Comparisons of chewing difficulty of consumed foods with mandibular conventional dentures and implant-supported overdentures in diabetic denture wearers

PURPOSE: This study compared the chewing difficulty of foods in diets of denture wearers with mandibular conventional and implant-supported overdentures. MATERIALS AND METHODS: One-week dietary logs were evaluated for 58 subjects with controlled diabetes at baseline with their original dentures and with new dentures 6 months after treatment completion. Subjects received new maxillary and mandibular complete dentures, 21 with mandibular conventional dentures and 37 with implant-supported overdentures. A 10-point chewing difficulty rating scale (10 for most difficult-to-chew foods) was used to rate food items in the dietary logs. RESULTS: ANOVA showed no differences between the chewing difficulty mean scores for all foods consumed either at baseline or posttreatment for the two groups. However, the mean scores for the combined consumption frequency of difficult-to-chew foods (6 to 10) showed a significant decrease following treatment with both types of dentures. This decline did not differ significantly between the denture types. With original dentures, more than 91% of subjects consumed foods with chewing difficulty scores of 6 to 10 at least seven times per week. With study dentures, only 21% maintained this level of consumption, with the frequency decreasing to four to six times per week in 24% and one to three times per week in 43% of subjects. The declines in consumption frequency of more difficult to chew foods with study dentures were in a higher percentage of subjects in the implant than in the conventional group. CONCLUSION: After 7 months of adaptation to new dentures, patients consumed fewer difficult-to-chew foods than with their original dentures. This decline was more frequent with mandibular implant-supported overdentures than with conventional dentures. Dietary counseling should be considered as part of implant and complete denture therapy.     

EMG activity of the masseter muscle in implant supported overdenture wearers during chewing of hard and soft food

The influence of texture of food on the surface electromyographic (EMG) activity of the masseter muscle was investigated in a sample of mandibular implant overdenture wearers. Six experienced denture wearers (mean age 57.8 years) with mandibular overdentures supported by two implants, consented to participate in this study. Fresh raw carrots and peeled apples of similar size and weight were chosen as representing hard and soft food, respectively. The findings were in line with those earlier reported in dentate subjects and complete denture wearers in that harder foods require higher chewing rates, higher EMG activity and higher relative contraction times, accompanied by shorter cycle durations. It was also concluded that rehabilitation with implant retained mandibular dentures may result in more regular chewing patterns with higher electrical activity of the masseter muscles, thus providing improved chewing function and comfort.     

Food selection and perceptions of chewing ability following provision of implant and conventional prostheses in complete denture wearers

The loss of natural teeth compromises chewing efficiency, and edentulous patients often have a diet that is deficient in fibre and vitamins. Prostheses that are retained on implants offer the possibility of overcoming some of the limitations of conventional dentures in terms of chewing efficiency. The aim of this study was to test the hypothesis that improvement in satisfaction with oral prostheses would result in improved food selection in edentulous patients. This prospective study involved three groups, namely (i) subjects who requested and received implants to stabilise a complete fixed or removable prosthesis (IG, n = 26), (ii) edentulous subjects who requested implant prostheses, but received conventional dentures (CDG1, n = 22), and (iii) edentulous subjects who requested and received conventional dentures (CDG2, n = 35). Data were collected using validated questionnaires pre- and postoperatively. Prior to treatment, all subjects were asked whether they ate a variety of hard and soft foods, to indicate the degree of difficulty they experienced when chewing these foods, and to rate their satisfaction with various aspects of their maxillary and mandibular complete dentures. Following the completion of treatment, subjects completed the questionnaires again. Pre- and postoperative data were compared. Subjects who received implant prostheses reported significant improvement in chewing hard and soft foods. CDG2 subjects also reported improvement, but CDG1 subjects reported no change or even deterioration following treatment. Despite reported improvement in satisfaction with comfort and ability to chew food, 30-50% of IG and CDG2 subjects still avoided eating foods such as carrot and apple. This suggests that, in the absence of tailored dietary advice, apparently successful prosthetic rehabilitation does not necessarily result in a satisfactory diet.     

