assessment of oral stereognosis and patient...

ASSESSMENT OF ORAL STEREOGNOSIS AND PATIENT SATISFACTION

IN COMPLETE DENTURE WEARERS - AN IN VIVO STUDY

Dissertation submitted to

THE TAMILNADU Dr. M.G.R.MEDICAL UNIVERSITY

In partial fulfilment for the Degree of

MASTER OF DENTAL SURGERY

BRANCH I

PROSTHODONTICS AND CROWN AND BRIDGE

2017

CERTIFICATE

This is to certify that this dissertation titled “ASSESSMENT OF ORAL

STEREOGNOSIS AND PATIENT SATISFACTION IN COMPLETE

DENTURE WEARERS - An in vivo study” is a bonafide record of work done by

Dr. GEETHA KUMARI. R under my guidance and to my satisfaction during her

postgraduate study period of 2014-2017.

This dissertation is submitted to THE TAMILNADU Dr. M.G.R MEDICAL

UNIVERSITY, in partial fulfilment for the degree of MASTER OF DENTAL

SURGERY in Prosthodontics including Crown and Bridge and Implantology,

Branch I. It has not been submitted (partially or fully) for the award of any other

degree or diploma.

Dr. V. R. THIRUMURTHY MDS

Vice Principal,

Professor and Head of the Department,

Guide

Department of Prosthodontics including

Crown and Bridge and Implantology

Sri Ramakrishna Dental College

and Hospital,

Coimbatore

Date:

Place: Coimbatore

Dr. V. PRABHAKAR MDS

Principal,

Sri Ramakrishna Dental College

and Hospital,

Coimbatore

ACKNOWLEDGEMENT

“A teacher's purpose is not to create students in his own image, but to develop

students who can create their own image”.

This proverb stands true for my guide, mentor and icon of empiricism,

Prof. (Dr.) V. R. Thirumurthy, Professor and Head of the Department. I wish to

express my sincere gratitude towards him for the wise guidance, untiring enthusiasm

and personal attention at every stage of this small endeavour of mine and throughout

my post graduate course.

I am highly obliged to Dr. Anjana Kurien, Professor, for her efforts,

constructive criticism and valuable suggestions throughout the course of the

dissertation.

I take this opportunity to thank Dr. Y. A. Bindhoo for her guidance, keen

interest, constant encouragement and support.

I extend my special thanks to Professor and Director, LT.GEN DR. MURALI

MOHAN, for being generous in sharing rich information and also to the Principal and

Prof. DR. V. PRABHAKAR for giving me this opportunity and his experienced

guidance.

Words do not suffice to express my sincere and humble gratitude to my

respected teachers Dr. Arun. M, Dr. Sriram Balaji, Dr. Vandana N, Dr. Ashwin, Sr

Lecturers for their expert opinion regarding this study.

I express my sincere thanks to Dr Anubala, Dr Menaka devi, Dr Madan for

their most valuable support.

Special thanks to Dr. Vishnu, Dr. Karthik, Ms. Aishwarya J, Ms. Jayashree

who not only helped me in completing my thesis but also inspired me with their

knowledge, dedication and their love towards the subject.

I am grateful to my seniors Dr.Manivasagam, Dr.Muthukumar,

Dr.Padmashini, Dr.Megashyam, Dr.Kumaran, Dr.Niranjana their advice, opinions

and problem solving greatly helped me in this project.

To my batch mates – Dr. Priyankaa and Dr. Vijaya priya, I express my

gratitude for their help, kindness and encouragement.

I take this opportunity to thank my juniors Dr. Parvathy, Dr. Monicasri, Dr.

Sruthi Priya, Dr. Muthu keerthana, Dr. Lawrance and Dr. Deepak Kumar for their

help in various parts of the study. Special thanks to my juniors Dr. Cathryn, Dr.

Praba, Dr. Sridevi, for their enthusiastic encouragement.

I thank all the non - teaching staff Mrs. Ranjini, Mrs. Mangai, Mrs. Sathya,

Mrs. Thangamani, Ms. Lavanya, Ms. Preetha and all the office staff who helped me

throughout these years.

I am taking this opportunity to convey my respectful thanks to

Mr. Jagadeeswaran, IT department, PSG Institution, whose innovative ideas helped

shape my thesis.

I extend my heartfelt thanks to Dr. Deepta Kumaran and Mr. Selvakumar

who helped me with statistics for my study.

I owe my sincere thanks to all the patients who have co-operated in my study.

I convey my respect and love to my grandmother (late) Smt. Gandhimathi

Velayutham for her immense love and care. I feel greatly indebted to my father

Mr. Valarkavi Radha Krishnan (whose affinity towards science projects helped

augment my thesis molds) and my mother Mrs. Vijayalakshmi for all the sacrifices

they have made for me, for their moral support and understanding. I also convey my

sincere thanks to my uncle and aunty Mr. Sivakumar V and Mrs. Mangayarkarasi,

for their kind support. Above all I bow my head in gratitude to the ALMIGHTY for

bestowing his choicest blessings on me.

CONTENTS

S. NO TITLE PAGE NUMBER

1. INTRODUCTION 1

2. AIM AND OBJECTIVES 5

3. REVIEW OF LITERATURE 6

4. MATERIALS AND METHODS 17

5. RESULTS 33

6. DISCUSSION 47

7. CONCLUSION 51

8. BIBLIOGRAPHY 53

LIST OF ABBREVIATIONS

ANOVA Analysis of Variance

Fig Figure

mm millimeter

OSA Oral stereognostic assessment

OST Oral stereognostic test

Pt Patient

Q1 Questionnaire 1 used in the first recall visit

Q2 Questionnaire 2 used in the second recall visit

Sam Sample

Sig Significant

WoD Oral stereognostic assessment done without denture

WD 1 Oral stereognostic assessment done on the day of insertion

WD 2 Oral stereognostic assessment done with denture in the

first week recall visit

WD 3 Oral stereognostic assessment done with denture in the

first month recall visit

LIST OF TABLES

S. NO TABLES PAGE NUMBER

1. Questionnaire 2 28

2. Score sheet 29

3. Scores of the patient without denture 33

4. Scores of the patient on insertion day 34

5. Scores of the patient – first recall visit 35

6. Scores of the patient – second recall visit 36

7. Score sheet - Questionnaire 1 37

8. Score sheet - Questionnaire 2 38

9.

Comparison between shape and surface

variation

40

10.

Descriptive analysis of oral stereognostic test

scores

41

11.

Minimum and maximum of oral stereognostic

score

41

12. ANOVA analysis of oral stereognostic scores 42

13. Post Hoc Test - Multiple comparisons 43

LIST OF CHARTS

S. NO TABLES PAGE NUMBER

14. Duncan analysis of oral stereognostic scores 44

15. Demographic details of the patients 44

16. Paired samples statistics 45

17. Paired sample correlations 46

18. Paired samples test 46

S. NO CHART

PAGE

NUMBER

1.

Comparison of mean Oral stereognostic test scores

across time period

39

2.

