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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 15  |  Issue : 3  |  Page : 426-431

Comparative evaluation of masticatory efficiency between conventional complete dentures and implant retained over dentures using color-changing chewing gum


1 Department of Prosthodontics and Implantology, Pacific Academy of Higher Education and Research University, Udaipur, Rajasthan, India
2 Department of Public Health Dentistry, Pacific Academy of Higher Education and Research University, Udaipur, Rajasthan, India
3 Private Consultant, Gulbarga, Karnataka, India
4 Department of Public Health Dentistry, Siksha O Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India

Date of Submission17-Jul-2019
Date of Decision30-Jul-2020
Date of Acceptance25-Aug-2020
Date of Web Publication1-Feb-2021

Correspondence Address:
Dr. Mohammed Abid Zahir Hussain
Department of Prosthodontics and Implantology, Pacific Academy of Higher Education and Research University, Udaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_109_19

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  Abstract 


Background: The prosthodontic treatment for the edentulous patient is always a major challenge among prosthodontists. Conventional complete denture wearers often complain about dissatisfactory performance of their lower dentures, this could be due to the instability and loss of retention owing to the poor alveolar ridge. Implant-retained overdentures help to solve this instability problem. Masticatory efficiency is considered a major indicator for determining the functional state of the masticatory system. Masticatory efficiency measurement may be an important parameter when planning dental implant treatment. Materials and Methods: This study involves the use of color-changing chewing gum and manual visualization with a color scale provided by the manufacturer to evaluate the masticatory efficiency in 20 edentulous patients wearing conventional complete dentures and compared with ball-retained implant overdentures and also bar-retained overdentures. Statistics: The paired t-test and ANOVA test were applied to statistically evaluate the data. Results: The results indicated that patients with bar-retained implant overdentures demonstrated significantly the higher levels of masticatory efficiency in implant-retained overdentures compared with conventional complete dentures and significant levels in overdentures retained with bar and clip as compared with ball-retained over dentures and conventional complete dentures. Conclusion: Masticatory efficiency levels were increased in bar IOD when compared with conventional complete dentures and ball IOD.

Keywords: Color changing chewing gum, conventional complete dentures, implant-retained overdentures, masticatory efficiency


How to cite this article:
Hussain MA, Bhat N, Gani SA, Nagarajappa R. Comparative evaluation of masticatory efficiency between conventional complete dentures and implant retained over dentures using color-changing chewing gum. J Datta Meghe Inst Med Sci Univ 2020;15:426-31

How to cite this URL:
Hussain MA, Bhat N, Gani SA, Nagarajappa R. Comparative evaluation of masticatory efficiency between conventional complete dentures and implant retained over dentures using color-changing chewing gum. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2021 Mar 4];15:426-31. Available from: http://www.journaldmims.com/text.asp?2020/15/3/426/308535




  Introduction Top


In the past century, life expectancy is enhanced in the elderly population, and today, we find more elders amongst us. Most of these elderly groups suffer either from the local or systemic health problems; many studies indicated that the prevalence and distribution of edentulism are relatively increasing in many countries.[1] Edentulism is a poor public health outcome that substantially affects the oral and general health status as well as quality of life. Edentulism is consistently shown to increase with age, with females having higher rates of edentulism than do males.[2],[3] The prosthodontic management of the edentulous patient has always been a major challenge to prosthodontists, and most of them consider complete maxillary and mandibular dentures as a standard of care. Historical records have shown that conventional complete denture treatment improves the quality of life of edentulous patients. However, many patients significantly complain adjusting and adapting to their mandibular dentures due to the lack of comfort, retention, stability, and inability to chew and eat. This condition may be especially debilitating in patients wearing mandibular dentures for a longer period. Overdenture therapy constitutes essentially a preventive prosthodontic concept as it endeavors to preserve the few remaining teeth and the supporting structures.[4] Overdentures help to partly overcome many of the problems posed by conventional complete dentures such as progressive bone loss, poor stability and retention, loss of periodontal proprioception, and low masticatory efficiency, leading to general dissatisfaction.[5]

