Masticatory function improvement with the use of mandibular single-implant overdentures in edentulous subjects: a systematic literature review.

INTRODUCTION: In this systematic review, several masticatory function parameters assessed during mandibular single-implant overdenture (SIO) use were compared to pre- SIO placement values in edentulous patients with aim of contributing to a consensus regarding denture treatment options. EVIDENCE ACQUISITION: This study was registered a priori in the PROSPERO database (CRD42018106567). Two independent reviewers carried out electronic searches in eight databases, without language or time frame limitations, to collate clinical studies comparing masticatory function of edentulous patients before versus after SIO installation with the implant placed on the mandibular midline. Risk of bias was assessed with a before-and-after tool and evidence certainty level was evaluated with the Grading of Recommendations Assessment, Development and Evaluation program. EVIDENCE SYNTHESIS: Eleven studies were included in this review (1 prospective, 3 crossover trials, 4 randomized clinical trials, 2 paired clinical trials, and 1 pilot). Enrolled patients were mostly over 60 years old; all patients were using conventional complete dentures (CD) prior to SIO installation. Masticatory performance, masticatory efficiency, bite force, and muscle activity were improved after the SIO placement compared to during mandibular CD use. Mandibular movement and masticatory ability data were inconclusive. Most of the studies had low risk of bias, but all had very low certainly level ratings due to methodological heterogeneity. CONCLUSIONS: Placement of SIO improves masticatory function, as reflected mostly by masticatory performance and efficiency data, relative to CD use. Further studies comparing dental rehabilitation options, including SIOs, are needed to improve the quality of evidence in the literature.

Tongue force, oral health-related quality of life, and sleep index after bruxism management with intraoral devices.

STATEMENT OF PROBLEM: Occlusal devices are the gold standard for managing the signs and symptoms of sleep bruxism (SB). Nevertheless, their influence on the tongue, quality of life, and sleep quality is not clear. PURPOSE: The purpose of this prospective clinical study was to evaluate the effects of an occlusal device on maximum tongue force, oral health-related quality of life (OHRQoL), and subjective sleep quality in individuals with SB. The correlation between maximum tongue force and tongue size and that between tongue size and dental arch size ratio were also assessed. MATERIAL AND METHODS: SB was diagnosed by clinical examination and by using the Bruxoff device. Fifteen bruxers received occlusal devices, and another 15 received palatal devices without occlusal coverage (control). Maximum tongue force was measured by using force sensors, while the Oral Health Impact Profile (OHIP-14) was used to evaluate OHRQoL. Subjective sleep quality data were obtained by using the Pittsburgh Sleep Quality Index (PSQI). Tongue size was measured by ultrasonography, while the dental arch size was considered as the distance between the mandibular right and left first molars. After baseline measurement, participants used the devices at night, and the variables were reevaluated after 30 and 60 days. Comparisons between groups and among time points were performed with analysis of variance in a generalized linear mixed model and Tukey-Kramer test as post hoc. Correlations were analyzed by the Pearson test. RESULTS: Maximum tongue force decreased after wearing both devices for 30 days (P<.001). OHIP-14 and PSQI scores also reduced on day 30 (both P<.001). Maximum tongue force was not correlated with tongue size nor the ratio between tongue size and dental arch size. CONCLUSION: Intraoral devices reduced maximum tongue force and improved OHRQoL and subjective sleep quality in bruxers.

Stress distribution of single-implant-retained overdenture reinforced with a framework: A finite element analysis study.

