aj/ of Group 1 and Group 2 showed less than 0.33. There is significant difference in all pairs of three monosyllables between Group 1 and Group 3 (p < 0.05). Conclusion: Using a Nasometer, these three monosyllables, /a/, /am/ and /aj/, could be used as standard test words and could reveal the level of air leakage in maxillectomy patients.
Purpose: This study evaluated the masticatory side as well as which side was the habitual chewing side by the use of wax cubes and a bite force measuring system in normal dentate subjects (ND) and complete denture wearers (CD). Methods: Forty two ND subjects (29 males, 13 females; mean age, 24.8 ± 2.4 years), and 11 CD subjects (4 males, 7 females; mean age, 72.8 ± 7.0 years) participated in the study. The test food used in this study was wax cubes to determine the masticatory side. The difference in the occlusal contact area and occlusal force between the masticatory side and the opposite side was investigated using Dental Prescale®. ND was classified into 2 groups: those whose agreement on the masticatory part was high (ND-H) or low (ND-L). The distribution of the center of the occlusal balance was analyzed by Dental Prescale® in ND-H, ND-L, and CD. Results: The occlusal contact area and occlusal force of the masticatory side was greater than the opposite one, and the center of the occlusal balance was wide in ND-H. In ND-L and CD, the occlusal contact area and occlusal force did not differ between the masticatory side and the opposite one, and the center of the occlusal balance developed a tendency to gather in the center. Conclusion: The results of this study suggested that the evaluation of the masticatory side and the use of Dental Prescale were helpful in determining the habitual chewing side.
Purpose: Hard resins for crowns and bridges are widely used for esthetic restorations. The objective of this study was to evaluate the mechanical properties of new commercial hard resins and to compare the results with those of the other hard resins previously investigated. Methods: Dentin and enamel made with two new hard resins (Epricord®: EP, Kuraray, Co., Ltd., Osaka, Japan and Prossimo®: PR, GC, Co., Ltd., Tokyo, Japan) were used in this study. Regarding the fundamental characteristics, the thermal expansion/shrinkage coefficient, the filler content, the polymerization shrinkage, and the wear were examined. Regarding the strength of resin, the bending strength, hardness, compression strength, elastic modulus, and fracture strength of a jacket crown were measured. Results: These resins showed comparatively lower levels than the other hard resins regarding the bending strength, hardness, compression strength, and fracture strength of the jacket crown. The total filler content rate and wear amount of these resins exhibited similar values to those of the other resins. The thermal expansion/shrinkage coefficients of these resins exhibited higher values than those of the other resins. EP showed a different tendency from PR about the compression strength, elastic modulus, and polymerization shrinkage. Conclusions: PR and EP did not show dramatically better physical properties. However, the results of each examination in this study may be acceptable clinically. The results of each investigation changed according to the products used, and proper use for each case and application was suggested.
Purpose: The aim of this study was to develop a means of coordinating helical computed tomography (CT)—based morphological data in 3 dimensions (3-D) with that pertaining to jaw movement as recorded by a device that measures jaw movement in six-degrees-of-freedom (6-DOF), thus producing multi-point movement analysis of the condyle. Methods: The study sample was two volunteers. One of the subjects had erosive bony changes in both condyles, while the other had healthy condyles. We employed a customized facebow, which enabled us to coordinate jaw movement data and morphological volume data from CT. Total uncertainty of the coordination was computed, according to International Organization for Standardization (ISO). In order to demonstrate the effects of multi-point analysis for complex condylar movement, we tried to visualize the trajectory of the working condyle in lateral excursion. Results: The overall uncertainty at a condylar center chosen as an example to illustrate the method was 0.38 mm, 0.19 mm, and 0.50 mm in antero-posterior, latero-medial, and supero-inferior directions, respectively, in terms of 95% coverage as defined by the ISO. Conclusion: We developed facebow-based X-ray markers with high clinical operability, which could correlate the helical CT's coordinate system with our 6-DOF jaw movement measuring system for precise analysis of 3-D condylar movements. In motion analysis of rotational condyle, even a small amount of measurement error cannot necessarily be neglected. Then, a multi-point approach such as that realized by our system presents the best option.
