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Prosthetic Outcome, Patient Complaints, and Nutritional Effects on Elderly Patients with Magnet-Retained, Implant-Supported Overdentures—A 1-Year Report
Abstract
Purpose:
To study the changes in treatment outcomes of complete dentures and magnet-retained, implant-supported overdentures in a group of elderly patients.
Materials and methods:
In this nonrandomized trial, 43 edentulous patients (14 men and 29 women) were fitted with complete dentures followed by implant-supported mandibular overdenture in a sequential model. Treatment outcomes used for analysis included objective assessment of denture quality (Woelfel's index), patient satisfaction, nutritional status, body mass index (BMI), and serum albumin level. The McNemar test was used to determine if significant differences in the Woelfel's index and nutritional status existed at different treatment phases. Repeated measures ANOVA and multiple pairwise comparison tests were used to analyze patient satisfaction. BMI status and serum albumin level at different treatment phases were analyzed with one-way ANOVA and Tukey post hoc test.
Results:
At the 1-year follow-up, significant improvements were recorded for the objective assessment of denture quality and patient complaints (P < .05). No subject was found to be malnourished at pretreatment and in subsequent treatment phases. BMI and serum albumin level were not significantly different at different treatment phases (P > .05) CONCLUSIONS: The present study demonstrated that in elderly patients with stable health and nutritional status, complete dentures made in a university clinic brought about overall improvement in denture quality and reduction in denture complaint score. Insertion of mandibular implant-supported overdentures further improved the mandibular denture quality and reduced the mandibular denture complaint score. In this group of patients, no improvement in BMI, serum albumin value, and nutritional status were documented.
... Nevertheless, OHRQoL in Table 2 Nutritional status according to full mouth rehabilitation with implant-supported prostheses or complete removable denture over time. patients rehabilitated with implant-supported prostheses (implant-supported fixed prostheses; implant-supported removable prostheses) was proved in many studies that revealed better chewing, satisfactory phonation and excellent adaptation, resulting in better OHRQoL [27,28]. Madhuri S and al revealed that denture insertion was effective in increasing OHRQoL six months after treatment [20]. ...
... At three and six months, a significant improvement in nutritional status was found in both groups. Several studies investigated the improvement of nutritional status of edentulous after treatment with implant-supportive prosthesis [28,30]. They were associated with greater masticatory efficiency that increases during the first year. ...
Background & aims
Improvement of nutritional status and perception of oral health are supposed to be different with complete conventional denture or implant-supported fixed or removable prostheses. Since no study has been conducted in Lebanon, the aim of our study was to assess the nutritional status and oral heath related quality of life (OHRQoL) in totally edentulous patients after treatment with complete denture or implant supported-prostheses.
Material and methods
This was an observational clinical prospective study. A convenient sample of Lebanese people aged 60 years or more was selected between September 2013 and July 2015 from the Departments of removable and fixed prosthesis at Saint-Joseph University of Beirut. The treatment options included complete denture, implant-supported complete denture and implant-supported fixed prostheses. Nutritional status and OHRQoL were assessed with the Mini-Nutritional Assessment Index (MNA) and the Geriatric Oral Health Assessment Index (GOHAI) respectively at Baseline (first visit before treatment), 2–3 weeks after treatment (t1), 3 months (t2) and 6 months (t3) after treatment.
Results
Fifty-one participants (mean age: 69.39 ± 7.164 years) were included. The results have shown an improvement over time in nutritional status and OHRQoL for all treatment groups. However, 2–3 weeks after treatment the number of participants at risk of malnutrition was higher with complete removable denture, intermediate with implant-supported complete denture and lower with implant-supported fixed prostheses (p-value = 0.049). Moreover, the mean GOHAI score was significantly lower over time with complete removable denture compared to implant-supported prostheses (p-value <0.05).
Conclusion
Our study has shown an enhancement in the quality of life and the nutritional status for implant supported-prostheses compared to conventional removable dentures. Therefore, it is fundamental that dentists communicate with their patients about implant treatment to understand their expectations, to explain the outcomes and achieve the desired clinical result.
... Among various attachments, magnetic attachments have advantages that they can maintain a constant initial attractive force during maintenance period, are small in size, are easy to install into prostheses and the patient has no difficulty in inserting and removing the denture. 19,20 In addition, patients are more satisfied because metal components are not exposed. Also, they can be applied to the patients who are considered to have bad prognosis when other attachments are used, because magnetic attachments prevent the abutment from traumatic injury by lateral force of upper prosthesis. ...
... Four types of magnetic attachments, Magfit IP, Magfit DX400, Magfit DX600, Magfit DX800 were used and 46, 2, 7, 5 were applied , respectively. The mean reduction ratio was 21.92 (± 26.79)% in Magfit IP, 19.10 (± 15.01)% in Magfit DX400, 19.49 (± 12.01)% in Magfit DX600 and 21.33 (± 34.00)% in Magfit DX800 in the order of Magfit IP, Magfit DX800, Magfit DX600 and Magfit DX400 according to higher value. ...
