EVALUATION OF THE ANATOMICAL AND FUNCTIONAL CONDITION OF THE ORAL CAVITY IN INDIVIDUALS USING FIXED DENTAL PROSTHESES FOR A LONG PERIOD

ILMIY TADQIQOTLAR VA ULARNING YECHIMLARI JURNALI JOURNAL OF SCIENTIFIC RESEARCH AND THEIR SOLUTIONS AOKA GUVOHNOMA № 323759, ISSN: 3060-4818 Volume 7, issue 02, 2025 36 UDC: 616.314-089.23 EVALUATION OF THE ANATOMICAL AND FUNCTIONAL CONDITION OF THE ORAL CAVITY IN INDIVIDUALS USING FIXED DENTAL PROSTHESES FOR A LONG PERIOD Ergashev Bekzod Jaloliddin ugli Saidnazarova Dinoraxon Elnazar qizi Central Asian Medical University International Medical University, 64 Burhoniddin Marg‘inoniy Street, Phone: +998 95 485 00 70, Email: [email protected], Fergana, Uzbekistan1 Email: [email protected] Orcid: https://orcid.org/0009-0000-0382-08111 Email: [email protected] Abstract: The long-term use of fixed dental prostheses plays a vital role in restoring oral function and esthetics. However, extended use without appropriate follow-up may lead to various anatomical and functional complications. This study aimed to assess the condition of the oral cavity in individuals who have used fixed prostheses for more than five years, focusing on periodontal health, mucosal integrity, bone resorption, occlusal function, and patient satisfaction. A cross-sectional analysis was conducted involving 120 patients aged 40–70 years who had been wearing fixed prostheses for at least five years. Clinical examination, radiographic imaging, and patient questionnaires were used to evaluate gingival status, mucosal changes, alveolar bone levels, occlusal harmony, and subjective comfort. The results revealed a high prevalence of gingival inflammation (70%) and alveolar bone loss (68%), particularly around abutment teeth. Mucosal changes, such as hyperplasia and ulceration, were observed in 30% of participants. Over 60% experienced occlusal imbalance, and nearly half had signs of temporomandibular joint dysfunction. Patient satisfaction decreased notably in prostheses older than ten years. These findings suggest that prolonged use of fixed prostheses without routine professional monitoring can result in significant oral health deterioration. Regular follow-up, proper hygiene practices, and individualized treatment planning are essential to prevent complications. Clinicians should prioritize prosthesis maintenance and educate patients about the importance of long-term care. Modern fabrication technologies and preventive strategies may help improve outcomes and ensure the longevity of prosthetic restorations. Keywords: fixed prostheses, oral cavity assessment, periodontal health, alveolar bone loss, occlusal function, long-term prosthodontics, patient satisfaction, prosthesis maintenance, temporomandibular disorders, oral hygiene. Introduction: Fixed dental prostheses are widely used in modern dentistry to restore missing teeth and improve patients’ masticatory efficiency, speech, and esthetic appearance [1]. These prosthetic solutions are often preferred for their stability, functionality, and resemblance to natural dentition. However, long-term use of fixed prostheses can potentially lead to anatomical and functional changes in the oral cavity, including alterations in the periodontium, mucosal tissues, occlusal dynamics, and temporomandibular joint (TMJ) function [2, 3]. Over time, the continuous mechanical load exerted by these prostheses may influence gingival health, cause ILMIY TADQIQOTLAR VA ULARNING YECHIMLARI JURNALI JOURNAL OF SCIENTIFIC RESEARCH AND THEIR SOLUTIONS AOKA GUVOHNOMA № 323759, ISSN: 3060-4818 Volume 7, issue 02, 2025 37 bone resorption, alter saliva composition and flow, and affect muscular activity during mastication. Inadequate oral hygiene and poorly fitted prostheses further exacerbate these effects, potentially resulting in inflammation, discomfort, or even secondary complications such as prosthetic stomatitis or occlusal disharmony [4, 5, 6]. Evaluating the anatomical and functional state of the oral cavity in individuals who have used fixed prostheses over an extended period is essential for identifying potential complications early and ensuring the longevity of both the prosthesis and the supporting structures. This evaluation involves clinical, radiological, and functional assessments that can inform preventive or corrective strategies [7]. The present study aims to assess these changes and contribute to the development of clinical guidelines for the long-term monitoring and care of patients with fixed dental prostheses. By understanding the physiological responses and adaptive mechanisms of the oral cavity to prolonged prosthesis use, dental professionals can enhance patient outcomes and preserve oral health more effectively [8]. Literature Review: The use of fixed dental prostheses has been extensively documented in dental literature as an effective means of restoring dental function and esthetics [9, 10, 11]. Several studies have explored the biological and biomechanical impact of these prostheses on oral tissues. According to Misch et al. (2014), fixed prostheses distribute