7. How to brush an attachment?

Oral hygiene instructions to attachment denture patients for dental hygienists

T. Masuda, Y. Sakakibara ¹,M. Kishimoto¹, K. Matsushita¹, M. Yamaguchi¹, K. Shyoji, R. Kanbara,

Y. Nakamura and Y. Tanaka

Department of Removable Proshodontics, School of Dentistry Aichi-Gakuin University

¹Dental Hygienist Section, School of Dentistry Aichi-Gakuin University Hospital

Introduction

  Dental hygienists in the Prosthodontic Department are in charge of the oral hygiene instructions provided to patients who complete prosthodontic treatment. Patients with specialized attachments are frequently encountered in a normal hygiene practice. Patients using partial dentures with special magnetic attachments are satisfied with esthetic result of treatment and their improved chewing ability.

  The shape of these magnetic attachments varies from the simple to the complex. While the basic shape of a magnetic attachment keeper or MT crownsappears simple, they are actually completely different from natural teeth. The specialized shaping of an extracoronal magnetic attachment include the complex features of a groove and interlock.

  Patients using attachment dentures often complain of difficulty in their oral hygiene and self-cleaning of the keeper attachment.

Objective

The present paper reports on the choice of magnetic attachment brushing materials and brushing methods.

Case Report

  The patient was a 42-year-old female with several chief complaints including: poor esthetics, difficulty in chewing, and malocclusion. Figure. 1 shows the patient’s image at first visit.

A magnetic attachment was used for the retaining abutment and final restoration. The chief complaints were addressed and reported improved upon. The patient stated satisfaction with prosthetic result and outcome. The present case was previously reported^1）A MT crown and groove design prosthetic treatment was placed in the maxilla, and an extracoronal magnetic attachment and MT crown prosthetic treatment was completed for the mandible (Fig.2).

Oral hygiene instruction was given to the patient during prosthodontic treatment, and the patient maintained excellent plaque control. However, the first PCR after the attachment denture placement was 60%. Dental plaque was observed in a groove and attachment base. It was difficult to remove plaque using toothbrush alone due to thetight complexity of prosthetic design structure. Dental plaque was also observed on the mesial and distal surfaces of the maxillary MT inner crown. The problem of hygiene access is related to the contour, position and access of the  the long and isolated MT crown structure and the patient awareness of the problem. (Fig. 3). Retained plaque was noted at the cervical and concave areas of the mandibular MT inner crown (Fig. 4). A denture plaque disclosing agent additionally identified dental plaque in these unbrushed areas. The patient lack of  awareness was significantly noted in the cleaning her denture (Fig. 5).

A scrubbing and brushing technique was taught at the first appointment oral hygiene instruction. The extracoronal attachment brushing method was taught at the second lesson. Specifically, a thick-type abrasive floss thread (Superfloss, GC) was inserted along with the attachment base and groove (Fig. 6).

A one tuft brush tip was then used to brush the interlock area (Fig. 7).

 The PCR gradually declined as the patient’s motivation and improvedof brushing skills to an increase in. The brushing of the MT inner crown was taught at the fourth appointment. The angle, stability, and grip of the one tuft brush was additionaly demonstrated for cleaning of the long maxillary MT crown. An attachment brush was used to clean the mandibular MT crown as access is difficult due a low  relativeprofile hight (Fig. 8).

 A evaluated PCR score showed a 5th measurement below 20%. (Fig. 9).

Figure 10 demonstrates stained remaining teeth with a plaque disclosing agent after brushing. The visualization of uncleaned areas improves patient awareness and stresses othe importance of denture cleaning.

PMTC is performed regularly at every 3-month checkup.

Discussions

  Although the patient showed an excellent plaque control during the prosthodontic phases of treatment, post treatment evaluation of multiple unbrushed areas was observed after attachment denture delivery. The visualization of hygiene problem areas is very important for patient awareness of the importance of denture and oral hygiene. Magnetic attachment designs of varying profiles and shapes are cleaned by appropriate use of adjunctive brush designs and hygiene tools.

Conclusions

  Although the present patient achieved a satisfactory PCR result, identical brushing methods cannot be used for all patients.  The brushing methods may be changed in response to a patient’s dexterity. The importance of prostheses plaque control and complex restorative attachment structures are confirmed. It is important for doctors and dental technicians to not only seek functional and esthetic results but also provide for  hygienic maintainability. Dental hygienists should give appropriate advice to each patient for correct tooth brush selection and recommended techniques considering the patient’s age, dexterity, and individual awareness. 

Reference

1.               Shyoji K, The Full Mouth Reconstruction using Magnetic Attachments, J J Mag Dent 18(1):69-70, 2009.