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Gonçalves TMSV, Bezerra AP, Reginaldo I, Wanghon ZML, Drummond LB, Feldmann A, Philippi AG, Mezzomo LAM. Four-year assessment of masticatory function in mandibular overdenture wearers: A randomised clinical trial comparing two to four implants to retain the prosthesis. J Oral Rehabil 2024. [PMID: 38873742 DOI: 10.1111/joor.13781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/25/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Limited data exist on the mid- to long-term masticatory capacity of mandibular overdenture (IOD) wearers, particularly regarding the use of posterior implants to retention. OBJECTIVES To periodically evaluate mastication of IOD wearers, comparing the effectiveness of two to four implants to retain the prosthesis. METHODS In a randomised controlled clinical trial, 20 complete edentulous patients (14 women), aged 51-84 years (mean age 69.1 ± 9.6), received new bimaxillary complete dentures (CD). After adaptation, baseline measurements of masticatory performance (X50) and swallowing threshold were conducted using the sieving method. Patients were then randomly assigned to groups: control (two intra-foraminal regular implants) and experimental (two intra-foraminal regular implants and two extra-short posterior implants) (n = 10 each). After 4 months, implants were splinted, and a new mandibular IOD was fabricated with bar/clip retention. Mastication was reassessed after 6, 12, and 48 months, and data analysed with repeated measures ANOVA and Sidak's post hoc (α = 0.05). RESULTS Despite a loss of two patients per group, masticatory performance significantly improved after mandibular IOD installation (p = .031) in both groups (p = .670). A second improvement was observed after 6 months (p = .027), with no subsequent changes (p > .05). Swallowing threshold improvements were noted with IOD, and no discernible differences between groups were observed (p > .05). CONCLUSION Masticatory function significantly improved after mandibular IOD installation, with the number of implants demonstrating minimal influence. CLINICAL TRIAL REGISTRATION The present study was not registered in a public database, as mandated. It is important to note that the recommendation for registration was initiated in 2017 by the Committee of Medical Journal Editors, while patient inclusion in the research took place in 2016. Given that the data presented in this manuscript cover a follow-up period of up to 4 years post-surgical intervention, delayed registration was not feasible.
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Affiliation(s)
| | - Adriana Pinto Bezerra
- Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Isabela Reginaldo
- Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Zuila Maria Lobato Wanghon
- Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Liliane Bonatto Drummond
- Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Alexandra Feldmann
- Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Analucia Gebler Philippi
- Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
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Carneiro DE, Zander LRM, Ruppel C, De La Torre Canales G, Auccaise-Estrada R, Sánchez-Ayala A. Influence of the radius of Monson's sphere and excursive occlusal contacts on masticatory function of dentate subjects. Arch Oral Biol 2024; 159:105879. [PMID: 38211398 DOI: 10.1016/j.archoralbio.2023.105879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/14/2023] [Accepted: 12/30/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE To determine the influence of the radius of Monson's sphere, the number of posterior laterotrusive, mediotrusive, and protrusive contacts, and the chewing rate on food comminution. DESIGN Sixty healthy dentate subjects, aged 21.22 ± 2.30 years, were selected. The three-dimensional coordinates of the cusp tips of the lower canine, premolar, and molar teeth were identified from the subjects' digital models. Monson's sphere was designed using the simplex method for function minimisation by adjusting the coordinates on its surface. The contacts were verified using 12 µm metal strips in jaw excursions at 0.5, 1.0, 2.0, and 3.0 mm. The masticatory performance and efficiency, swallowing threshold, and chewing rate were assessed through particle size fractionation. Data were analysed with multiple linear regression (α = 0.05). RESULTS The sphere's radius, laterotrusive and protrusive contacts at 0.5 mm, and chewing rate were found to be negative predictor variables for masticatory performance until 20 chewing cycles (R2 = 0.429). For 40 cycles, the radius and total contacts (0.5 mm) were also explanatory factors (R2 = 0.223). Only the radius (R2 = 0.176) and the chewing rate (R2 = 0.082) were found to be significant for 60 cycles and swallowing threshold, respectively. Masticatory efficiency was influenced by masticatory performance until 40 and 60 cycles, as well as the radius and total contacts at 2.0 and 3.0 mm (R2 = 0.958). CONCLUSION A larger radius of Monson's sphere and a greater number of posterior excursive contacts were found to be related to better masticatory function.