Purpose:
Although magnetic attachment is used frequently for overdenture, it is reported that attractive force can be decreased by abrasion and corrosion. The purpose of this study was to establish the clinical basis about considerations and long term prognosis of overdenture using magnetic attachments by investigating the change in attractive force of magnetic attachment applied to the patients.
Materials and methods:
Among the patients treated with overdenture using magnetic attachments in Dankook University Dental Hospital, attractive force records of 61 magnetic attachments of 20 subjects who re-visited from July 2013 to June 2014 were analyzed. Dental magnet tester (Aichi Micro Intelligent Co., Aichi, Japan) was used for measurement. The magnetic attachments used in this study were Magfit IP-B Flat, Magfit DX400, Magfit DX600 and Magfit DX800 (Aichi Steel Co., Aichi, Japan) filled with Neodymium (NdFeB), a rare-earth magnet.
Results:
Reduction ratio of attractive force had no significant correlation with conditional variables to which attachments were applied, and was higher when the maintenance period was longer (P<.05, r=.361). Reduction ratio of attractive force was significantly higher in the subject group in which attachments were used over 9 years than within 9 years (P<.05). Furthermore, 16.39% of total magnetic attachments showed detachment of keeper or assembly.
Conclusion:
Attractive force of magnetic attachment is maintained regardless of conditional variables and reduction ratio increased as the maintenance period became longer. Further study on adhesive material, attachment method and design improvement to prevent detachment of magnetic attachment is needed.
... Walls et al. [2] stated that dentition is a significant factor for efficient chewing, which is important for the maintenance of bodily nutrition as well as systemic, psychological, and physical functions. However, other studies have suggested that nutrition does not improve after the fitting of new dentures [3][4][5]. Awad et al. [3] suggested that implant overdentures do not have a more positive post-treatment effect on the nutritional state of elderly edentate individuals than new complete dentures. Similarly, Khoo el al. [4] demonstrated that the insertion of mandibular implant-supported overdentures did not cause an improvement in body mass index (BMI), serum albumin value, or nutritional status. ...
... Awad et al. [3] suggested that implant overdentures do not have a more positive post-treatment effect on the nutritional state of elderly edentate individuals than new complete dentures. Similarly, Khoo el al. [4] demonstrated that the insertion of mandibular implant-supported overdentures did not cause an improvement in body mass index (BMI), serum albumin value, or nutritional status. Muller et al. [5] found no difference in chewing efficiency between an implant overdenture group and a mandibular complete denture group, in terms of BMI, nutritional assessment, and blood markers, reflecting the fact that nutritional intake is complex and not solely determined by dental condition. ...
Objectives:
To evaluate the change in masticatory efficiency and quality of life of patients treated with mandibular Kennedy class I removable partial dentures (RPDs) and maxillary complete dentures at the Department of Dentistry of the Federal University of Rio Grande do Norte.
Materials and methods:
A total of 33 Kennedy class I patients were rehabilitated with maxillary complete dentures, and mandibular RPDs were selected for this non-randomized prospective intervention study. The patients had a mean age of 59.1 years. Masticatory efficiency was evaluated by colorimetric assay using fuchsin capsules. The measurements were conducted at baseline and 2 and 6 months after prosthesis insertion. Quality of life was evaluated using the Oral Health Impact Profile (OHIP-14) at baseline and 6 months after denture insertion. The Kolmogorov-Smirnov normality test was applied. Masticatory efficiency was evaluated by repeated measures ANOVA. Oral health-related quality of life was compared using the paired t test.
Results:
There was no statistically significant difference in masticatory efficiency after denture insertion (p = 0.101). Significant differences were found (p = 0.010) for oral health-related quality of life. A significant improvement in psychological discomfort (p < 0.01) and psychological disability (p < 0.01) was observed. Mean difference value (95 % confidence interval) was 6.8 (3.8 to 9.7) points, reflecting a low impact of oral health on quality of life, considering the 0-56 range of variation of the OHIP-14 and a Cohen's d of 1.13.
Conclusion:
According to the results of the present study, rehabilitation with Kennedy class I RPDs and complete dentures did not influence masticatory efficiency but improved oral health-related quality of life.
Clinical relevance:
The association between the patient's quality of life and the masticatory efficiency is important for treatment predictability.
... Treating CD wearers with IODs led to obvious improvements of patients' satisfaction with their oral status as seen from custom-made questionnaires (3,4,16,(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48), the general satisfaction scores (4,27,33,40,44,(48)(49)(50), the Vervoorn questionnaires (4,48,50,51), the OHIP-20 (46,(52)(53)(54), the OHIP-EDENT (13,55,56) and the McGills denture satisfaction questionnaire (57,58), the self-reported denture satisfaction scale (13,53,59) and the patient denture complaint questionnaire (60). The improvement in satisfaction did not necessarily lead to improvement in general QoL (32) or health-related QoL (46). ...