For edentulous patients, the McGill consensus statement for mandibular two-? implant overdentures (IOD) is accepted by many practioners as the first choice of care.[6] Researchers have investigated and reported no significant difference between splinted and unsplinted design for implant survival and peri-implant outcomes; they also have recommended the use of either ball and socket or bar-supported overdentures in the rehabilitation of edentulous cases.[7] Studies in the past also indicate the preference of most of the patients for overdentures with bar-clip attachments as compared to ball socket.[8],[9] The patient's masticatory efficiency varies with the design of prosthesis and also largely depends upon the integrity and consistency of the testing materials and methods. Although there is a range of methods to evaluate the masticatory efficiency, the most commonly preferred are electromyography, sieving,[10] and clinical observation, but due to the procedural complexity and variances in the testing materials, their validity questionable.[11] In this study Xylitol,[12] a color-changing chewing gum with handheld color scale provided by the manufacturer was used as recommended by Kamiyama et al.,[13] Ishikawa et al.[14] The aim of the present study was to compare and evaluate the masticatory efficiency using a color-changing chewing gum between the mandibular conventional dentures and implant-supported overdenture with different types of attachments.


  Materials and Methods Top


Twenty edentulous patients aged between 40 and 65 years with an average of 55 years participated in this study. All participants were healthy and free from acute/chronic systemic diseases that may contradict the implant surgery. The informed consent was obtained before the start of treatment. The research proposal was accepted and approved by the Ethics Committee, Pacific Dental College, PAHER University, Udaipur, Rajasthan, India.

After complete intraoral, extraoral, and radiological examinations (Orthopantomagram (OPG) and cone-beam computed tomography) [Figure 1], each patient was fabricated with conventional complete dentures following standard prosthodontic protocol [Figure 2]. The dentures were adjusted for better adaptation during follow-up visits [Figure 3]. Once the patient expresses his complete satisfaction with new dentures, he was recalled and masticatory efficiency was checked on both right and left sides.
Figure 1: OPG of edentulous arches

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Figure 2: Finished maxillary and mandibular dentures

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Figure 3: Dentures after insertion

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The lower dentures were duplicated to fabricate a splint with autopolymerized acrylic, it was verified in the patient's mouth for adaptation [Figure 4]. This splint served as an aid in the positioning of implants. Following standard two-stage implant surgical protocol, two implants were surgically placed on the right and left sides at canine regions in the mandible [Figure 5] under local anesthesia and antibiotic coverage. The site was sutured primarily, and implants left submerged for 3–4 months for osseointegration [Figure 6]. The patient was advised not to wear the denture for 2 weeks following surgery and to report after this period for subsequent modification and relining of the dentures.
Figure 4: Surgical splint tried on the mandibular arch

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Figure 5: Sequential surgical drilling and racheting for implant placement

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Figure 6: OPG showing implant position

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The patient was recalled after 3 months for the second stage surgery, wherein the implant site was reopened, healing caps were placed [Figure 7] and site closed with mattress sutures. After 2 weeks of healing, the healing capes were removed, ball abutments and silicone O-rings were fixed [Figure 8] and the dentures were modified to accommodate the socket casing on the intaglio surface [Figure 9]. The dentures were relined and subsequently left for adaptation to functions. The patient was recalled after 2 weeks, and masticatory efficiency was recorded as done earlier with complete dentures [Figure 10]. Later, the ball and socket were replaced with bar and clip attachment system with standard prosthetic protocol [Figure 11] and following complete adaptation, again the masticatory efficiency was recorded as previously.
Figure 7: The second stage surgery healing screws placed

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Figure 8: Following the 2nd-stage surgery, ball abutments placed over implants

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Figure 9: Silicone O-ring with metal casing on the abutment

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Figure 10: Metal casing transferred to the intaglio surface of the denture

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Figure 11: Mandibular denture tried on ball abutments

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Method of assessing masticatory efficiency

The participating individuals were given about one-third quantity (1 g) of Xylitol chewing gum [Figure 12]. They were asked to chew with 15, 30, and 45 times/strokes, respectively, on right and left sides, with a constant frequency of one stroke/sec till they reached the required number of strokes. This was repeated three times similarly with 1 min interval. The color of the chewing gum changes as the patient bites and the chewing strokes proceeds [Figure 13], masticatory efficiency can be evaluated by visual assessment, conforming to theoretical color changes of a gum. After the completion of the required strokes of 15, 30, and 45, the bolus was collected on a polyethylene film and compressed to obtain a uniform thickness of 1.5 mm between the two glass plates [Figure 14]. Color changes are measured using a hand-held color scale provided by the manufacturer [Figure 15].
Figure 12: Bar fabricated and tried on the cast in the laboratory