Comparison between I week score (WD 2) and

questionnaire 1; I month score (WD 3) and

questionnaire 2

39

LIST OF COLOR PLATES

S. No TITLE

1. Mitsubishi - Wire Electrode Discharge Machine

2. Zinc Plated Stainless Steel mold

3. Materials used for fabricating test samples

4. Vertex Multicure

5. Fabricated Test Specimens

INTRODUCTION

INTRODUCTION

1

In spite of development of preventive dentistry which intends to preserve

natural teeth many people become edentulous. The most common way of treating

edentulousness is still by means of a conventional full denture. Complete

edentulousness mainly causes difficulty in mastication and more than that it causes

psychological stigma that the elderly population often have to deal with. Complete

denture therapy in such individuals provide a very significant improvement in their

functional and esthetic aspect. The performance of complete denture is not only limited

intraorally but should also satisfy the patient’s needs psychologically. As stated by,

Dr.M. M De Van, we must meet the mind of the patient before we meet the mouth of

the patient. First and foremost the new denture should satisfy patient’s mind and then

it should meet all the necessary anatomic and physiologic factors. For this, patient’s

perception to the complete denture and alteration in their sensory capabilities at the time

of insertion and post insertion play a crucial role. Stereognosis has been defined as

the appreciation of the form of objects by palpation. The term was introduced by

H. Hoffmann in 1883. Whilst this definition holds good for the manual exploration of

objects, it is possible for the shape of objects to be explored intra orally referred to as

Oral Stereognosis.

Various methods to measure oral sensations have been used, including Two-

point discrimination test25, interdental thickness determination50, weight-discrimination

tests17, intra-oral size judgments of small holes9, and oral form recognition29.

RL Ringel25 developed an oral esthesiometer to study two–point discrimination.

Thermal sensation tests include cold, warm and heat pain tests. The Minnesota thermal

disk25 is a simple and useful equipment for testing cold sensation. To determine

interdental thickness Plexiglas wedges50 were presented in pairs, one at a time, and

INTRODUCTION

2

patients were asked to judge whether the second wedge was the same, smaller, or larger

in relation to the first wedge. Weight determination test17 was done with Ball bearings

of varying diameter. The oral size illusion9 has been studied by cross-modality testing,

in which individuals estimate the size of stimuli presented to the tongue by using their

fingers to select a matching object from a comparator series. Oral form recognition test

was introduced by Berry and Mahood in the year 1966 and tried to develop a

standardized test procedure (e.g. shape, size, number, material). Their samples were

made of acrylic resin.

After this pioneering work by Berry and Mahood24, oral stereognostic ability,

also denoted as oral form recognition, received further attention in the literature.

Shelton R, Arndt W24 in 1967 introduced various shapes made of plastic to assess oral

stereognosis. Litvak H et al31 in the year 1971, was the first to introduce surface texture

variation in oral stereognostic test and he used metal alloy to fabricate test samples with

different shapes and surface pattern. Landt and Fransson29 (1975) who reintroduced

acrylic resin material, fabricated the samples with shape and surface variation. It was

only after fifteen years Van Aken et al47 in 1991, who studied stereognosis in complete

denture patients using plastic test samples. Until then, researchers used non edible

substances to fabricate test samples which were harmful if accidentally swallowed. This

kindle the interest in Garrett et al19 (1994), who developed the test by making test

samples from raw carrot. Müller et al38 in the year 1995, used stereognosis as valid tool

to assess patient’s adaptation to complete dentures. The National Institute of Dental and

Craniofacial Research, U.S (formerly called as The National Institute of Dental

Research which is a branch of the U.S. National Institutes of Health) has developed a

range of 20 shapes and suggested to use test forms within this range for assessment of

oral stereognosis. Jacobs et al25 in 1997, used 5 different test forms from the set of 20

INTRODUCTION

3

forms advocated by The National Institute of Dental and Craniofacial Research to test

the stereognostic ability of natural dentitions versus implant-supported fixed prostheses

or overdentures.

Only a very few studies have been done to correlate oral stereognosis to denture

satisfaction in old denture wearers. In this regard there is not a single study that

collectively correlates the oral stereognosis before and after rehabilitation, with denture

satisfaction in new complete denture patients. The understanding of oral stereognosis

and its application in recognizing patient’s satisfaction with complete denture therapy

which is otherwise enigmatic process provide better psychologic acceptance.

Oral stereognostic testing can also measure recognition times, surface texture

of objects and sensibility thresholds. The following parameters apply to the recognition

of forms: (1) Pieces must not have sharp angles, (2) A length of 2 to 3mm is adequate,

(3) Metallic pieces were not tolerated and flexible forms were not correctly identified,

(4) Form must be defined in a simple way (square, round, triangle), (5) A small number

of pieces must be used.

Patients with high scores in the stereognosis test presumably receive more

complete and accurate sensorial data about objects inside their mouth, and in

consequence have a better ability to appreciate the functional limitations imposed by

the presence of a complete removable denture, as well as noticing more clearly any

defects in the artefact, compared to subjects with lower stereognostic ability. This

would mean that the oral stereognosis test is a valid aid in predicting adaptability to

complete removable dentures and their acceptance by the patient. The evaluation of oral

stereognosis in complete denture patients and understanding the difference could

provide a significant increase in the level of acceptance with complete dentures.

INTRODUCTION

4

It is proposed that, by this study of oral stereognosis, is clinically correlated with

the answers from a questionnaire, targeted specially to gauge patient’s mental attitude

towards complete denture.

This study was intended to use different samples to assess oral stereognosis and

mental attitude and to see if there is any correlation. So this study tends to identify the

clinical significance of oral stereognosis and complete denture satisfaction.

AIM AND OBJECTIVES

AIM AND OBJECTIVES

5

AIM:

The purpose of the study was to evaluate the Oral Stereognostic ability of new

completely edentulous patient before denture insertion, at the time of insertion and

within one week (second visit) and in a time period of three months of denture usage

(third visit).

OBJECTIVES OF THE STUDY:

The present study is designed with the following objectives:

To assess the Oral Stereognostic score without dentures, on the day of

denture insertion (first visit), within one week (second visit) and in a

time period of three months of denture usage (third visit).

Assess the denture acceptance of patient on second and third recall

visits using questionnaire.

Assess the possible presence of inter relationship between these

factors.

NULL HYPOTHESIS:

The null hypothesis of the study assumes that there is no significant

improvement in oral stereognosis in new complete denture patients in a time period of

three months.

REVIEW OF LITERATURE


6

McDonald ET, Aungst LF 34 (1967), stated that the development of oral

stereognostic tests, which permit active exploration of the stimulus applied

seems to be the most promising method to evaluate oral sensorimotor function.

Litvak H, Silverman SI, Garfinkel L 31 (1971), studied oral stereognosis in

dentulous and edentulous subjects, to investigate the relationship of oral

perception to diagnostic and therapeutic procedures in dental treatment. No

significant differences in scores were seen between the dentulous and

edentulous groups over 60 years of age. Oral stereognostic scores in the

dentulous subjects were higher when no restrictions on the use of teeth were

imposed during identification. The oral stereognostic scores in the edentulous

subjects were higher when the subject had both the maxillary and mandibular

denture in place. The edentulous subjects who reported with the greatest number

of post-insertion problems and who expressed the lowest level of satisfaction

demonstrated higher levels of oral perception than those subjects who reported

few or no problems.

