The Effect of Palatal Rugae Design in Complete Denture on Patient Satisfaction and Quality of Life

Edentulism, the complete loss of natural teeth, remains a significant public health concern due to its profound impact on oral function, speech, comfort, and psychosocial well-being. Although dental implants provide a favorable treatment option for many edentulous patients, financial limitations, medical contraindications, and inadequate bone structure often prevent their use. Consequently, conventional complete dentures continue to serve as the primary option for oral rehabilitation in a large proportion of patients.

In conventional maxillary complete dentures, the palatal surface plays an essential role in retention, support, and stability. However, full palatal coverage may also reduce tactile sensitivity and compromise patient comfort, speech clarity, and the ability to perceive taste and temperature. The natural palate contains palatal rugae-elevated folds rich in mechanoreceptors that contribute to oral proprioception and assist in guiding tongue movements during speech, swallowing, and mastication. In contrast, the palatal surface of a conventional denture is typically smooth, which may limit the tongue's ability to adapt effectively to the prosthesis.

Multiple techniques have been proposed to incorporate palatal rugae patterns into complete dentures, including tin-foil duplication, dental floss carving, silicone putty impressions, small palatal windows, roughening procedures, and vacuum-formed templates. While each method offers certain benefits, they also present limitations such as material instability, operator sensitivity, cost, or the need for additional laboratory steps. Previous research comparing polished, roughened, and open rugae designs has shown that designs with greater tactile feedback may improve user satisfaction and oral health-related quality of life (OHRQoL), whereas excessive modification-such as open rugae windows-may reduce comfort and function. Despite these findings, limited evidence is available regarding the comparative effectiveness of polished, roughened, and vacuum-formed thermoplastic rugae designs in maxillary complete dentures.

This randomized controlled trial aims to address this gap by evaluating how three different palatal rugae textures-polished, roughened, and vacuum-formed thermoplastic sheet-affect patient satisfaction and OHRQoL among complete denture wearers. Ninety participants will be randomly allocated into one of three groups. All dentures will be fabricated using standard clinical and laboratory protocols, with the only experimental variation occurring in the palatal rugae region.

The polished-surface group will receive dentures with a conventional smooth palatal surface finished with standard pumice polishing. The roughened-surface group will receive dentures in which the rugae area is textured using 120-µm aluminum oxide sandblasting at 2 bar for 10 seconds. The vacuum-formed group will receive dentures incorporating a rugae pattern created from a 0.5-mm thermoplastic sheet molded over a cast and transferred to the waxed denture before processing. These three designs represent accessible, commonly used techniques with potential clinical benefits in recreating natural palatal anatomy.

Participants will be evaluated at one week, one month, and three months after denture insertion. During each follow-up, participants will complete the OHIP-EDENT questionnaire to assess the impact of the denture on daily function, psychosocial well-being, and oral discomfort. A Visual Analog Scale (VAS) will also be used to measure subjective satisfaction with comfort, chewing, speech, esthetics, and overall denture experience. Clinical assessments will include denture fit, speech clarity, comfort, mucosal condition, and any necessary adjustments.

The primary outcome of the study is the difference in OHIP-EDENT scores among the three rugae design groups over time. Secondary outcomes include VAS-based satisfaction scores and patient-reported ease of adaptation. Through this structured comparison, the study aims to determine whether incorporating specific palatal rugae textures can improve comfort, enhance sensory feedback, aid speech articulation, and contribute positively to oral health-related quality of life.

Ultimately, this research seeks to inform evidence-based improvements in complete denture design, offering clinicians practical guidance for selecting palatal rugae configurations that enhance patient experience and long-term adaptation.