Sensorial Ability, Mastication and Nutrition of Single-Implant Overdentures Wearers

Four-year assessment of masticatory function in mandibular overdenture wearers: A randomised clinical trial comparing two to four implants to retain the prosthesis

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.

Nutritional status and dietary habits in older adults with fixed implant dental prostheses: a case-control study

Aim

To evaluate the nutritional status, nutritional risk, and dietary habits of patients treated with bimaxillary implant-supported fixed prostheses in comparison with a group of natural dentate patients.

Methods

A study group (n = 25, 8 women, mean age = 70.6 ± 7.5 years) with bimaxillary implant-supported fixed prostheses and a control group (n = 25, 13 women, mean age = 69.0 ± 5.3) with a mean of 27.7 ± 1.8 natural teeth were recruited. The nutritional status and nutritional risk of the participants were evaluated with Mini Nutritional Assessment (MNA) and Seniors in the Community: Risk Evaluation for Eating and Nutrition; (SCREEN-14), while the dietary habits were recorded by data from a three-day dietary record. The data were analyzed with the Mann-Whitney U-test and independent t-test to evaluate the differences between the groups.

Results

The results showed that although both the groups had normal nutrition status as revealed by the MNA scores the study group showed significantly higher BMI (p = 0.005) but lower SCREEN-14 (p = 0.012) scores, than the control group. The results also showed that higher SCREEN-14 scores were significantly associated with higher odds of being in the control group, with an odds ratio of 1.159 (p = 0.024). Further, the results of the analysis of the dietary records showed that the participants in the study group consumed fewer meals (p = 0.006) and fewer varieties of food (p < 0.001), particularly fewer fruits (p = 0.011) than the control group.

Conclusion

The results indicate that people with fixed implant prostheses may be susceptible to nutritional deficiencies according to the SCREEN-14 scores compared to their natural dentate counterparts. Further, people with implant prostheses also tend to have higher BMI and consume a smaller variety of foods, especially fruits, than the natural dentate control group.

Chewing and its influence on swallowing, gastrointestinal and nutrition-related factors: a systematic review

The study aimed to evaluate the hypothesis that chewing is a mechanical and physiological contributor to swallowing, physiologic/pathologic processes of the gastrointestinal tract (GIT), and nutrition-related factors. A search strategy was applied to three different databases to investigate if chewing function in adults affects the swallowing, physiologic/pathologic processes of the GIT, and nutrition-related factors compared to controls with no exposure. The included studies were evaluated for methodological quality and risk of bias and certainty of evidence. The results showed 71 eligible studies. Overall, the results showed that 46 studies supported the hypothesis while 25 refuted it. However, the GRADE analysis showed low to very low certainty of the evidence to support the hypothesis that chewing is an important contributor in the swallowing process, and physiologic/pathologic processes in the GIT. The GRADE analysis also showed a moderate to very low certainty of the evidence to suggest that chewing function contributes to nutrition-related parameters. The overall results of the current study showed that a majority (64.7%) of the studies (46 out of 71) supported the hypothesis. However, robust studies with proper design, adequate sample size, and well-defined outcome parameters are needed to establish conclusive evidence.

The Single Midline Implant in the Edentulous Mandible-Current Status of Clinical Trials

The single midline implant in the edentulous mandible is a treatment concept that has often been controversially discussed. Nearly 30 years ago, the first available clinical results revealed high implant survival rates and remarkable improvements in oral comfort, function, patient satisfaction and oral health-related quality of life for edentulous patients compared to the situation with no implant. However, the clinical trials were predominantly conducted with a small number of patients over a short to medium follow-up period. Today, numerous clinical investigations on the single midline implant in the edentulous mandible, which increasingly include longer-term observation periods, are available. It is the aim of this overview to present the current literature and to highlight the clinical problems. This article is a 2023 update of a review published by the authors in the German language in 2021 in the German journal Implantologie. In total, 19 prospective clinical trials with a follow-up period of 0.5-10 years were analyzed. Over this observation period, single implants with modern rough implant surfaces in the edentulous mandible reveal high implant survival rates of between 90.9 and 100% when a conventional delayed loading protocol was applied.

Path pattern and movement during mastication on habitual and non-habitual chewing sides

PURPOSE

To clarify the presence or absence of differences in path pattern and movement during mastication between the habitual and non-habitual chewing sides.

METHODS

Participants were 225 healthy adults with natural dentition. Mandibular movement while chewing gummy jelly on each side was recorded, and masticatory path pattern was classified into five types (one normal and four abnormal). The frequency of each pattern was measured and compared between chewing sides. The amount, rhythm, velocity, and stability of movement and masticatory performance were measured and compared between chewing sides.

