The influence of implant number and attachment type on maximum bite force of mandibular overdentures: a retrospective study

doi: 10.1111/j.1741‐2358.2010.00421.x
The influence of implant number and attachment type on maximum bite force of mandibular overdentures: a retrospective study Aim: Assessment of the influence of such factors as attachment type, number of implants, gender and age of patients on maximum bite force (MBF). Material and methods: Sixty‐two edentulous patients (32 females, 30 males; aged 64.03 ± 10.07 years, range 42–90 years) with mandibular implant overdentures with various attachment types were included in the study and their MBFs were recorded. The results were evaluated statistically at a significance level of p < 0.05. Results: The MBF in male patients was found to be statistically significantly (p < 0.05) higher than in female patients. No statistically significant differences (p > 0.05) were found with respect to age groups, attachment types and number of implants supporting the mandibular overdentures. Conclusion: Within the limitations of this study, it is concluded that independent of the number applied, dental implants increase MBF in edentulous patients. While males show higher bite force, patient age and attachment type seem not to play an important role.     

Responses of jawbone to pressure

Objective: To provide a literature review of bone resorption of edentulous jaws focusing on responses to pressure. Background: After the extraction of all teeth in a jaw there is a continuous reduction of the residual ridge. The individual variation of bone resorption is great, and the aetiology is complex and not yet well understood. Materials and methods: A search of the literature published up to May 2003 on bone resorption and pressure was performed using PubMed/Medline. Results: Animal studies have demonstrated that excessive and constant pressure induces bone resorption. Recent experimental research has indicated that bone resorption is a pressure‐regulated phenomenon with a lower threshold for continuous than for intermittent pressure. Clinical studies have suggested that residual ridge resorption is due more to the effects of denture wearing than to disuse atrophy. However, the results of leaving out dentures at night are not conclusive. Nor does the literature offer any strong evidence for the so‐called combination syndrome, which has been described as a result of unfavourable loading. Clinical studies using multivariate analyses indicate that female gender and systemic factors may be of greater importance than oral and denture factors. Implant‐supported prostheses have a bone preserving effect rather than the continuing resorption under complete dentures. Conclusions: The best way to reduce bone resorption is to avoid total extraction, preserve a few teeth and fabricate overdentures. In edentulous jaws, placement of implant‐supported prostheses will lead to less bone loss and may even promote bone growth. To increase our knowledge of residual ridge resorption extended experimental, clinical and statistical methods will be needed, preferably including collaboration between dental and medical researchers.     

Insertion and follow‐up of complete dentures: a literature review

Gerodontology 2010; 00; doi: 10.1111/j.1741‐2358.2010.00368.x Insertion and follow‐up of complete dentures: a literature review Objective: The aim of this study was to present the importance of clinical procedures related to insertion and follow‐up of complete dentures in elderly patients. Materials and Methods: The success of rehabilitation with complete dentures results from the accuracy of clinical and laboratorial procedures that makes the denture insertion an important step of treatment. Conclusion: The follow‐up and professional maintenance of function and hygiene facilitates long‐term efficiency.     

Decreasing of residual alveolar ridge height in complete denture wearers. A five year follow up study

The resorption of the residual alveolar ridges is a chronic and continuous process of bone remodeling. The aim of this study was to analyse the rate of residual ridge resorption at different sites in the both jaws in complete denture wearers, through a five-year period of denture wearing. Residual ridge changes were measured on successive lateral cephalograms at 5 measurement points of the maxilla and the mandible. The first lateral radiograph was obtained at the delivery of complete dentures. The second lateral cephalogram was obtained after five years of denture wearing. Measurements were performed using a calibrated grid. The results of this study showed the existence of a significant alveolar ridge resorption at all five measurement points of the maxilla and the mandible. The observed variables, such as body mass index and the night time denture wearing had no significant influence on the rate of residual alveolar ridge resorption (p > 0.05). The duration of edentulousness had a significant influence on the rate of residual ridge resorption with significantly higher amounts of alveolar bone height decrease in those patients who had lost the last remaining teeth more recently.     