The effectiveness of 2‐implant overdentures – a pragmatic international multicentre study

Summary The purpose of this multicentre observational study was to determine patient satisfaction with either conventional dentures or mandibular 2‐implant overdentures in a ‘real world’ setting. Two hundred and three edentulous patients (mean age 68·8 ± 10·4 years) were recruited at eight centres located in North America, South America and Europe. The patients were provided with new mandibular conventional dentures or implant overdentures supported by two implants and ball attachments. At baseline and at 6 months post‐treatment, they rated their satisfaction with their mandibular prostheses on 100‐mm visual analogue scale questionnaires. One hundred and two (50·2%) participants had valid baseline and 6‐month satisfaction data. Although both groups reported improvements, the implant overdenture group reported significantly higher ratings of overall satisfaction, comfort, stability, ability to speak and ability to chew. These results suggest that edentulous patients who choose mandibular implant overdentures have significantly greater improvements in satisfaction, despite their relatively higher cost, than those who choose new conventional dentures.     

Effect of prosthetic restoration on masticatory function in patients with shortened dental arches: a multicentre study

The aim of this multicentre study was to investigate the effect of prosthetic restoration for missing posterior teeth on mastication in patients with shortened dental arches (SDAs). Partially dentate patients who had an intact teeth in anterior region and missed distal molar(s) (2–12 missing occlusal units) classified as Kennedy Class I or Class II were recruited from seven university‐based dental hospitals in Japan. Of the 125 subjects who underwent baseline (pre‐treatment) and follow‐up/post‐treatment evaluation, 53 chose no replacement of missing teeth and 72 chose treatment with removable partial dentures (n = 53) or implant‐supported fixed partial dentures (n = 19). Objective masticatory performance (MP) was evaluated using a gummy jelly test. Perception of chewing ability (CA) was rated using a food intake questionnaire. In the no‐treatment group, mean MP and CA scores at baseline were similar to those at follow‐up evaluation (P > 0·05). In the treatment group, mean MP after treatment was significantly greater than the pre‐treatment mean MP (P < 0·05). However, the mean perceived CA in the treatment groups was similar at pre‐ and post‐treatment (P > 0·05). In a subgroup analysis of subjects in the treatment group, subjects with lower pre‐treatment CA showed a significant CA increase after treatment (P = 0·004), but those with higher pre‐treatment CA showed a significant decrease in CA (P = 0·001). These results suggest that prosthetic restoration for SDAs may benefit objective masticatory performance in patients needing replacement of missing posterior teeth, but the benefit in subjective chewing ability seems to be limited in subjects with perceived impairment in chewing ability before treatment.     

Masticatory performance and chewing experience with implant-retained mandibular overdentures

The relationship between masticatory performance and chewing experience has not yet been explored for patients with implant-retained overdentures. Although many relationships have been found between parameters of objective and subjective oral function, the structure of these relationships remain unclear. Therefore, we studied in a randomized clinical trial the relationship between the comminution of an artificial test food, i.e. masticatory performance, and the subjective chewing experience. The trial involved a comparison between two groups receiving implant treatment and one group receiving conventional complete dentures (CD). The implant treatment involved either a mainly implant-supported mandibular overdenture on a transmandibular implant (TMI) or an implant-tissue-supported mandibular overdenture on two IMZ implants (IMZ). Masticatory performance as well as chewing experience were substantially better for the implant-retained overdentures compared with the complete denture group. No significant differences emerged between the TMI and the IMZ group. A multiple regression analysis did not provide any comprehensibility in the relationship between masticatory performance and the variables of chewing experience. In the linear structural relation analysis (LISREL) no direct relationship was found between masticatory performance and functional complaints mandibular denture. The results show that an improvement in masticatory performance does not imply the same improvement in chewing experience and vice versa.     

Patient satisfaction with mandibular implant overdentures and conventional dentures 6 months after delivery

Purpose

This study examined patient satisfaction with conventional complete dentures and mandibular implant overdentures opposing conventional maxillary dentures 6 months after delivery.