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Affiliation(s)
| | | | - Carolina Ruppel
- Department of Dentistry, University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
| | - Giancarlo De La Torre Canales
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, Almada, Portugal; Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Center for Orofacial Neurosciences (SCON), Flemingsberg, Huddinge, Sweden; Department of Dentistry, Ingá University Center, Uningá, Maringá, Paraná, Brazil
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Da Silva FP, Dos Santos IM, Carneiro DE, De La Torre Canales G, Sánchez-Ayala A. Effect of artificial eccentric occlusal interferences on masticatory performance: A randomised double-blind clinical trial. J Oral Rehabil 2024; 51:536-545. [PMID: 37964439 DOI: 10.1111/joor.13620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/20/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Occlusal interferences lead to changes in mandibular kinematics to compensate and improve function. However, the effects of different types of eccentric disturbance on the comminution capacity are not known. OBJECTIVE To determine the immediate effect of eccentric occlusal interferences on masticatory performance. METHODS This crossover clinical trial included 12 healthy dentate subjects aged 25.2 ± 3.3 years who were randomly submitted to seven types of occlusal interference: unilateral and bilateral laterotrusive and mediotrusive, protrusive, dummy and control (no interference). The interference forms were planned in a semi-adjustable articulator, fabricated with composite resin and adhered to the mandibular first molars such that subjects' maximum intercuspation was maintained. Masticatory performance and the chewing rate during 20 cycles were evaluated during subjects' comminution of silicone test food under one interference condition per test day; the multiple sieve method was applied to the comminuted particles. The interference was removed upon test completion, and a 1-week washout period was applied between tests. RESULTS Comminuted median particle sizes were larger under unilateral (4.94 ± 0.41 mm) and bilateral (4.81 ± 0.49 mm) laterotrusive, bilateral mediotrusive (4.65 ± 0.50 mm) and protrusive (4.83 ± 0.54 mm) interferences (p < .05) than under the control (4.01 ± 0.52 mm) and dummy (4.18 ± 0.58 mm) conditions (p < .05). Only unilateral and bilateral laterotrusive interferences narrowed the comminuted particle size dispersion (p < .05). The chewing rate did not differ among conditions (p = .1944). CONCLUSION Artificial eccentric interferences had an immediate adverse effect on masticatory performance by resulting in larger comminuted particles. CLINICAL TRIAL REGISTRATION Brazilian Registry of Clinical Trials (RBR-8g5zfg8).
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Affiliation(s)
| | | | | | - Giancarlo De La Torre Canales
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, Almada, Portugal
- Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Center for Orofacial Neurosciences (SCON), Flemingsberg, Huddinge, Sweden
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Yoshimoto T, Hasegawa Y, Maria MTS, Marito P, Salazar S, Hori K, Ono T. Effect of mandibular bilateral distal extension denture design on masticatory performance. J Prosthodont Res 2023; 67:539-547. [PMID: 36740265 DOI: 10.2186/jpr.jpr_d_22_00135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Removable partial dentures have a wide range of applications as missing tooth prostheses, and the denture design can be quite diverse. However, the factors affecting masticatory function remain unclear. We investigated the effect of denture design, especially the use of indirect retainers and major connectors, on masticatory function in patients with mandibular bilateral distal extension dentures. METHODS Fifty-three patients with mandibular Kennedy Class I and Eichner classification B occlusal support were included in this study. Masticatory performance (MP) was assessed using gummy jelly. For the dentures, the type of major connector (bar or apron), presence or absence of indirect retainers, number of rests, and number of artificial teeth were evaluated. The number of functional teeth and occlusal support, Eichner classification, maxillary denture usage, mandibular residual ridge height, and duration of denture use were also evaluated. The factors influencing on the MP were evaluated using the Mann-Whitney U test, Spearman's correlation coefficient, and logistic regression analysis. RESULTS MP was significantly higher when the major connector was bar-type or when there was an indirect retainer than with an apron-type or no indirect retainer. MP was positively correlated with the number of functional teeth, occlusal support, and number of rests. Logistic regression analysis revealed that the number of functional teeth and the presence or absence of an indirect retainer were factors that significantly influenced the MP. CONCLUSIONS An indirect retainer setting is useful for achieving good masticatory performance in mandibular bilateral distal extension dentures.