Berg E5 (1988), conducted a study to assess patient's satisfaction with complete

dentures during the first 2 years of the post insertion period. After 2 years no

further, or only minor, deterioration in patient satisfaction occurred. No

significant change was found for the variables related to the maxillary denture.

Garret NR, Kapur KK, Jochen DG 19 (1994), examined the relationship between

masticatory performance and oral stereognostic ability in dentulous individuals


7

and denture wearers. Stereognosis was evaluated in denture wearers with and

without dentures in place. No significant differences were noted between the

stereognostic scores of either group.

Muller F, Link I, Fuhr K, Utz KH 38 (1995), conducted a study to evaluate the

oral stereognosis and tactile sensibility in edentulous subjects and related these

to patient age and capability of adaptation to new prostheses. The capability of

adaptation was evaluated by a questionnaire. Denture retention was assessed by

clinical examination. The number of correctly identified test-pieces and the

average identification time were related to the age, but no relation was found to

patients' capability of adaptation. The tactile sensibility was found to be

impaired with age and diminished capability of adaptation. Both adaptation and

oral tactile sensibility were significantly lower in subjects with poor lower-

denture retention. They concluded that there was no relationship between high

oral stereognosis and adaptation problems. However, good denture retention

facilitates the adaptation process.

Al-Rifaiy MQ, Sherfudhin H, Aleem MA1 (1996), conducted a study on the oral

stereognostic ability of edentulous subjects with and without complete dentures.

A questionnaire was completed by the subjects to aid in the subjective

evaluation of denture performance with respect to retention, stability,

mastication and speech. They concluded that subjects with high stereognostic

score showed more subjective complaints (poor performance) than those with

low scores. A significant relationship between subjective complaints (retention

and stability, mastication and speech) and oral stereognosis was observed.


8

Brunello DL, Mandikos MN10 (1998), studied a group of 100 patients who

experienced ongoing difficulties with their new complete dentures, and stated

possible underlying causes. On comparing factors like age, gender, medical and

psychologic status with the number of complaints, there was no significant

relationship. They suggested that in most instances, complete denture patients

presented with complaints only when there was a real design fault or a tissue

problem.

Mantecchini G, Bassi F, Pera P, Preti G32 (1998), conducted a study and

concluded that oral stereognostic ability decreases with age; oral stereognostic

ability was not correlated with duration of edentulism; covering the palatal

mucosa with a denture does not reduce oral stereognostic ability; the presence

of a correct prosthetic restoration was determinant in improving oral

stereognostic ability; the score in the oral stereognosis test administered without

any denture in place shows a negative correlation with the degree of satisfaction

and adaptability to the rehabilitation.

Sato Y, Hamada S, Akagawa Y, Tsuga K44 (2000), conducted a study to clarify

the degree of contribution of various factors to overall satisfaction, and to

develop a method for quantitative assessment of overall satisfaction with

complete dentures. This study clarified that seven satisfaction factors [chewing,

speech, pain (lower), aesthetics, fit (upper), retention (lower), and comfort


9

(upper)] were highly correlated to the overall satisfaction of complete denture

patients.

Yazdanie N51 (2002), conducted a study to evaluate responses of patients to

variation in denture forms as determined by intra oral force measurements.

Their stereognosis tests used five basic shapes, with a small and a large version,

making ten test forms in all. Patients who have low denture tolerance generally

tend to have high stereognostic ability and vice versa and older patients were

seem to have lower scores than younger in oral motor ability tests. The presence

of foreign object (prostheses) in an edentulous mouth was bound to elicit

difficult stimuli in the sensory-motor system, which in turn influences oral

motor behavior.

Celebic A12 (2003), conducted a study to evaluate patient satisfaction with

denture and concluded that the patient’s level of education, self-perception of

affective and economic status, and quality of life are all related to satisfaction

with denture. However, the quality of dentures shows the strongest correlation

with patient satisfaction. Not only has the quality of the denture-bearing area

but the denture-wearing experience itself seemed to be more important in

determining patient satisfaction with mandibular complete denture. Younger

patients wearing dentures for the first time and with short periods of being

edentulous, were more satisfied with the retention of maxillary complete

denture. In contrast, younger patients with first-time dentures, a short period of

being edentulous, and with better quality mandibular denture-bearing areas gave

lower ratings to the retention and comfort of wearing mandibular denture.


10

Michael RF, Martyn S36 (2004) investigated the clinical quality of new complete

dentures to predict patient satisfaction with the usage of the dentures and

concluded that initial clinical quality of new complete dentures was not a

significant factor in determining patients’ satisfaction with, and use of these

dentures two years after insertion, provided that patients had been able to wear

the dentures during the first three months after first insertion. Patient satisfaction

with dentures over time declines for denture fit and for other aspects of

maxillary dentures but improves over time for chewing ability and comfort of

mandibular dentures.

Rossetti PHO, Bonachela IWC, Nunes LMO42 (2004), made a review and

indicated that there exists a lack of standardization in tests for the shape of

objects and recognition of forms. Stereognostic ability diminishes with age.

Stereognosis can improve with training. Degree of satisfaction was not related

to a high or low oral perception level. The use of complete dentures during the

rehabilitation of oral-motor disorders enhances oral sensation. Implant-

supported prosthesis provides stereognostic levels nearly that of natural

dentition.

Kaiba Y, Hirano S, Hayakawa I27 (2006) conducted a study and concluded that

the score in the oral stereognosis test with and without palatal coverage showed

no difference.

Ozdemir AK, Ozdemir HD, Polat NT, Turgut M, Sezer H39 (2006) conducted a

study to determine the correlation between personality type and denture


11

satisfaction of completely and partially edentulous patients. They grouped

patients into three categories. The personality type of the patients had an effect

on their satisfaction with dentures. Denture satisfaction was also affected by

age, gender, type of prosthesis and denture usage period.

Eitner S, Wichmann M, Schlegel A, Holst S18 (2007) conducted a study to use

oral stereognosis test to evaluate possible intraoral/ sensorimotor causes in

patients with psychologic diagnosis of psychogenic prosthesis incompatibility

and to evaluate possible correlations between oral stereognosis and the

psychologic diagnostic tools. There was lack of correlations between the

functional/ anatomic aspects of oral stereognostic ability, psychologic

diagnostic tools, and the clinical picture of psychogenic prosthesis

incompatibility.

Ikebe K, Amemiya M, Morii K, Matsuda K, Furuya-Yoshinaka M, Nokubi T22

(2007) conducted a study to examine the age-related difference in oral sensory

function by testing oral stereognostic ability (OSA) and to determine the effect

of wearing complete dentures on OSA. The OSA score in older dentulous

participants and complete denture wearers was significantly higher than in

younger dentulous subjects. However, no significant difference was found in

the OSA score between older dentulous participants and complete denture

wearers. When older edentulous subjects removed the maxillary and mandible

complete dentures, the OSA score was significantly lower and the response time

was significantly longer than with dentures. Oral sensory function was not


12

significantly different between completely dentulous persons and complete

denture wearers in the elderly.

Kawagishi S, Kou F, Yoshino K, Tanaka T, Masumi S28 (2009) investigated the

stereognostic ability of the tongue in young adults and seniors. The findings

indicated that seniors showed decreased stereognostic ability of the tongue

compared with young adults.