... Chewing muscle thickness increased after IOD treatment (13) and muscle activity during rest decreased (16). No (positive) changes in salivary flow (13), BMI (13, 60) blood markers (13,60,72) were seen. ...
Oral function with removable dentures is improved when dental implants are used for support. A variety of methods is used to measure change in masticatory performance, bite force, patient's satisfaction and nutritional state. A systematic review describing the outcome of the various methods to assess patients' appreciation has not been reported. The objective is to systematically review the literature on the possible methods to measure change in masticatory performance, bite force, patient's satisfaction and nutritional state of patients with removable dentures and to describe the outcome of these. Medline, Embase and The Cochrane Central Register of Controlled Trials were searched (last search July 1, 2014). The search was completed by hand to identify eligible studies. Two reviewers independently assessed the articles. Articles should be written in English. Study design should be prospective. The outcome should be any assessment of function/satisfaction before and at least 1 year after treatment. Study population should consist of fully edentulous subjects. Treatment should be placement of any kind of root-form implant(s) to support a mandibular and/or maxillary overdenture. Fifty-three of 920 found articles fulfilled the inclusion criteria. A variety of methods was used to measure oral function; mostly follow-up was 1 year. Most studies included mandibular overdentures, three studies included maxillary overdentures. Implant-supported dentures were accompanied by high patient's satisfaction with regard to denture comfort, but this high satisfaction was not always accompanied by improvement in general quality of life (QoL) and/or health-related QoL. Bite force improved, masseter thickness increased and muscle activity in rest decreased. Patients could chew better and eat more tough foods. No changes were seen in dietary intake, BMI and blood markers. Improvements reported after 1 year apparently decreased slightly with time, at least on the long run. Treating complete denture wearers with implants to support their denture improves their chewing efficiency, increases maximum bite force and clearly improves satisfaction. The effect on QoL is uncertain, and there is no effect on nutritional state.
... Clinically, many tests were applied to evaluate the masticatory abilities and degradation level of foods like peanuts, carrots, and bananas, or synthetic substances like Optosil and Optocal. Moreover, there are several methods to evaluate the efficiency of mastication, such as the evaluation of mandibular border motions while eating, chewing, swallowing, jaw muscular functions, peak biting intensity, and serum plasma concentrations of homocysteine, vitamin B12, vitamin B6, albumin, blood folate, and creative protein levels [14][15][16][17]. ...
Objectives: To evaluate the effects of different base materials of mandibular implant-supported overdenture with bar/clip attachment on masticatory efficiency.
Materials and Methods: Twenty-four edentulous patients were selected to place two interforaminal mandibular implants with custom-made cast bars to retain overdentures made from two different base materials and divided into two groups: Group I was the patients with heat-cured acrylic resin overdentures, and Group II was the patients with thermoplastic base overdentures. Masticatory efficiency was tested using three food categories (carrots, bananas, and apples) and measured by four parameters. One-way analysis of variance (ANOVA) with a post hoc Tukey test was used at the chosen probability level p<0.05.
Results: Group II was more efficient than Group I with the carrots as the difference was statistically significant for two parameters: the number of chewing strokes until the mouth was free of food with p=0.018 and the number of swallows it takes for the mouth to be empty of food p≤0.001. With apples, the significance was related to two parameters: how many chews there were before the first swallow p=0.053 and the number of swallows until the mouth was empty of food p≤0.001. With bananas, the significance is related to two parameters, the number of swallows until the mouth was free of food with p≤0.001 and the time in seconds until the mouth was free from food p=0.037.
Conclusions: The overdentures made with the thermoplastic base material and supported with bar/clip attachments were more masticatory efficient than patients whose overdentures were made of the traditional acrylic resin.
Trial Registration: This clinical study presentation has been registered and publicly figured at clinical trial.gov PRS for protocol registration and results system under ID NCT05877092 University and conducted following the CONSORT checklist.
... Magnetic attachment could significantly improve the stability and retention of single implant-retained overdentures (10) . It can maintain a constant initial attractive force during maintenance period, it is small in size, easy to install into prostheses and the patient has no difficulty in inserting and removing the denture (11) . ...
... Studies have shown that patients with a compromised oral function are not always able to fragment the real or artificial test food; their maximum bite force can be below the force needed to break the test food particles. Other methods to assess masticatory ability include the evaluation of: mandibular border movements during chewing and chewing patterns; 20 swallowing threshold; 2 jaw muscle activity and maximum bite force; 10 blood plasma levels of homocysteine, vitamin B12, vitamin B6, albumin, serum folate, and Creactive protein concentrations; questionnaires to rate the difficulty associated with chewing foods of various textures; 1 body mass index; 13,21 and two-colored gum mixing ability tests. 11,13 Of all these tests, the two-colored wax mixing ability test is much better at discriminating between people with compromised masticatory ability. ...
Background
The effect of maxillary implant overdentures on masticatory ability in edentulous patients with complaints regarding their conventional maxillary dentures is unknown.