RESULTS

A normal pattern was observed on the habitual chewing side in 84.4% of participants. There was a significant difference between chewing sides in masticatory path pattern (χ² = 35.971, P < 0.001). Values of parameters regarding the amount and velocity of movement and masticatory performance were significantly higher on the habitual chewing side. Values of parameters regarding rhythm and stability of movement were significantly lower on the habitual chewing side.

CONCLUSION

The present findings of functional differences between chewing sides in terms of path pattern and movement during mastication suggest that these factors should be analyzed on the habitual chewing side.

Single mandibular implant study - chewing efficiency - 5-year results from a randomized clinical trial using two different implant loading protocols

PURPOSE

To investigate the chewing efficiency of edentulous patients wearing complete dentures, treated with a single implant in the mandible, placed underneath the existing mandibular dentures, using two different loading protocols (immediate loading or conventional loading), over an observation period of 5 years.

METHODS

One-hundred and fifty-eight (158) edentulous seniors aged 60-89 years received an implant in the midline of the lower jaw and were randomized either to the immediate loaded group A (n=81) or the conventional loaded group B (n=77). Chewing efficiency was obtained before treatment, one month after implant placement during the submerged healing phase (only group B) and 1, 4, 12, 24 and 60 months after implant loading.

RESULTS

After 5 years, chewing tests from 89 patients (45 in the immediate loading group and 44 in the conventional loading group) were available for every recall visit and thus statistically analyzed. The chewing efficiency increased over time in both groups. A significant increase was observed up to 4 months after loading (p≤0.05). Later, chewing efficiency further increased, but not significantly. Between the two loading protocols, chewing efficiency did not differ significantly (p>0.05) at any follow-up investigation.

CONCLUSION

A single mandibular implant placed underneath existing mandibular dentures improves chewing efficiency of edentulous patients significantly over an observation period of 5 years, irrespective of the loading protocol.

Speech and the swallowing threshold in single implant overdenture wearers: A paired control study

BACKGROUND

Single implant mandibular overdentures (SIMOs) can improve mastication in edentulous elderly people. However, little attention has been paid to their effects on articulation disorders and the swallowing threshold relative to those of conventional complete dentures (CDs).

OBJECTIVE

To compare the effects of new conventional CD set and SIMOs on articulation disorders, mandibular movements during speech and swallowing threshold using a paired study design.

METHODS

Twenty-two edentulous Brazilian Portuguese-speaking elderly people (mean age 66.7 ± 4.6 years) were first evaluated whilst wearing their old conventional CDs. Articulation disorders were analysed by audio and video recordings, mandibular movements during speech were measured by kinesiography, and the swallowing threshold was assessed by masticatory cycle counting and medium particle size (X₅₀ ) calculation. Participants then received new conventional CDs, and evaluations were repeated 2 months later. Subsequently, single implants were installed in the midlines of subjects' mandibles, and the conventional CDs were converted to SIMOs. After 2 months of SIMOs use, the evaluations were repeated. Data were submitted to the Cochran-Mantel-Haenszel and ANOVA.

RESULTS

No difference in articulation disorders was found between new conventional CD and SIMO use. The frequency of anterior lisp during /s/ and /z/ phoneme pronunciation was reduced with new conventional CD use relative to old conventional CD use (p < .05). The X₅₀ decreased progressively with new conventional CD and SIMO use (both p < .05).

CONCLUSION

SIMOs do not alter speech relative to new well-fitted conventional CDs, but improved the swallowing threshold, in edentulous elderly people.

Stability of masticatory movements after placement of implant-supported denture

The purpose of this study was to clarify the stability of masticatory movement after placement of implant-supported denture. Fourteen patients (patient group) with mandibular implants denture and maxillary complete denture and 30 dentate adults (control group) were asked to chew a boiled fishpaste, and the masticatory movement was recorded using MKG. For the 10 cycles beginning with the 5th cycle of mastication, the parameters representing the stability of masticatory movement were calculated. Data collected at 1, 3, 6, 9 months and 1, 2, 3 years after insertion of implants denture were compared between sessions and also between the patient and control groups. The mean and standard deviation of the values in the patient group at 1 month after insertion of implants denture were large, but gradually decreased 6 to 9 months after insertion of implants denture. Each parameter maintained almost the same value from 1 to 3 years. The parameter values of the patient group were significantly larger than those of control group from 1 to 9 months after insertion of implants denture, but 1 year after insertion of implants denture, there was no significant difference between the two groups in 5 out of 7 parameters. From these results, it was suggested that a certain duration, about 9 months to 1 year, was necessary for patients with implants denture to adapt to the new masticatory function and that the timing of functional evaluation should be set to 1 year after insertion of implants denture.