Amarasena J, Jayasinghe V, Amarasena N, Yamada Y3 (2010) conducted a

study to assess oral stereognostic score of experienced and non-experienced

denture wearers and stated that OSA was significantly improved in both

experienced and non-experienced complete denture wearers after 1 month of

wearing dentures, irrespective of the previous experience in wearing dentures.

Bhandari A, Hegde C, Prasad KD7 (2010) conducted a study to evaluate the

possible association between the oral stereognostic ability and masticatory

efficiency at the time of denture insertion and after 6 months in complete

denture wearers and concluded that oral stereognostic ability improves with

time, which might be due to adaptation to the denture. As adaptation towards

denture improves masticatory efficiency improves as well. They also stated that

there might be a weak association between oral stereognosis and masticatory

efficiency.


13

Patel JR, Sethuraman R, Chaudhari J40 (2010) conducted a study to evaluate the

effect of complete dentures on oral stereognosis in completely edentulous

patients. The results showed that covering the palatal mucosa with a denture

does not reduce oral stereognostic ability. The presence of a prosthetic

restoration was a determinant in improving oral stereognostic ability

Ćesir AK, Džonlagić A, Ajanović M, Delalić A13 (2011) conducted a study to

assess patient’s satisfaction with retention, aesthetics, chewing, speech and

comfort of wearing removable denture. They concluded that patients were

mostly satisfied with their removable dentures, which were evaluated as

satisfactory by the dentist. Male patients with removable denture were less

satisfied with chewing than female patients. Factors as age, gender, marital

status, level of education, presence of the chronic disease, smoking habits did

not make any influence on the patient's satisfaction with the denture.

Gosavi SS, Ghanchi M, Malik SA, Sanyal P20 (2013) did a survey on complete

denture patients experiencing difficulties with their prosthesis and stated that

mastication was the most frequent complaint among complete denture wearers

and the common cause of complaints was looseness and loss of retention. A

significant correlation was seen with age groups but not with gender. This study

suggested that complete denture patients present with complaints most often

when there are denture faults. So, dental professionals should pay serious

attention to their patients for subjective acceptable result of the dentures.


14

Ashwini AK, Godbole SR, Sathe S4 (2013), evaluated oral stereognosis in

dentulous patients and in edentulous patients before and after denture insertion

and observed significant difference of oral stereognosis in edentulous patient

without denture and with denture. Oral stereognosis provides degree of the oral

discriminatory skill of a patient and it was reported to be the highest in dentulous

patient followed by denture wearer.

Vinay SB, Krishnaprasad D, Prakyath M48 (2014) conducted a study on

dentulous, completely edentulous, edentulous wearing maxillary denture,

edentulous wearing mandibular denture, and edentulous wearing both dentures

and concluded that the level of oral perception score was higher in dentulous

state, which usually decreases as the state of edentulism sets in. Also, oral

stereognostic assessment scores in edentulous subjects are highest when the

subjects wear both maxillary and mandibular dentures. It can also be concluded

that covering of the palatal mucosa with a denture does not reduce subject’s oral

stereognostic ability.

Dalaya MV16 (2014) evaluated oral stereognostic levels in patients of different

age groups, dentulous and edentulous subjects and in patients with and without

dentures. They concluded that the oral stereognostic level was highest in

younger dentulous age group and decreased as the age increases. The oral

stereognostic level was higher in dentulous subjects than edentulous subjects.

The oral stereognostic level of totally edentulous subjects (without denture) was

higher than subjects of complete denture wearer. The oral stereognostic level


15

was higher in subjects who expressed lowest level of denture satisfaction and

oral stereognostic level was lower in satisfied denture wearers.

Meenakshi S, Anil Kumar Gujjari H, Thippeswamy N, Raghunath N37 (2014)

conducted a study on completely edentulous patients and concluded that

covering the palatal mucosa with a denture did not reduce oral stereognostic

ability. Secondly oral stereognostic test was reliable to measure patient’s oral

stereognostic perception which enabled the patient to appreciate the functional

limitations of the denture. The dentist can be aware of what he can expect in the

form of patient response during and after the treatment.

Park JH41 (2017) conducted a study to assess changes in oral stereognosis of

healthy adult by age and concluded that the younger group had higher test scores

than the older group, except for comparisons between the 20s and 30s age

groups. The older the subjects, the more frequently they misidentified test

pieces in other groups rather than in the same group. Also they stated that,

younger people identified the samples in shorter time when compared to older

people. Therefore, an increase in the response time can indicate low OS. As a

result, there were differences in the test scores depending on the shapes of the

test pieces. In each group, the ratio of correct answers increased as the size of

the test pieces increased because a large object has a wider contact area that a

subject can feel, thus providing more sensory information. In addition, the ratio

of correct answers was higher for test pieces with sharp angles, and for

asymmetrical test pieces. This was because the subjects easily differentiated the


16

shapes of the test pieces in each group based on unique characteristics,

providing a strong input that served as clues during the tests.

MATERIALS AND METHODS


17

MATERIALS USED IN THE STUDY

The following materials were used for the study:

1. Stainless steel block with zinc electroplating (fig 2)

2. DPI – RR Cold Cure Acrylic Repair Material (fig 3)

3. GDC Lecron’s carver (fig 3)

4. GDC Wax Knife Spatula (fig 3)

5. Glass slab (fig 3)

6. Porcelain mixing jar (fig 3)

7. Petrolatum jelly (fig 3)

EQUIPMENTS USED IN THE STUDY

1. Equipment used for mold fabrication

a. Mitsubishi - Wire Electrode Discharge Machine FA 10S made in Tokyo,

Japan. (fig 1)

b. 0.25mm diameter brass hardened wire used for profile cutting

c. Drawings prepared in AutoCAD software for 2D modelling and Solid

works for 3D Modelling.

d. Vertex Multicure Pressure Pot made in Netherlands. (fig 4)


18

Methodology of the study

Drawings prepared in AutoCAD software for 2D modelling and Solid

works for 3D Modelling

Standardized metal mold prepared in stainless steel

Zinc electroplating was done to facilitate easy removal of set acrylic sample

DPI – RR Self cure acrylic material used to make test specimens

Oral Stereognosis test conducted in the selected patients before denture

insertion

Test conducted on the day of insertion with dentures

Test repeated on the second visit (within one week). Questionnaire 1 to

assess patient’s satisfaction with new denture

Test repeated within a time period of three months and questionnaire 2 was

used to evaluate patient’s satisfaction

Statistical analysis


19

I. Fabrication of stainless steel mold:

The specimens used in this investigation were the modifications of Berry,

Mahood and Muller et al test specimens. The eight specimens to be tested were

divided into two groups. In one series, four specimens represent varying degrees of

surface alteration. The second set represents varying alterations in basic shape. This

incorporates both surface and shape modification in the testing of oral perception.

The mold was made of stainless steel and the test specimens were made from DPI–

RR self-cure acrylic material.

