The Effects of Improvements in Poorly Fitting Complete Dentures and New Dentures on Patient Satisfaction (An in Vivo Study)

Introduction

Edentulism remains a widespread public health problem, particularly among the elderly, despite advances in preventive dentistry and implant-supported rehabilitation. Complete dentures continue to represent the most common solution for restoring oral function in completely edentulous patients, particularly in resource-limited settings. However, long-term denture wear is often associated with progressive alveolar ridge resorption, altered vertical dimension, occlusal disharmony, and impaired retention and stability. These complications compromise aesthetics, speech, and mastication, ultimately diminishing both functional performance and patient satisfaction, which is increasingly recognized as a key outcome in prosthodontics.¹

Although clinical indices such as denture fit and masticatory efficiency remain important, they do not always align with patient-reported outcomes, particularly when psychological adaptation, expectations, and prior experiences are considered.² Patient-centered evaluations highlight that perceived comfort and psychological adaptation are central to satisfaction, even when objective measures such as masticatory efficiency show limited change.³ With the aging global population and rising demand for prosthetic services, clinicians face the decision of whether to improve existing dentures through systematic adjustments or to provide new prostheses. This decision is based on the assumption that improvements in fit, occlusal balance, and vertical dimension correlate with enhanced patient-reported outcomes. Nevertheless, despite significant technical progress in materials and clinical protocols, a gap often persists between clinical excellence and subjective satisfaction.⁴

Significant advances in impression techniques, occlusal schemes, and biomaterials have enhanced denture therapy outcomes. However, residual ridge resorption remains a major challenge, compromising long-term denture success, especially in the mandible.^5,6 Relining procedures are frequently employed to re-establish tissue contact, although their long-term effectiveness in improving satisfaction compared with new denture fabrication remains debated.⁷

The design and long-term performance of complete dentures involve a complex interplay between anatomical factors, prosthetic design, and patient psychology.⁸ The development of digital workflows, novel biomaterials, and chairside technologies has improved treatment efficiency and accuracy, but ridge resorption continues to impair long-term retention and stability, with highlight on both functional and psychosocial effects of interventions.⁹ Heidecke et al.¹⁰ demonstrated that implant-retained overdentures significantly improve patient satisfaction; however, conventional complete dentures remain widely used and cost-effective. Similarly, Fenlon and Sherriff¹¹ reported that perceived aesthetics and retention are key determinants of satisfaction, independent of age and gender.

Validated assessment tools such as the Oral Health Impact Profile (OHIP-EDENT), visual analog scales, and the McGill Denture Satisfaction Questionnaire enable multidimensional evaluations that include both functional and emotional domains.¹² Patient personality and psychological traits also play a significant role in adaptation and overall satisfaction. However, the influence of sequential denture modifications—particularly occlusal refinements designed to re-establish balanced occlusion—remains underexplored.¹³

Recent studies have highlighted the importance of subjective factors such as retention and aesthetics in predicting satisfaction. Gonçalves et al.¹⁴ emphasized that occlusal balance and polished surface adaptation are critical for speech, function, and psychosocial well-being. Relining procedures, particularly soft relines, have shown potential for improving comfort and function in the short term, but their impact on long-term satisfaction remains inconclusive. Despite the availability of validated outcome measures and growing research, limited studies have examined the cumulative effects of sequential denture modifications prior to new prosthesis fabrication. This study therefore applies a structured stepwise intervention model—including occlusal adjustments, relining, and new denture fabrication—to evaluate their comparative and cumulative effects on patient satisfaction in a controlled clinical setting.¹⁵

Materials and Methods

Patient Selection and Clinical Examination

Ten completely edentulous patients aged 55–88 years were randomly selected from the Prosthodontics Department outpatient clinic at Al Mustaqbal University. Ethical approval was obtained from the institutional university review board, Iraq–Babylon 51001, and all participants signed informed consent forms. Each patient underwent comprehensive examination by a single calibrated clinician to ensure consistency. Retention was assessed by resistance to vertical dislodgement, while stability was evaluated under lateral and functional forces. Phonetic and aesthetic parameters, inter-arch relationships, occlusal contacts, and mucosal health were also documented.