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Affiliation(s)
- Tasuku Yoshimoto
- Division of Comprehensive prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Yoko Hasegawa
- Division of Comprehensive prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Ma Therese Sta Maria
- Division of Comprehensive prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
- College of Dentistry, Manila Central University, Caloocan, Philippines
| | - Pinta Marito
- Division of Comprehensive prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
- Faculty of Dentistry, University of Indonesia, Depok, Indonesia
| | - Simonne Salazar
- Department of Dentistry, Centro Escolar University, Manila 1000, Philippines
| | - Kazuhiro Hori
- Division of Comprehensive prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Takahiro Ono
- Division of Comprehensive prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
- Department of Geriatric Dentistry, Osaka Dental University, Osaka, Japan
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Association of the number of teeth and self-rated mastication with self-rated health in community-dwelling Japanese aged 40 years and older: the Yamagata cohort study. Sci Rep 2022; 12:21025. [PMID: 36471165 PMCID: PMC9722922 DOI: 10.1038/s41598-022-25690-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Self-rated health (SRH) is a predictive factor for health-related prognoses such as mortality. This study aimed to comprehensively investigate the risk factors for poor SRH in the general population of Japan, focusing on the combination of the number of teeth and self-rated mastication. Individuals aged at least 40 years in Yamagata Prefecture, Japan, were surveyed from 2017 to 2021. The participants answered a self-administered postal survey on lifestyle factors, medical history, physical and mental conditions, oral health, and dietary intake, and 6739 participants were included. Multivariate logistic regression analysis showed that individuals with less than 20 teeth and who bite tightly on one side or neither side were at a 1.422- and 1.952-fold significantly higher risk, respectively, of poor SRH than individuals with at least 20 teeth and who bite tightly on both sides. Moreover, individuals who had less than 20 teeth but could bite tightly on both sides did not have a significant risk compared to those who had at least 20 teeth and could bite tightly on both sides. Regarding individuals with more than 20 teeth, there was no difference between those who could and could not bite tightly on both sides, although the odds ratios for poor SRH tended to increase for those who could bite on one side or neither side. Our results emphasize the importance of having at least 20 teeth without periodontal disease and oral rehabilitation using a type of prosthesis for SRH, even with less than 20 teeth.
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Goodacre CJ, Goodacre BJ. What Occlusal Scheme Should Be Used with Removable Partial Dentures? J Prosthodont 2021; 30:78-83. [PMID: 33783088 DOI: 10.1111/jopr.13313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Multiple clinical studies have been published comparing different philosophies of complete denture occlusion and different types of denture teeth. However, it is unclear whether comparable data are available for occlusal schemes used with removable partial dentures (RPDs). Therefore, this review investigated the dental literature related to occlusal schemes for RPDs. MATERIALS AND METHODS A PubMed search of English language articles was performed using the term "removable partial denture, occlusion" with 765 results. When the term "occlusion in removable partial prosthodontics" was used there were 784 results. Seventy-four articles were identified using the different search term of "RPD, occlusion" while use of the term "occlusal scheme, with removable partial dentures" listed 18 publications. The term "removable partial denture, occlusion, literature reviews" produced 38 potential publications related to the topic. Using the term "removable partial denture occlusion systematic review" resulted in 2 citations. Using the term "RPD occlusion literature review" resulted in one foreign language manuscript whereas using the term "RPD occlusion systematic