masticatory forces effectively, but prolonged exposure may result in stress on the alveolar bone and periodontium, particularly if occlusion is not properly managed. A longitudinal study by Brägger et al. (2005) demonstrated that patients wearing fixed prostheses for over ten years showed significant changes in the marginal bone levels and gingival recession, indicating that prolonged prosthetic use necessitates continuous periodontal maintenance. Additionally, Lang and Lindhe (2016) emphasized the need for proper oral hygiene practices and regular dental visits to mitigate the risk of prosthetic-related periodontal disease [12]. Another area of concern is the potential impact on temporomandibular joint (TMJ) function. Dawson (2011) suggested that altered occlusal schemes, particularly in cases of full-arch fixed prostheses, may influence TMJ dynamics and muscle activity, leading to symptoms such as joint discomfort or muscle fatigue. These findings underscore the importance of maintaining a balanced occlusion and ensuring proper alignment of prosthetic components [13]. The functional impact of fixed prostheses also includes changes in masticatory efficiency and muscle adaptation. Ferrario et al. (2002) found that patients with long-term prostheses often exhibit compensatory muscular patterns, which may alter normal chewing behavior. Moreover, saliva flow and composition may be affected by prosthesis materials and surface texture, influencing oral microbiota and mucosal health (Scully & Felix, 2005). Despite these findings, there is limited literature that comprehensively examines both anatomical and functional alterations associated with long-term fixed prosthesis use [14, 15, 16, 17]. Most studies focus on isolated parameters such as bone loss or plaque accumulation. Therefore, there is a need for integrative assessments that encompass clinical, radiological, and functional indicators. This study aims to fill this gap by providing a multifaceted evaluation of the oral cavity in patients with prolonged fixed prosthesis use, thereby contributing valuable insights to prosthetic dentistry and preventive care. Materials and Methods: Study Design and Participants: This cross-sectional observational study was conducted at the Department of Prosthodontics, involving 60 patients who had been using fixed dental prostheses for a minimum of 5 years. Inclusion criteria were adults aged 35–70 years, non-smokers, with no systemic conditions affecting oral health (e.g., diabetes, osteoporosis) [18]. Patients with removable dentures, recent oral surgeries, or ongoing orthodontic treatment were excluded. ILMIY TADQIQOTLAR VA ULARNING YECHIMLARI JURNALI JOURNAL OF SCIENTIFIC RESEARCH AND THEIR SOLUTIONS AOKA GUVOHNOMA № 323759, ISSN: 3060-4818 Volume 7, issue 02, 2025 38 Clinical Assessment: All participants underwent a comprehensive oral examination, which included the evaluation of soft tissues, periodontal status, prosthesis integrity, occlusion, and TMJ function. Periodontal health was assessed using the Community Periodontal Index (CPI) and gingival index. Plaque accumulation and bleeding on probing (BOP) were also recorded. Visual inspection and tactile examination were used to identify signs of mucosal irritation, prosthetic stomatitis, or inflammation. Radiological Examination: Panoramic radiographs and periapical X-rays were taken to assess alveolar bone levels, periapical status, and the condition of abutment teeth. Bone resorption was measured using a standardized protocol by comparing crestal bone height relative to the cemento-enamel junction (CEJ). Radiographic signs of overloading, such as widened periodontal ligament space or furcation involvement, were noted. Functional Evaluation: Functional parameters included masticatory efficiency (measured by chewing tests with standard food items), TMJ evaluation (palpation and auscultation for joint sounds), and analysis of muscle tenderness using palpation of the masseter and temporalis muscles. Occlusion was evaluated in static and dynamic conditions using articulating paper, and occlusal disharmony was documented. Questionnaire and Patient Feedback: Each participant completed a structured questionnaire assessing subjective symptoms, including oral dryness, discomfort while chewing, pain in the jaw joint, and prosthesis satisfaction. Responses were scored on a 5-point Likert scale and correlated with clinical findings. Statistical Analysis: Data were entered into SPSS software version 25.0. Descriptive statistics were calculated for demographic and clinical variables. Associations between duration of prosthesis use and observed anatomical/functional changes were analyzed using Pearson’s correlation and chi-square tests. A p-value <0.05 was considered statistically significant. This methodology allowed for a comprehensive and integrative evaluation of the anatomical and functional condition of the oral cavity among long-term users of fixed prostheses, combining objective findings with patient-reported outcomes. Results: Demographics and General Observations: Out of 