Two separate metal molds were designed using AutoCAD software for 2D

modelling and Solid works for 3D Modelling in the Centre for Advanced Tooling

and Precision Dies, (PSG College of Engineering, Coimbatore). It was then

fabricated in stainless steel metal with Mitsubishi - Wire Electrode Discharge

Machine FA 10S. The wire diameter of the machine was 0.25mm. Zinc

electroplating was done. 0.01mm thickness zinc plating was done using zinc coating

machine. It was first dipped and cleaned in acid. It was then dipped in the zinc

powder and the machine was made to run for about one hour. It was finally dipped

in hot water.

Dimensions of the test specimens

First set of test specimen has variation in basic shape. The dimensions are

Circle of diameter 12mm,

Key hole shape 12mm length, circle with 7mm radius

Triangle 12mm x 12mm x 12mm,

Cross of length 12mm x 12mm

All the test specimens have uniform thickness of 0.6mm.


20

The second set of test specimen has variation in surface texture. The dimensions are

12mm x 12mm cube with

Single line on four of six surfaces,

Double line in four of six surfaces,

Triple line in four of six surfaces, and

Smooth cube without any surface alteration.

Schematic diagram of the stainless steel mold

Diagram - 1.The first set of test specimens has variation in basic shape

Diagram – 2. The second set of test specimens has surface variation

The dimensions are

a- 12mm,

b- b - 7mm,

c- c - 3mm,

d- d - 12mm,

e- e - 1mm

a

b

a

a a

a

c c

d

d

e

d

d

d

d

d

d

e e


21

Diagram - 3. AutoCAD 2D Model

Diagram - 4. 2D Image of the Mold


22

II. Fabrication of Stereognostic Test Specimens:

Separating medium used was petrolatum jelly. The cold cure acrylic

resin material was mixed according to the manufacturer’s instructions (3:1 ratio) and

placed onto the mold. Working time was 4 minutes and Vertex pressure pot was used

for cold cure dental acrylics with a fixed pressure of 36.26psi and constant water

temperature of 55˚C.

III. Oral stereognostic test:

INCLUSION CRITERIA

Completely edentulous patients with age ranging from 30 to 75years of age.

EXCLUSION CRITERIA

The exclusion criteria are:

o Patients with mucosal lesions.

o Patients under neurological drugs or having any psychological

problems.

o Patients with implant supported complete denture prostheses.

The patients included in this study were explained about the procedure

and the purpose of study following which informed consent was obtained.

The test was conducted in a quiet environment.

First test without denture

Second test after denture insertion

Third test within one week

Fourth test within a time period of three months of denture usage.


23

On the day of denture insertion, patient was asked to sit relaxed on the dental chair. A

chart with the picture (size 5x times) of test samples was given to the patient. The test

specimens were disinfected by immersing in 2.4% cidex solution for 15minutes before

commencement of the test. At first without the dentures in the mouth, patients were

asked to identify the test specimens and the corresponding picture was pointed out for

each shape by the patient. Randomly all the eight test specimens were placed in the

mouth without patient’s knowledge. To prevent learning effect, no practice trials were

held. Participants were not informed of the correct answers at any point during testing.

Again test was repeated with the dentures inserted.

The answers were recorded on a scoring chart. A maximum of three minutes

was given to identify the test specimens. If the patient was unable to identify within the

time, the score was marked zero.

A correct identification was scored as two points;

An incorrect identification within the same group of specimens was scored as

one point.

Zero score for not identifying the test specimens.

Within the first week of denture insertion, patient was recalled and the Oral

Stereognostic test was carried out with the dentures in. The eight test specimens were

placed in the mouth one after the other and patients were asked to identify each test

specimen and the patient was asked to point out the picture. Participants were not

prompted of the answers at any point during testing. Questions were asked to the

patients in a questionnaire format in the local language regarding denture satisfaction

and rate it on grading scale. There were totally four domains in which the questions


24

were asked and rated with five scores on the grading scale very happy and satisfactory,

happy, average, below average, not happy or unsatisfactory.

Test was repeated on the second recall visit and questionnaire 2 was given to

assess patient satisfaction and were asked to mark on a five point scale.


25

PARTICIPANT CONSENT FORM FOR ORAL STEREOGNOSTIC STUDY

Title: Assessment of Oral Stereognosis and Patient Satisfaction in

Complete Denture Wearers - An In Vivo Study

Participant’s name: Address:

OP. No:

Title of the project:

The details of the study have been provided to me in writing and explained to

me in my own language. I confirm that I have understood the above study and had the

opportunity to ask questions. I understand that my participation in the study is voluntary

and that I am free to withdraw at any time, without giving any reason, without the

medical care that will normally be provided by the hospital being affected. I agree not

to restrict the use of any data or results that arise from this study provided such a use is

only for scientific purpose(s). I fully consent to participate in the above study.

Signature of the participant: ______________________

Date: _____________

Date: _____________

Date: _____________

Signature of the staff in-charge: ________________________


26

Title: Assessment of Oral Stereognosis and Patient Satisfaction in

Complete Denture Wearers - An In Vivo Study

.Questionnaire – 1

Questions about satisfaction level with the dentures

1. பல் செட்டின் த ோற்றம் உங்களுக்கு திருப்தி ருகிற ோ?

With respect to appearance, how satisfied are you with your dentures?

2. உங்கள் புன்னகக ் த ோற்றம் திருப்திகரமோக இருக்கிற ோ?

Are you satisfied with your smile (esthetic)?

3. இயற்ககப் பற்ககளப் தபோலதே உணவு உடச்கோள்ககயில்

பல்செட் திருப்திகரமோன மனநிகலகய ் ருகிற ோ?

How do you feel about the pleasure you get from food, compared with the time

when you had natural teeth?

4. பல்செட், உணகே சமன்றுதின்ன உ வுகிற ோ?

With respect to chewing, how satisfied are you with your dentures?

5. உணவு உடச்கோள்ள பல்செட் ஏதுேோக இருக்கிற ோ?

With respect to eating, how satisfied are you with your dentures?


27

6. உங்கள் பணியின் தபோது, தபெச்ு மற்றும் உெெ்ரிப்பில்,

பல்செட்டின் செயல்போடு திருப்தி அளிக்கிற ோ?

With respect to your professional performance, how satisfied are you with your

oral conditions (phonetics)?

7. மன நிகறவு அளிப்பதில், பல்செட்டின் செயல்போடு எே்ேோறு

உணரக்ிறீரக்ள்?

With respect to how comfortable your dentures are, how satisfied are you?

8. பிறதரோடு இணங்கிப் பழக, பல்செட் ஏற்புகடய ோக

உள்ள ோ?

With respect to your social and affective relationships, how satisfied are you

with your oral conditions?

9. பல்செட் ேடிேகமப்பு உங்களுக்கு சுயக ரியம் நம்பிக்கக

ஆகியேற்கறக் சகோடுக்கிற ோ?

With respect to being self-assured and self-conscious, how satisfied are you

with your dentures?