Inclusion criteria were: minimum of one year of denture wear; dissatisfaction with current denture function; and good general health without neuromuscular disorders affecting masticatory function. Patients with previous implant therapy and systemic conditions affecting oral mucosa were excluded.

Sequential Modification Protocol

A standardized sequential protocol was applied to each patient's existing dentures. Occlusal adjustments were performed using a facebow and articulator, followed by selective grinding to correct premature contacts and re-establish bilateral balanced occlusion (Figure 2). A functional impression was made using Xantopren®, and the denture base was relined with tissue conditioner to re-establish adaptation to the underlying mucosa (Figure 3; Figure 4). These modifications aimed to improve load distribution, retention, and masticatory efficiency.¹⁶

New Complete Denture Fabrication

New complete dentures were fabricated using conventional protocols. Primary impressions were made with impression compound using stock trays (Figure 5), and primary casts were poured to fabricate special custom trays (Figure 6). Final impressions were taken with zinc oxide eugenol impression material using border-molded custom trays (Figure 7). Maxillomandibular records were obtained using a semi-adjustable articulator.¹⁷ Acrylic resin was used for denture bases, and anatomical posterior teeth were arranged with bilateral balanced occlusion (Figure 8). Each modification was performed sequentially, with two-week intervals between sessions to allow for patient adaptation and feedback collection.

Assessment Instruments

Three complementary assessment instruments were applied at each stage (T1: initial evaluation; T2: post-modification; T3: after new denture delivery):

1. Retention and Stability Scales (scored −2 to +2) based on objective clinician assessment.¹⁸
2. Visual Analog Scales (VAS) ranging from −2 (worst) to +2 (best) for subjective evaluation of comfort, function, aesthetics, and phonetics.¹⁹
3. Patient Questionnaire developed from the OHIP-EDENT and McGill Denture Satisfaction Instrument, encompassing daily function, psychosocial well-being, and overall prosthesis acceptance.²⁰

Domains assessed included functional parameters (chewing, retention, speech), hygiene (odor, cleaning), subjective outcomes (eating enjoyment, satisfaction), and symptoms (pain, discomfort).

Statistical Analysis

Given the ordinal nature of the response scale (−2 to +2) and the small sample size, non-parametric statistical tests were employed. Repeated-measures comparisons were conducted using the Friedman test for ordinal variables and Cochran's Q test for binary variables. Pairwise post-hoc comparisons were performed using the Wilcoxon signed-rank test. Severity ratings were converted to ordinal scales where appropriate. Statistical analysis was conducted using SPSS version 26.0 (IBM Corp, Armonk, NY). A significance level of p < 0.05 was adopted for all tests.

Results

This study evaluated denture-related outcomes in ten patients aged 51–88 years across three distinct time points: T1 (initial evaluation of existing dentures), T2 (two weeks after denture relining and modification), and T3 (after the delivery of new complete dentures). Retention and stability scores demonstrated progressive improvements throughout all stages. The initial mean retention score was −0.6, which increased to +0.8 following occlusal adjustments and relining, and further improved to +1.8 after the fabrication of new dentures. Stability followed a similar trend, with mean scores rising from −0.2 at baseline to +0.9 after relining and +1.6 post-new denture delivery. The addition of occlusal adjustments during the relining phase contributed significantly to improved denture balance and stability, as patients reported more even bite forces and fewer instances of denture tipping during mastication. Descriptive statistics are summarized in Table 1, while Table 2 presents the Friedman test and related statistical results across denture treatment phases (T1–T3).