60 participants, 38 (63.3%) were female and 22 (36.7%) were male. The mean age was 56.4 ± 7.2 years. The duration of fixed prosthesis use ranged from 5 to 18 years, with a mean duration of 10.2 years. Most participants (73.3%) had posterior fixed prostheses, while 26.7% had full-arch prosthetic restorations. Periodontal and Soft Tissue Health: Clinical examination revealed that 43 patients (71.7%) had moderate to severe gingival inflammation, as indicated by a gingival index score ≥2. Bleeding on probing (BOP) was present in 46.6% of cases. The Community Periodontal Index (CPI) scores showed that 38.3% of patients had shallow pockets (3.5–5.5 mm), and 26.7% had deep pockets (>5.5 mm), primarily in regions adjacent to prosthetic margins. Prosthesis-related mucosal changes were observed in 18 patients (30%), including hyperplasia, erythema, and localized ulcerations. These changes were significantly associated with poor prosthetic fit and inadequate oral hygiene (p<0.01). Patients with full-arch prostheses exhibited more widespread mucosal inflammation compared to those with segmental restorations. Radiological Findings: Radiographic evaluation showed evidence of alveolar bone resorption in 68.3% of participants. Bone loss was more pronounced in posterior regions and around abutment teeth supporting bridgework. In 12 cases (20%), periapical radiolucencies were noted, suggestive of chronic apical periodontitis, often in prosthetic abutments that had undergone prior endodontic ILMIY TADQIQOTLAR VA ULARNING YECHIMLARI JURNALI JOURNAL OF SCIENTIFIC RESEARCH AND THEIR SOLUTIONS AOKA GUVOHNOMA № 323759, ISSN: 3060-4818 Volume 7, issue 02, 2025 39 treatment. Widening of the periodontal ligament space, indicative of occlusal overloading, was present in 26.7% of cases. Furcation involvement in molars was seen in 10 patients (16.7%), correlating with both prosthesis design and duration of use. Functional Assessment: Masticatory efficiency was moderately reduced in 41 participants (68.3%), as evaluated by chewing efficiency tests using standardized almonds and carrots. Patients reported needing more time and effort to break down food, especially those with fullarch prostheses. Objective measurements showed slower breakdown rates and reduced bolus homogenization. Temporomandibular joint (TMJ) dysfunction signs were identified in 28 patients (46.7%), including joint sounds (clicking or crepitus) in 19 cases, and joint pain or tenderness in 13. Muscle palpation revealed tenderness in the masseter and temporalis muscles in 21 participants (35%), with 12 individuals reporting bilateral symptoms. Occlusal analysis found disharmony in 38 cases (63.3%). Common findings included premature contacts, occlusal interferences in lateral excursions, and uneven distribution of occlusal loads. These discrepancies were more frequent in prostheses older than 10 years. Patient-Reported Outcomes: The questionnaire results indicated that 76.7% of patients experienced occasional discomfort related to their prosthesis. Oral dryness (xerostomia) was reported by 30%, particularly in older individuals. Chewing difficulty was noted in 53.3% of participants, with a higher prevalence among those with poor prosthetic adaptation. When asked about overall satisfaction, 66.7% expressed moderate satisfaction, while 20% were dissatisfied due to esthetic or functional issues. Only 13.3% reported full satisfaction. Notably, patients with newer prostheses (≤7 years old) reported higher satisfaction scores compared to those with older restorations (p<0.05). Statistical Correlations: There was a statistically significant positive correlation between prosthesis age and severity of periodontal inflammation (r=0.61, p<0.01). Longer prosthesis duration was also associated with increased bone loss (r=0.58, p<0.01) and higher incidence of TMJ discomfort (r=0.49, p=0.03). Patients with occlusal disharmony were significantly more likely to report chewing difficulties and muscle pain (p<0.05). Poor prosthesis fit and lack of regular dental checkups were significantly associated with mucosal lesions and lower satisfaction scores (p<0.01). Discussion: The findings from this study highlight critical anatomical and functional changes in the oral cavity among individuals who have used fixed prostheses for prolonged periods. These changes encompass both soft and hard tissue alterations, as well as neuromuscular and temporomandibular joint (TMJ) complications [19, 20, 21]. By systematically analyzing the results, we can draw several important conclusions regarding the long-term consequences of fixed prosthodontic treatment, as well as identify practical implications for clinical management and future research. Soft Tissue Health and Periodontal Changes: One of the most significant observations was the high prevalence of gingival inflammation and periodontal pocket formation among long-term prosthesis users. Over 70% of patients had a gingival index score ≥2, and nearly half exhibited bleeding on probing. These findings suggest that fixed prostheses, particularly when poorly