Materials and Methods

Sixty edentulous subjects (aged 65 to 75 years) were randomly assigned to either a mandibular conventional denture or an overdenture supported by two implants with ball-shaped retentive anchors. Patients rated their general satisfaction and other features of their prostheses, together with their ability to eat certain food items, on 100-mm visual analogue scales before assignment, and after 2 and 6 months.

Results

Both treatment groups reported greater satisfaction with their new prostheses at 6 months. General satisfaction ratings were higher in the implant group than in the conventional denture group by approximately 36% (mean difference 22.3 mm). The implant group also rated comfort (mean difference 22.4 mm), stability (mean difference 28.5 mm), and ability to chew (mean difference 17.3 mm) significantly higher. Significantly higher scores were also given by the implant group for their ability to chew certain hard foods. A trend for an increase in the differences between the groups, in favor of the implant group, was observed between the 2- and 6-month recalls, although the increase was only significant for ease of cleaning. The primary influence on general satisfaction 6 months after the delivery of the prostheses was the provision of the two-implant overdenture.

Conclusion

Edentulous seniors who received mandibular implant overdentures opposing a conventional denture rated their general satisfaction approximately 36% higher than did a comparable group provided with new conventional dentures.     

Masticatory function and patient satisfaction with implant-supported mandibular overdentures: a prospective 5-year study

PURPOSE: The aim of this study was to assess the outcome of treatment with implant-supported mandibular overdentures in terms of biting and chewing, in entirely satisfied and not fully satisfied patients. MATERIALS AND METHODS: Twelve edentulous patients who had worn dentures for at least 5 years participated. They were in good health but had retention problems with their mandibular dentures. First, all patients received new dentures. After 3 months, two Astra Tech implants were placed in the anterior part of the mandible, and 6 months later the abutments were connected. Patient assessment (questionnaire) and functional recordings (chewing ability, bite force, electromyographic activity) were performed with the new dentures, and again 3 months, 1 year, and 5 years after overdenture treatment. RESULTS: After treatment, all patients were able to comminute hard and tough food, the maximum bite force and the chewing activity increased in parallel, and the duration of the chewing cycle was reduced. Every patient felt improved function and reduction of chewing pain. However, the seven patients not fully satisfied with the function of the implant-supported mandibular overdentures were characterized by lower muscle activity, even before implant placement, than the entirely satisfied patients. CONCLUSION: Implant-supported mandibular overdenture treatment permits better biting and chewing function than conventional complete dentures.     

One-Year Prospective Evaluation of the Early Loading of Unsplinted Conical Brånemark Fixtures with Mandibular Overdentures Immediately following Surgery

Background: Prospective evaluation of the early loading of unsplinted Branemark implants with mandibular over‐dentures opposing conventional dentures is not evident in the implant‐related literature. Purpose: To clinically evaluate progressive and early loading of 20 unsplinted conical Brånemark implants in edentulous mandibles with overdentures. Materials and Methods: Ten edentulous patients all had two conical Brånemark implants placed in the anterior mandible with mandatory primary stability with bicortical anchorage. Ball abutment connection was performed simultaneously. Previously constructed conventional mandibular dentures were temporarily relined with tissue conditioner postoperatively and worn with moderation for the first 2 weeks to allow progressive loading. Early loading of the implants followed after 2 weeks, with inclusion of the respective matrices in the mandibular dentures, using a definitive reline procedure. Results: All patients successfully functioned with their mandibular implant overdentures from 2 to 52 weeks postoperatively. Mean marginal bone loss was within established criteria for success:0.22 mm (SD = 0.48 mm) mesially and 0.30 mm (SD = 0.39 mm) distally on the conical implants. Mobility tests using the Periotest instrument became more negative, although not at statistically significant levels. Difficulties in the management of the peri‐implant mucosa between surgery and loading at 2 weeks were observed in 40% of the patients. Conclusions: These preliminary 1‐year results show that successful early loading of unsplinted conical Brånemark implants with mandibular overdentures is possible.     