Purpose
To assess the change in objective masticatory ability (mixing ability index, MAI), patient reported masticatory ability (questionnaire), and patient satisfaction (GSS) after maxillary implant overdenture treatment with either solitary attachments or bars.
Materials and Methods
Two groups randomly received four‐implant maxillary overdentures on either solitary attachments (group I, n = 25) or bars (group II, n = 25). The MAI, questionnaire, and GSS were scored before (T0) and 12 months (T12) after treatment.
Results
After treatment, both groups had significantly better MAI outcomes, better questionnaire scores and better GSS. Post‐treatment questionnaire scores and GSS were significantly better for group II. Before treatment a strong, positive correlation between the MAI and the questionnaire was found for all participants who had had full conventional dentures combined (group I, n = 17; group II, n = 3).
Conclusion
Mixing ability was the same for all the participants treated with maxillary implant overdentures on either solitary attachments or bars. Patient reported masticatory ability and satisfaction was better for participants treated with maxillary implant overdentures on bars. There was a correlation between MAI and patient reported masticatory ability in participants with full conventional dentures.
... 7,[11][12][13][14] However, MP of 2-IODs retained by magnet attachments was less than that associated with other attachments. 6 In previous studies, 15 -17 corrosion has been identified as a disadvantage of magnet attachments. However, recent magnet attachment designs include encapsulation in stainless steel, titanium, or palladium by using a laser-welded coating, which results in durable containment that protects the magnets from corrosion. ...
Background
Two‐implant overdentures (2‐IODs) is an expected treatment option to improve the masticatory performance (MP) of edentulous individuals.
Purpose
The purpose of the current study was to compare MPs between immediately loaded and conventionally loaded mandibular 2‐IODs retained by magnet attachments.
Materials and Methods
Nineteen participants with edentulous mandibles were randomly assigned to an immediately loaded group or a conventionally loaded group. Each participant received two implants. The immediate group was loaded on the same day as implant insertion, whereas the conventional group was loaded 3 months after implant insertion. Both MP, measured by a color‐changeable chewing gum and a gummy jelly, and maximum occlusal force were assessed at baseline and at 1, 3, 6, 12, 24, and 36 months after implant insertion.
Results
A significantly higher MP, measured by gummy jelly, was observed at the 6‐month time‐point in the immediate group (P = .034). No significant differences in MP, measured by chewing gum, or maximum occlusal force were observed between the two groups at any time‐point.
Conclusions
Within the limitations of the present study, immediate loading of 2‐IODs could improve MP at an earlier time‐point than conventional loading of 2‐IODs.
... SD = 5.78) finally attended for final clinical examination and detailed data collection for analyses. No patient was deemed malnourished in this cohort of patients either at baseline or at 1-year followup visit (Khoo et al. 2013). The BMI of the patients at loading of the implants and at the latest follow-up visit also showed no significant changes. ...
... The four non-RCTs [25, 26•, 29, 30] also reported mixed results on the effect of dental prosthesis treatments on nutrition among older adults. Three studies [25, 26•, 30] found significant improvement in dietary quality or quantity of the intervention group, whereas, one study [29] found no favorable impact of dental prosthesis treatments on nutrition. Notably, one study by Bartlett et al. [26•] evaluated interventions that combined dental treatment with dietary counseling, which was found to have significantly positive impact on the nutritional status of older adults. ...
Purpose of Review
The purpose of the review is to find recent evidence for a bidirectional relationship between oral diseases and malnutrition.
Recent Findings
Electronic search of MEDLINE using PubMed and a manual search of key journals for literature published in English between January 2013 and June 2016, was conducted and resulted in the selection of 25 papers. These selected studies comprised 19 observational studies, which included 17 cross-sectional and 2 longitudinal designs, and 6 interventional studies. A majority of the studies demonstrated a significant association between the following conditions in older adults: older adults with oral diseases are at risk for malnutrition and malnourished older adults are at risk for oral diseases. Treatment with dental prosthesis may have positive effects on the nutritional status of older adults.
Summary
The current review revealed that research findings support a potential bidirectional relationship between oral diseases and malnutrition; however, there is insufficient evidence to draw definitive conclusions. Additional high-quality studies are necessary to accumulate more evidence.
... This innovative technique proved a boon to the patients who cannot afford expensive treatment like implants and other precision attachments. Also, magnet retained implant supported over dentures are gaining popularity 12 . ...
... SD = 5.78) finally attended for final clinical examination and detailed data collection for analyses. No patient was deemed malnourished in this cohort of patients either at baseline or at 1-year followup visit (Khoo et al. 2013). The BMI of the patients at loading of the implants and at the latest follow-up visit also showed no significant changes. ...
Objective:
The purpose of this prospective clinical study was to determine whether reduced bone mineral density (BMD) is correlated with a higher risk for dental implant therapy in an elderly patient population.