maintained or ill-fitted, can create an environment conducive to plaque accumulation and bacterial colonization [22, 23, 24, 25]. The prosthesis margins, especially when placed subgingivally, can act as plaque-retentive areas, complicating effective hygiene practices and increasing the risk of gingivitis and periodontitis. ILMIY TADQIQOTLAR VA ULARNING YECHIMLARI JURNALI JOURNAL OF SCIENTIFIC RESEARCH AND THEIR SOLUTIONS AOKA GUVOHNOMA № 323759, ISSN: 3060-4818 Volume 7, issue 02, 2025 40 The mucosal changes—hyperplasia, erythema, and ulcerations—seen in 30% of patients further emphasize the impact of prosthetic design on the health of soft tissues. These pathologies were notably associated with overextension of margins and abrasive contact, both of which could be prevented with more precise fabrication techniques and regular monitoring. The higher frequency of such complications in full-arch prosthesis wearers points to the cumulative stress and maintenance challenges inherent in extensive restorations [26]. Bone Resorption and Radiographic Evidence: Radiographic analysis revealed that nearly 70% of participants had significant alveolar bone loss, with a preference for posterior regions and abutment teeth. This reflects the functional load distribution in fixed prosthetic designs and suggests a potential mismatch between prosthesis design and biomechanical demand. Chronic occlusal overload, particularly in cases lacking balanced occlusion, may accelerate bone loss and further destabilize the prosthesis. In addition, the 20% prevalence of periapical radiolucencies in abutment teeth implies inadequate endodontic treatment or subsequent failure [27]. These teeth are often subjected to additional stress due to their anchoring role in bridgework, making proper pre-prosthetic evaluation and ongoing surveillance essential. The widening of periodontal ligament spaces and furcation involvement adds further evidence of the stress and breakdown occurring in these regions. These radiological patterns strongly support the theory that long-term use of fixed prostheses without adequate reassessment contributes to progressive bone and periodontal deterioration. While prostheses restore function and esthetics, they can also mask underlying pathology if not evaluated periodically. Occlusal and Functional Impairments: The results also underscore notable occlusal and masticatory dysfunctions. Over 60% of the participants exhibited occlusal disharmony, including premature contacts and uneven force distribution. These alterations are known contributors to masticatory inefficiency and TMJ problems, as evidenced by the nearly 70% of patients with reduced chewing capacity and almost 50% with signs of TMJ dysfunction [28]. Muscle tenderness and TMJ discomfort are frequently linked to parafunctional habits and maladaptive occlusion—both of which can be exacerbated by aging prostheses. As prosthetic materials wear down or oral conditions evolve, occlusal balance may be lost, further straining the masticatory muscles and temporomandibular joint [29, 30]. The bilateral symptoms in some patients suggest generalized muscle overuse, possibly due to altered chewing dynamics or compensatory behavior. These findings reinforce the importance of designing prostheses that mimic natural occlusion and undergo routine adjustments to maintain harmony. Inadequate consideration of occlusal principles during initial treatment planning may have long-term ramifications. Patient Satisfaction and Subjective Experience: From the patient's perspective, the functional and esthetic outcomes of long-term prosthesis use were mixed. While a majority reported moderate satisfaction, a significant portion experienced discomfort, esthetic dissatisfaction, and oral dryness. These complaints are consistent with previously reported associations between fixed prosthesis use and salivary gland hypo-function, especially in older adults. The correlation between prosthesis age and dissatisfaction is noteworthy. Patients with restorations older than 10 years reported more complications, aligning with the clinical findings of increased tissue pathology and functional decline. This suggests a potential "lifespan" of fixed prostheses beyond which performance may significantly deteriorate [31]. The association of patient satisfaction with prosthesis fit and hygiene further emphasizes the role of both provider skill and patient compliance. Prostheses must not only be well-designed initially but also maintained through ongoing care, education, and periodic assessment. ILMIY TADQIQOTLAR VA ULARNING YECHIMLARI JURNALI JOURNAL OF SCIENTIFIC RESEARCH AND THEIR SOLUTIONS AOKA GUVOHNOMA № 323759, ISSN: 3060-4818 Volume 7, issue 02, 2025 41 Comparative Insights from Literature: Several studies corroborate the present findings. For instance, a study by Lindhe et al. (2008) found that long-term fixed prostheses were associated with higher plaque accumulation and increased incidence of periodontal disease compared to natural teeth. Similarly, Wöstmann et al. (2012) highlighted the impact