Camila Heitor Campos

Mastication Improvement After Partial Implant-supported Prosthesis Use

Partially edentulous patients may be rehabilitated by the placement of removable dental prostheses, implant-supported removable dental prostheses, or partial implant fixed dental prostheses. However, it is unclear the impact of each prosthesis type over the masticatory aspects, which represents the objective of this paired clinical trial. Twelve patients sequentially received and used each of these 3 prosthesis types for 2 months, after which maximum bite force was assessed by a strain sensor and food comminution index was determined with the sieving method. Masseter and temporal muscle thicknesses during rest and maximal clenching were also evaluated by ultrasonography. Each maxillary arch received a new complete denture that was used throughout the study. Data were analyzed by analysis of variance for repeated measures, followed by the Tukey test (p < .05). Maximum bite force and food comminution index increased (p < .0001) after implant-supported dental prosthesis and implant fixed dental prosthesis use, with the higher improvement found after the latter’s use. Regardless of implant-retained prosthesis type, masseter muscle thickness during maximal clenching also increased (p < .05) after implant insertion. Partial implant-supported prostheses significantly improved masseter muscle thickness and mastication, and the magnitude of this effect was related to prosthesis type (International Clinical Trial Registration RBR-9J26XD).

Implant retainers for free-end removable partial dentures affect mastication and nutrient intake.

OBJECTIVES This study measured swallowing threshold parameters and nutrient intake in partially dentate subjects rehabilitated by conventional free-end removable partial dentures (RPD) and by RPD over posterior implant retainers and ball attachments (BA). MATERIALS AND METHODS Eight subjects (two men and six women; mean age 60.1 ± 6.6 years old) received conventional total maxillary dentures and free-end RPD in the mandible. Two months after denture insertion, swallowing threshold and nutrient intake assessments occurred, which included an evaluation of the number of masticatory cycles and medium particle size (X₅₀) of a silicone test material (Optocal). A 3-day food diary verified nutrient intake based on a standard Brazilian Food Composition Table. Then, osseointegrated implants were placed bilaterally in the mandibular first molar region, followed by BA, which was fitted in the RPD bases after healing. After 2 months of the RPD over implants and BA use, variables were again assessed. Wilcoxon signed rank tests evaluated the data (P < 0.05). RESULTS Masticatory cycles did not differ (P > 0.05); however, subjects showed decreased X₅₀ values at the swallowing moment (P = 0.008) and increased daily energy (P = 0.008), carbohydrate (P = 0.016), protein (P = 0.023), calcium (P = 0.008), fiber (P = 0.016), and iron (P = 0.016) intake with RPD implants and BA inserts. No differences were found in fat consumption (P > 0.05). CONCLUSION Implants and BA retainers over a free-end RPD resulted in smaller swallowed median particle size and improved nutrient intake.

IMPLANT RETENTION AND SUPPORT FOR DISTAL EXTENSION PARTIAL REMOVABLE DENTAL PROSTHESES: SATISFACTION OUTCOMES

STATEMENT OF PROBLEM The rotational movements of the distal extension denture base of partial removable dental prostheses frequently harm the prosthesis stability, leading to discomfort during function. PURPOSE This study evaluated the use of distal implants to retain and support partial removable dental prostheses and assessed the outcomes with respect to specific aspects of patient satisfaction. MATERIAL AND METHODS Twelve participants (mean age, 62.6 ± 7.8 years) received new conventional mandibular partial removable dental prostheses and complete maxillary dentures. After 2 months of conventional prosthesis use, the participants completed a questionnaire assessing their satisfaction. Implants were then inserted bilaterally in the mandibular posterior region and, after 4 months, ball attachments were placed on the implants and on the partial removable dental prosthesis acrylic resin base. The implants and remaining teeth were followed up with clinical and image examinations. After 2 months, satisfaction was reevaluated, and the data were analyzed by the paired Student t test and the Bonferroni correction (α=.05). RESULTS Clinical evaluation found stable periodontal conditions around the implants, no intrusions or mobility of teeth, and no radiographic changes in bone level. Participants reported significant improvements (P<.05) in retention, comfort, masticatory capacity, and speaking ability after implant placement. CONCLUSIONS Implant-retained and -supported removable prostheses improve retention and stability, minimize rotational movements, and significantly increase participant satisfaction.

Effects of implant-based prostheses on mastication, nutritional intake, and oral health-related quality of life in partially edentulous patients: a paired clinical trial.