Patient satisfaction with mandibular implant overdentures and conventional dentures 6 months after delivery

PURPOSE: This study examined patient satisfaction with conventional complete dentures and mandibular implant overdentures opposing conventional maxillary dentures 6 months after delivery. MATERIALS AND METHODS: Sixty edentulous subjects (aged 65 to 75 years) were randomly assigned to either a mandibular conventional denture or an overdenture supported by two implants with ball-shaped retentive anchors. Patients rated their general satisfaction and other features of their prostheses, together with their ability to eat certain food items, on 100-mm visual analogue scales before assignment, and after 2 and 6 months. RESULTS: Both treatment groups reported greater satisfaction with their new prostheses at 6 months. General satisfaction ratings were higher in the implant group than in the conventional denture group by approximately 36% (mean difference 22.3 mm). The implant group also rated comfort (mean difference 22.4 mm), stability (mean difference 28.5 mm), and ability to chew (mean difference 17.3 mm) significantly higher. Significantly higher scores were also given by the implant group for their ability to chew certain hard foods. A trend for an increase in the differences between the groups, in favor of the implant group, was observed between the 2- and 6-month recalls, although the increase was only significant for ease of cleaning. The primary influence on general satisfaction 6 months after the delivery of the prostheses was the provision of the two-implant overdenture. CONCLUSION: Edentulous seniors who received mandibular implant overdentures opposing a conventional denture rated their general satisfaction approximately 36% higher than did a comparable group provided with new conventional dentures.     

A patient-based assessment of implant-stabilized and conventional complete dentures

STATEMENT OF PROBLEM: Outcomes of oral implant therapy have been described primarily in terms of implant survival rates and the durability of implant superstructures. Reports of patient-based outcomes of implant therapy have been sparse, and none of these studies have used oral-specific health status measures. PURPOSE: This study assessed the impact of implant-stabilized prostheses on the health status of complete denture wearers using patient-based, oral-specific health status measures. It also assessed the influence of preoperative expectations on outcome. MATERIAL AND METHODS: Three experimental groups requesting replacement of their conventional complete dentures completed an Oral Health Impact Profile (OHIP) and a validated denture satisfaction scale before treatment. One group received an implant-stabilized prosthesis (IG), and 2 groups received new conventional complete dentures (CDG1 and CDG2). After treatment, all subjects completed the health status measures again; preoperative data were compared with postoperative data. RESULTS: Before treatment, satisfaction with complete dentures was low in all 3 groups. Subjects requesting implants (IG and CDG1) had high expectations for implant-stabilized prostheses. Improvement in denture satisfaction and OHIP scores was reported by all 3 groups after treatment. Subjects who received their preferred treatment (IG and CDG2 subjects) reported a much greater improvement than CDG1 subjects. Preoperative expectation levels did not appear to influence satisfaction with the outcomes of implant therapy in IG subjects. CONCLUSION: Subjects who received implants (IG) that replaced conventional complete dentures reported significant improvement after treatment, as did subjects who requested conventional replacement dentures (CDG2). The OHIP appears useful in identifying patients likely to benefit from implant-stabilized prostheses.     

Biting and chewing in overdentures, full dentures, and natural dentitions

It has been suggested that the provision of dental implants can improve the oral function of subjects with severely resorbed mandibles, possibly restoring function to the level experienced by satisfied wearers of conventional complete dentures. Nevertheless, a quantitative comparison has never been made and can be drawn from the literature only with difficulty, since studies differ greatly in methodology. To make such a comparison, we measured bite force and chewing efficiency by using identical methods in subjects with overdentures, complete full dentures, and natural dentitions. Our results indicated that bite forces achieved with overdentures on dental implants were between those achieved with artificial and natural dentitions. Chewing efficiency was significantly greater than that of subjects with full dentures (low mandible), but was still lower than that of subjects with full dentures (high mandible) and overdentures on bare roots. Differences in the height of the mandible revealed significant differences in chewing efficiency between the two full-denture groups. Furthermore, subjects with a shortened dental arch exerted bite forces similar to those of subjects with a complete-natural dentition, but their chewing efficiency was limited due to the reduced occlusal area. For all groups combined, a significant correlation was found between maximum bite force and chewing efficiency. Nearly half of the variation in chewing efficiency was explained by bite force alone.     