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Figure 13: Xylitol color.changing gum strip (1GM)

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Figure 14: Change of gum color at different strokes

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Figure 15: Color scale description on the cover of the gum

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Statistical analysis

The data collected were statistically evaluated applying? SPSS software version 21.0 (SPSS Inc., Chicago, Illinois, USA) using the paired t-test and one-way ANOVA test to analyze the difference between the values.

Ethical clearance

The Institutional Ethics Committee of Pacific Dental College, PAHER University, Udaipur, Rajasthan, India has approved the Research work proposed to be carried out at Pacific Dental College, PAHER University. Date: 9th Sept 2018 with Reference no PAHER/EC/2018/226.


  Results Top


No significant differences in color scores were noted between the right side and left side with conventional dentures during the 15, 30, and 45 strokes (P > 0.05) and also during the 15 and 30 strokes with ball IOD and bar IOD. However, with 45 strokes, a significant difference was reported between the right side and left side in all the three groups [Table 1]. The results indicated a very high significant difference in color scores with 15 chewing cycles as compared between the conventional complete denture (CCD) versus ball IOD and CCD versus bar IOD (P < 0.001). However, a significant difference was noted between the ball IOD versus bar IOD (P < 0.05). For 30 chewing cycles, high significant differences in color were noted between the CCD versus ball IOD, the CCD versus bar IOD, and the ball IOD versus bar IOD (P < 0.001). High significant differences in color scores were recorded with 45 chewing cycles between the CCD versus ball IOD, the CCD versus bar IOD, and the ball IOD versus bar IOD (P < 0.001). In case of bar IOD, high significant differences in color scores between 15 versus 30 chewing cycles and 30 versus 45 chewing cycles (P < 0.001) were noted. The one-way ANOVA (F) test showed that with 15, 30, and 45 chewing cycles, there were high significant differences in color scores between the CCD, ball IOD, and bar IOD (P < 0.001) [Table 2].
Table 1: The mean values recorded for color scores with conventional complete denture, ball implant overdenture, and bar implant overdenture

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Table 2: Comparison between conventional complete denture, ball implant overdenture, and bar implant overdenture groups at a defined number of strokes

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  Discussion Top


The evaluation for the masticatory efficiency of dental prosthesis is most often a subjective analysis by many practitioners, and also the decision for replacing with new prosthesis is based on the practioners knowledge, skill, experience and affordability of the patients. Literature reported many objective methods for the evaluation of the patient's masticatory efficiency; most of them require materials and costly instruments and involve complex procedures. In this study, a simple method was used for evaluating the masticatory efficiency by using color-changeable chewing gum was used as a test material and manual visualization with a handheld color scale provided by the manufacturer. This procedure is quite simple, easy reliable, valid, and cost-effective method.

The result of the present study found highly significant differences in masticatory efficiency between the conventional denture with overdenture supported by bar attachment (bar IOD) and the conventional denture with overdenture supported by ball and socket attachment (ball IOD). These findings were similar with the results reported by Chen et al.[15] However, when comparing the effect of overdenture supported by bar attachment and overdenture supported by ball and socket attachment on the masticatory efficiency at different masticatory cycles (15, 30 and 45), the result of the present study found a significant increase in the masticatory efficiency when using overdenture supported by bar attachment. The results also demonstrate that the patients restored with implant-supported overdenture showed higher masticatory efficiency than those restored with conventional dentures. However, between bar and ball, the differentials were significantly different. This was similar to the findings reported in the studies conducted by van Kampen et al.[16] and Haas et al.[17]


  Conclusion Top


This study can be concluded with the following findings:

