The quality of life for patients treated with immediate total dentures can be
   greatly improved, regardless of age. Modern achievements within the fields of
   medicine and stomatology do not cover the numerous contraindications when it
   comes to prosthetic recovery as a result of total immediate dentures.</jats:p

Lj. Dzambas

Sanja Gnjato

Z. Vukic

Archives of Biological Sciences

The quality of life for patients treated with immediate total dentures can be  greatly improved, regardless of age. Modern achievements within the fields of  medicine and stomatology do not cover the numerous contraindications when it  comes to prosthetic recovery as a result of total immediate dentures

Gnjato Sanja

Džambas Lj.

Vukić Z.

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Arch. Biol. Sci., Belgrade, 64 (3), 1141-1145, 2012 DOI:10.2298/ABS1203141D1141LIFE QUALITY OF THE ELDERLY WITH IMMEDIATE TOTAL DENTURESLJ. DŽAMBAS1, SANJA GNJATO² and Z. VUKIĆ2.1 Faculty of Medicine, Clinic of Dental Medicine of Vojvodina, 21000 Novi Sad, Serbia 2 Faculty of Medicine, Department of Stomatology, 78000 Banjaluka, Bosnia and HerzegovinaAbstract - The quality of life for patients treated with immediate total dentures can be greatly improved, regardless of age. Modern achievements within the fields of medicine and stomatology do not cover the numerous contraindications when it comes to prosthetic recovery as a result of total immediate dentures.Key words: Immediate total dentures, life qualityINTRODUCTIONAn immediate total denture is a total denture im-planted where there are still several natural teeth left, whether they are in the lower or upper jaw. Follow-ing the production of the immediate total denture in the dental laboratory and clinical testing in the prac-titioner’s office, the denture is applied to the patient immediately after the extraction of the teeth (Krstić et al., 1991; Branovački et al., 1980).Dental-prosthetic rehabilitation after the applica-tion of an immediate total denture aims at maximum function recovery, including the following: articula-tion, phonetics, masticatory function, aesthetics, as well as the psychological satisfaction of the patient. Nowadays, in the framework of modern practical medicine and stomatology (along with the use of di-agnostic and therapy approaches) many contraindi-cations, both absolute and relative, can be narrowed down to the point where dental prosthetic recovery with an immediate total denture is highly achievable. Certainly, the cooperation of experts and medical specialists  (internist-hematologist,  internist-endo-crinologist, and neurologist), an oral surgeon, pros-thetics stomatologist, and dental prosthetics techni-cian are an imperative. If this cooperation is good, success is inevitable (Zarb and Bolender, 2003).Indications for the production of an immediate  total denture•	 Patients	that	have	undergone	prosthetic	rehabili-tation by laminated acrylic denture•	 Patients	who	retain	habitual	occlusion,	i.e.	the	in-terjaw relation is preserved•	 Patients	suffering	from	a	hematologic	syndrome	•	 Patients	suffering	from	a	gastrointestinal	illness	•	 Patients	whose	teeth	residue	causes	focalosis•	 Patients	whose	teeth	are	in	a	terminal	stadium	of	parodontopathy•	 Remaining	teeth	that	do	not	meet	the	profession-al and functional demands of the patient1142 LJ. DŽAMBAS ET AL.•	 Remaining	teeth	do	not	meet	aesthetic	criteria	Absolute contraindications•	 Elderly	patients•	 Patients	suffering	from	malignant	diseases	of	the	stomatognathic system or some other malignant disease •	 Patients	with	severe	forms	of	undernourishment	(cachexia) with poor prospects of recovery•	 Patients	with	psychological	imbalances•	 Patients	clinically	proven	to	be	allergic	to	acryl	With regard to the modern way of life (stress, chronic diseases, and use of various types of drugs), we should also mention the following:Relative contraindications•	 Patients	suffering	from	cardiovascular	conditions•	 Patients	suffering	from	endocrine	conditions•	 Patients	suffering	from	a	hematologic	condition•	 Patients	suffering	from	an	acute	infection	illness	There are numerous positive and justifiable rea-sons for the implantation of an immediate total den-ture, i.e. when a denture is produced while there are still some teeth remaining in the oral cavity and the denture is placed into the cavity immediately upon the extraction of the existing teeth (Igić and Igić, 1998).Apart from all the functions mentioned above, such  orthodontic  dentures  have  a  preventive  role since	they	positively	affect	food	attrition,	the	gas-trointestinal system, acido-peptic activity and gastric secretion (Džambas et al., 1993). A well-made im-mediate  total  denture,  along  with  the  appropriate psychological preparation of the patient, can signifi-cantly improve a patient’s quality of life. Although the patient will not be able to smile immediately due to the pain and inconvenience, they will feel an in-ner gratification, which they will be able to share with friends and family shortly after the intervention (Džambas et al., 2005).AIMS AND METHODOLOGYOur  aim  was  to  demonstrate  how  oral-prosthetic rehabilitation in the elderly, using immediate total dentures, can have multiple benefits for the patients and should not be ‘exclusively’ used for younger pa-tients. The main goal was to bring such intervention closer to patients and thereby make the life quality of the elderly better and safer. The medical history of 126 patients aged between 65 and 75 and of both gender, was taken, in addition to a clinical examination and their personal practi-tioner’s approval (this is very relevant for chronic pa- Fig. 2 Teeth condition in the upper jawFig. 