review" resulted in one article unrelated to dentistry. The term "clinical studies of RPD occlusion" produced 5 results with none related to the topic. There were 23 results using the term "clinical studies of removable partial denture occlusion" with one potentially related to RPD occlusal schemes. RESULTS A review of the titles and abstracts revealed 12 articles that appeared to contain specific information about the occlusal scheme used with RPDs. Following a detailed review of those publications, only 4 contained recommendations for RPD occlusion and were included in this review. The available information regarding the recommendations for occlusal schemes in these articles was based on expert opinion. A decision was made to include a hand search of 9 textbooks containing varying amounts of information related to occlusal schemes for RPDs, but no evidence-based references related to RPD occlusal schemes were found in the textbooks. Since this entire review is based on expert opinion, no attempt was made to critique the opinions expressed by these authors but rather to present their perspectives for evaluation by readers. CONCLUSIONS The occlusion developed with RPDs should be physiologically harmonious, allowing the supporting structures to remain in a good state of health with functional stress distributed among all the occluding teeth. Multiple authors indicate the occlusion in maximum intercuspation/centric occlusion should incorporate bilateral posterior contacts with no deflective occlusal contacts. When most occlusal contacts on natural teeth are missing, it has been proposed that extension base RPDs have their occlusal contacts developed in centric occlusion. Regarding eccentric occlusal relationships, a balanced occlusal scheme has been recommended by multiple authors with one author advocating use of a lingualized balanced. An anterior guided (canine-protected) occlusion has also been recommended when the canines are present and not periodontally compromised. When RPDs oppose a complete denture, several authors indicate a bilateral balanced occlusion should be used to help stabilize the complete denture.
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Affiliation(s)
- Charles J Goodacre
- Advanced Education Program in Implant Dentistry, Loma Linda University School of Dentistry, Loma Linda, CA
| | - Brian J Goodacre
- Division of General Dentistry, Loma Linda University School of Dentistry, Loma Linda, CA
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Yoshizawa H, Miyamoto JJ, Hanakawa T, Shitara H, Honda M, Moriyama K. Reciprocal cortical activation patterns during incisal and molar biting correlated with bite force levels: an fMRI study. Sci Rep 2019; 9:8419. [PMID: 31182743 PMCID: PMC6557817 DOI: 10.1038/s41598-019-44846-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 05/24/2019] [Indexed: 11/24/2022] Open
Abstract
In humans, the incisors and molars have distinct functions during mastication, analogous to the two main types of handgrip, the precision and power grips. In the present study, we investigated cortical activation and masticatory muscle activity during incisal and molar biting via simultaneous functional magnetic resonance imaging and electromyogram (EMG) recordings. We conducted recordings in 15 healthy adult participants while they performed incisal and molar biting tasks at three step-wise force levels using two custom-made splints. Regarding the results of the ROI analysis, we found a significantly stronger positive linear correlation between the blood oxygenation level dependent signal and EMG activity during molar biting than incisal biting, which was particularly prominent in the primary sensorimotor cortex and the cerebellum. We also found a significantly stronger negative linear correlation during incisal biting than molar biting, which was particularly prominent in the rostral cingulate motor area, superior frontal gyrus, and caudate nucleus. These findings indicate that molar biting enables powerful chewing: brain activity in several brain areas related to motor function was increased with increasing bite force levels, while incisal biting enables fine motor control: brain activity in several brain areas related to motor control was increased with reduced bite force levels.
