Do implant-supported prostheses affect bioavailability of nutrients of complete and partially edentulous patients? A systematic review with meta-analysis.

BACKGROUND & AIMS: Debate still exists about the impact of dental implant-supported prostheses on nutritional status of partially and complete edentulous patients. This review aims to answer the focused question: "Do complete and partial edentulous patients, using implant-supported prostheses, present better nutritional and masticatory functions when compared to those using conventional rehabilitations?". A possible cause-effect relationship between masticatory improvements and nutritional gain was also evaluated. METHODS: Literature search included 6 databases (PubMed/Medline, Embase, LILACS, Scopus, Web of Science, and The Cochrane Library - CENTRAL), grey literature (Google Scholar, Proquest Dissertations and Thesis and Open Grey databases) and manual search (last update June 2020), without language, publication time and follow-up restrictions. We included only studies evaluating both masticatory and nutritional outcomes. The PICO question comprised complete and partial edentulous patients (Population), submitted to implant-supported prostheses (Intervention), in comparison to conventional dental prosthetic rehabilitation, evaluating masticatory function and nutrition parameters (outcomes). Risk of bias was assessed by using Cochrane Collaboration's tool (randomized clinical trials), Joanna Briggs Institute critical appraisal checklist (paired clinical trials), and Meta-Analysis of Statistics Assessment and Review Instrument" (JBI - MAStARI) critical appraisal tools (cohort studies). All meta-analyses were conducted at 5% level of significance. This report followed the PRISMA guidelines. (Review registration PROSPERO - CRD42019135744). RESULTS: We identified 1199 articles while searching databases. Fourteen articles met eligibility criteria, including 817 prostheses installed in 660 patients (mean age = 66.8 years-old). Patients wearing implant overdentures (IOD) presented better masticatory function in comparison to conventional complete denture (CD) wearers (p < 0.05). However, bioavailability of several nutrients remained within the same range, except for serum folate that was lower in IOD patients after 6 (mean difference 3.51 nmol/L; p = 0.01) and 12 months of rehabilitation (mean difference 3.69 nmol/L; p = 0.003). When comparing the effects of CD and IOD rehabilitations along time (for the same patient), serum albumin and vitamin B12 levels also decreased for both groups after 12 months-follow-up, but still within the reference range. The additional retention of the implants did not interfere in body weight, but reduced the risk of malnutrition (using the Mini Nutritional Assessment). Implant-supported partial prostheses also improved mastication in comparison to the conventional ones, increasing short-term daily intake of carbohydrates, protein, calcium, fiber, and iron, whereas decreasing the consumption of cholesterol. However, no long-term changes on bioavailability of most nutrients were observed, expect for a slight increase in ferritin and cholinesterase, and a small reduction in folate and Vitamin A. CONCLUSION: Current evidence indicates significant masticatory improvements for dental fixed implant-supported prostheses in comparison to conventional removable prostheses. However, bioavailability remained stable for most of the nutrients, especially for complete edentulous patients. These results indicate the importance of a multidisciplinary approach during oral rehabilitation (nutrient specialist), in order to enhance food choices and promote health benefits to the patients.

Consensus on the terminologies and methodologies for masticatory assessment.

A large number of methodological procedures and experimental conditions are reported to describe the masticatory process. However, similar terms are sometimes employed to describe different methodologies. Standardisation of terms is essential to allow comparisons among different studies. This article was aimed to provide a consensus concerning the terms, definitions and technical methods generally reported when evaluating masticatory function objectively and subjectively. The consensus is based on the results from discussions and consultations among world-leading researchers in the related research areas. Advantages, limitations and relevance of each method are also discussed. The present consensus provides a revised framework of standardised terms to improve the consistent use of masticatory terminology and facilitate further investigations on masticatory function analysis. In addition, this article also outlines various methods used to evaluate the masticatory process and their advantages and disadvantages in order to help researchers to design their experiments.

Smartphone use while eating increases caloric ingestion.