Correlation between residual ridge resorption and radiomorphometric indices

doi: 10.1111/j.1741‐2358.2011.00514.x Correlation between residual ridge resorption and radiomorphometric indices Objectives: The study evaluated the relationship between residual ridge resorption (RRR) and radiomorphometric indices, including mandibular cortical index (MCI), mandibular cortical width (MCW) and panoramic mandibular index (PMI), along with demographic factors. Material and methods: Panoramic radiographs of 1863 patients over 20 years of age were assessed. Gender, age and dental status of each patient were recorded. Relationships between RRR and demographic factors and radiomorphometric indices were evaluated using chi‐square and Fisher’s exact tests with level of significance of p = 0.05. Results: Residual ridge resorption was not affected by gender (p > 0.05), but was more frequently seen in patients over the age of 50 compared with those below 49 years of age (p < 0.001). RRR was significantly associated with edentulism (p < 0.001) and with severe erosions of endosteal margin of mandible (p < 0.05). RRR was more frequently seen in patients with PMI below 0.30 (p < 0.001) and with MCW below 3 mm in 50‐ to 69‐year‐old age group (p < 0.001). Conclusions: Patients younger than 50 years of age who demonstrate severe erosions of endosteal margin of mandible and have MCW < 3 mm and PMI < 0.30 appear to be suitable candidates for early implant placement or for maintaining roots or natural teeth to preserve bone, regardless of gender.     

Examination of denture-cleaning methods based on the quantity of microorganisms adhering to a denture

doi: 10.1111/j.1741‐2358.2011.00461.x Examination of denture‐cleaning methods based on the quantity of microorganisms adhering to a denture Objectives: To investigate effective denture‐cleaning methods, we examined the relationships between the quantity of microorganisms adhering to dentures and the use of a denture brush and the frequency of use of a denture cleanser. Subjects and Methods: Denture plaque was collected from the mucosal surface of the examined dentures, which were 142 and 80 upper and lower complete dentures, respectively, worn by 96 outpatients (mean age: 71.9 years) of a university hospital and 41 nursing home residents (mean age: 84.8 years). The collected microorganisms were counted in terms of isolated representative colonies that were cultured and identified using standard methods. The use of a denture brush, the frequency of use, and the type and soaking time of denture cleansers as denture‐cleaning methods were surveyed. Results: The quantity of microorganisms was significantly lower in dentures of denture brush users than in those of non‐users in the outpatients (p < 0.01, Mann–Whitney U test). The quantity of microorganisms was significantly lower in the dentures of outpatients who used a denture cleanser daily or 3–4 times a week than in those who used one once or less per month and in the dentures of nursing home residents who used one daily than in those who used one at other frequencies (p < 0.05, Kruskal–Wallis test, followed by Dunn’s Multiple Comparison test). Conclusion: Within the limitations of this study, it was concluded that the use of a denture brush and daily use of denture cleanser should be recommended to complete dentures wearers as denture‐cleaning methods that effectively reduce the quantity of microorganisms adhering to dentures.     

The effect of osteoporosis on residual ridge resorption and masticatory performance in denture wearers

doi: 10.1111/j.1741‐2358.2011.00610.x The effect of osteoporosis on residual ridge resorption and masticatory performance in denture wearers Aim: To compare masticatory performance, masticatory efficiency and residual ridge resorption (RRR) in osteoporotic and non‐osteoporotic edentulous subjects after rehabilitation with complete dentures. Method: Thirty subjects fulfilling the inclusion criteria were enrolled from the patients visiting the Department of Prosthodontics for complete denture fabrication. Two groups consisting of control subjects (group I; N = 15) and osteoporotic subjects (group II; N = 15) were formed. Complete dentures satisfying certain criteria were fabricated for both groups. Masticatory performance and efficiency were measured 6 months after denture insertion. Areal measurements were taken on lateral cephalograms before and 6 months after denture fabrication. The data were then computed to analyse differences between groups I and II using SPSS statistical software version 15.0. Results: Six months after denture fabrication, the masticatory performance and efficiency were significantly higher (p < 0.001) for group I, with a significant decrease in maxillary and mandibular sagittal area seen in both groups. The rate of bone loss was more in group II compared with group I. Conclusion: Greater masticatory function was demonstrated by the non‐osteoporotic group, and the rate of RRR was more in the osteoporotic group compared with the normal group. In this pilot study, osteoporosis leads to greater RRR, decreased masticatory performance and efficiency in edentulous subjects 6 months after denture insertion. Screening for osteoporosis is suggested as a routine procedure for all edentulous subjects undergoing rehabilitation. Recall check‐ups for osteoporotic patients should be more frequent, and these patients may require more frequent denture remakes.     