Relationship between prosthodontic evaluation and patient ratings of mandibular conventional and implant prostheses

PURPOSE: The purpose of this study was to compare clinicians' ratings of the state of oral tissues and their satisfaction with treatment to edentulous patients' ratings of treatment success after provision of mandibular implant overdentures or conventional dentures. MATERIALS AND METHODS: Sixty subjects randomly received either mandibular overdentures retained by two implants (n = 30) or new conventional mandibular complete dentures (n = 30). All were given new conventional maxillary dentures. Baseline measures included clinical evaluation of the oral soft and hard tissues. Patients rated their general satisfaction before and after treatment, as well as their satisfaction with stability, speech, and esthetics on visual analogue scales. The treating prosthodontist rated the dentures for the same categories. Patient and clinician ratings were compared using correlations, t tests, and linear regression. RESULTS: None of the clinical variables were significantly correlated with patient satisfaction before or after treatment. The prosthodontist rated mandibular implant overdentures significantly better than conventional dentures regarding general satisfaction, stability, speech, and esthetics. Implant overdentures were also easier to fabricate (P < .0001). The prosthodontists' scores were not significantly correlated with patient scores for any question. CONCLUSION: Clinicians' assessments of the quality of denture-supporting tissues are poor predictors of patient satisfaction with mandibular implant or conventional prostheses. Prosthodontists and patients both rate mandibular implant overdentures as significantly superior to conventional dentures, but patients and clinicians do not usually agree when evaluating individual prostheses.     

The impact of dietary advice on edentulous adults' denture satisfaction and oral health‐related quality of life 6 months after intervention

Objective: The aim of this study was to compare the impact of customised dietary advice on patients' satisfaction with their dentures and oral health‐related quality of life (OHRQoL) in patients wearing implant‐supported mandibular overdentures (IOD) or conventional dentures (CD). Materials and methods: In this prospective cohort study, 28 IOD (two implant‐retained mandibular overdenture) and 26 CD patients completed a denture satisfaction scale and the 20‐item oral health impact profile (OHIP‐20) before and 6 months following provision of customised dietary advice. Results: At 6 months following provision of individualised dietary advice, the IOD group showed significantly greater satisfaction than the conventional group for denture comfort (80.6, ± 15.6, vs. 68.7 ± 15.6 P=0.001), stability (75.8 ± 15.9 vs. 59.5 ± 30.4, P=0.002), and perceived chewing ability (79 ± 30.4 vs. 59.5 ± 30.4, P=0.027) ± when adjusted for baseline scores. Before delivery of the dietary advice there were no significant differences between groups for Satisfaction or OHIP scores. No difference in OHRQoL was seen between groups. Conclusions: The delivery of customised dietary advice to edentulous patients impacts differently on their satisfaction with denture comfort, stability and chewing ability depending on the nature of their prosthesis. This re‐evaluation of satisfaction occurs when edentulous patients challenge themselves to consume more fruits, vegetables and fibre‐rich foods. The IOD group reported an increased level of satisfaction and perceived chewing ability whereas it appeared that CD wearers may have had their awareness of the shortcomings of this sort of prosthesis reawakened. To cite this article:
Ellis JS, Elfeky AF, Moynihan PJ, Seal C, Hyland RM, Thomason M. The impact of dietary advice on edentulous adults' denture satisfaction and oral health‐related quality of life 6 months after intervention.
Clin. Oral Impl. Res. 21 , 2010; 386–391.
doi: 10.1111/j.1600‐0501.2009.01859.x     