The use of smartphones during meals may possibly influence the number of ingested calories. We evaluated the influence of smartphones' distraction during eating on caloric intake. Physical (masticatory parameters, sex and body mass index - BMI); environmental (with or without distraction) and psychological (stress levels) variables were evaluated as confounding factors. Sixty-two adults were recruited for experimental snack tests performed on four different days. At baseline, we evaluated masticatory performance, swallowing threshold, masticatory frequency and body mass index (BMI). In the following three sessions, volunteers were presented a snack test in which participants ate under three experimental conditions: no distraction, using their smartphones, or reading a printed text. At the end of each session, total and nutritional compound stratified caloric intake was measured. Three-way mixed model ANOVA was used to test the effect of experimental condition on the total, carbohydrate and lipid caloric intakes. Hierarchical multiple linear regression models were used to estimate the influence of confounding factors on the total caloric intake. We found an effect of the condition (no distraction, smartphone or reading) on the total caloric (p = .007) and lipid intake (p = .002). When eating without distraction, the mean caloric intake was 535 (±164) kcal, in comparison to 591 (±203) kcal using smartphone (p = .05) and 622 (±226) kcal (p = .002) reading a text (no significant difference between distracters). Eating with distracters increased approximately 15% caloric ingestion. An interaction condition*sex effect was observed on lipid intake (p = .020). Energy intake was found to be dependent on sex and age, in which older men ingested more calories. Smartphone use during a meal increased caloric and lipid intake, depending on sex and age in young adults with complete dentition.

The association between a mixing ability test and patient reported chewing ability in patients treated for oral malignancies.

INTRODUCTION: Mastication has been assessed in several ways in the past. Both patients reported and objective assessment methods have been developed. The University Medical Center (UMC) Utrecht has developed a mixing ability test (MAT) using a two-coloured wax tablet. The present study investigates the association between the mixing ability test and a chewing related questionnaire in patients treated for oral malignancies. PATIENTS AND METHODS: In a cohort study, patients treated for oral malignancies were assessed 4-6 weeks before and 4-6 weeks after treatment, as well as 6 months, 1 year and 5 years after treatment. The mixing ability test was assessed using 10 and 20 chewing strokes and was compared to seven questions about several aspects of mastication. Regression analysis was performed and density plots were drawn for statistical analysis. RESULTS: One hundred and twenty-three patients were included in this study. The questionnaire was less predictive for the 10-chewing stroke test and the test was less discriminatory for different food types than the 20-chewing stroke mixing ability test. Three questions about the ability to chew solid, soft and thickened liquid food types were found to be significantly predictive for the 20-chewing stroke test. Threshold values on the mixing ability index were around 20 for the ability to chew solid food types and 24 for soft food types. CONCLUSION: The 10-chewing stroke mixing ability test is less suitable than 20-chewing strokes for patients with and treated for oral cancer. The 20-chewing stroke mixing ability test has a fair association with self-reported outcomes.

Masticatory function and related factors after oral oncological treatment: A 5-year prospective study.

BACKGROUND: Chewing ability is often compromised in patients with oral cancer. The aim of this study was to identify which factors affect masticatory performance in these patients. METHODS: Patients with primary oral cancer were assessed for up to 5 years after primary treatment. Healthy controls were assessed once. A mixed-model analysis was performed, with masticatory performance as outcome measure. RESULTS: A total of 123 patients were included in the study. Factors positively associated with masticatory performance were number of occlusal units (OU), having functional dentures, and maximum mouth opening (MMO). The impact of tumor location and maximum bite force (MBF) differed per assessment moment. Masticatory performance declined for up to 1 year but recovered at 5 years after treatment. CONCLUSION: Masticatory performance in patients treated for oral cancer is affected by MBF, MMO, number of OU, and dental status. These should be the focus of posttreatment therapy.

The relationship between masticatory and swallowing behaviors and body weight.