Masticatory performance in 80-year-old individuals

Objective: To evaluate the masticatory performance of elderly people at the age of 80 years. Subjects: A total of 283 individuals of 80 years of age took part in a general and dental health survey. Main outcome measures: A dental examination including the number of remaining teeth, occlusion, prostheses, bite force recording, and a questionnaire regarding masticatory performance were recorded. Setting: Five municipalities (Okazaki city, Tokoname city, Tahara town, Atsumi town and Minami‐chita town) in Aichi prefecture, Japan. Results: There were 20 or more teeth in 7.4% subjects, and 44.5% were edentulous. Subjects with no occlusion accounted for 77.4% of the total. Subjects with prostheses accounted for 90.8%. Maximum bite force and masticatory ability score for patients with 20 or more teeth or not wearing prostheses were higher than other groups. The non‐wearing prostheses group had a low masticatory ability score. Conclusion: Most of the 80‐year‐old individuals recovered their masticatory ability with the assistance of prostheses. Several individuals with 20 or more remaining teeth or without removable dentures present in both jaws had a high score for bite forces and masticatory abilities.     

The influence of age and denture wear on the size of edentulous structures

Objectives : This study was designed to evaluate the influence of age and denture use on the size of arches and residual ridges in edentulous patients. Design : At two nursing homes, maxillary and mandibular stone casts of 302 fully edentulous patients were utilized to measure the size of the arches and residual ridges, according to age and use of complete dentures. Age cohorts were divided into three groups; 60–69, 70–79, and 80–89 years old. Two hundred and forty‐nine denture wearers used complete dentures for at least 2 years before examinations. Fifty‐three non‐denture users had never worn removable prostheses. Chi‐square analysis (p<0.05) was used to establish the possible relations between the linear values and the size indexes of the ridges and arches and the two examined parameters: age and denture wear. Results : Young old patients possessed edentulous structures that were not significantly larger than elderly old patients in both the maxilla and the mandible. Non‐denture users had significantly bigger arches and ridges in both edentulous jaws than denture users. Conclusions : Young old, non‐denture users tended to have bigger residual edentulous tissues compared to elderly old patients who used complete dentures.     

The effect of different attachment systems with implant‐retained overdentures on maximum bite force and EMG

doi: 10.1111/j.1741‐2358.2010.00389.x The effect of different attachment systems with implant‐retained overdentures on maximum bite force and EMG Objective: To compare the effect of different attachment systems with implant‐retained overdentures on maximum bite force and muscle activity using electromyography (EMG). Background: Denture retention and stability is of considerable interest in prosthetic dentistry. Materials and methods: Thirty‐five patients were examined: 15 edentulous patients treated with mandibular implant‐retained overdentures (MIRO) and maxillary dentures (MCD) (two implant‐ball attachment) (BC); 10 edentulous patients treated with MIRO and MCD (four implants‐bar attachments) (BRC); 10 patients with edentulous mandibular treated with MIRO and maxillary fixed partial dentures (MFPD) (two implant‐ball attachments) (BF). Before implant placement all patients received new dentures. After using these dentures for 3 months the maximum bite force and electrical activity of masseter muscle were measured. Two or four implants were then inserted into the intraforaminal region. After osseointegration periods, patients were treated with MIRO which duplicated their dentures and after three months the measurements were repeated. The data were collected and statistically analysed. Results: Muscle activity and chewing ability increased in the second period of measurements. Also chewing time was significantly decreased at the first measurements. The highest muscle activity was observed in the group of patients treated with group BF. Conclusion: The EMG values of the masseter muscle significantly increased when an implant attachments was used in the overdenture.     