  1. The mandibular implant overdentures (both ball and bar) were clinically more retentive and stable than that of convention complete dentures. Hence, this insufficiency makes mandibular IOD a preferred option
  2. Masticatory efficiency is very important parameter for implant selection and prosthodontic case planning, especially in edentulous patients who are capable of delivering very high occlusal loads
  3. Patients rehabilitated with overdenture retained by ball or bar clip attachments had a significant improvement in masticatory efficiency when compared with conventional dentures
  4. The result of the present study concluded that the efficiency levels were significantly lower in ball IOD as compared to bar IOD participants. Also highly significant increase in was reported with bar clip attachment when compared with conventional denture and over denture supported by ball and socket attachment.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kaira LS, Dabral E. Prevalence of complete edentulism among Udaipur population of India. Saudi J Dent Res 2014;5:139-45.  Back to cited text no. 1
    
2.
Hunt RJ, Beck JD, Lemke JH, Kohout FJ, Wallace RB. Edentulism and oral health problems among elderly rural Iowans: The Iowa 65+rural health study. Am J Public Health 1985;75:1177-81.  Back to cited text no. 2
    
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Felton DA. Edentulism and comorbid factors. J Prosthodont 2009;18:88-96.  Back to cited text no. 3
    
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Henking JP. Overdentures. J Dent 1982;10:217-25.  Back to cited text no. 4
    
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Reitz PV, Weiner MG, Levin B. An overdenture survey: Preliminary report. J Prosthet Dent 1977;37:246-58.  Back to cited text no. 5
    
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Thomason JM, Kelly SA, Bendkowski A, Ellis JS. Two implant retained overdentures – A review of the literature supporting the McGill and York consensus statements. J Dent 2012;40:22-34.  Back to cited text no. 6
    
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Pan YH, Yu LM, Lin TM. Dental implant-retained mandibular overdenture therapy: A clinical study of patients' response. J Dent Sci 2014;9:118-24.  Back to cited text no. 7
    
8.
Walton JN. A randomized clinical trial comparing two mandibular implant overdenture designs: 3-year prosthetic outcomes using a six-field protocol. Int J Prosthodont 2003;16:255-60.  Back to cited text no. 8
    
9.
Cune MS, van Kampen FM, van der Bilt A, Bosman F. Patient satisfaction and preference with magnet, bar-clip, and ball-socket retained mandibular implant overdentures: A cross-over clinical trial. Int J Prosthodont 2005;18:99-105.  Back to cited text no. 9
    
10.
van der Bilt A, Fontijn-Tekamp FA. Comparison of single and multiple sieve methods for the determination of masticatory performance. Arch Oral Biol 2004;49:193-8.  Back to cited text no. 10
    
11.
Escudeiro Santos C, de Freitas O, Spadaro AC, Mestriner-Junior W. Development of a colorimetric system for evaluation of the masticatory efficiency. Braz Dent J 2006;17:95-9.  Back to cited text no. 11
    
12.
Hayakawa I, Watanabe I, Hirano S, Nagao M, Seki T. A simple method for evaluating masticatory performance using a color-changeable chewing gum. Int J Prosthodont 1998;11:173-6.  Back to cited text no. 12
    
13.
Kamiyama M, Kanazawa M, Fujinami Y, Minakuchi S. Validity and reliability of a self-implementable method to evaluate masticatory performance: Use of color-changeable chewing gum and a color scale. J Prosthodont Res 2010;54:24-8.  Back to cited text no. 13
    
14.
Ishikawa Y, Watanabe I, Hayakawa I, Minakuchi S, Uchida T. Evaluations of masticatory performance of complete denture wearers using color-changeable chewing gum and other evaluating methods. J Med Dent Sci 2007;54:65-70.  Back to cited text no. 14
    
15.
Chen L, Xie Q, Feng H, Lin Y, Li J. The masticatory efficiency of mandibular implant-supported overdentures as compared with tooth-supported overdentures and complete dentures. J Oral Implantol 2002;28:238-43.  Back to cited text no. 15
    
16.
van Kampen FM, van der Bilt A, Cune MS, Bosman F. The influence of various attachment types in mandibular implant-retained overdentures on maximum bite force and EMG. J Dent Res 2002;81:170-3.  Back to cited text no. 16
    
17.
Haas R, Haimbock W, Mailath G, Watzek G. The relationship of smoking on periimplant tissue: A retrospective study. J Prosthet Dent 1996;76:592-96.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15]
 
 
    Tables

  [Table 1], [Table 2]



 

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