28

Table 1: QUESTIONNAIRE 2

DOMAIN Very

happy

Happy Satisfied Ok Unhappy

APPEARANCE

Look

Smile

Color of the denture

Shade of the teeth

Size of the teeth

MASTICATION

Chewing

Taste sensations

Hard food substances

Soft food substances

Liquid food

substances

SPEECH AND

SECRETION

Alphabets

Numbers

Passage reading

Voice level

Salivary secretion

PSYCOLOGICAL

FEEL

Comfort

Confidence

Social and affective

relationship

Natural feel

Smell


29

ASSESSMENT OF ORAL STEREOGNOSIS AND PATIENT

SATISFACTION IN COMPLETE DENTURE WEARERS

- An in vivo study

Patient Name:

OP no:

Phone no:

Table 2: Score sheet

OST Date

Shape variation Surface variation

Before

insertion

On the

day of

insertion

Within

one

week

After

one

month

COLOR PLATES

MATERIALS AND METHODS – COLOR PLATES

30

Fig 1 - Mitsubishi - Wire Electrode Discharge Machine

Fig 2 – Zinc Plated Stainless Steel Mold


31

Fig 3 – Materials used for fabricating test samples

Fig 4 – Vertex multicure


32

Fig 5 – Fabricated Test Specimens

RESULTS

RESULTS

33

I. Oral stereognostic score of 15 patients

(I – IV scores of shape variation, V – VIII scores of surface variation)

I – circle, II – triangle, III – keyhole shape, IV – cross

V – Plain cube, VI – cube with single line, VII – cube with double line,

VIII – cube with triple line.

TABLE 3: SCORES OF THE PATIENT WITHOUT DENTURE

WITHOUT DENTURE (WoD)

Patient/

sample


I II III IV V VI VII VIII

1 2 2 2 2 2 1 1 2

2 2 2 2 2 2 1 1 2

3 2 2 2 2 2 2 2 2

4 0 0 0 1 0 0 0 0

5 2 2 2 2 2 2 1 1

6 2 2 2 2 1 1 1 2

7 1 2 2 2 1 2 2 2

8 2 2 2 2 2 1 1 1

9 2 2 2 2 2 2 1 1

10 2 2 2 2 2 0 1 1

11 2 2 2 2 2 1 2 2

12 2 2 2 2 2 2 1 1

13 2 2 2 2 2 1 1 1

14 2 1 2 2 1 1 1 1

15 1 2 2 2 2 2 1 1

RESULTS

34

II. Oral stereognostic score of 15 patients on the day of insertion.



V – plain cube, VI – cube with single line, VII – cube with double line,


TABLE 4: SCORES OF THE PATIENT ON INSERTION DAY

ON THE DAY OF DENTURE INSERTION (WD 1)

Patient/

sample



1 2 2 2 2 2 1 1 2

2 2 1 2 2 2 1 1 1

3 2 1 2 2 1 1 2 1

4 2 2 2 2 2 1 1 1

5 2 2 2 2 2 2 2 2

6 2 2 1 2 2 2 1 1

7 2 2 2 1 1 1 2 1

8 2 2 2 2 1 1 1 1

9 2 2 2 2 2 1 2 2

10 2 2 2 2 1 1 1 2

11 2 2 2 2 2 1 2 2

12 1 2 2 2 2 2 2 1

13 2 2 2 2 2 2 2 2

14 2 2 2 2 2 0 1 1

15 1 2 2 2 2 2 1 1

RESULTS

35

III. Oral stereognostic score of 15 patients after one week.





TABLE 5: SCORES OF THE PATIENT – FIRST RECALL VISIT

I WEEK (WD 2)

Patient/

sample



1 2 2 2 2 2 1 1 2

2 2 2 2 2 2 2 1 1

3 2 2 2 2 2 1 1 1

4 2 1 2 1 2 1 1 1

5 2 2 2 2 2 2 1 2

6 2 1 1 2 2 2 1 1

7 2 2 2 1 1 1 2 1

8 2 2 2 2 0 1 1 1

9 2 2 2 2 2 1 2 2

10 2 2 2 2 2 1 2 1

11 2 2 2 2 2 1 1 1

12 2 2 2 2 2 2 2 2

13 2 2 2 2 1 1 1 2

14 2 2 2 2 2 1 1 2

15 2 2 2 2 2 2 2 2

RESULTS

36

IV. Oral stereognostic score of 15 patients after one month.





TABLE 6: SCORES OF THE PATIENT – SECOND RECALL VISIT

I MONTH (WD 3)

Patient/

sample



1 2 2 2 2 2 1 1 2

2 2 2 2 2 2 1 2 1

3 2 2 2 2 2 1 1 1

4 2 2 2 2 2 0 1 0

5 2 2 2 2 2 2 1 2

6 2 2 2 2 2 2 2 1

7 2 2 2 2 2 1 2 1

8 2 2 2 2 2 1 0 1

9 2 2 2 2 2 2 2 2

10 2 2 2 0 2 2 0 1

11 2 2 2 2 2 2 2 2

12 2 2 2 2 2 2 1 2

13 0 0 2 2 1 1 1 2

14 2 2 2 2 2 2 1 2

15 2 2 2 2 2 2 2 1

RESULTS

37

V. Scores of 15 patients for questionnaire 1

TABLE 7: SCORE SHEET - QUESTIONNAIRE 1

QUESTIONNAIRE - I

Patient/

Sample

I II III IV V VI VII VIII IX

1 5 5 5 5 5 5 5 5 5

2 5 5 1 3 3 5 5 5 5

3 3 5 3 4 3 4 3 3 4

4 2 2 1 1 2 3 2 3 2

5 3 4 3 3 4 3 2 3 4

6 5 5 3 5 3 5 5 5 5

7 3 4 3 2 1 5 4 3 4

8 5 4 3 2 1 4 3 3 4

9 3 4 2 4 3 4 4 2 5

10 5 5 5 3 5 5 5 5 5

11 5 5 5 5 5 5 5 5 5

12 4 5 4 4 4 3 4 3 4

13 2 1 3 1 1 3 2 1 1

14 5 5 5 5 5 5 5 5 5

15 4 4 4 3 3 4 4 5 4

RESULTS

38

VI. Scores of 15 patients for questionnaire 2

TABLE 8: SCORE SHEET - QUESTIONNAIRE 2

QUESTIONNAIRE - II

Pt/

sam 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

1 5 5 5 5 5 5 5 5 5 5 4 3 4 5 5 5 5 5 5 5

2 5 5 4 3 4 3 4 2 5 5 5 5 5 5 5 5 4 5 5 5

3 4 5 5 5 5 4 3 3 4 4 4 4 3 5 2 4 5 5 4 5

4 5 4 3 3 3 2 4 5 5 4 5 5 5 5 3 5 5 5 5 5

5 5 5 5 5 5 2 4 1 5 5 5 5 5 2 1 4 5 5 4 5

6 5 5 5 5 5 3 5 2 5 5 5 5 5 5 4 5 5 5 4 5

7 5 5 5 5 5 3 5 4 5 5 3 4 4 5 5 5 5 5 5 2

8 5 5 5 5 5 4 5 3 5 5 4 4 3 1 5 3 4 3 3 4

9 4 4 5 5 5 3 5 2 5 5 5 5 5 5 5 5 5 5 5 5

10 5 5 5 5 3 5 3 5 2 5 5 5 5 4 5 5 5 5 5 5

11 4 4 4 4 4 3 4 1 5 4 4 4 4 4 4 4 5 5 5 4

12 4 5 5 5 5 4 5 3 5 5 5 5 4 4 4 5 5 5 5 5

13 1 1 5 5 1 4 5 5 5 5 5 5 5 2 5 2 3 3 2 5

14 5 5 5 5 5 5 3 5 5 5 4 5 5 5 4 5 5 5 4 4

15 5 5 4 5 4 4 3 2 3 4 4 4 4 4 3 3 3 3 3 3

After obtaining these values from the study, statistical analysis was performed.