The present study aimed to compare the main objective parameters of mastication among individuals with different body mass indexes. One hundred and sixty participants matched for gender and age were divided in the following groups according to their body mass index (BMI): Obese group (30 ≤ BMI < 35), Overweight group (25 ≤ BMI < 30), normal range group (18.5 ≤ BMI < 25) and underweight group (17 ≤ BMI < 18.5). Each group was composed by forty subjects. The maximum bite force, the masticatory performance, chewing rate and three variables related to swallowing (number of chewing cycles, chewing time, and median particle size) were assessed in all groups. The oral conditions, including the number of teeth, number of occlusal units and salivary flow (unstimulated and stimulated) were also evaluated. Regardless of the BMI, males had a larger bite force and better masticatory and swallowing performances than females. They also chewed faster than females. Individuals of the obese group had the largest median particles sizes (both after 20 chewing cycles and at the moment of swallowing), which indicates a less good masticatory performance. The median particle sizes were negatively correlated with the number of teeth and number of occlusal units in the obese group. We did not observe large differences in masticatory performance and swallowing variables among the four weight groups, although there was a tendency that individuals of the obese group swallowed larger particles. The results of this study do not support the existence of an "obese chewing style".

Health-related quality of life after segmental resection of the lateral mandible: Free fibula flap versus plate reconstruction.

OBJECTIVES: Segmental resection of the mandible causes functional, aesthetic and social problems affecting health-related quality of life (HRQoL). It is often assumed that reconstruction with composite free flaps guarantees better function and aesthetics than bridging the defect with reconstruction plates. METHODS: Using the European Organization for Research and Treatment of Cancer questionnaires (EORTC QLQ-C30 version 3.0 and EORTC QLQ-H&N35), we compared HRQoL in patients who received free fibula flaps versus reconstruction plates after segmental resection of the lateral mandible. RESULTS: Thirty-seven completed questionnaires (18 fibula reconstructions and 19 patients with reconstruction plates) were available. Reconstruction with a free fibula flap did not provide clear additional benefit to bridging the defect with a reconstruction plate after segmental resection of the lateral mandible. In particular aspects known to have the most impact on HRQoL like swallowing, speech and chewing were not influenced by the type of reconstruction. CONCLUSIONS: Reconstruction of segmental defects of the lateral mandible with free fibula flap and reconstruction plate resulted in comparable HRQoL. If dental rehabilitation by means of dental implants is not anticipated in the fibula, then plate reconstruction with adequate soft tissue remains a suitable technique for the reconstruction of segmental defects of the lateral mandible.

Fighting Against Disuse of the Masticatory System in Duchenne Muscular Dystrophy: A Pilot Study Using Chewing Gum.

Duchenne muscular dystrophy patients report masticatory problems. The aim was to determine the efficacy of mastication training in Duchenne muscular dystrophy using chewing gum for 4 weeks. In all, 17 patients and 17 healthy age-matched males participated. The masticatory performance was assessed using a mixing ability test and measuring anterior bite force before, shortly after and 1 month after the training. In the patient group the masticatory performance improved and remained after 1-month follow-up, no significant changes in anterior maximum bite force was observed after mastication training. In the healthy subject the bite force increased and remained at the 1-month follow-up; no significant differences in masticatory performance were observed. Mastication training by using sugar-free chewing gum in Duchenne muscular dystrophy patients improved their masticatory performance. Since bite force did not improve, the working mechanism of the improvement in chewing may relate to changes of the neuromuscular function and coordination, resulting in improvement of skills in performing mastication.

Effects of integrated dental care on oral treatment needs in residents of nursing homes older than 70 years.

AIM: To determine effects of integrated dental care in older nursing home residents. METHODS: In three nursing homes offering integrated dental care, we studied the oral treatment need of 355 residents older than 70 years. To determine effects of integrated care, we discriminated between short-stay residents (≤6 months) and long-term residents (>6 months). RESULTS: Treatment need, determined intraorally by two dentists, remains high among short-stay residents (78%) and long-term residents (67%). The association between treatment need and length of stay was not significantly affected by indication for stay (somatic vs. psychogeriatric). All dentate residents needed oral treatment, except one long-term resident. However, among edentulous residents, particularly with a psychogeriatric indication for stay, treatment need appeared to reduce significantly in time, from 74% to 57%. CONCLUSION: Despite integrated dental care, oral treatment need remains in virtually all dentate residents and more than half of edentulous residents.

Micro-structured calcium phosphate ceramic for donor site repair after harvesting chin bone for grafting alveolar clefts in children.