1 Chronic parodontopathy, terminal stadium of illness LIFE QUALITY OF THE ELDERLY WITH IMMEDIATE TOTAL DENTURES 1143tients and those using a basic condition therapy). In addition, interviews with the patients were held re-garding the process of prosthetic rehabilitation with an immediate total denture (Džambas et al., 2002). After  obtaining  the  written  approval  of  a  general practitioner or specialist, the immediate total den-tures were produced in line with the common pro-tocol, with a few minor deviations (Van Waas et al., 1993; Lavere and Krol, 1973). All 126 patients provided information regarding their physical condition. Some of the questions from the questionnaire were answered before rehabilita-tion, and the rest were answered once the procedure was completed. The questionnaire mostly referred to the quality of life before and after the immediate total denture was introduced (Džambas et al., 2007).RESULTSOur research has shown that with persistent use of the dentures, it took the patients around two months to get accustomed to wearing them. Many patients at this age (65 – 75) said they had not expected to get such high-quality dentures that would help them eat, smile and speak normally. They had been initially re-luctant to undergo the procedure due to the fact that their dentures were being made while they still had teeth in their mouth.More than 78% of the patients had regular checks with a prosthetic orthodontist. Only a few of them did not follow the instructions on the denture usage and hygiene. In essence, our approach to the production of immediate  total  dentures  was  according  to  stand-ard  procedure.  The  priority  was  our  patients  and their satisfaction was the greatest compliment to our work.Fig. 3 Upper jaw alveolar ridge immediately upon the teeth ex-tractionFig. 4. The immediate total denture was implanted right after the teeth were extracted   1144 LJ. DŽAMBAS ET AL.Reasons for not signing in earlier Patients No. PercentageThey thought their age was a limiting factor  98 77%Waiting for each tooth to be extracted separately  89 70.63%Fear of extracting all the teeth at once 115 91.26%Fear of their chronic conditions 76 60.31%They are using a regular therapy (chronic patients) 82 65.07%This type of denture made them: Patients No. Percentage Pleased 82 (65.07%)Partially	pleased 19  (15.08%)Displeased 25  (19.84%)Coming for denture corrections Patients No. Percentage After 24 hours (regularly) 126 (100%)Two or three times 82 (65.07%)More than three times 44 (34.92%)Patients said that the dentures made them feel Patients No. Percentage More comfortable 89 (70.63%)Increased their self-esteem 76 (60.31%)Younger 62 (49.20%)Safer among other people 75 (59.52%)More prone to smile 69 (54.76%)Improved social life (visiting friends) 93 (73.80%)They lost problems with Patients No. Percentage Chewing 84 (66.66%)Speech 79 (62.69%)Digestion 76 (60.31%)Solitude 68 (53.96%)Their life quality with immediate total denture has Patients No. Percentage Improved 89 (70.63%)Partially	improved 20 (15.87%)Not improved 17 (13.49%)Where and who do you live with Patients No. Percentage Alone in my home 47 (37.30%)With husband/wife/children 54 (42.85%)In nursing home 25 (19.84%)LIFE QUALITY OF THE ELDERLY WITH IMMEDIATE TOTAL DENTURES 1145CONCLUSIONWhen we first chose elderly patients (aged 65 and above) for the application of immediate total den-tures, we expected some reluctance on their part as we were usually asked questions such as what type of dentures these were or would they function properly. On the other hand, upon the completion of  the  recovery  process  (not  immediately,  but  a few days later) most of our patients, regardless of gender, were evidently happy. Most of them said they would have applied for this procedure earlier if they had known about it. The quality of life of the patients with immediate total dentures greatly improved and they smiled again despite the fact they were in the late 60s and 70s. The most com-mon sentiment expressed was: Thank you for not forgetting about us and bringing a smile to our faces again.REFERENCESKrstić, M., Petrović, A., Stanišić-Sinobad, and D., Z. Stošić (1991) Stomatološka protetika, Totalna zubna proteza. Beograd. Dečje novineBranovački, D., and B. Sokolović (1980) Totalna proteza. Naučna knjiga, Gradina.Van Waas, M. A. J., Jonkman, R. E. G., Kalk, W., Van ‘t Hof, M. A., Plooij, J., and J. H. Van Os (1993)	Differences	two	years	after tooth extraction in mandibular bone reduction in pa-tients treated with immediate overdentures or with imme-diate complete dentures J. Dent Res 72 (6), 1001 - 1004,.Igić, S., and A. Igić  (1998) Imedijatna mobilna zubna proteza, Niš., Tibet Niš.Lavere, A.M., and A.J. Krol  (1973) Immediate denture service. J Prosthet Den, 29, 10-15Zarb, G.A., and C.L. Bolender 	(2004)	Prosthodontic	treatment	for edentulous patients. 12th ed. St. Louis: MosbyDžambas Lj., Selaković S., Džambas B., and S. Mirković (2002) Kvalitet života pacijenata saniranih mobilnim protezama. III  KONGRES  NA  STOMATOLOZITE  OD  MAKE-DONIJA, so međunarodno učestvo. Ohrid, usna prezent-acija. Knjiga predavanja.Džambas  Lj.,  and  S.  Selaković  (2001)  Removable  dentures  in management of oral cavity and their impact on acidopep-tic activity and gastric secretion. 6th Congress of Balkan Stomatological  Society.  BaSS2001;  Romania  Bucharest. 371Džambas Lj., and S. Čupić (2005) Kvalitet života pacijenata sani-ranih  imedijatnom  intraoralnom  postresekcionom  pro-tezom  nakon  hirurškog  odstranjenja  malignih  tumora gornje vilice. Medicina danas; 4 (3 - 4), 458-462.Džambas, Lj., et al. Totalna imedijatna zubna proteza. Narodna i Univerzitetska biblioteka Republike Srpske Banja Luka 2007.

Life quality of the elderly with immediate total dentures

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