Single implant overdenture reinforced with a metallic framework: A 2-year clinical follow-up

INTRODUCTION

To prevent single-implant overdenture (SIO) fracture, the inclusion of a framework in the overdenture has been suggested. However, no investigations verified their benefits.

OBJECTIVE

To evaluate prosthetic maintenance events, patient satisfaction, and mastication of SIO reinforced by metallic framework users.

MATERIAL AND METHODS

Fifteen volunteers had a new set of complete dentures converted into an SIO containing a framework. Maintenance events were recorded, while patient satisfaction was assessed using a visual analog scale. Masticatory performance (MP) was evaluated using the sieving method, maximum bite force (MBF) by pressure sensors, and masseter thickness by ultrasound. Measurements were performed 2, 12, and 24 months after SIO use. Repeated-measures ANOVA and paired Student's t-tests (p < 0.05) were applied.

RESULTS

Matrix exchange was the most prevalent maintenance event (83.6%), and no SIO was fractured during the entire follow-up. Satisfaction with the SIO stability decreased (p < 0.01) after 12 months. MP did not change between evaluations (p > 0.05). Conversely, MBF and masseter thickness improved after 12 and 24 months of SIO use (p < 0.05).

CONCLUSIONS

Reinforced SIO did not fracture during 2 years but requires maintenance. It improves bite force and muscle thickness, maintaining MP values. Satisfaction with SIO stability decreased in the first year of use.

Do implant-supported prostheses affect bioavailability of nutrients of complete and partially edentulous patients? A systematic review with meta-analysis

BACKGROUND & AIMS

Debate still exists about the impact of dental implant-supported prostheses on nutritional status of partially and complete edentulous patients. This review aims to answer the focused question: "Do complete and partial edentulous patients, using implant-supported prostheses, present better nutritional and masticatory functions when compared to those using conventional rehabilitations?". A possible cause-effect relationship between masticatory improvements and nutritional gain was also evaluated.

METHODS

Literature search included 6 databases (PubMed/Medline, Embase, LILACS, Scopus, Web of Science, and The Cochrane Library - CENTRAL), grey literature (Google Scholar, Proquest Dissertations and Thesis and Open Grey databases) and manual search (last update June 2020), without language, publication time and follow-up restrictions. We included only studies evaluating both masticatory and nutritional outcomes. The PICO question comprised complete and partial edentulous patients (Population), submitted to implant-supported prostheses (Intervention), in comparison to conventional dental prosthetic rehabilitation, evaluating masticatory function and nutrition parameters (outcomes). Risk of bias was assessed by using Cochrane Collaboration's tool (randomized clinical trials), Joanna Briggs Institute critical appraisal checklist (paired clinical trials), and Meta-Analysis of Statistics Assessment and Review Instrument" (JBI - MAStARI) critical appraisal tools (cohort studies). All meta-analyses were conducted at 5% level of significance. This report followed the PRISMA guidelines. (Review registration PROSPERO - CRD42019135744).

RESULTS

We identified 1199 articles while searching databases. Fourteen articles met eligibility criteria, including 817 prostheses installed in 660 patients (mean age = 66.8 years-old). Patients wearing implant overdentures (IOD) presented better masticatory function in comparison to conventional complete denture (CD) wearers (p < 0.05). However, bioavailability of several nutrients remained within the same range, except for serum folate that was lower in IOD patients after 6 (mean difference 3.51 nmol/L; p = 0.01) and 12 months of rehabilitation (mean difference 3.69 nmol/L; p = 0.003). When comparing the effects of CD and IOD rehabilitations along time (for the same patient), serum albumin and vitamin B12 levels also decreased for both groups after 12 months-follow-up, but still within the reference range. The additional retention of the implants did not interfere in body weight, but reduced the risk of malnutrition (using the Mini Nutritional Assessment). Implant-supported partial prostheses also improved mastication in comparison to the conventional ones, increasing short-term daily intake of carbohydrates, protein, calcium, fiber, and iron, whereas decreasing the consumption of cholesterol. However, no long-term changes on bioavailability of most nutrients were observed, expect for a slight increase in ferritin and cholinesterase, and a small reduction in folate and Vitamin A.

CONCLUSION

Current evidence indicates significant masticatory improvements for dental fixed implant-supported prostheses in comparison to conventional removable prostheses. However, bioavailability remained stable for most of the nutrients, especially for complete edentulous patients. These results indicate the importance of a multidisciplinary approach during oral rehabilitation (nutrient specialist), in order to enhance food choices and promote health benefits to the patients.

Patient-reported outcome measures of edentulous patients restored with single-implant mandibular overdentures: A systematic review

AIM

To review the literatures concerning the effect of the single-implant mandibular overdenture (SIMO) on patient-reported outcome measures (PROMs) and masticatory function in the fully edentulous patients.