OBJECTIVES: The purpose of this study was to evaluate the use of synthetic bone graft material as a filling material at the mandibular symphysis donor site of autologous bone in children. MATERIALS AND METHODS: A blinded patient group comprised 20 patients with unilateral (UCLP) or bilateral (BCLP) cleft of lip and palate, all with an indication for alveolar cleft repair. The study took the form of a prospective randomized clinical trial. We used lateral cephalograms for the measurement of the symphyseal donor area defect both peroperatively and at 12 months postoperatively. The data obtained were digitalized and the treatment outcome expressed in numbers. Comparisons with a previous study were made. Histology of biopsies and CT scans were used for visualising bone formation. RESULTS: This study demonstrates that the micro-structured, resorbable calcium phosphate ceramic provides good regeneration properties for the repair of a critical size bony defect in children. One year postoperatively, the measurements taken from lateral cephalograms show that there is scarcely any visible residual defect. Histological investigations of the bone biopsies show solid, induced bone formation and almost complete resorption of the micro-structured calcium phosphate. CONCLUSIONS: The findings of this study (novel in children) indicate that micro-structured resorbable calcium phosphate is an excellent alternative to autologous bone. The digital findings showed a restored donor site defect significantly indicating the efficacy (i.e., osteoconductivity and resorbability) of this bone substitute. The biopsy histology demonstrated the overall presence of newly formed vital bone and the resorption of the bone substitute. Its use for grafting the alveolar cleft is currently researched and it may become the new standard. CLINICAL RELEVANCE: As co-morbidity and prolonged operation time at the donor operation site are inherent to the alveolar cleft repair procedure, the use of the described bone substitute is winning progress.

Donor site complications in bone grafting: comparison of iliac crest, calvarial, and mandibular ramus bone.

PURPOSE: To compare the donor site complication rate and length of hospital stay following the harvest of bone from the iliac crest, calvarium, or mandibular ramus. MATERIALS AND METHODS: Ninety-nine consecutively treated patients were included in this retrospective observational single-center study. RESULTS: Iliac crest bone was harvested in 55 patients, calvarial bone in 26 patients, and mandibular ramus bone in 18 patients. Harvesting of mandibular ramus bone was associated with the lowest percentages of major complications (5.6%), minor complications (22.2%), and total complications (27.8%). Harvesting of iliac crest bone was related to the highest percentages of minor complications (56.4%) and total complications (63.6%), whereas harvesting of calvarial bone induced the highest percentage of major complications (19.2%). The length of the hospital stay was significantly influenced by the choice of donor site (P = .003) and age (P = .009); young patients with the mandibular ramus as the donor site had the shortest hospital stay. CONCLUSIONS: Harvesting of mandibular ramus bone was associated with the lowest percentage of complications and the shortest hospital stay. When the amount of bone to be obtained is deemed sufficient, mandibular ramus bone should be the first choice for the reconstruction of maxillofacial defects.

Neck and shoulder function in patients treated for oral malignancies: a 1-year prospective cohort study.

BACKGROUND: Neck and shoulder complaints can be a direct result of a neck dissection. METHODS: Maximal active lateral flexion of the neck, forward flexion and abduction of the shoulder, and self-perceived function were determined in 145 patients treated for oral cancer. RESULTS: No short-term influence of radiotherapy was found on measured range of motion and self-perceived neck and shoulder function (p > .05). One year after a bilateral neck dissection, patients showed deteriorated lateral flexion of the neck, whereas patients treated with a unilateral modified radical neck dissection still reported pain during neck movements. Maximal forward flexion of the shoulder recovered to the level of healthy controls, but maximal abduction was still reduced in all patients. CONCLUSIONS: Neck dissection, tumor site, and extensive reconstruction are related to deterioration of shoulder function shortly after intervention. Maximal active shoulder abduction was affected most.

Influence of periodontal treatment on objective measurement of masticatory performance.