Electromyographic evaluation of masseter and anterior temporalis muscles in rest position of edentulous patients with temporomandibular disorders, before and after using complete dentures with sliding plates

Objectives: This study was performed with the purpose of investigating electromyographic (EMG) activity of the anterior temporalis and masseter muscles in edentulous individuals with temporomandibular disorder (TMD), before and after using sliding plates on complete dentures in the mandibular rest position. Background: Edentulous patients may present TMD, which is characterised by pain in temporomandibular joints, masticatory and neck muscles, uncoordinated and limited mandible movements, joint sounds and an altered occlusal relationship. It is imperative to offer treatment in order to re‐establish stomatognathic system structures before submitting the individual to any definitive restorative treatment. Materials and methods: The patients were edentulous for at least 10 years. EMG recordings were made before the insertion of the dentures (0 months) and also after using the sliding plates at the fourth month, 9th month and 12th month, using computerised electromyography K6‐I/ EMG Light Channel Surface. EMG evaluations of the muscles were performed under the following clinical conditions: rest position with dentures (R1), rest position without dentures (R2), rest position with dentures post‐activity (chewing) (R3), rest position without dentures post‐activity (chewing) (R4). Results: All patients obtained remission of muscular fatigue and reduced pain in stomatognathic system structures. Temporalis muscle showed significant increase in EMG activity compared with initial values (p < 0.01). Masseter muscles showed significantly lower mean values (p < 0.01) compared with initial values. Conclusion: The sliding plates allowed the process of neuromuscular deprogramming, contributing to muscular balance of the masticatory system, and are therefore indicated to be used before the fabrication of definitive complete dentures in patients with TMD.     

Linear vertical jaw resorption potential in elderly complete denture wearers: a five-year follow-up study

Human bones decrease in quality and increase in porosity beginning at about the third decade of life. The aim of this study was to establish an equation to predict the maxillary and mandibular linear vertical resorption potential for elderly edentulous patients on the basis of the analysis of the cervical vertebrae in a single cephalometric radiograph. The morphology of the bodies of the third and fourth cervical vertebrae and measurements of linear vertical resorption in the frontal region of the jaws were analyzed in two consecutive cephalometric observations of 26 elderly edentulous patients over the five-year period of wearing complete dentures. An equation was determined to obtain maxillary and mandibular linear vertical resorption on the basis of measurements in the third and fourth cervical vertebral bodies and the average errors between the predicted and the actual values were 0.14 mm. The cervical vertebrae exhibited significant decrease in the height and width, and residual alveolar ridges exhibited significant decrease in the height over the 5-year period of wearing dentures (p < 0.01). These results suggest that using cervical vertebral measurements might allow predicting the maxillary and mandibular resorption for edentulous elderly patients wearing complete dentures.     

Clinical studies on the appearance of natural anterior teeth in young and old adults

Objectives: To evaluate the typical appearance of natural anterior teeth in young and elderly people and to develop guidelines for the natural appearance of dentures. Design: Clinical examination and photography. Inclusion criteria were a dental state with natural anterior teeth and no more than two crowns. Subjects: A study group (SG) consisting of 64 patients ranging in age from 60 to 86 years (67.3 ± 5.8) and a control group (CG) composed of 64 dental students aged 21–33 years (25.8 ± 2.4). Setting: Dental schools of the Johannes‐Gutenberg‐University Mainz and the University of Leipzig. Results: Most participants were content with the appearance of their own natural teeth. With relaxed lips a mean of 1.5 (±0.19) mm of upper incisors and 1.6 (±0.19) mm of lower incisors were visible in the SG compared with 2.5 (±0.16) and 0.4 (±0.07) mm in the CG, respectively. The subjects in the SG showed a greater diversity in position of teeth in the anterior arch and this was more often with incisors than with canines. Features such as stains, cracks and defects were much more noticeable in the SG. An inter‐dental ‘black triangle’ seemed to be a typical feature of an aged dental appearance. Conclusion: The majority of people older than 60 years who still have their own natural anterior teeth would not wish for a change in appearance if they needed a prosthodontic reconstruction. Thus techniques for customisation should be promoted to obtain a natural appearance in dentures.     