The analysis of key functional domains revealed several important findings. Chewing ability showed a statistically significant improvement across all stages (p < 0.05), indicating that most gains occurred after relining (T1–T2), with a plateau for some patients at T3. Retention during chewing, however, did not show statistical significance (p > 0.05), suggesting that subjective improvements may not have been sufficient to overcome anatomical or denture adaptation limitations. Regarding pain from pressure points, no significant change was observed in the occurrence of pain, though its severity notably decreased over time, particularly after new denture delivery. Speech outcomes remained inconsistent and statistically insignificant, as changes in articulation varied among patients, possibly due to variations in palatal contour or tongue space. Ease of cleaning and satisfaction with cleanliness showed significant improvements (p < 0.05), likely due to enhanced surface integrity and contour adaptation in new dentures. Similarly, eating enjoyment demonstrated a significant improvement (p < 0.05), reflecting both better masticatory performance and enhanced psychosocial satisfaction during meals.

Pairwise post-hoc analysis using the Wilcoxon signed-rank test (Table 3) compared outcomes between the three treatment stages: A (Initial/T1), B (Post-Reline/T2), and C (New Denture/T3). Statistically significant improvements were found between A–B and A–C across most domains, while no significant difference emerged between B and C. This suggests that denture modifications alone produced major functional and subjective improvements, with new dentures offering only marginal additional benefits.

Graphical representations further illustrated these findings. The line graph (GP1) below displays the progression of mean scores for retention, stability, and overall satisfaction (VAS −2 to +2), showing clear improvement across all phases, with the most pronounced gains following relining (T1→T2) and smaller yet consistent gains with new dentures (T2→T3).

The grouped bar chart (GP2) compares patient outcomes across six functional and psychosocial domains at each treatment stage, confirming that the most substantial improvements occurred post-modification (T2), while new dentures achieved the highest overall scores across all parameters.

Boxplots (GP3) depict the distribution of score improvements across pairwise comparisons, emphasizing the largest gains from A (pre-treatment) to B (post-reline) and smaller, plateauing improvements from B to C (new dentures). In summary, functional outcomes such as chewing and eating improved significantly following denture relining and further after the provision of new dentures, underscoring the clinical importance of even minor denture modifications in improving patient-perceived outcomes.

Speech results remained variable, indicating the need for targeted phonetic interventions post-prosthesis. Although pain from pressure points was not entirely resolved, its severity was notably reduced, and retention improvements contributed to greater comfort and function. Enhanced psychological satisfaction was evident through increased enjoyment of eating, improved aesthetics, and greater ease of hygiene maintenance. Overall, this study highlights the substantial clinical and psychological benefits of denture relining and replacement, demonstrating that while relining alone offers major functional gains, new denture fabrication provides additional, though smaller, improvements — especially in domains such as chewing, cleaning, and retention.

Discussion

This research supports the clinical claim that modifications of ill-fitting complete dentures play a critical role in improving patient satisfaction, especially in the areas of retention, stability, comfort, and aesthetics. Occlusal adjustments became one of the key elements in the range of modification strategies, addressing disharmonies that interfere with mastication, phonetics, and general denture balance. These refinements were useful in re-establishing effective occlusion, removing premature contacts, and increasing comfort while decreasing relative discomfort during mastication.²¹

Although objective measures of masticatory efficiency or occlusal force may not increase significantly after minor modifications, the subjective experience of comfort and utility is important in predicting the level of overall patient satisfaction.²¹ The described changes in speech, aesthetics, and psychological well-being after denture modifications highlight the importance of psychosocial factors in the success of prosthodontics. Increased individual confidence and decreased social anxiety have both been broadly recorded as advantages of improved prosthesis performance.²²

The researchers established that newly fabricated dentures produced greater satisfaction levels than modified dentures. This difference may be attributed to several reasons, including enhanced adaptation, enhanced occlusal harmony, and enhanced aesthetics through the use of new materials and flawless fabricating technique.²³ The superiority of new dentures over modified dentures as observed in this study underlines the combined benefits of modern fabrication methods, precise jaw relation records, and optimal material choice. These observations support previous studies by Carlsson, who proposed timely replacement of worn-out prostheses to maintain oral function and neuromuscular control, and by Fenlon and colleagues, who showed that new dentures improved patient-reported outcomes with regard to fit and function.⁴