In a previous study, we evaluated the influence of periodontal treatment and physiological parameters on the subjective perception of mastication using the Oral Impact on Daily Performance Questionnaire (OIDP). In this study, we investigated the influence of periodontal treatment on the objective measures of masticatory performance in the same study sample. Patients with chronic periodontitis (n = 28) were examined on two occasions with a 45-day interval. Electrical activity of the masticatory muscles and maximum bite force were determined. In addition, masticatory performance was assessed using silicone impression blocks as test material. The median particle size of the chewed blocks was determined employing a sieving method. The number of teeth and the probing depth were also recorded. The probing depth was significantly reduced following treatment (P < 0.001). The median particle size of the chewed material was also reduced, which indicates a significant improvement in masticatory performance after treatment (P < 0.001). Bite force and muscle activity were significantly correlated both before and after treatment (P < 0.05). There was a negative correlation between masticatory performance and number of teeth (P < 0.05); moreover, individuals with a lower number of teeth exhibited poorer masticatory performance (P = 0.01). Periodontal treatment had a positive influence on masticatory performance 45 days after conservative treatment.

Free vascularized flaps for reconstruction of the mandible: complications, success, and dental rehabilitation.

PURPOSE: To evaluate complications and success of mandibular reconstruction with free fibula flaps, iliac crest flaps, and forearm flaps with reconstruction plates and to evaluate dental rehabilitation after these reconstructions. PATIENTS AND METHODS: Eighty-three patients with segmental mandibular defects were included. Correlation analyses were used to determine the relationship between reconstruction type and clinical parameters with recipient-site complications and success. The dental rehabilitation was evaluated in successfully reconstructed survivors. RESULTS: Multivariate analyses showed significant correlations between flap type and success (P < .0001). Of the patients, 51 (61%) were alive 2 years after the reconstruction. Mandibular reconstruction with a free forearm flap and reconstruction plate was associated with higher complication rates at the recipient site and higher failure rates compared with reconstruction with free vascularized bone flaps. Of the 32 successfully reconstructed survivors, 14 (44%) had a complete dental rehabilitation, of which 10 had dental implants and 4 did not. Only 6 (29%) of the edentulous survivors ultimately had an implant-supported prosthesis. CONCLUSIONS: Reconstruction of the mandible with a free vascularized bone flap is superior to reconstruction with a free forearm flap with a reconstruction plate. Complete dental rehabilitation was reached in fewer than half of the surviving patients.

The influence of auditory and visual information on the neuromuscular control of chewing crispy food.

The influence of auditory and/or visual information on the neuromuscular control of chewing a crispy food was investigated. Participants chewed biscuits of three different levels of crispness under four experimental conditions: no masking, auditory masking, visual masking, and auditory plus visual masking. The order of the four masking condition blocks was randomized. The sound of chewing was masked by loud sounds on a headphone, and visual masking of the food was achieved by closing the eyes. Mechanical tests were performed on the biscuits to determine their characteristics, yield force, and sound production. Skull vibration, jaw-muscle activity, and jaw movement were measured while the subjects chewed and swallowed the food. Auditory and/or visual masking did not have a significant effect on skull vibration, muscle activity, and number of chewing cycles until swallowing. However, auditory and/or visual masking significantly increased the chewing cycle duration, but only for the participants who started the experiments with auditory and/or visual masking. The other participants were not influenced by masking. The memory of the unmodified stimuli helped these subjects to maintain their habitual chewing rate in later trials.

Dental treatment needs in Dutch nursing homes offering integrated dental care.

The purpose of this study was to determine the dental treatment needs of the residents in nursing homes (NHs) where integrated dental care has been offered without financial barriers. The dental status and surgical, prosthetic, restorative, and periodontal treatment needs were determined for 432 residents (average age 78.8 years) in three Dutch NHs. Although the subjects had no complaints, 72% had dental treatment needs. It was determined that treatment was necessary for 64% of the edentulous subjects (N = 316), 100% of the partially dentate subjects (N = 76), and 87% of the fully dentate subjects (N = 40). We concluded that when residents can no longer carry out oral hygiene independently, it is very difficult for them to maintain a level of oral health where their dental treatment needs have been met, especially for dentate residents.

Assessment of mastication with implications for oral rehabilitation: a review.