Purpose: The aim of this study was to investigate the relationship between medicine and stimulated saliva and oral moisture. Methods: Fourteen patients with subjective oral dryness and 13 healthy adults were enrolled in this study. Disease, medicine, and medicines that had a side effect of oral dryness were investigated. The Saxon test was performed by chewing a piece of gauze sponge for 2 min. Oral moisture was measured at the lingual and buccal mucosa using an oral moisture checking device. Statistical analysis was performed by the Mann-Whitney U-test and Student t-test. Results: Stimulated saliva and oral moisture did not differ according to the number of diseases. Oral moisture at lingual mucosa was different between a minor medicine group (0-2 types of medicine) (31.3 ± 1.9%) and a major medicine group (≥3 types of medicine) (29.5 ± 2.2%) (p = 0.05). Oral moisture differed between a group not taking any medicine that had a side effect of oral dryness (31.2 ± 1.8% at lingual mucosa and 33.8 ± 1.4% at buccal mucosa) and a group taking such medicine (29.3 ± 2.3% at lingual mucosa and 32.4 ± 1.8% at buccal mucosa) (p < 0.05). Conclusion: The results of this study showed that oral moisture tended to decrease in the subjects who took many types of medicine or who took medicine that had a side effect of oral dryness. The medicine did not influence the amount of stimulated saliva. Therefore, it was suggested that medicine could influence the moisture of the oral mucosa.
Purpose: The aim of this study was to investigate the factors influencing the outcome of prostheses on speech rehabilitation of mandibulectomy patients. Methods: Eleven patients (6 males and 5 females) who underwent mandibulectomy without glossectomy because of a tumor participated in the study. A Speech Intelligibility (SI) test was applied without and with a prosthesis to evaluate their speech ability. The type of resection, whether soft tissue grafting was undertaken or not, the continuity of mandibular bone, and the number of remaining teeth related to the stability of the prosthesis were determined from the medical records. The some of acoustic features, Formant 1 and Formant 2 range, were investigated to evaluate objectively the limitation of tongue movement. Five questionnaires were sent out to evaluate subjectively the difference in sense of discomfort while speaking with and without the prosthesis. These eleven items were entered into stepwise multiple regression models to determine the predictors of the differences in SI score without and with a prosthesis. Results: Three variables, the ease of tongue movements, whether soft tissue grafting was undertaken or not, and whether the mandibular bone was continuous or not, contributed to the recovery of speech ability with prosthodontic treatment. Conclusion: The ease of tongue movement, no soft tissue grafting, and the continuity of mandibular bone contribute to the recovery of speech ability with prosthodontic treatment.
Purpose: The riegel and swing-lock® attachments are excellent retainers in terms of secure retention, but the former requires a great volume of abutment tooth reduction and the latter has problems with aesthetics and abrasion. In contrast, the RPI and RPA clasps have been highly appreciated as excellent retainers for abutment tooth protection, but any retentive forces are needed. Thus, the purpose of the study is to design a retainer that made the use of these merits. Methods: The form of the retainer (named Suginaka Riegel® lock retainer) for this purpose is based on the RPPA, for which a lingual arm is provided. In applying this technique, the buccal arm corresponding to the Akers-type buccal arm in the RPPA utilizes the undercut area below the survey line, ranging from the distal to the mesial corner. This buccal arm extends from the metal tooth that turns the hinge placed in the buccal denture border. The Suginaka Riegel® device placed in the denture base locks the metal tooth in place. Results: Utilizing the deeper undercut below the survey line provides secure retention while eliminating the risk of adverse forces being exerted on the abutment tooth during denture function or insertion and removal. Conclusion: This new, additional form of the Suginaka Riegel® lock denture allows the abutment tooth to provide latch effect-derived retention solely by preparation of the rest seat and guide plane. This allows use on a healthy tooth and on a tooth for which prosthodontic treatment has already been completed.