Tooth loss, denture wearing and associated factors among an elderly institutionalised Brazilian population

Objective: This cross‐sectional study assessed the prevalence and extent of tooth loss as well as denture wear and associated factors in institutionalised elderly in Brazil. Background: There is scarcity of research in Brazil concerning geriatric oral health issues. Material and methods: A sample of 335 individuals over 60 years of age, representative of the institutionalised elderly from Belo Horizonte, Brazil, were selected through a stratified sampling strategy. Data were collected from structured questionnaires, reviews of medical records and intra‐oral examinations. Results: Edentulousness was observed in 74.9% of the elderly and was related to age, years of study, income, length of institutionalisation, systemic diseases and mini‐mental score. Among the dentate subjects, 17.9% possessed 20 or more teeth. Approximately half the edentulous elderly (42.6%) and most of the partially dentate subjects (66.7%) did not wear dentures. The multivariate analysis showed that subjects that wear dentures were more likely to be female, possess higher incomes, be more functionally independent and married. Furthermore, the odds of wearing dentures among the elderly who had lost 13–32 teeth were 9.11 times higher than those who had lost up to 12 teeth. Conclusion: Tooth loss is highly prevalent in this institutionalised Brazilian population, and the prevalence of denture wear is low. The extent of tooth loss, income, functional status and marital status are important predictors for denture wear. The development of an oral health programme for these individuals should assist in their rehabilitation needs and promote in‐home care or safe transport for the elderly to a health care location.     

A cross-sectional study of oral health and oral health-related quality of life among frail elderly persons on admission to a special oral health care programme in Copenhagen City, Denmark

doi: 10.1111/j.1741‐2358.2011.00486.x
A cross‐sectional study of oral health and oral health‐related quality of life among frail elderly persons on admission to a special oral health care programme in Copenhagen City, Denmark Aim: To describe the oral health and the oral‐health‐related quality of life (OHRQoL) of citizens in Copenhagen City on admission to a specific oral health‐care programme for disabled elderly persons. Further, to analyse how various factors influence the oral health and the OHRQoL among these patients. Methods: A cross‐sectional study of 189 persons (average 85 years) consecutively admitted to a special oral health‐care programme. Clinical data and data from interviews comprising social factors, life‐style, dental visit habits, oral hygiene practices and self‐perceived oral health were collected. A modified index on perceived dysfunction, discomfort and disability due to oral disorders was used. Results: Sixty‐eight per cent had natural teeth, among those 57% had decayed teeth and two out of three wore dentures. Smoking habits influence the number of teeth present and the OHRQoL (p < 0.05) of the patients. Edentulousness, decayed teeth, and presence of dentures did not seem to cause OHRQoL problems, while higher OHRQoL scores (more problems) were reported by those with 1–9 teeth and tooth mobility. Conclusion: OHRQoL of these patients can be increased by removal of loose teeth and provision of dentures to those with very few teeth rather than focus on traditional caries treatment.     

Relationship between behavioral and psychological symptoms of dementia and oral health status in the elderly with vascular dementia

doi: 10.1111/j.1741‐2358.2012.00664.x Relationship between behavioral and psychological symptoms of dementia and oral health status in the elderly with vascular dementia Objectives: The aim of this study was to clarify the relationship between behavioral and psychological symptoms of dementia (BPSD) and oral status in the elderly with vascular dementia. Background: There have been some reports of a relationship between disease symptoms and oral status in the elderly with Alzheimer’s disease, but few reports have been conducted in the elderly with vascular dementia. Until now, the relationship between BPSD and oral status has been unknown. Materials and methods: An investigation was conducted concerning BPSD and oral status among 57 subjects with vascular dementia (mean age, 85.7 ± 5.5 years). The wearing of dentures and oral activities of daily living (oral ADL) were examined. Results: Subjects with activity disturbances and those with aggressiveness had significantly lower rates of denture wearing than those without these two symptoms (p < 0.05). Significantly lower oral ADL scores were obtained from subjects with delusional ideas, hallucinations, activity disturbances and diurnal rhythm disturbances (p < 0.05), as well as those with affective disturbances (p < 0.01). Conclusion: This study indicated a relationship between BPSD and the wearing of dentures in the elderly with vascular dementia. The study also demonstrated relationships between BPSD and oral ADL.     