RESULTS

39

CHARTS:

1. COMPARISON OF MEAN OST SCORES ACROSS TIME PERIOD

2. COMPARISON BETWEEN I WEEK SCORE (WD 2) AND

QUESTIONNAIRE 1 AND I MONTH SCORE (WD 3) AND

QUESTIONNAIRE 2

12.20

12.40

12.60

12.80

13.00

13.20

13.40

13.60

13.80

WithoutDenture (WoD)

At the time ofinsertion (WD

1)

One week afterinsertion (WD

2)

One monthafter insertion

(WD 3)

12.733

13.46713.533

13.667M

ean

OST

sco

res

0

10

20

30

40

50

60

70

80

90

100

Ist Week Questionaire 1 Ist Month Questionaire 2

Mea

n S

core

(WD 2) (WD 3)

RESULTS

40

STATISTICAL ANALYSIS

TABLE 9: COMPARISON BETWEEN SHAPE AND SURFACE VARIATION

Shape Variation Surface Variation

without

denture

(WoD)

sum 110 sum 81

mean 1.8333333 mean 1.35

sd 0.492887262 sd 0.633125152

min 0 min 0

max 2 max 2

on the day of

denture

insertion

(WD 1)

sum 114 sum 88

mean 1.9 mean 1.466666667

sd 0.30253169 sd 0.535729082

min 1 min 0

max 2 max 2

I week

(WD 2)

sum 115 sum 88

mean 1.9 mean 1.466666667

sd 0.278717807 sd 0.535729082

min 1 min 0

max 2 max 2

I month

(WD 3)

sum 114 sum 91

mean 1.9 mean 1.516666667

sd 0.439568355 std 0.624137823

min 0 min 0

max 2 max 2

RESULTS

41

TABLE 10: DESCRIPTIVE ANALYSIS OF ORAL STEREOGNOSTIC TEST

SCORES

ORAL STEREOGNOSTIC TEST

TABLE 11: MINIMUM AND MAXIMUM OF ORAL STEREOGNOSTIC

SCORE

The data obtained was subjected to statistical analysis to test the null hypothesis.

N Std.

Deviation

Std. Error

95% confidence interval

for mean

Lower

bound

Upper

bound

Without denture

On the day

I week

I month

Total

15

15

15

15

60

3.45309

1.45733

1.59762

2.05866

2.25362

.89158

.37628

.41250

.53154

.29094

10.8211

12.6596

12.6486

12.5266

12.7678

14.6456

14.2737

14.4181

14.8067

13.9322

Minimum Maximum

Without denture

On the day

I week

I month

Total

1.00

12.00

11.00

9.00

1.00

16.00

16.00

16.00

16.00

16.00

RESULTS

42

Analysis No 1:

ANOVA test: The Analysis Of Variance (ANOVA) is a collection of statistical models

used to analyse the differences among group means. One-way ANOVA is used to test

for differences among two or more independent groups.

TABLE 12: ANALYSIS OF VARIANCE (ANOVA) OF ORAL

STEREOGNOSTIC SCORES

OST Sum of Squares df Mean Square F Sig.

Between Groups

Within Groups

Total

7.917

291.733

299.650

3

56

59

2.639

5.210 .507

.679

The mean value of oral stereognostic scores in all four appointments and mean value

of scores of patients in all appointments was subjected to ANOVA test (p = 0.679).

Analysis No 2:

Post Hoc Test – multiple comparison: A stepwise multiple comparisons procedure

used to identify sample means that are significantly different from each other. It is used

often as a Post Hoc test whenever a significant difference between two or more sample

means has been revealed by an analysis of variance (ANOVA). This test was used to

compare scores obtained in first month recall visit with the other scores and it shows

significant improvement.

RESULTS

43

TABLE 13: POST HOC TEST - MULTIPLE COMPARISONS

Dependant Variable: Oral Stereognostic Test

LSD

(I)

Factor (J) Factor

Mean

Differe

nce (I-

J)

Std.

Error Sig.

95% 95%

Lower

Bound

Upper

Bound

I

month

W/o denture

On the day

I week

.93333

.20000

.13333

.83343

.83343

.83343

.268

.811

.873

-.7362

-1.4696

-1.5362

2.6029

1.8696

1.8029

*The mean difference is significant at the 0.05 level

Analysis 3:

Duncan's multiple-range test: Duncan's multiple-range test is based on the

comparison of the range of a subset of the sample means with a calculated least

significant range. The LSD (Least Significant Difference) test is a two-step test. First

the ANOVA F test is performed. If it is significant at level ALPHA (0.05), then all

pairwise t-tests are carried out, each at level ALPHA. The Duncan analysis shows

significant improvement in oral stereognosis of the patients.

RESULTS

44

Homogeneous Subsets

TABLE 14: DUNCAN 'S MULTIPLE-RANGE TEST OF ORAL

STEREOGNOSTIC SCORES

Factor

N

Subset for alpha =

0.05

1

Duncana

Without denture 15 12.7333

On the day 15 13.4667

I week 15 13.5333

I month 15 13.6667

Sig. .315

Means for groups in homogeneous subjects are displayed.

a. Uses Harmonic mean sample size = 15.000

TABLE 15: DEMOGRAPHIC DETAILS OF THE PATIENTS

Gender Frequency Minimum Maximum Mean

Std.

Deviation

Male 6 (40%) 40 72 61.00 11.49

Female 9 (60%) 45 73 55.44 10.09

Total 15 40 73 57.67 10.64

This table shows the statistical details of the patients participated in this study

RESULTS

45

Analysis 4:

The paired sample statistics: A paired sample t-test is used to determine whether

there is a significant difference between the average values of the same measurement

made under two different conditions. Both measurements are made on each unit in a

sample, and the test is based on the paired differences between these two values. There

are three tables: Paired Samples Statistics, Paired Samples Correlations, and Paired

Samples Test. Paired Samples Statistics gives univariate descriptive statistics (mean,

sample size, standard deviation, and standard error) for each variable entered. Paired

Samples Correlations shows the bivariate Pearson correlation coefficient (with a two-

tailed test of significance) for each pair of variables entered. Paired Samples Test gives

the hypothesis test results

TABLE 16: PAIRED SAMPLES STATISTICS

Mean N Std. Deviation Std. Error Mean

Pair 1

I week(WD 2) 13.5333 15 1.59762 .41250

Questionnaire 1 33.9333 15 9.29260 2.39934

Pair 2

I month(WD 3) 13.6667 15 2.05866 .53154

Questionnaire 2 86.6667 15 7.35495 1.89904

RESULTS

46

TABLE 17: PAIRED SAMPLES CORRELATIONS

N Correlation Sig.

Pair 1 I week (WD 2) &

Questionaire 1 15 .310 .260

Pair 2 I_month (WD 3) &

Questionaire 2 15 .313 .256

TABLE 18: PAIRED SAMPLES TEST

From the results, oral stereognosis score and denture satisfaction were weakly and

positively correlated (r = 0.310, 0.313, p<0.001)

There was significant difference between oral stereognosis and denture satisfaction (t14

= -8.851, -40.449, p<0.001)

Paired Differences

t df

Sig.