Material and methods:
Seventy-nine patients recruited at the Prince Philip Dental Hospital were provided with 2-implant-supported mandibular overdentures. Skeletal BMD was recorded before the implant therapy. The World Health Organization Osteoporosis Diagnosis Classification (femoral neck score) was utilized to define the osteoporosis status of patients. Periapical radiographs were taken with a special radiographic holder at the time of implant loading (baseline) and at follow-up examinations. The mesial and distal marginal bone levels of each implant were measured. The mean marginal bone loss (mMBL) and greatest marginal bone loss (GBL) of four implant sites at patient level were recorded for data analysis. Clinical examination including plaque score (PI) and bleeding on probing (BOP) was recorded.
Results:
Of the 79 patients recruited in the study, the survival rate of implant was 98.7%. Sixty-three patients (79.7%) were finally available for data collection and statistical analyses. The mean follow-up time was 62.9 (SD = 15.2) months with the mean MBL 0.65 mm (SD = 0.67) and mean GBL 1.25 mm (SD = 0.83), respectively. The average BOP and PI of patients were 49.6% (SD = 30.8) and 47.4% (SD = 37.4). Only BOP was found significantly correlated with mMBL (r = 0.321, P = 0.01). Skeletal BMD was not associated with marginal bone loss (mean MBL: r = -0.094, P = 0.466; mean GBL: r = 0.04, P = 0.761).
Conclusions:
Within the limits of this study, osteoporosis was not a contraindication for implant therapy, and reduced skeletal BMD was not associated with increased marginal bone loss around implants or other complications in an elderly population.
Objectives
To evaluate implant survival and success rates in elderly patients, comparing younger old adults (65–75 years) to older implant patients (> 75 years).
Methods
A systematic search was conducted using Medline, Cochrane Library, and PubMed Central for clinical studies on implant therapy in patients aged 65 and older. Outcomes included implant survival and success rates, peri‐implant parameters, bone‐level changes (BLC), and type of restoration and retention. Three‐ and five‐year survival and success rates, as well as implant loss per 100 implant‐years, were estimated with 95% confidence intervals (CI). Poisson regression models and incidence rate ratios (IRR) were used to compare study groups, and meta‐regression with restricted maximum likelihood estimation (REML) assessed BLC.
Results
Twenty‐seven studies with a total of 3892 implants were included. Patients > 75 years had significantly higher five‐year survival rates (96.8%, CI: 95.9–97.5) compared to the 65–75 age group (92.1%, CI: 83.0–96.4; p = 0.031), with lower implant loss rates per 100 implant‐years. No significant difference in success rates was observed ( p = 0.229). Although plaque and bleeding on probing (BOP) were more frequent in the older group, there was no significant difference in BLC (mean difference: 0.41 mm; p = 0.189). In patients > 65 with implant overdentures, single attachments showed significantly higher implant loss rates than bars ( p = 0.035).
Conclusions
Dental implants are a reliable treatment for older adults, including those over 75 years. Despite more frequent plaque and BOP in the older group, peri‐implant bone remained stable. Splinting implants in overdenture wearers aged > 65 is associated with 5.6 times higher survival rates.
Objectives To systematically review the patients’ satisfaction of implant supported mandibular dentures and conventional dentures. Methods PubMed, EMbase, The Cochrane Library, CNKI, WanFang and VIP databases were searched to collect randomized controlled trials (RCTs) on patients’ satisfaction of implant supported mandibular dentures (IODs) and conventional dentures (CDs) from inception to November 31st, 2016. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of the included studies. Then, meta-analysis was conducted using RevMan 5.3 software. Results Seven randomized-controlled trials were identified. The results of meta-analysis showed that compared with CDs group, IODs group had a relatively higher level of patients’ satisfaction (SMD=1.11, 95%CI 0.79 to 1.43, P<0.001) and oral health quality of life (MD=–12.41, 95%CI –18.96 to –5.86, P<0.001). Conclusions The current evidence suggests that IODs may be a better choice for mandibular edentulous patients than CDs. Due to the limitations of the quality and quantity of the included studies, the above conclusions still require larger sample and high quality research to verify. © 2018, West China University of Medical Science. All rights reserved.
Purpose: To compare the oral health-related quality of life (OHRQoL) in a prospective, randomized crossover trial in patients with mandibular overdentures retained with two or four locators. Materials and Methods: In 30 patients with edentulous mandibles, four implants (ICX-plus implants [Medentis Medical]) were placed in the intraforaminal area. Eight weeks after transgingival healing, patients were randomly assigned to have two or four implants incorporated in the prosthesis. After 3 months, the retention concepts were switched. The patients with a two-implant-supported overdenture had four implants incorporated, whereas patients with a four-implant-supported overdenture had two retention locators taken out. After 3 more months, all four implants were retained in the implant-supported overdenture in every patient. To measure OHRQoL of the patients, the Oral Health Impact Profile 14, German version (OHIP-14 G), was used. Results: A considerable increase in OHRQoL could be seen in all patients after the prosthesis was placed on the implants. Also, a statistically significant difference of OHRQoL could be seen in the OHIP-14 G scores between two-implant and four-implant overdentures. Patients had a higher OHRQoL after incorporation of four implants in the overdenture compared with only two implants. Conclusion: Patients with implant-retained overdentures had better OHRQoL compared with those with conventional dentures. The number of incorporated implants in the locator-retained overdenture also influenced the increase in OHRQoL, with four implants having a statistically significant advantage over two implants.