A 3-year longitudinal study of quality-of-life outcomes of elderly patients with implant- and tooth-supported fixed partial dentures in posterior dental regions

doi: 10.1111/j.1741‐2358.2011.00592.x
A 3‐year longitudinal study of quality‐of‐life outcomes of elderly patients with implant‐ and tooth‐supported fixed partial dentures in posterior dental regions Background: Clinical studies have mainly been focused on oral health‐related quality‐of‐life (OHRQoL) outcomes of removable dentures. Objective: To evaluate therapy of elderly patients with implant‐supported fixed partial dentures (IFPD) and tooth‐supported fixed partial dentures (FPD) in the posterior dental regions. Patients and methods: The OHIP49 was used to measure OHRQoL in 64 patients with IFPD and 38 patients with FPD, before, 3 weeks and 3 years after rehabilitation. A control group (CG) consisted of 62 individuals. Results: The Oral Health Impact Profile questionnaire (OHIP) follow‐up scores of the patients with FPD and the patients with IFPD were significantly smaller in comparison with the baseline scores (p < 0.01). The OHIP scores were further reduced at the 3‐year follow‐up. The patients with IFPD had significantly higher scores than the patients with FPD and the CG at the baseline and at the follow‐ups. In the patients with FPD, both age groups (≤60 and >60) showed equal improvement of the OHRQoL. In the IFPD group, patients older than 60 years showed better improvement (p < 0.05). There were no significant differences dependent on gender and antagonistic teeth (p > 0.05). Conclusion: The FPD and the IFPD treatment showed significant improvement of OHRQoL. The FPD treatment improved OHRQoL equally in both age groups, while the IFPD treatment improved OHRQoL better in older patients.     

Eight-year mortality associated with dental occlusion and denture use in community-dwelling elderly persons

Objective: To evaluate the influence of dental occlusion, with or without the use of dentures, on mortality in community‐dwelling elderly persons. Subjects: A total of 1030 randomly selected healthy independent elderly aged 65 and over were surveyed in 1995. For the study reported here, subjects were classified into three groups according to the presence or absence of maxillo‐mandibular tooth contacts. Subjects with no maxillo‐mandibular tooth contacts were further subdivided into those with and without dentures. Methods: Data on mortality were obtained from Kure City Council in September 2003. Cox regression models were used in analysing the risk for death with gender and age as covariates. Results: Individuals whose teeth had contact in at least the bilateral premolar regions at baseline had 0.78 times (95% CI: 0.60–0.99) smaller risk for death during the succeeding 8 years than those who had no occlusion. Among those who had no occlusion with their own teeth, the risk for mortality among denture non‐users was 1.52 times (95% CI: 1.25–1.83) higher than the risk for denture users. Conclusion: These results may support the view that, in the elderly, poor dental occlusion is associated with an increased risk for mortality and that, in the edentulous, the use of dentures is associated with a decreased risk for mortality.     

Oral status in home-dwelling elderly dependent on moderate or substantial supportive care for daily living: prevalence of edentulous subjects, caries and periodontal disease

doi: 10.1111/j.1741‐2358.2011.00507.x Oral status in home‐dwelling elderly dependent on moderate or substantial supportive care for daily living: prevalence of edentulous subjects, caries and periodontal disease Objectives: The aim of this study was to compare the prevalence of edentulous subjects, caries and periodontal disease among the home‐dwelling elderly with moderate and substantial needs of support for daily living. Materials and method: A sample of 302 randomly selected elderly with moderate or substantial needs of supportive care were examined in Sweden. Several oral clinical variables were registered: number of teeth, dentures, caries, probing pocket depth, gingival bleeding and Eichner’s index. Results: Both in general and in oral health, the differences were small when comparing elderly with moderate and substantial care needs for daily living. Those with substantial needs had more caries lesions (p < 0.01) and more gingival bleeding (p < 0.05), while the number of teeth and prevalence of edentulous subjects did not differ in relation to the need of daily support. The elderly had, on average, 9.8–11.7 teeth, one‐third of whom had no natural teeth. According to Eichner’s index, half of the elderly in both groups had no opposing tooth contacts. Fifty‐five per cent used dentures. Conclusions: Elderly people with needs of supportive care have lost many teeth before they become dependent. Health promotion should be a priority in early ageing populations to prevent oral diseases and tooth loss.