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Affiliation(s)
- Hideyuki Yoshizawa
- Department of Maxillofacial Orthognathics, Division of Maxillofacial and Neck Reconstruction, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Jun J Miyamoto
- Department of Maxillofacial Orthognathics, Division of Maxillofacial and Neck Reconstruction, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan. .,Department of Functional Brain Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Takashi Hanakawa
- Department of Functional Brain Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hitoshi Shitara
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Manabu Honda
- Department of Functional Brain Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Keiji Moriyama
- Department of Maxillofacial Orthognathics, Division of Maxillofacial and Neck Reconstruction, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Bonnet G, Batisse C, Peyron MA, Nicolas E, Hennequin M. Which variables should be controlled when measuring the granulometry of a chewed bolus? A systematic review. J Texture Stud 2018; 50:194-216. [PMID: 30365162 DOI: 10.1111/jtxs.12376] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/04/2018] [Accepted: 10/15/2018] [Indexed: 12/14/2022]
Abstract
The distribution of food particles in a chewed bolus characterizes the food destruction after food oral processing (FOP). Previous reviews report that it could be affected by a lot of parameters as the number of chewing strokes, the dental status, but the conditions for producing reproducible data allowing inter-studies comparison have not been clearly described yet. This systematic review aims to identify the variables that can affect bolus granulometry determination, and to calculate their relative weights in the median particle size (D50 ) variations. The systematic review focuses on granulometry expressed as D50 of the most used foods (peanuts, carrots, and almonds) and materials (Optosil and Optocal). Based on 58 studies, 5 variables among 60 being extracted could explain the D50 variations. Conceptual differences between the conditions for FOP should be considered. After Chewing-test, the bolus is collected after a predefined number of strokes and its granulometry characterizes the effects of the dental and muscular apparatus on food destruction, while after Mastication-test the bolus is collected at the swallowing threshold, and its granulometry reflects the outcome of the abilities of the subject to adapt his/her mastication behavior to food texture. Experimental conditions related either to physical sieving or image analysis used to analyze the collected boluses impact the D50 values. Finally, when type of test, sieving conditions, type of food or material, number of chewing strokes, and the oral status of the subjects are controlled, mean D50 values are reproducible and could be used for inter-studies comparisons. PRACTICAL APPLICATIONS: This review provides tables that could be useful to control mean D50 variations in further research.
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Affiliation(s)
- Guillaume Bonnet
- Université Clermont Auvergne, CROC EA4847, Dental Faculty, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Dental service, Clermont-Ferrand, France
| | - Cindy Batisse
- Université Clermont Auvergne, CROC EA4847, Dental Faculty, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Dental service, Clermont-Ferrand, France
| | - Marie-Agnès Peyron
- Université Clermont Auvergne, INRA, UNH, Unit of Human Nutrition, CRNH, Saint Genès Champanelle, France
| | - Emmanuel Nicolas
- Université Clermont Auvergne, CROC EA4847, Dental Faculty, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Dental service, Clermont-Ferrand, France
| | - Martine Hennequin
- Université Clermont Auvergne, CROC EA4847, Dental Faculty, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Dental service, Clermont-Ferrand, France
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Fueki K, Igarashi Y, Maeda Y, Baba K, Koyano K, Sasaki K, Akagawa Y, Kuboki T, Kasugai S, Garrett NR. Effect of prosthetic restoration on masticatory function in patients with shortened dental arches: a multicentre study. J Oral Rehabil 2016; 43:534-42. [DOI: 10.1111/joor.12387] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2016] [Indexed: 11/27/2022]
Affiliation(s)
- K. Fueki
- Removable Partial Prosthodontics; Oral Health Sciences; Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - Y. Igarashi
- Removable Partial Prosthodontics; Oral Health Sciences; Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - Y. Maeda
- Department of Prosthodontics; Gerodontology and Oral Rehabilitation; Osaka University; Suita Osaka Japan
| | - K. Baba
- Department of Prosthodontics; Showa University School of Dentistry; Tokyo Japan
| | - K. Koyano
- Section of Implant and Rehabilitative Dentistry; Division of Oral Rehabilitation; Faculty of Dental Science; Kyushu University; Fukuoka Japan
| | - K. Sasaki
- Division of Advanced Prosthetic Dentistry; Graduate School of Dentistry; Tohoku University; Sendai Japan
| | - Y. Akagawa
- Department of Prosthodontics; Ohu University; Koriyama Japan
| | - T. Kuboki
- Department of Oral Rehabilitation and Regenerative Medicine; Graduate School of Medicine; Dentistry and Pharmaceutical Sciences; Okayama University Graduate School of Medicine and Dentistry; Okayama Japan
| | - S. Kasugai
- Oral Implantology and Regenerative Dental Medicine; Oral Health Sciences; Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental university; Tokyo Japan
| | - N. R. Garrett
- Advanced Prosthodontics; Biomaterials and Hospital Dentistry; UCLA School of Dentistry; California USA
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