The influence of occlusal scheme on masticatory forces using implant stabilized bridges

summary The objectives of this study were to determine the effects on masticatory forces of using implant stabilized mandibular bridges with occlusal schemes providing either balanced or unbalanced articulation. The investigation was carried out in a group of six subjects who had dentate, or restored dentate maxillary arches and who used implant-stabilized mandibular prostheses. Peak masticatory forces, chewing frequency and load rate were determined when chewing bread, carrots and nuts. The mean peak masticatory force varied markedly from subject to subject, and, together with the masticatory load rate were lowest when eating bread and highest when chewing nuts, with values for chewing carrots between the two. There was no detectable difference in mean peak masticatory force or load rates associated with chewing bread with the two occlusal schemes; however, these were lower with balanced occlusion when chewing nuts and carrots. The ranking of subjects in terms of mean peak masticatory force and load rate was consistent and peak load rates of up to 2000 N/sec were recorded. Chewing frequency was relatively consistent for a particular subject irrespective of the foodstuff.     

Short‐term post‐operative pain and discomfort following insertion of mini‐implants for retaining mandibular overdentures: a randomized controlled trial

The retention of removable dentures by mini‐implants is a relatively recent treatment modality and may lead to minimal post‐operative trauma. This study compared post‐operative pain and discomfort following the insertion of mini‐implants (two or four) or two standard‐size implants for the retention of mandibular overdentures. One hundred and twenty edentulous participants (mean age 59·5 ± 8·5 years) were randomly allocated into three groups according to received treatment: (GI) four mini‐implants, (GII) two mini‐implants or (GIII) two standard implants. Seven days after implant insertion, patients answered questions (100‐mm VAS) relating to pain, swelling, and discomfort with chewing, speech and hygiene, considering their experiences during the 1st and 6th day. Groups were compared by two‐way anova (α = 0·05). All participants (GI: 38; GII: 42; GIII: 40) were analysed after 7 days. At the 6th day, GI felt significantly higher pain than GII and GIII. GI also reported more difficulty in performing oral hygiene practices than GIII during the 1st day. There was no significant difference between groups for the other questions and periods. No participant suffered unexpected side effects. The use of four mini‐implants induces more intense post‐operative pain at the 6th day than the insertion of two mini‐ or conventional fixtures, as well as more difficult oral hygiene on the 1st day. Clinicaltrials.gov, NCT01411683; FAPESP, 2011/00688‐7 and 2011/23347‐0.     

Early functional loading of unsplinted roughened surface implants with mandibular overdentures 2 weeks after surgery

Background: Before early functional loading of unsplinted implants with mandibular overdentures can become widespread, more clinical studies are needed to investigate the success of the approach. Purpose: To evaluate the success rates of two types of roughened titanium surface implants with early 2‐week functional loading of paired mandibular interforaminal implants with overdentures. Materials and Methods: Random allocation divided 24 strictly selected edentulous participants into two groups, with each group to receive a different implant system (ITI Dental Implant System, Straumann AG, Waldenburg, Switzerland; or Southern Implant System, Southern Implants, Irene, South Africa). Two implants were placed in the anterior mandible of all participants using one‐stage standardized surgical procedures. Previously constructed conventional mandibular dentures (opposing maxillary complete dentures) were temporarily relined and worn by the participants for the first 2 weeks; participants used a soft diet. Two weeks after implant surgery and following some mucosal healing, the mandibular dentures had the tissue conditioner removed and the appropriate matrices included for an unsplinted prosthodontic design. Results: No implant from either group was lost. Resonance frequency analysis (RFA) indicated higher primary stability at surgery for the Southern group than for the ITI group, with a statistically significant difference between the groups throughout the study period. The drop in RF values between surgery and 6 weeks was significant and was greater for the Southern group. RFA also indicated stabilized osseointegration between 6 to 12 and 12 to 52 weeks, with no participant showing any decrease in those values over time. Participants with type 3 bone showed a significant improvement in RF values between 12 and 52 weeks, eventually matching those of participants with type 2 bone. There were no significant differences in marginal bone loss, periimplant parameters, or prosthodontic maintenance between the groups over the study period. Conclusions: Using only strict patient selection criteria, 1‐year follow‐up data indicate that early functional loading of ITI and Southern implants with mandibular two‐implant overdentures is possible as early as 2 weeks after implant surgery.     