Patient: An 83-year-old woman visited the hospital for new complete dentures. A mesh type stainless palatal plate (Trutissu plate) was selected, because it enables the patient to experience the taste and temperature of food. Twenty one months after insertion, the patient returned complaining of pain on mucosa under the mandibular denture base. On clinical examination, a small swollen area was observed on the palatine rugae region of the mesh plate. By making a small hole in the swollen part, a creamy mass of dark brown color was discharged from the swollen space between the laminated structure of the Trutissu plate. Three months after the first deformation was corrected, further deformation of the Trutissu plate was observed. The patient admitted that she had not used the ultrasonic cleansing apparatus. A candidiasis-like lesion was observed on the palatal mucosa. Discussion: The formation of Candida biofilms on dentures may assist survival of fungal cells and contribute to the disease process in patients with denture stomatitis. In this case, the patient did not use ultrasonic cleaner, thus resulting in microbial accumulation and morphological change of the laminated mesh plate. However, this is rare in the clinical use of the Trutissu mesh plate, and the only case reported in 20 years. Ultrasonic cleansing was effective in removing microorganisms from the denture. Conclusion: Routine ultrasonic cleansing should be performed to avoid the possible accumulation of microorganisms in the laminated mesh structure.
Patient: A 58-year-old man with a complaint of masticatory disturbance presented. His mandibular left premolars and molars were missing, and the mandibular left canine, which was neighboring to the missing part, showed marked labial tipping. A cobalt-chromium removable partial denture was fabricated using a new magnetic attachment retainer because it seemed difficult to apply a conventional clasp for this case. This retainer is constructed from the buccal hook arm sliding bucco-lingually and the magnetic attachment which works to lock the movable part when it was closed. Six years after the delivery of this denture, both the abutment tooth and the periodontal tissue are healthy, and the denture is functioning well. Discussion: As this retainer does not use the elasticity of clasp arms, block out area can be minimized, and the maximum area of the contacting surface of the hook arm brings about very positive retention and bracing. The function of attractive force is to resist the splitting force and not to become directly involved in the retention of the denture. Therefore, the attractive force for this system does not need to be very strong. This system also provides the advantages of a sectional denture, allowing protection of the abutment tooth and the use of the abutment tooth in its original form. Conclusion: The retainer described in this report has many advantages including, no hazardous lateral force, adequate retentive force, and application to natural teeth or tipped teeth.
Patient: A 71-year-old woman came to our clinic complaining of discomfort and esthetic problem of upper and lower anterior region caused by implants inserted in inappropriate positions. For this case implant-retained removable dentures with telescope crowns and magnet attachments were applied. The patient was followed for > 5 years without any problems. Discussion: Telescope crown may cause excessive stress for implants; however, in this case adequate maintenance including adjustments of occlusion and the fitness of denture base may have contributed to the long-time success. Conclusion: Problems caused by implants inserted in inappropriate positions were overcome using implant-retained removable dentures with both telescope crowns and magnet attachments.
Patient: The patient was a 46-year-old woman who complained of masticatory dysfunction with bilateral lower free end missing. At first, she wanted to receive dental implants, but she was afraid of undergoing surgery for implant insertion. Therefore she had taken an immediate removable partial denture. However, she was not satisfied with this denture on her requirements of retention, stability, and aesthetics. Considering this situation, we applied her cone crown telescopic denture. Discussion: The new cone crown telescopic denture has an excellent prognosis for the long-term. This denture, which has a rigid support design with adequate diagnosis, was indispensable to obtain such a fine result. Conclusion: It is suggested that the cone crown telescopic denture was the best selection for the prosthetic treatment of this patient. Repeated maintenance of the denture and regular examination of periodontal tissue will be necessary to keep the good prognosis.
Patient: A 71-year-old man complained of articulation disorder caused by poor retention of the upper and lower complete dentures. Both maxillary and mandibular residual ridges showed severe resorption. The dentures had short base borders and poor retentions, and were sway with mandibular functional movement. First, I planned to improve the retention and mandibular position of his dentures by repairing his dentures. When I confirmed to make a good retention and an appropriate mandibular position, I started to make new dentures, and then set them. Discussion: Evaluation before and after treatment showed recovery of articular function. The new denture, which has suitable tongue space, made the tongue movement area during speaking wider. This might result from the patient acclimatizing to a new condition. Conclusion: New dentures showing stable retention and good articular function were not sway during functioning or articulation, and the patients articulation became clear.