PURPOSE This study evaluated the effects of different implant-based prostheses on swallowing threshold, dietary intake, and oral health-related quality of life (OHRQoL). MATERIALS AND METHODS This prospective paired controlled clinical trial followed partially edentulous subjects, who sequentially used implant-supported removable partial dentures and implant-supported fixed partial dentures (IFPDs). Swallowing threshold was assessed by counting the masticatory cycles and median particle size (X₅₀) calculation. Nutritional intake was verified by a 3-day food record. OHRQoL was measured with the Oral Health Impact Profile (OHIP-49). Data were evaluated with repeated-measures analysis of variance. RESULTS Twelve subjects (mean age 62.6 ± 7.8 years; range, 55 to 87) took part in the study. IFPD treatment significantly reduced X₅₀ values and the number of chewing cycles. Higher intake of fiber, calcium, and iron and lower consumption of cholesterol-rich food were observed after IFPD use. OHIP summary score and OHIP physical pain domain were lower with the IFPD. CONCLUSION IFPD use leads to more efficient mastication and improves dietary intake and OHRQoL. This information will guide dentists to better clinical management of partially edentulous patients.

Mastication and jaw motion of partially edentulous patients are affected by different implant-based prostheses

The main goal of prosthetic treatment is to restore masticatory function. However, insufficient evidence supports the recommendation of one specific prosthetic intervention for partially edentulous patients. Function after the use of three different prostheses by the same partially edentulous subject. Mastication was assessed in 12 subjects (mean age 62.6 ± 7.8 years) after they had used removable partial dentures (RPDs), implant-supported partial dentures (IRPDs) and implant-fixed partial dentures (IFPDs). Masticatory ability (MA) was estimated by visual analogue scale questionnaire, while the mandibular chewing motion was evaluated by kinesiographic device, representing an objective measurement of masticatory function. Data were analysed by repeated-measures anova followed by Tukey-Kramer (P < 0.05). MA improved after IRPD and IFPD use (P < 0.05). Opening, closing and total cycle time duration were reduced after both IRPD and IFPD use (P < 0.05), irrespectively the implant prosthesis type. IFPDs and IRPDs restore the masticatory function of partially edentulous patients better than RPDs.

Implant-Supported Removable Partial Denture Improves the Quality of Life of Patients with Extreme Tooth Loss

This study aimed to evaluate oral health-related quality of life (OHRQoL) in partially dentate subjects, presenting extreme tooth loss in posterior region with missing post-canines, comparing the use of conventional removable partial dentures (RPDs) and implant-supported RPDs. OHRQoL was measured using the Brazilian version of the Oral Health Impact Profile. Twelve subjects presenting maxillary total and mandibular Kennedy Class I edentulism (mean age 62.6±7.8 years) first received complete maxillary dentures and conventional mandibular free-end RPDs. After two months, the subjects had their OHRQoL assessed. Osseointegrated implants were inserted bilaterally in the mandibular first molar regions, and after four months ball abutments were placed to support the free-end RPD. Two months later, the patients had their OHRQoL reassessed. Wilcoxon signed-rank test was used to evaluate differences in OHRQoL (α=0.05). Results showed improvement in all OHIP-49 domains (p<0.05) after associating implants to the RPD. The mandibular implant-supported free-end RPD significantly improved OHRQoL.

Mandibular movements and bite force in Alzheimer's disease before and after new denture insertion

Chewing impairment has been observed in elders with Alzheimers disease (AD); however, it is unknown whether oral rehabilitation can improve their masticatory function. This study evaluated the influence of new removable prostheses on chewing function of patients with AD. Participants using removable dentures were divided into two groups: patients with mild AD (77·2 ± 5·8 years, n = 16) and controls (76·0 ± 4·4, n = 16). All participants received general dental treatment and new total and/or partial removable prostheses. After 2 months of adaptation to the new dentures, chewing was evaluated by the following parameters: masticatory cycle time (CT), cycle velocity (CV), and opening (OA) and closing mandibular angles (CA), registered by a kinesiographic device. Maximum bite force (MBF) was assessed using a strain sensor. Evaluations were performed at baseline and after insertion of the new prostheses. A mixed model (α = 5%) was used for within- and between-subject analyses. After insertion of new prostheses, CT was reduced, and CV and MBF were increased in both groups (P < 0·05). There were no changes in OA or CA (P > 0·05). Compared to controls, elders with AD showed higher CT and reduced MBF and CV both at baseline and after insertion of new prostheses (P < 0·05). However, OA and CA did not differ between groups (P > 0·05). Insertion of new removable prostheses improved masticatory function in elders with and without AD, but patients with mild AD still had reduced chewing parameters compared to controls.