As masticatory efficiency diminishes drastically in edentulous patients, several researchers have studied over the past two decades how dietary intake varies when different types of oral rehabilitation are provided. Since the use of implants to support prostheses in edentulous mandibles has been shown to significantly improve masticatory performance, the question remains as to whether this improvement will influence the nutritional status. The purose of this study was to evaluate the nutritional status of edentulous patients who randomly received either a mandibular conventional denture (CD) or an implant-supported overdenture (IP) 1 year previously. Weight, height, body composition and handgrip strength measurements were collected for analysis. Blood tests were performed to measure plasma parameters of diet intake. Participants responded to a Food Frequency Questionnaire and a Masticatory Function Questionnaire. Fifty-three people participated (58% men, 42% women; mean age = 53). Body composition indicators as well as plasma parameters were generally within normal range, and no statistically significant difference (p>0.05) was found between the groups. Patients in the CD group had significantly lower ratings for items regarding difficulty in chewing (p<0.05), but no significant difference was found for dietary intake (p>0.05). Although the CD wearers reported having more difficulty in chewing hard foods, both groups appeared to have a similar nutritional status.
Purpose:
This study examined patient satisfaction and oral health-related impacts on the quality of life of patients restored with complete conventional or duplicate dentures.
Materials and methods:
Forty patients (aged 55 to 85 years) were assigned to receive new complete maxillary and mandibular dentures using either a conventional or duplication technique according to clinical need. Patients rated their satisfaction with their dentures on 100-mm visual analogue scales before treatment and 1 month after delivery of their new dentures. Their oral health-related quality of life was determined by completion of an Oral Health-Related Impacts on Quality of Life questionnaire (OHIP-20) at the same time points.
Results:
Both groups of patients had similar satisfaction and OHIP ratings at the beginning of the study and 1 month after delivery of their new dentures. The two groups were comparable with regard to age and gender. Statistically significant improvement in the OHIP domains of functional limitation and physical and psychological disability was seen in both groups. The conventional group also showed significant improvement with regard to handicap, whereas the duplicate denture group showed significant improvement in the patients' rating of pain and psychological discomfort. Patient satisfaction improved significantly in both groups across all variables except ease of cleaning and ability to speak. The duplication technique resulted in patients being less satisfied with the esthetics of their new dentures.
Conclusion:
In this study, the provision of new dentures either with a conventional technique or with a duplication technique resulted in an overall improvement in oral health-related quality of life and satisfaction. These improvements were statistically significant for some domains, which varied depending on the technique used for construction of the new dentures. Neither technique was seen to be superior, which may be a reflection of the patients' treatment expectations at the outset. Patients' reported satisfaction with their dentures and the impact that dentures have on their quality of life may not be useful measures for determining the most appropriate technique for providing new dentures.
The aim of this study was to present all the relevant studies that have evaluated, with valid scientific methodology, the possible physical and nutrient intake improvement of edentulous subjects rehabilitated with removable and supported or retained implant denture, without restriction of suprastructure modalities, compared with those wearing conventional removable dentures.
Several electronic databases (Pubmed, Medline-Medline In-Process, Cochrane Library Database, Embase, and Lilacs) were searched, without language limitation. References from the selected articles were also hand searched. Abstracts which appeared to fulfill the initial selection criteria (comparison of nutritional state between conventional removable and supported or retained implant denture wearers) were selected by consensus and their original articles were then retrieved. Clinical trials that included anthropometric measurements or nutrient intake in removable and supported or retained implant denture wearers without syndrome and systemic influences, nor presenting surgical or other simultaneous treatment, which could affect the integrity during the evaluation period were finally selected.
Only 5 articles met the selection criteria. Two studies (randomized clinical trials and prospective) found inadequate nutrient intake after treatment. One randomized clinical trial presented an improvement in nutritional state after treatment. One cross-sectional study showed an adequate nutritional state before and after treatment. These 4 studies found no significant difference between implant and conventional treatments. Finally, 1 cross-sectional study presented a difference between treatments, showing that the risk of malnutrition was higher for removable complete denture wearers.
Considering the available evidence, the effect on the nutritional state in edentulous subjects treated with implant therapy is similar to the 1 obtained with conventional removable dentures. This effect does not necessarily mean an optimum nutritional state, which also depends on other factors not related to prosthodontic treatment.
The aim of this study was to examine systematically the data published on the efficacy of mandibular implant-retained overdentures from the patient's perspective.