Patient: The patient was a 50-year-old woman who complained of left temporomandibular joint pain during mastication and wide mouth opening. The diagnosis of this patient was bilateral osteoarthritis in temporomandibular joint; therefore maxillary full-arch stabilization appliance (SA) was delivered. In response, the TMD signs and symptoms were alleviated. However she subsequently complained of dysfunction of mastication due to anterior and posterior open bite. Sometime thereafter, after applying SA and provisional adhesion onlay, occlusal reconstruction was performed by means of porcelain direct-bonding onlay. Discussion: After 6 years follow-up, there were no failure finding on the porcelain direct-bonding onlay, no occlusal alteration, and no complaint of TMD signs and symptoms. Conclusion: This direct-bonding adhesion prosthetic approach contributed not only to prevent aggravation of osteoarthritis but also to elevate QOL of this patient.
Patient: A 62-year-old male patient visited our clinic with a chief complaint of chewing difficulty due to pain of the left lower molar. To relieve the pain, the second premolar with root fracture was extracted. Implant-supported fixed prostheses were selected for bilateral free-end space. Full-arch provisional restorations were used with monitoring the balance of occlusal force. Final prostheses were converted in May 2002. Discussion: It was suggested that the careful monitoring of occlusal balance by means of provisional restoration was one of the important factors for successful occlusal reconstruction. Conclusion: Even for patients with a history of Para function or tooth fracture, dental implant treatment of bilateral free-end space was indicated feasible for recovery of occlusal support and protection of remaining teeth on condition that the prostheses were very carefully designed.
Patient: A 74-year-old woman visited our hospital with a chief complaint of masticatory dysfunction due to upper left molar denture breakage and poor retention of upper and lower dentures. The cause of the denture breakage was a lack of clearance, and that of denture instability was the unilateral design in the upper jaw, and breakage of the indirect retainer in the lower jaw. The treatment plan was set to securing the denture strength and bracing via a bilateral design. Discussion: Stability was improved by bilateral design. Ensuring clearance and subsequent place on the dentures may have secured the strength. Conclusion: The ability of mastication was improved by the new dentures. Regarding the strength, no breakage of the dentures occurred during the follow-up period, indicating that prosthetic treatment was appropriate.
Patient: A 58-year-old woman presented with a chief complaint of masticatory dysfunction caused by the missing of lower right molars and the detachment of fixed partial denture at the upper right molar region. For this case, implant-retained fixed partial denture with hybrid ceramics facing cast crowns for lower right molar region and conventional fixed partial denture for upper right molar region, considering both the secondary caries and the extrusion of upper right second molar, were fabricated. The patient was followed for > 4 years after treatment, and separation between mandibular implant prosthesis and the lower right second premolar was observed during the follow-up period. The interdental separation was treated by refabrication of the prosthesis of the second premolar. Discussion: Physical teeth movement may cause separation between natural tooth and implant-retained prosthesis. Conclusion: Functional problems caused by the loss of occlusal support were successfully rehabilitated using implant-retained fixed partial denture.
Patient: The patient was a 75-year-old woman who underwent maxillary bone resection due to maxillary left gingival carcinoma. The treatment denture for defected jaw was applied, and adjustment was done several times. Thereafter, the final denture for defected jaw was inserted. Discussion: We applied the hollow-type obturator for the treatment denture for defected jaw. Because we considered that adjustment of the hollow-type obturator was easier than buccal flange type because of the patient's deficient ability of mouth opening. Adjustment was done several times; theseafter, the final denture of which the obturator was buccal flange type, was applied for optimal fitting. Conclusion: It was important to select a suitable form of the obturator acceptable to the condition of the patient.
Patient: The patient was a 63-year-old man with a chief complaint of dysmasesis. Following occlusal reconstruction and periodontal treatment, a complete denture and fixed partial denture with indirect composite resin were implanted in the patient. Discussion: The results of this case show that regular check-up may be effective for coloration and discoloration. Conclusion: Indirect composite attached plaque to interdental space and pontic easily. However, combination use of toothbrush and sonic brush could improve oral health. The patient was satisfied with the fun ction and the dental esthetic.