Oral and general health-related quality of life with conventional and implant dentures

Implant overdentures and conventional prostheses have been compared in several trials using a variety of functional and oral health-related quality of life (OHQOL) outcomes. In this paper, we describe the impact of implant overdentures on general and OHQOL in seniors. OBJECTIVES: To compare the oral health-related and general quality of life of seniors (aged 65-75 years) who received either mandibular implant overdentures or conventional dentures. METHODS: Sixty edentulous patients were recruited. Thirty received mandibular overdentures retained by two implants (IOD) and a conventional maxillary denture, the other 30 subjects received new maxillary and mandibular conventional complete dentures (CD). All completed the 20-item version of the Oral Health Impact Profile (OHIP-20) before treatment, then at two and 6 months after delivery of the dentures. The SF-36 general health questionnaire was completed at baseline and 6 months only. RESULTS: Pretreatment and 6-month data from 55 subjects were analyzed. Those who received the IODs had significantly better OHIP-20 total scores at 6 months. Results for IOD subjects were also superior in the functional limitation, physical pain, physical disability and psychological disability subscales. While no significant between group difference was found on the SF-36 health survey, significant pre-post-treatment differences within the IOD group were detected for the role emotional, vitality and the social function scales. CONCLUSIONS: Mandibular overdentures retained by two implants provide elderly patients with better OHQOL. General health-related quality of life improved in the implant group.     

A longitudinal study of quality of life outcomes in older adults requesting implant prostheses and complete removable dentures

A longitudinal clinical trial involving 103 subjects was undertaken to assess the impact of oral implant therapy on the psychosocial well-being of subjects with complete denture wearing problems. There were four experimental groups: (1) an implant group, where subjects were edentulous/edentate in one jaw and requested and received implants to retain an oral prosthesis (IG); (2) subjects edentulous/edentate in one jaw requesting implants but who received conventional dentures (CDG1); (3) edentulous subjects requesting replacement of their dentures by conventional means (CDG2); (4) dentate subjects requiring routine treatment, who were included for comparison. Data were collected in each group pre- and post-treatment using validated oral specific [the Oral Health Impact Profile (OHIP)], and generic (the SF36) health status measures. Subjects in IG, CDG1 and CDG2 also completed a denture satisfaction scale. IG and CDG1 subjects reported that tooth loss and denture wearing problems had a much greater impact on their quality of life than subjects seeking conventional dentures. Dentate subjects had a much better oral health status compared with denture-wearing subjects. Following treatment, subjects who received implant-retained prostheses (IG) reported a significant improvement in satisfaction and health-related quality of life, as did subjects who requested and received conventional dentures (CDG2). Subjects who requested implants, but received conventional dentures (CDG1), reported little improvement in denture satisfaction and only modest improvement in their quality of life. None of the denture-wearing subjects reported health-related quality of life that was as good as that of dentate subjects. The findings have significant implications in the assessment of outcomes in future clinical trials.     

Swallowing thresholds of mandibular implant-retained overdentures with variable portion sizes

We analysed the effect of three portion sizes Optocal Plus (small, medium and large) on swallowing thresholds in subjects with either conventional complete dentures or mandibular implant-retained overdentures (transmandibular and permucosal cylindric implants). Tests were carried out in 52 women and 15 men (mean age 59 years) 4 years after treatment in a randomised controlled clinical trial. The results indicated that the degree of mucosal support for the mandibular denture did not affect the number of chewing strokes, time till swallowing or swallowed particle size. Only the chewing rate differed: subjects wearing mandibular implant-retained overdentures chewed the food at a higher rate than complete-denture wearers. With larger portion sizes, subjects needed significantly more chewing strokes and time until swallowing and they would have swallowed larger particles. Men chewed their food more efficiently than women, as they used the same number of chewing strokes and time, but achieved a greater particle size reduction at the swallowing moment.