During chewing, food is reduced in size, while saliva moistens the food and binds the masticated food into a bolus that can be easily swallowed. Characteristics of the oral system, like number of teeth, bite force and salivary flow, will influence the masticatory process. Masticatory function of healthy persons has been studied extensively the last decades. These results were used as a comparison for outcomes of various patient groups. In this review, findings from literature on masticatory function for both healthy persons and patient groups are presented. Masticatory function of patients with compromised dentition appeared to be significantly reduced when compared with the function of healthy controls. The influence of oral rehabilitation, e.g. dental restorations, implant treatment and temporomandibular disorder treatment, on masticatory function will be discussed. For instance, implant treatment was shown to have a significant positive effect on both bite force and masticatory performance. Also, patient satisfaction with an implant-retained prosthesis was high in comparison with the situation before implant treatment. The article also reviews the neuromuscular control of chewing. The jaw muscle activity needed to break solid food is largely reflexly induced. Immediate muscle response is necessary to maintain a constant chewing rhythm under varying food resistance conditions. Finally, the influence of food characteristics on the masticatory process is discussed. Dry and hard products require more chewing cycles before swallowing than moist and soft foods. More time is needed to break the food and to add enough saliva to form a cohesive bolus suitable for swallowing.

ß-TCP versus autologous bone for repair of alveolar clefts in a goat model.

OBJECTIVE: The aim of this study in goats was to test the hypothesis that a novel synthetic bone substitute beta tricalcium phosphate (ß-TCP) can work as well as autologous bone harvested from the iliac crest for grafting and repair of alveolar clefts. DESIGN: Ten adult Dutch milk goats (Capra hircus) were used in a split-mouth study design. MAIN OUTCOME MEASURES: Volumetric histologic assessment of new bone formation and radiographic measurement of orthodontic movement of teeth in a formerly created alveolar cleft. CONCLUSIONS: The synthetic bone substitute ß-TCP was shown to result in bone healing similar to that of iliac crest bone. The surgical, orthodontic, and histologic results now warrant the testing of ß-TCP in the human cleft situation.

Mastication in patients treated for malignancies in tongue and/or floor of mouth: A 1-year prospective study.

BACKGROUND: People confronted with oral cancer run a high risk of deteriorated masticatory performance. Reduced masticatory function may affect quality of life and food choice. An altered food choice may result in lower intakes for key nutrients and weight loss. METHODS: Dental state, bite force, and masticatory performance were determined in a group of 45 patients with squamous cell carcinoma of the tongue and/or floor of mouth. Measurements were performed before surgery and at various moments after surgery and/or radiotherapy. RESULTS: Surgical intervention had a large negative impact on oral function. Radiotherapy further worsened oral function. Also, the recovery of oral function 1 year after surgery was less prominent for the surgery-radiotherapy group than for the surgery group. CONCLUSION: Objective determination of oral function 1 year after surgery showed that patients treated for malignancies in the tongue and/or floor of mouth had significantly deteriorated masticatory performance, bite force, and dental state.

Mandibular overdentures retained by two implants: 10-year results from a crossover clinical trial comparing ball-socket and bar-clip attachments.

PURPOSE: The aim of this study was to evaluate patient satisfaction and clinical and prosthetic outcomes of two-implant mandibular overdenture treatment with different attachment types after 10 years of function. MATERIALS AND METHODS: In a crossover clinical trial, 18 edentulous subjects with complaints regarding their mandibular dentures received two implants and a new denture with magnet, ball-socket, or bar-clip attachments that were applied in a random order. At the end of the experiment, the attachment type of their choosing was fitted in the overdenture. After 10 years, 7 subjects with a ball-socket and 7 subjects with a bar-clip attachment were available for evaluation. The same questionnaire from 10 years before was completed, and subjects were asked to express their overall appreciation of their dentures on a visual analog scale (VAS). Six scales of denture complaints were constructed. Mean scale and VAS scores between initial evaluation and after 10 years were compared. In addition, marginal probing depths, Bleeding Index, and radiographic marginal bone loss were assessed. RESULTS: There was no marked difference in satisfaction between subjects with ball-socket- and bar-clip-retained two-implant mandibular overdentures at initial evaluation and after 10 years of function. CONCLUSION: Patients' appreciation of their implant-retained denture was and remained high over time. Clinical parameters revealed healthy mucosal conditions and stable marginal bone levels, determined radiographically. Probing depths around implants provided with ball-socket attachments were slightly shallower than those with bar-clip attachments after 10 years of function (P < .05).