STATEMENT OF PROBLEM: Studies have demonstrated the effectiveness of a single-implant-retained mandibular overdenture for elderly patients with edentulism. However, due to the high concentration of stress around the housing portion of the single implant, this prosthesis tends to fracture at the anterior region more than the 2-implant-retained mandibular overdenture. PURPOSE: The purpose of this finite-element analysis study was to evaluate the stress distribution in a single-implant-retained mandibular overdenture reinforced with a cobalt-chromium framework, to minimize the incidence of denture base fracture. MATERIAL AND METHODS: Two 3-dimensional finite element models of mandibular overdentures supported by a single implant with a stud attachment were designed in SolidWorks 2013 software. The only difference between the models was the presence or absence of a cobalt-chromium framework at the denture base between canines. Subsequently, the models were imported into the mathematical analysis software ANSYS Workbench v15.0. A mesh was generated with an element size of 0.7 mm and submitted to convergence analysis before mechanical simulation. All materials were considered to be homogeneous, isotropic, and linearly elastic. A 100-N load was applied to the incisal edge of the central mandibular incisors at a 30-degree angle. Maximum principal stress was calculated for the overdenture, von Mises stress was calculated for the attachment and implant, and minimum principal stress was calculated for cortical and cancellous bone. RESULTS: In both models, peak stress on the overdenture was localized at the anterior intaglio surface region around the implant. However, the presence of the framework reduced the stress by almost 62% compared with the overdenture without a framework (8.7 MPa and 22.8 MPa, respectively). Both models exhibited similar stress values in the attachment, implant, and bone. CONCLUSIONS: A metal framework reinforcement for a single-implant-retained mandibular overdenture concentrates less stress through the anterior area of the prosthesis and could minimize the incidence of fracture.

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

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

Impact strength and fracture morphology of denture acrylic resins.

STATEMENT OF PROBLEM: Microwave-polymerization cycles may affect the impact strength and fracture morphology of denture base acrylic resin, and the microstructural effects of these processes have not been fully determined. PURPOSE: This study evaluated the impact strength and fracture morphology of denture base acrylic resins processed by microwave energy and hot water bath. MATERIAL AND METHODS: Twenty specimens measuring 65 x 10 x 2.5 mm were fabricated from each of 4 acrylic resins processed according to the manufacturers' recommendations: Lucitone 550 (control; 9 hours at 74 degrees C); Onda Cryl (3 minutes at 360 W + 4 minutes pause + 3 minutes at 810 W); Acron MC (3 minutes at 500 W); and Vipi Wave (20 minutes at 180 W + 5 minutes at 540 W). The impact strength was evaluated in an impact testing machine using the Charpy method with a load (impact action) of 3.95 J. Mean values of impact strength were compared by Tukey honestly significant difference test (alpha = .05). Fractures were classified as brittle or intermediate. Fractographic analysis was performed for all fragments by angle analyses of crack propagation, and the microstructural morphology characterization was accomplished with scanning electron microscopy (SEM). Data from the fractography analysis were submitted to the Kruskal-Wallis test for angles and radius (alpha = .05). RESULTS: Significant differences (P < .001) were found in the impact strength for Vipi Wave and Acron MC acrylic resins, which demonstrated the lowest values (0.19 +/- 0.04 and 0.21 +/- 0.02, respectively). Most fractures were classified as brittle (Lucitone 55%; Onda Cryl 75%; Acron MC 90%; Vipi Wave 65%). Fractographic angle analysis of brittle fractures showed no differences among acrylic resins studied; however, angle values of intermediate fractures for Onda Cryl were lower in comparison with those from Lucitone 550 and Vipi Wave (P = .03). The SEM observations revealed that brittle fractures showed defined and organized crystallographic planes, whereas the intermediate fractures had a disorganized appearance. CONCLUSION: Within the limitations of this study, it was observed that impact strength in microwave-polymerized acrylic resins varies according to the period of irradiation. Acrylic resins exhibited a high number of brittle fractures, irrespective of the processing technique.

Effect of interocclusal appliance on masticatory performance of patients with bruxism.

This study was designed to evaluate masticatory performance in bruxist patients. The experimental group was composed of 16 dentate volunteers presenting with bruxism and treated by interocclusal appliances and a control group, consisting of 16 dentate volunteers with no symptoms of bruxism. To evaluate masticatory performance, the volunteers chewed .03 grams of peanuts contained in polyvinyl wrapper for four and twelve masticatory cycles. The number of chewed particles was counted using an optical scanning method by Image-Pro Plus 1.4 software (Media Cybernetics, Inc., Silverspring, MD). The score was expressed as the mean of the number of chewed particles for each wrapper. Masticatory performance evaluations were carried out in a single period for the control group and for the experimental group, before interocclusal appliance insertion, and after seven, 15, 30, and 60 days. Comparison between groups, as well as between before and after interocclusal appliance insertion, showed no significant differences (P>.05), irrespective of the number of masticatory cycles.