The influence of mandibular implant-retained overdentures in masticatory efficiency

Masticatory performance, self-perception of oral health, oral health-related quality of life and nutritional status of completely edentulous elderly patients submitted to different rehabilitation treatments: A cross-sectional study

BACKGROUND

The impact of treatments on completely edentulous individuals on masticatory performance (MP), oral health-related quality of life (OHRQoL), nutritional status (NS) and socio-economic profile (SP) is unclear in the literature.

OBJECTIVE

To compare the MP, OHRQoL, NS and SP of totally edentulous elderly users of bimaxillary complete dentures (CD) and users of lower implant-supported fixed complete dentures (IFCD).

METHODS

Forty participants were allocated into groups according to rehabilitation treatment (n = 20): bimaxillary CD (G1) and lower IFCD, and upper CD (G2). The evaluation of MP used almonds by the method of sieves. Four questionnaires (Geriatric Oral Health Assessment Index-GOHAI and Oral Health Impact Profile Edent-OHIP-Edent, Brazilian Economic Classification Criteria-ABEP and Mini Nutritional Assessment-MNA) were applied to assess the OHRQoL, SP and NS of the elderly, respectively. After evaluating the statistical assumptions, the Mann-Whitney (α = .05) test was applied to compare the groups regarding MP, OHRQoL, NS and SP. Spearman's correlation (α = .05) was performed to verify the correlation between the MP, the OHRQoL and the NS of the participants.

RESULTS

G2 showed better MP (p < .05) in all masticatory cycles, OHRQoL (p < .05) and NS than the G1. However, the participants' self-perception of oral health did not differ between groups (p < .05). A moderate negative correlation was found between MP and OHRQoL for 40 masticatory cycles (r2  = -0.513; p = .001).

CONCLUSION

Individuals rehabilitated with IFCD had a higher average monthly family income and achieved superior behaviour in MP and OHRQoL, in addition to lower risks of malnutrition when compared to individuals using bimaxillary CD.

An implant-supported overdenture for a mandibular defect after tumor resection guided by 3-dimensional finite element analysis: A clinical report

This clinical report describes the rehabilitation of a mandibular defect after tumor resection with an implant-supported overdenture and the attachment selection as guided by 3-dimensional finite element analysis. Autologous bone grafting was declined by the patient who demanded the restoration of lateral appearance and mastication function. Three implants were placed based on the condition of the bone, and a satisfactory definitive prosthesis was provided that corresponded with the results of the finite element analysis.

A randomised crossover clinical trial of masticatory function in complete denture wearers with conventional and lingualised balanced occlusion

OBJECTIVES

The purposes of the present study were as follows: (1) to conduct a randomised crossover clinical trial to evaluate masticatory performance in wearers of conventional complete dentures in both arcs with conventional balanced occlusion (CBO) and lingualised balanced occlusion (LBO), using almonds as natural test food chewed for (a) 30 chewing cycles, (b) 40 chewing cycles and (c) until the subject felt ready to swallow and (2) to perform a randomised crossover clinical trial of oral health self-perception through the Geriatric Oral Health Assessment Index (GOHAI) questionnaire.

BACKGROUND

During rehabilitation with full dentures, achieving stability and retention is essential for masticatory performance. A factor that can act is the appropriate occlusal scheme to be used, although the literature is full of discussions as to the most suitable occlusal scheme to be used, being CBO and LBO the most used in complete dentures.

MATERIALS AND METHODS

The clinical trial was conducted with 30 participants (14 males and 16 females; average age 65.8 years). A base of interchangeable posterior teeth in the lower dentures was used, thereby changing the occlusal schemes without needing to make another complete denture. The masticatory tests and GOHAI application were conducted in two sessions: first with each occlusal scheme, and second only after participants did not report discomfort with dentures. The analysis of variance for the mixed repeated-measures test (ANOVA) was used to verify the results (α = 0.05).

RESULTS

The results showed no difference in masticatory performance according to the occlusal scheme (P = .519). The masticatory performance increased with the number of cycles (P < .001) tested, regardless of the type of occlusion scheme, and oral health self-perception was higher after the second masticatory evaluation session (P = .027).

CONCLUSION

The masticatory performance was similar between the two occlusal schemes, increasing according to the number of chewing cycles. The adaptive period is relevant, regardless of the occlusion scheme, because the time factor was decisive for the improvements noted in the oral health self-perception of the participants (according to the GOHAI results).