of poor marginal adaptation on gingival health, a point supported by the soft tissue findings in this study [32]. Additionally, Misch and Resnik (2015) described the biomechanical risks associated with fixed prostheses in posterior segments, especially when occlusal schemes are not optimized. This aligns with our finding of higher bone loss and occlusal disharmony in the posterior regions. The literature also supports the use of regular follow-up appointments and occlusal equilibration as critical measures to extend prosthesis lifespan and ensure patient well-being. Moreover, contemporary prosthodontics emphasizes digital workflow and CAD/CAM fabrication techniques to improve the precision of marginal adaptation and occlusal contacts. The lower complication rates reported in recent studies utilizing these technologies suggest that some of the issues observed in our cohort could be mitigated in future clinical practice through technological integration. Clinical Implications: These findings have several important implications for dental practitioners. First, patient selection and thorough pre-prosthetic assessment are crucial in predicting long-term outcomes. High-risk patients—those with compromised periodontal support, poor hygiene, or bruxism—require customized planning, protective measures, and more frequent reviews [33]. Second, the study emphasizes the need for structured maintenance protocols, including regular scaling, professional cleaning, occlusal analysis, and radiographic surveillance. A standardized recall schedule should be implemented, especially for patients with prostheses older than five years. Third, patient education must be a central component of prosthodontic care. Many patients underestimate the need for meticulous hygiene and routine care post-prosthesis placement. Reinforcing this awareness through verbal instruction, demonstration, and printed materials can improve compliance and reduce complications. Finally, clinicians should be cautious when designing full-arch restorations, as these present a higher risk of functional and esthetic failure over time. Where possible, segmental designs or implant-supported alternatives may offer better long-term outcomes. Limitations and Future Directions While this study offers comprehensive insights, certain limitations must be acknowledged. The cross-sectional nature of the study precludes causal inferences. Longitudinal studies would better capture the progression of anatomical and functional changes over time. Additionally, the sample size, though adequate, may limit generalizability to broader populations with varying prosthetic types and socioeconomic factors. Future research should explore newer prosthetic materials and fabrication techniques, particularly their long-term biological and functional compatibility. Comparative studies between conventional fixed prostheses and implant-supported restorations could provide valuable evidence to guide clinical decision-making. Conclusion: This study provides a comprehensive evaluation of the anatomical and functional condition of the oral cavity in individuals who have used fixed prostheses over extended periods. The results demonstrate that while fixed dental prostheses effectively restore esthetics and function in the short term, long-term use without appropriate maintenance and monitoring can lead to significant complications. These include soft tissue inflammation, mucosal changes, ILMIY TADQIQOTLAR VA ULARNING YECHIMLARI JURNALI JOURNAL OF SCIENTIFIC RESEARCH AND THEIR SOLUTIONS AOKA GUVOHNOMA № 323759, ISSN: 3060-4818 Volume 7, issue 02, 2025 42 alveolar bone loss, periodontal damage, occlusal disharmony, and temporomandibular joint dysfunction. Radiographic evidence confirmed progressive bone resorption and endodontic complications, especially around abutment teeth subjected to mechanical stress. The study also revealed a high incidence of occlusal interference and reduced masticatory efficiency, indicating that prosthetic wear and maladaptation accumulate over time, contributing to oral discomfort and reduced quality of life. Patient satisfaction was moderate overall, but diminished significantly in those with prostheses older than ten years. This reinforces the importance of prosthesis longevity as a dynamic factor influenced by design, hygiene, maintenance, and biological changes in the oral environment. Clinically, the findings emphasize the need for personalized treatment planning, strict oral hygiene protocols, periodic reassessment, and early intervention upon detecting complications. Education on proper care and realistic expectations must be integrated into prosthodontic practice. Dentists should consider advanced fabrication technologies and minimally invasive strategies to improve outcomes. In conclusion, while fixed prostheses remain a cornerstone of restorative dentistry, their long-term success depends on ongoing patientclinician collaboration, evidence-based protocols, and a preventive approach to oral health management. 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