An important finding brought forward by this research is the usefulness of patient-reported outcome measures (PROMs) in the assessment of prosthodontics. Although subjective in nature, PROMs offer essential insights into the lived experience of the patient and the quality-of-life implications of denture therapy. Their adoption into the normal clinical evaluation process improves the clinician's ability to match technical interventions with patient expectations and functional needs. Validated instruments including the Oral Health Impact Profile for Edentulous Patients (OHIP-EDENT) and Visual Analogue Scales (VAS) provide valuable information about subjective areas of measurement such as comfort, speech clarity, and social interaction — domains frequently not well represented in conventional clinical scales.¹³

The results also indicate that there is a need to monitor denture fit and comfort regularly, particularly in older individuals who often undergo alveolar ridge resorption and mucosal alterations. Continued clinical assessment, enhanced by patient feedback and timely interventions — whether through relining, adjustment, or manufacturing of new dentures — is critical in maintaining oral functioning and psychosocial well-being.²⁴

Notably, the researchers like Carlsson and Felton found that newly made dentures produced higher satisfaction scores than modified existing dentures. This disparity can be explained by several factors, including better adaptation, better occlusal harmony, and better aesthetics of newer materials and more accurate fabrication methods. Denture bases and teeth deteriorate over time, and their capacity to conform to the changing oral anatomy decreases, which results in the need to fabricate new prostheses. These observations are in agreement with the article by Carlsson et al., who suggested that dentures should be replaced periodically to ensure the best performance and comfort to the patient.^3,4

In summary, PROMs such as the OHIP and GOHAI (Geriatric Oral Health Assessment Index) may be used to standardize the subjective process of assessing outcomes and enhance the comparability of future studies. This paper has restated that denture adjustments can be a viable and cost-efficient measure in most clinical settings, though not as capable of resulting in the same level of satisfaction as new dentures. The psychosocial advantages of better phonetics, aesthetics, and confidence highlight the holistic need for care in prosthodontics. These findings support the necessity of considering success in terms of both functional performance and patient-centered outcomes.

Conclusion

This clinical investigation demonstrates that sequential modifications of poorly fitting complete dentures result in appreciable improvements in patient satisfaction, with the most significant gains observed in retention, stability, and aesthetic appeal. Despite these improvements, newly fabricated dentures provided the highest overall satisfaction levels, likely due to the precision of fit and the integrity of new materials. Some denture modifications can provide a valuable short-term solution; the fabrication of new complete dentures remains the gold standard for restoring optimal oral function and enhancing quality of life in edentulous patients.

A multidisciplinary, patient-centered approach, including follow-up care, education, and individualized planning, remains critical for successful long-term prosthodontics outcomes. These findings emphasize that while denture modifications are a viable interim solution, the fabrication of new prostheses should be prioritized whenever clinically and financially feasible. Moreover, the subjective experiences of patients — encompassing comfort, speech, aesthetics, and psychological well-being — are paramount in evaluating the success of prosthodontics treatments. Regular reassessment of denture condition and fit is essential, especially in aging populations susceptible to anatomical changes.

The findings also justify the suggestion that occlusal harmony should be assessed and checked regularly as a component of entire denture care. Irregular contacts, wear in the occlusal surface, and loss or gain of vertical dimension can jeopardize the stability and comfort of patients in the long run. With the help of timely correction of these problems through occlusal adjustment, it is possible to avoid more severe complications and increase the functional life of existing prostheses. Finally, this paper highlights that although new denture fabrication is the most appropriate procedure to restore the best performance and appearance, conservative treatment — especially occlusal adjustments — is a useful and evidence-based intervention to improve the performance and well-being of patients with existing dentures.

Acknowledgements

The authors thank the staff of the Prosthodontics Department at Al Mustaqbal University for their assistance and all patients who participated in the study. No funds, grants, or other support were received for the conduct of this research.

Conflicts of Interest

The authors declare no conflicts of interest.

Funding

No funds, grants, or other support were received for the conduct of this research.

Data Availability Statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Ethical Approval

The study protocol was reviewed and approved by the Institutional Ethics Committee, Al Mustaqbal University — Prosthodontics Department, in accordance with the Declaration of Helsinki.