Oral Health in Elders with Parkinson's Disease

This study aimed to evaluate objectively and subjectively the oral health of elders with Parkinsons disease (PD), using clinical oral assessments and the General Oral Health Assessment Index (GOHAI). Subjects included 37 removable prosthesis wearers, 17 with PD (mean age 69.59±5.09 years) and 20 without PD (mean age 72.00±5.69 years). The objective assessment included an evaluation of oral characteristics, including the number of remaining teeth, decayed, missing and filled teeth (DMFT), visible plaque index (VPI), salivary flow rate and removable prosthesis conditions. The subjective assessment included self-perception of oral health collected using the GOHAI index. The number of remaining teeth, DMFT, VPI, salivary flow rate and GOHAI data were compared between the groups using t-tests. Removable prosthesis conditions were analyzed using χ2 tests (p<0.05). There were no group differences in the number of remaining teeth, DMFT, VPI or salivary flow rate (p>0.05). Greater maxillary prosthesis defects were observed in the control group (p=0.037). GOHAI scores were low for the PD group and moderate for controls, yielding a group difference (p=0.04). In conclusion, elders with PD have similar oral health to controls. Although all elders had few remaining teeth, high DMFT and high VPI, PD elders had more negative self-perceptions of their oral health than did the controls.

Mastication and oral health–related quality of life in removable denture wearers with Alzheimer disease

Statement of problem. Alzheimer disease (AD) can affect masticatory function, affecting oral health–related quality of life (OHRQoL). Whether oral rehabilitation with conventional removable prostheses can restore masticatory function and improve OHRQoL in these individuals is unknown. Purpose. The purpose of this clinical study was to evaluate the influence of oral rehabilitation with removable prostheses on masticatory efficiency and OHRQoL in elders with and without AD. Material and methods. Thirty‐two elders with mild AD (n=16, mean age=76.7 ±6.3 years) or without AD (n=16, mean age=75.2 ±4.4 years) were recruited. All participants first underwent masticatory efficiency and OHRQoL evaluations, and 2 months after insertion of new removable prostheses, the variables were reassessed. Masticatory efficiency was determined using the sieving method, and OHRQoL was measured by applying the Geriatric Oral Health Assessment Index (GOHAI). The data from the baseline and after insertion of the new removable prostheses were compared by paired t test. Group differences at each time point were assessed by t test (&agr;=.05). Results. After insertion of the new removable prostheses, masticatory efficiency and OHRQoL improved in both the elders with AD and the control. At baseline, elders with AD had lower masticatory efficiency and higher OHRQoL than controls (P<.05). After removable prosthesis insertion, elders with AD continued to show lower masticatory efficiency values than controls, but their OHRQoL was similar. Conclusions. Oral rehabilitation with new removable prostheses improved the masticatory efficiency and OHRQoL of elders with and without AD, although masticatory efficiency did not reach control levels in elders with AD.

Influence of a removable prosthesis on oral health-related quality of life and mastication in elders with Parkinson disease

Statement of problem Parkinson disease (PD) symptoms, such as muscle rigidity, tremors in the lips and tongue, and involuntary mandibular movements, may cause oral health‐related problems, mastication difficulties, and denture discomfort because of the difficulty in controlling a prosthesis with the oral musculature. Purpose The purpose of this observational clinical study was to evaluate the influence of oral rehabilitation with a removable prosthesis on oral health‐related quality of life (OHRQoL) and masticatory efficiency (ME) in elders with PD. Material and methods Thirty‐four elders with PD (n=17, mean age 69.4 ±4.7 years) or without PD (n=17, mean age 70.7 ±4.7 years) were recruited. All participants first underwent OHRQoL and ME evaluations. Two months after the insertion of new removable prostheses, the participants were reassessed. The OHRQoL was measured with the Oral Health Impact Profile (OHIP‐49). ME was evaluated by determining the percentage weight of the comminuted silicone‐based artificial material that passed through a 2.8 mm sieve. For each group, data were compared between baseline and after insertion of new removable prostheses by paired t test or Wilcoxon sign test/signed‐rank test. Group differences were assessed at each time point by t test (&agr;=.05). Results After the insertion of removable prostheses, elders with PD showed improved OHRQoL and ME. Controls also showed improvements on both measures after insertion of removable prostheses. At baseline, elders with PD had lower OHRQoL and ME compared with the controls (P<.05). After removable prosthesis insertion, the elders with PD continued to show lower ME values than the controls, but their OHRQoL was similar. Conclusions Oral rehabilitation with new removable dental prostheses improved the OHRQoL and ME in elders with and without PD, although ME did not reach control levels in elders with PD.