Medline, Embase, The Cochrane Central Register of Controlled Trials and The Cochrane Systematic Reviews Database were searched and complemented by hand searching. All randomized-controlled trials published in English or French up to April 2007 were included, in which conventional dentures and mandibular implant overdentures in adult edentulous individuals were compared. The outcomes of interest were patient satisfaction, oral and general health-related quality of life. Random effects models were used to pool the effect sizes (ES) of all included studies.
Ten publications of seven randomized-controlled trials were identified and eight were included in the meta-analysis. When compared with mandibular conventional dentures, implant overdentures were rated to be more satisfactory at a clinically relevant level [pooled ES 0.80, z=3.56, 95% confidence intervals (CI) 0.36-1.24, P=0.0004], but a statistical heterogeneity was found (chi(2)=31.63, df=5, P<0.00001, I(2)=84%). The pooled ES for oral health quality of life was -0.41 (z=1.31, 95% CI, -1.02 to 0.20; P=0.19, chi(2)=11.53, df=2, P<0.003, I(2)=83%). There was a lack of evidence to show the impact of mandibular implant overdenture on perceived general health.
Our findings suggest that, although mandibular implant-retained overdentures may be more satisfying for edentulous patients than new conventional dentures, the magnitude of the effect is still uncertain. There is a need for additional evidence including cost-effectiveness analyses on the impact of mandibular implant overdentures and conventional dentures.
Nowadays, there is some speculation among dental educators that the need for complete dentures will significantly decrease in the future and that training in their provision should be removed from the dental curriculum.
To sensitise the reader to the functional shortcomings of complete denture therapy in the edentulous patient and present restorative options including implants to improve edentulous quality of life in these patients.
Information retrieval followed a systematic approach using PubMed. English articles published from 1964 to 2008, in which the masticatory performance of patients with implant-supported dentures was assessed by objective methods and compared with performance with conventional dentures, were included.
National epidemiological survey data suggested that the adult population in need of one or two complete dentures will increase from 35.4 million adults in 2000 to 37.9 million adults in 2020. Clinical studies have showed that the ratings of general satisfaction were significantly better in the patients treated with implant overdentures post-delivery compared with the complete denture users. In addition, the implant group gave significantly higher ratings on comfort, stability and ability to chew. Furthermore, patients who received mandibular implant overdentures had significantly fewer oral health-related quality of life problems than did the conventional group.
Implant-supported dentures including either complete overdentures or a hybrid prosthesis significantly improve the quality of life for edentulous patients compared with conventional removable complete dentures. Therefore, the contemporary dental practitioner should consider other options as well as conventional removable complete dentures to restore edentulous patients.
A total of 249 complete denture wearers were examined from a geriatric population of 610 patients in seven institutions in four different countries. The evaluation of denture quality was made by the patients' opinions and the examiners rankings with a questionnaire on interocclusal distance, occlusal function, extension, stability, comfort, and esthetics of the dentures. At each of the surveyed institutions, the patients consistently considered their dentures better than did the examiners and the maxillary dentures were rated better that the mandibular dentures by the clinicians and by the patients.
Compromised masticatory efficiency places edentulous persons at risk of consuming a diet low in non-starch polysaccharide (NSP) ('dietary fibre'). No study has quantified NSP intake in edentulous people using a valid and reliable method of dietary assessment. The aim of this study was to provide quantitative data on NSP intake of edentulous persons, together with information on its dietary sources. Using the dietary history method, habitual intake of NSP was compared between edentulous persons (n = 30) and dentate persons (n = 30) between the ages of 40 and 60. Groups were matched for sex and social class. The edentulous group had a median NSP intake of 73 (31-211) g/week. This was significantly lower than that of the dentate group of 106 (25-225) g/week (P = 0.014). Neither group completely met current UK guidelines. NSP intake of 56% (n = 17) of the edentulous group was below 84 g/week, whilst 17% (n = 5) of the dentate group was below this figure--a level of intake below which increased occurrence of gastrointestinal complaints has been observed. The dentate group obtained significantly more NSP from all rich sources, including wholemeal breads, cereals, vegetables and fruit. Depending on their form and preparation, such foods are not necessarily difficult to chew. Specific advice on food selection is required to ensure the edentulous patient has an adequate intake of NSP. Education of the dentist for this purpose is of paramount importance.
The duplication technique is a well recognised method of replacing complete dentures. Advantages claimed for this technique are that patients adapt more easily to their new complete dentures and the numbers of treatment visits are reduced. The case notes of 100 patients were examined retrospectively, 50 of whom had had dentures constructed by undergraduates using a duplication technique and 50 with a conventional technique. In addition, a questionnaire was sent to the patients to obtain their views on the replacement dentures. The 'duplication group' required fewer visits for the delivery of the dentures, but there was no statistical difference between the numbers of post-insertion visits, for the two groups, needed to make the dentures comfortable. The only identifiable reason for selecting a duplication technique was the failure of construction of new dentures by a conventional method in 15 patients. Apart from this the two groups appeared remarkably similar when comparing age of dentures being replaced, period of edentulousness, number of previous complete dentures and medical histories. As judged by the questionnaire more patients in the duplication group continued to wear their new dentures compared to the conventional group.