MATERIALS AND METHODS

Electronic databases (PubMed, Cochrane Library, EMBASE and Web of Science) were searched, complemented with manual resources. Prospective studies published in English up to February 2020 reporting the effect of SIMO on PROMs and masticatory function in the edentulous patients were included. This review focused on oral health-related quality of life (OHRQoL), satisfaction and masticatory function outcomes.

RESULTS

Of 1157 initially screened articles, 9 randomised controlled trials (RCTs) and 8 prospective studies involving 551 subjects fulfilled the inclusion criteria. Two RCTs were graded as high risk of bias or some concern, while others were low risk. All prospective studies had adequate representativeness and assessment, but only one study had a controlled cohort. In general, the edentulous patients restored with SIMOs had improved OHRQoL and general satisfaction compared to those with conventional complete dentures (CCDs), but the outcome of masticatory function was controversial. Compared with two-implant mandibular overdenture (TIMO), SIMO showed no significant differences regarding general satisfaction and satisfaction with speech, comfort, chewing ability, aesthetics and social life. Conflicting results were observed in OHRQoL and satisfaction with retention and stability. Better masticatory performance was observed in TIMO group than SIMO group.

CONCLUSION

Within the limitation of this review, SIMO is featured with better OHRQoL and satisfaction than CCD. SIMO and TIMO rendered similar patient satisfaction, but TIMO had better masticatory performance.

Masticatory function improvement with the use of mandibular single-implant overdentures in edentulous subjects: a systematic literature review

INTRODUCTION

In this systematic review, several masticatory function parameters assessed during mandibular single-implant overdenture (SIO) use were compared to pre- SIO placement values in edentulous patients with aim of contributing to a consensus regarding denture treatment options.

EVIDENCE ACQUISITION

This study was registered a priori in the PROSPERO database (CRD42018106567). Two independent reviewers carried out electronic searches in eight databases, without language or time frame limitations, to collate clinical studies comparing masticatory function of edentulous patients before versus after SIO installation with the implant placed on the mandibular midline. Risk of bias was assessed with a before-and-after tool and evidence certainty level was evaluated with the Grading of Recommendations Assessment, Development and Evaluation program.

EVIDENCE SYNTHESIS

Eleven studies were included in this review (1 prospective, 3 crossover trials, 4 randomized clinical trials, 2 paired clinical trials, and 1 pilot). Enrolled patients were mostly over 60 years old; all patients were using conventional complete dentures (CD) prior to SIO installation. Masticatory performance, masticatory efficiency, bite force, and muscle activity were improved after the SIO placement compared to during mandibular CD use. Mandibular movement and masticatory ability data were inconclusive. Most of the studies had low risk of bias, but all had very low certainly level ratings due to methodological heterogeneity.

CONCLUSIONS

Placement of SIO improves masticatory function, as reflected mostly by masticatory performance and efficiency data, relative to CD use. Further studies comparing dental rehabilitation options, including SIOs, are needed to improve the quality of evidence in the literature.

Do implant-retained mandibular overdentures maintain radiographic, functional, and patient-centered outcomes after 3 years of loading?

OBJECTIVES

Analyzing whether radiographic, functional, and oral health-related quality of life (OHRQoL) outcomes are maintained over 3 years of implant-retained mandibular overdenture (IMO) function and investigating the bite force associations in the 3rd year of function.

MATERIAL AND METHODS

A longitudinal clinical study in which 24 IMO users were evaluated during a 3-year follow-up period. Patients' posterior area index, masticatory function, OHRQoL and bite force were assessed. The masticatory function parameter ST_X50 reflects the opening through which 50% of the crushed particles would pass, ST_B describes the homogeneity of the bolus, and the masticatory efficiency parameters ME_5.6 and ME_2.8 represent the % of material retained in the 5.6 and 2.8 mm sieves, respectively.

RESULTS

A significant increase in posterior area index (p ≤ .01) was found in all evaluated periods. Minor deteriorations in ST_X50 (p ≤ .01) and ME_5.6 (p ≤ .01) between the 2nd and the 3rd year coincided with improvements in ST_B (p ≤ .01), number of cycles (p ≤ .01), and cycle time (p = .02). The global OHIP-Edent score (p = .02) and the scores in the functional limitation (p = .02), psychological discomfort (p ≤ .01), and handicap domains (p ≤ .01) increased significantly between the 2nd and the 3rd year. Correlations between bite force and cycle time (p = .03) and between posterior area index and ST_X50 (p ≤ .01) and ME_2.8 (p = .02) were also found.

CONCLUSION

Changes in posterior area index, masticatory function, and OHRQoL are still ongoing during the 3rd year of IMO function. Bite force and posterior area index influence the masticatory function outcomes in the 3rd year of IMO function.