Masticatory efficiency, bite force and electrical activity of the masseter and temporalis muscles in bodybuilders

Background

This study aimed to compare the masticatory efficiency, the maximum voluntary occlusal bite force (MVOBF) and the electrical activity (EMG) of masticatory muscles of practitioners of upper limb bodybuilding before and after physical activity.

Material and Methods

Twenty healthy individuals (10 men and 10 women, age from 18 to 30 (mean of 24.7 years old) without masticatory system disorders, that regularly practice hypertrophic physical activity were submitted to the analyses of masticatory efficiency, MVOBF, and surface EMG of the temporalis and masseter muscles. The masticatory efficiency was analyzed by comminution of the artificial material (Optocal®) and a sieving method. The MVOBF was measured by a dynamometer, and EMG was evaluated during resting mandibular position, maximum voluntary clenching (MVC), and MVC with a Parafilm M tape between teeth, and free mastication of chewing gum. The analyses were made before (T0) and immediately after the performance of upper limb bodybuilding exercises (T1). The data of masticatory efficiency and MVOBF were submitted to the Student T-test, and their correlations were analyzed by the Pearson correlation test, and the EMG data were submitted to the 2-way repeated measures ANOVA, all tests with a 5% significance.

Results

There was a significant decrease of masticatory efficiency after the training. No statistical difference in the MVOBF and EMG was found, and there was a positive correlation between masticatory efficiency and MVOBF.

Conclusions

Therefore, changes were found for masticatory efficiency only, which decreased after hypertrophic exercise. There was a positive correlation between masticatory efficiency and MVOBF. Key words:Masticatory efficiency, bite force, physical activity, electromyography.

Consensus on the terminologies and methodologies for masticatory assessment

A large number of methodological procedures and experimental conditions are reported to describe the masticatory process. However, similar terms are sometimes employed to describe different methodologies. Standardisation of terms is essential to allow comparisons among different studies. This article was aimed to provide a consensus concerning the terms, definitions and technical methods generally reported when evaluating masticatory function objectively and subjectively. The consensus is based on the results from discussions and consultations among world‐leading researchers in the related research areas. Advantages, limitations and relevance of each method are also discussed. The present consensus provides a revised framework of standardised terms to improve the consistent use of masticatory terminology and facilitate further investigations on masticatory function analysis. In addition, this article also outlines various methods used to evaluate the masticatory process and their advantages and disadvantages in order to help researchers to design their experiments.

A low-profile universal attachment system with housing welded to metal reinforcement framework to retain mandibular implant overdenture: A clinical report

Literature has proved that implant-retained overdenture is one of the best prosthetic options in the rehabilitation of complete edentulism. Tissue-supported implant-retained overdentures have been an appropriate treatment modality for atrophic mandibular ridges. In this case report, the patient presented with Class I maxillomandibular relationship and Class II Prosthodontic Diagnostic Index. The patient was concerned about esthetics as well as the retention of the lower denture. Taking into consideration the above concerns, an implant-retained mandibular overdenture was the chosen treatment modality. There are numerous attachment systems that have been used to improve the retention, stability, and support of implant-retained overdenture. Every attachment system has its own set of advantages. The OT Equator is a new line of low-profile attachment which is a radically modified OT-CAP Normo. The rationale for using this attachment is that it is considered the smallest attachment system available with the least overall dimension. It is a resilient and self-aligning attachment system which can be used in limited inter-arch space situation. OT equator derives its name from the OT Dental Laboratory (Bologna, Italy) used as a brand name. Considering these advantages, this was the chosen attachment and proved beneficial in terms of both patient satisfaction and the overall success of the treatment.

Cost-effectiveness of implant-supported dental prosthesis compared to conventional dental prosthesis

OBJECTIVE

To conduct a cost-effectiveness analysis of alternatives for rehabilitation treatment of mandibular edentulism in the context of the Brazilian Unified Health System (implant-supported total dental prosthesis versus conventional total dental prosthesis).

METHODS

A Markov model was developed to capture long-term clinical and economic outcomes. The model’s population was comprised of a hypothetical cohort of 1,000,000 patients, aged 55 years, with total mandibular edentulism and without medical contraindications for performing surgical procedures. The adopted analysis perspective was that of the Brazilian Unified Health System. Based on the proposed model, we calculated cost – in BRL, and effectiveness – measured by quality-adjusted prosthesis year (QAPY). The time horizon of the analysis was 20 years.