(2-

tailed) Mean Std.

Deviation

Std.

Error

Mean

95% Confidence

Interval of the

Difference

Lower Upper

Pair

1

I week(WD 2) -

Questionaire_1 -20.4000 8.92669 2.30486 -25.34343 -15.45657 -8.851 14 .000

Pair

2

I month(WD 3) -

Questionaire_2 -73.0000 6.98979 1.80476 -76.87082 -69.12918 -40.449 14 .000

DISCUSSION

DISCUSSION

47

In spite of the increased use of dental implants, the most common way of

treating edentulousness is still by means of a conventional complete denture. According

to Berg5, construction of a good set of complete dentures depends on psychological

factors and interactions between the patient and dentist as much as it does, on technical

and biological factors.

A great majority of patients attain acceptable levels of satisfaction with

complete denture treatment. However, it is often observed that even dentures

constructed in accordance to the established clinical guidelines produce dissatisfaction

in the prosthetic outcome in some patients. The ability to predict patient performance

with complete dentures remains elusive, no matter which approach and level of clinical

proficiency is applied to the fabrication of the prosthesis. When the functions of speech,

mastication, and general comfort are used as criteria for comparison, some patients with

clinically acceptable complete dentures function well and others function poorly. Even

in patients who have obvious clinical shortcomings in their dentures, there are degrees

of success in patient performance. Such success can be attributed in part to high tissue

tolerance to denture inadequacies, but factors of diminished sensory feedback and

neuromuscular control relating these appliances are probably more significant.

Oral form recognition test was introduced by Berry and Mahood in1966. Later

H Litvak31 introduced surface variation in the samples along with shape variation, and

the samples were made from metal alloy. McDonald and Aungst34 found that the ability

to identify forms in the mouth improves from childhood to adulthood, remains stable

in young adults, and deteriorates with age. These findings are similar to those of Litvak,

Silverman, and Garfink who found that stereognosis ability decreased with age and was

also less acute in denture wearers.

DISCUSSION

48

A careful review of literature would point, there is no correlation between a high

level of oral perception and the adaptation capability in complete denture wearers.

In a recent study by Akber Pasha KS et al2, in 2017, showed that the level of

oral perception was higher in the younger age group as compared to older age group.

The level of perception was found to be directly proportional to the period of wearing

dentures.

In this study, newly edentulous patients of age between 30 and 75 with an

average age of 58years were chosen. Out of the 15 patients, nine patients were female

with average age was 55years and six male patients with average age was 61years. The

study was conducted before insertion (without denture), and with the dentures on the

day of insertion, after one week (second visit) and one month (third visit). On their

second and third visits (i.e one week and one month after insertion), patients were given

a questionnaire to answer.

In this study, Oral stereognostic test was conducted with eight different

samples; four with basic shape variation and four with surface variation. Without

dentures (WoD), the least score was 0 and maximum was 2 for both shape and surface

variation. On the day of denture insertion (WD 1), the minimum score was 1 and

maximum was 2 for shape variation; and for surface variation minimum score was 0

and maximum was 2. On the first recall visit, after one week (WD 2), the minimum

score was 1 and maximum was 2 for shape variation; and for surface variation minimum

score was 0 and maximum was 2. On the second recall visit (WD 3), the least score was

0 and maximum was 2 for both shape and surface variation.

The results of this study showed an improvement in the stereognostic ability of

deture wearers with mean OST of patients without denture (WoD) is 12.73, on the day

of denture insertion (WD 1) is 13.46, I week (WD 2) score is 13.53 and I month score

DISCUSSION

49

(WD 3) is 13.66. The mean difference was significant at the 0.05 level. There is

significant improvement in oral stereognosis in new complete denture patients with

time.

The questionnaire was mainly based on appearance, speech, mastication and

psychological comfort. All the patients were quite satisfied with appearance, speech

and psychological feel but had difficulty during chewing hard food substances. Patients

who were above 60 years of age were comparatively more satisfied with their denture

including chewing hard food substances. Patients who were dependent on others for

transport performed less when compared to others. This reflected in their stereognostic

score as well as questionnaire. The patient who scored very less in oral stereognostic

test at the second recall visit showed incomplete satisfaction towards the treatment.

Thus it was evident that the scores which the patient provide for the questionnaire is

mainly based on their attitude towards dental treatment and mental status of the patient

during that appointment.

The stereognostic scores at the first week appointment and the questionnaire which

patient had answered on that day is (pair 1) was compared with scores after one month

and scores of questionnaire 2 (pair 2). The results of pair 1(sig = .260) and pair 2 (sig

= .256) suggested that when higher the oral perception, lower is the patient’s

satisfaction with dentures.

Limitations of this study:

1. The sample size selected in the study is limited. Although limited by the

small sample size, the results of this study appear to show that oral

perception, evaluated through the oral stereognosis test, might play a role in

DISCUSSION

50

the complex process of incorporating and accepting rehabilitation with

complete removable dentures.

2. Another limitation of this study is lack of standardized questionnaire for

evaluating patient’s satisfaction with complete denture.

3. In this study the dentures were fabricated by different dentists, thus patient

dentist interaction would be a critical factor for patient’s satisfaction.

CONCLUSION

CONCLUSION

51

This study of oral stereognosis in new complete denture patients, is clinically

correlated with the answers from a questionnaire targeted specially to gauge patient’s

mental attitude towards complete denture. Test samples were fabricated in self-cure

acrylic resin with variation in basic shape and surface pattern. The following

conclusions are drawn from this study after a thorough statistical analysis.

1. Oral stereognosis was significantly improved in non - experienced complete

denture wearers after 1 month of wearing dentures. Thus lead to the conclusion,

Stereognosis can improve with training.

2. Most patients who were able to identify shape which was simple, experienced

difficulty in identifying samples with surface variation which was more

complex.

3. From the study it was noted that the degree of satisfaction is not related to a

high or low oral perception level.

4. The questionnaire, completed by the edentulous patient, is an excellent method

of gathering information on patient needs. It quickly identifies problem areas

and serves as a reference for post-insertion problems.

5. The patient’s perception level is a critical factor in adapting to dentures, but

other factors like patient’s mental attitude towards dental treatment, time,

duration of appointment, dentist patient interaction, and socioeconomic status

all play a great role in patient’s satisfaction.

6. Thus, Oral stereognostic test can be used as a reliable test to measure patient’s

oral stereognostic perception - which would enable the patient to appreciate the

functional limitations of the denture.

CONCLUSION

52

Any treatment is said to be successful only when the patients are fully satisfied. An

extension of the study investigating the mental attitude of the patient will help to

elucidate the success of complete denture therapy. Future prospects in the study would

be development of standardised test samples with both shape and surface variation can

provide elaborate and accurate details of patient’s oral perception. Unlike stereognosis

which is a constant factor, answering a questionnaire is a variable which depends on

many factors. Therefore careful improvement and standardisation of questionnaire is

essential to assess both clinical quality as well as patient’s attitude towards the denture

therapy. This would help in providing enhanced rehabilitation to the needy geriatric

population.

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