The nutrient content of the diet of edentulous patients who have various oral prostheses is of concern. This study compared baseline food records to those records kept semiannually for 3 years after treatment to ascertain whether nutrient intake of edentulous patients changed after they received new implant-supported mandibular dentures (n = 41) or new conventional dentures (n = 30). No significant differences in intake of calories or of 27 nutrients were noted between the two groups (p > 0.01). A decline in the percent of calories from fat with a corresponding increase in carbohydrate calories within both groups (p < 0.01) reflected a national trend; a slight decrease in calories was similarly observed (p < 0.02). More than 40% of patients in both groups were found to have inadequate intakes of dietary fiber, calcium, or both, and 25% to 50% had low intakes of vitamins A, E, D, B6 and/or magnesium. Intakes were similar to those reported for two age-matched populations.
To evaluate, in an elderly population, whether poor oral status might be a contributing factor to the development of undernutrition and might be associated with less eating pleasure, more subjective eating difficulty and increased mashed food consumption.
An oral examination and an evaluation of masticatory capacity were performed on 120 institutionalized elderly subjects. The nutritional assessment included serum albumin concentration, the Mini Nutritional Assessment and a questionnaire on eating habits.
Edentulous subjects without dentures or with only one complete denture had significantly lower MNA scores than edentulous subjects with two complete dentures (p < 0.05). Edentulous subjects with two complete dentures more frequently reported taking pleasure from eating (p = 0.05), and had less frequent difficulties with hard foods (p = 0.01) than edentulous subjects without dentures or with only one complete denture. Mashed food consumption (p < 0.01) was also reported more frequently in edentulous subjects without dentures or with only one complete denture. Subjects with two complete dentures had similar or better MNA scores as dentate subjects with relatively few remaining teeth (10.4 +/- 7.8 teeth). About half of the subjects (53%) could not perform the masticatory test. These subjects had lower MNA scores (p = 0.001) and a larger proportion ate mashed food (p < 0.001) compared to those who were able to perform the test.
Poor oral status (edentulous without dentures or with only one complete denture) increased difficulty in eating hard foods, increased mashed food consumption and decreased eating pleasure. It seemed also to put institutionalized subjects at higher risk of undernutrition.
To assess how the dental status of older people affected their stated ability to eat common foods, their nutrient intake and some nutrition-related blood analytes.
Cross-sectional survey part of nation-wide British National Diet and Nutrition Survey: people aged 65 years and older. Data from a questionnaire were linked to clinical data and data from four-day weighed dietary records. Two separate representative samples: a free-living and an institutional sample. Seven-hundred-and-fifty-three free-living and 196 institution subjects had a dental exam and interview.
About one in five dentate (with natural teeth) free-living people had difficulty eating raw carrots, apples, well-done steak or nuts. Foods such as nuts, apples and raw carrots could not be eaten easily by over half edentate (without natural teeth but with dentures) people in institutions. In free-living, intakes of most nutrients and fruit and vegetables were significantly lower in edentate than dentate. Perceived chewing ability increased with increasing number of teeth. Daily intake of non-starch polysaccharides, protein, calcium, non-haem iron, niacin, vitamin C and intrinsic and milk sugars were significantly lower in edentate. Plasma ascorbate and retinol were significantly lower in the edentate than dentate. Plasma ascorbate was significantly related to the number of teeth and posterior contacting pairs of teeth.
The presence, number and distribution of natural teeth are related to the ability to eat certain foods, affecting nutrient intakes and two biochemical measures of nutritional status.
To investigate the clinical and psychological outcomes with ball attachment supported mandibular overdentures on Branemark implants placed in a single stage surgical approach. MATERIAL AND METHODS Sixteen edentulous patients aged 32-74, with atrophic (flat) mandibular residual alveolar ridges, and a history of having difficulty coping with technically adequate mandibular dentures made within the last 2 years were recruited. Mark II Branemark implants were placed using a single stage surgical technique with healing abutments placed at time of surgery. Mandibular complete dentures were modified by relieving the areas over the abutments and a resilient liner was placed. After a period of 3 months, healing abutments were replaced with ball abutments and new complete dentures were made and the patients followed for a period of 2 years. Patients completed the General Health Questionnaire (GHQ) and answered further questions relating to the functional and psychological impact of complete denture wearing before treatment and 3 months after the dentures were provided. Patients additionally completed the GHQ 2 years after overdenture insertion.
Six patients suffered from loss of one of their two implants in the first 2 years after placement. Three of the implants had failed to osseointegrate, which was detected at initial loading 3 months after placement. General Health Questionnaire scores were statistically significantly reduced after treatment and the improvement was maintained over 2 years. Responses to the functional and psychological questions were similarly improved.
Single stage surgery led to a higher rate of implant failure than expected. Patients showed significant psychological health benefits from the treatment provided.