RESULTS

Considering a 5% discount in costs and effects, the incremental cost-effectiveness ratio of implant-supported total dental prostheses compared to conventional total dental prosthesis (BRL 464.22/QAPY) was lower than the willingness to pay threshold adopted in the model (BRL 3,050.00/QAPY).

CONCLUSIONS

The results of this economic analysis showed that the rehabilitation of mandibular edentulous patients by implant-supported total prosthesis is very cost-effective when compared to conventional complete prosthesis, considering the cost-effectiveness limits employed.

Oral Health-Related Outcomes in Edentulous Patients Treated With Mandibular Implant-Retained Dentures Versus Complete Dentures: Systematic Review With Meta-Analyses

The objective of this systematic review was to determine the effect on oral health-related outcomes from mandibular implant-retained dentures opposing maxillary complete dentures in edentulous middle-age and older adults, compared with complete removable dentures in both arches. Randomized controlled trials included participants with an average age of 65 years or older. The Cochrane Library, MEDLINE, and Web of Science were searched. A total of 228 abstracts were reviewed for inclusion criteria, with 14 trials included and analyzed for risk of bias. Eleven of these studies were assessed as being at an unclear risk of bias, and 3 were at high risk. Mandibular implant-retained overdenture therapy showed statistically significant improvements in the patients' general satisfaction (P = .003), oral health-related quality of life (P &lt; .001), and chewing ability (P &lt; .001), over the patients with complete dentures. There were no significant differences in the percentage of patients who were satisfied with their overdentures vs complete dentures for comfort, retention, esthetics, or chewing ability; however, only 2 studies reported these outcomes. In terms of nutritional status 1 year after treatment, vitamin B12 blood levels increased significantly in the implant-retained group (P = .003), but not the other nutritional values. Implant-retained mandibular overdentures are an option for middle-aged and elderly edentulous patients as they significantly improve some of the outcomes; however, the quality of the evidence was moderate/low, due to the small number of studies included and the risk of bias. Future research should include objective outcomes such as masticatory performance, chewing efficacy, and muscular coordination.

Technical Quality of Complete Dentures: Influence on Masticatory Efficiency and Quality of Life

PURPOSE

To evaluate the effect of the technical quality of conventional complete dentures (CD) on masticatory efficiency and quality of life (QoL) of denture wearers during a 1-year follow-up.

MATERIALS AND METHODS

A prospective clinical trial with 32 edentulous patients (mean age of 60.2 years) wearing mandibular and maxillary dentures was conducted. All patients were evaluated wearing their preexisting dentures and after 3, 6, and 12 months postinsertion of new dentures. A reproducible method for objective evaluation of the technical quality of CDs was employed. Masticatory efficiency was evaluated by the colorimetric method using beads as artificial testing food. The oral health impact on patient QoL was measured using the OHIP-EDENT (Oral Health Impact Profile in Edentulous Adults) questionnaire. The nonparametric Wilcoxon test was applied to reveal any differences in technical quality between the preexisting and new dentures. The Friedman test was used to detect differences in masticatory efficiency and oral health impact on QoL. Spearman's correlation was applied to reveal correlation between the variables.

RESULTS

Comparing preexisting and new dentures, significant improvement was found in technical quality between the dentures (p < 0.001). There was no statistically significant difference in masticatory efficiency. A significant decrease was found in the total OHIP-EDENT scores after denture replacement. A positive correlation was found between technical quality and OHIP in the new denture wearers (p = 0.011).

CONCLUSIONS

According to the results of this study, denture quality significantly improved patients' oral health-related QoL; however, insertion of new dentures did not influence masticatory efficiency.

Impact of mandibular conventional denture and overdenture on quality of life and masticatory efficiency

The aim of this non-randomized controlled clinical trial was to evaluate the oral health-related quality of life and masticatory efficiency of patients rehabilitated with mandibular two-implant overdentures with immediate loading or conventional dentures. Fifty completely edentulous patients wearing bimaxillary conventional dentures, for at least one year, were recruited. The patients were then assigned to either two treatment groups: mandibular overdentures supported by two implants with bar-clip system and a maxillary conventional denture (n = 25), and new maxillary and mandibular conventional complete dentures (n = 25). Masticatory efficiency and oral health-related quality of life were assessed before and 3 months after denture insertion. The Brazilian version of OHIP-Edent questionnaire was used to assess the oral health-related quality of life. Masticatory efficiency was evaluated with chewing capsules through a colorimetric method. The results revealed fewer oral health-related quality of life problems in patients wearing mandibular two-implant overdentures compared to the conventional dentures group. In addition, the implant overdenture group presented statistically significant improvement in masticatory efficiency (p = 0.001). There was no correlation between masticatory efficiency and OHIP in the implant group (p > 0.05), however a correlation was found in the conventional denture group (p < 0.05). Therefore, these short-term results suggest that mandibular overdenture retained by 2 implants with immediate loading combined with maxillary conventional dentures provide better masticatory efficiency and oral health-related quality of life than mandibular conventional dentures.

Efficacy of Mandibular 2-implant Overdenture: An Updated Meta-analysis on Patient-based Outcomes

The extent of heterogeneity regarding the efficacy of the mandibular 2-implant overdenture is still in question. The aim of this meta-analysis is to provide an update on the existing evidence from randomized controlled trials assessing the efficacy of the mandibular 2-implant overdenture in regard to patient-based outcomes. Electronic searches were carried out to September 2015 through MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Systematic Reviews. Only randomized controlled trials that compared conventional dentures with mandibular 2-implant overdentures were included. Patient-based outcomes were assessed, including patient satisfaction and oral health- and general health-related quality of life. Random effects models were used to pool the effect sizes of all included studies. Further stratified analyses and heterogeneity analyses were tested, as was publication bias. In addition to the 7 randomized controlled trials that were included in the previous meta-analysis, 4 new trials were identified and included in this update. A random effects model showed that, when compared with conventional dentures, mandibular 2-implant overdentures significantly improved patient satisfaction (pooled effect size = 0.87, z = 5.31, 95% confidence interval: 0.55 to 1.19, P < 0.0001, χ² = 41.82, df = 8, P < 0.0001, I² = 81%) and oral health-related quality of life (pooled effect size = -0.66, z = 2.72, 95% confidence interval: -1.13 to -0.18, P = 0.007, χ² = 21.26, df = 4, P = 0.0003, I² = 81%). The differences in participant recruitment and their pretreatment condition were important sources of heterogeneity among the studies. Only 1 study investigated the impact of mandibular implant overdentures on perceived general health, and it revealed no between-treatment differences. The 2-implant mandibular overdenture improves patient satisfaction and quality of life for the general edentate population. Health status, poor oral condition, and patient characteristics may effect patient-based outcomes and should be considered by clinicians in treatment planning. Knowledge Transfer Statement: This meta-analysis shows that mandibular 2-implant overdentures are significantly more satisfactory to the general edentate populations than new conventional dentures. The results also show that mandibular 2-implant overdentures provide significantly better oral health-related quality of life than do new conventional dentures. These results should be shared with edentate patients in planning their treatment.

The Effect of Reading Aloud Exercises for Complete Denture Patients during the Functional Rehabilitation Period

PURPOSE

The focus of this study was to evaluate the effect of reading aloud on masticatory performance and patient satisfaction of patients rehabilitated with conventional complete dentures for the first time.

MATERIALS AND METHODS

Sixty-two edentulous patients who received conventional complete denture treatment for the first time were randomly divided into two equal groups. After insertion of the dentures, patients in group I were asked to read a news report three times per day for 4 weeks, while those in group II did not read. The reading duration increased by 5 minutes per week, from 5 minutes in the first week to 20 minutes in the fourth week. The patients' mouth opening during reading aloud was advised to gradually increase throughout the training project. Two and four weeks after insertion of the dentures, masticatory performance was assessed using the sieving method, and patient satisfaction was measured using a visual analogue scale, which combined the patient's perceptions in relation to comfort, esthetics, stability, ability to talk, and ability to chew.

RESULTS

There were significant improvements in masticatory performance with reading aloud exercises after the insertion of complete dentures (p < 0.001) at the 2- and 4-week follow-up visits. Masticatory performance also showed significant improvement within each group in the follow-up periods (p < 0.001). No significant differences were found between the two groups in patient satisfaction (p > 0.05) at 2 weeks, but at 4 weeks, patient satisfaction regarding stability, ability to talk, and ability to chew was significantly higher for group I (p < 0.001).

CONCLUSIONS

The results of this study suggest that reading aloud exercises significantly improved early masticatory performance and patient satisfaction for denture wearers who were treated with conventional complete dentures for the first time, and may be a useful clinical application for more effective denture treatment.