|Year : 2018 | Volume
| Issue : 5 | Page : 416-419
|Bite force evaluation in complete denture wearer with different denture base materials: A randomized controlled clinical trial
Mostafa I Fayad1, Hussam Hakem T. Alruwaili2, Muhammad Sartaj Khan3, Muhammad Nadeem Baig4
1 Department of Removable Prosthodontics, Faculty of Dental Medicine, Al-Azhar University, Cairo, Egypt; Department of Substitutive Dental Sciences, College of Dentistry, Taibah University, Medina, Saudi Arabia
2 Dentist, Ministry of Health, Saudi Arabia
3 Department of Prosthetic Dental Sciences, College of Dentistry, AlJouf University, Saudi Arabia
4 Department of Preventive Dentistry, College of Dentistry, AlJouf University, Saudi Arabia
|Date of Submission||01-Jan-2018|
|Date of Acceptance||24-Apr-2018|
|Date of Web Publication||8-Oct-2018|
Dr. Mostafa I Fayad
College of Dentistry, Taibah University, Medina, Saudi Arabia; Faculty of Dental Medicine, Al-Azhar University, Cairo, Egypt
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aim: The aim of this study is to evaluate the maximum bite force (MBF) with different denture base materials in completely edentulous patients.
Materials and Methods: MBF was evaluated in randomly selected 100 completely edentulous patients. Patients were selected from the Outpatient Clinic, College of Dentistry, Aljouf University, Saudi Arabia. The patients were randomly divided into two equal groups: Group I (control group): Patient received a conventional heat-cured acrylic complete denture (Vertex™ Regular, Vertex-Dental B.V., The Netherlands) and Group II (experimental group): Patient received a thermoplastic complete denture (Vertex™ ThermoSens, Vertex-Dental B.V., The Netherlands). MBF measurements were taken at the time of new denture placement and after 6 months of denture use. Statistics were analyzed using independent t-test to compare the MBF measurements between both groups.
Results: At the time of denture placement, there was no significant difference in bite force measurements between both groups. Bite force is increasing considerably after 6 months of denture use, and it was higher than MBF recorded at the time of new prosthesis placement in the same group. The MBF values were considerably higher in patients with a thermoplastic denture than patients with conventional acrylic denture with statistically significant difference after 6 months of denture use.
Conclusion: After 6 months of denture use, patients with a thermoplastic denture have a higher biting force than patients with a conventional acrylic denture. Therefore, it could be considered a treatment plan option according to the ridge nature and quality to solve the problem of diminished bite force in old age patients.
Keywords: Acrylic dentures, bite force, denture base materials, thermoplastic denture base
|How to cite this article:|
Fayad MI, Alruwaili HH, Khan MS, Baig MN. Bite force evaluation in complete denture wearer with different denture base materials: A randomized controlled clinical trial. J Int Soc Prevent Communit Dent 2018;8:416-9
|How to cite this URL:|
Fayad MI, Alruwaili HH, Khan MS, Baig MN. Bite force evaluation in complete denture wearer with different denture base materials: A randomized controlled clinical trial. J Int Soc Prevent Communit Dent [serial online] 2018 [cited 2019 Jul 17];8:416-9. Available from: http://www.jispcd.org/text.asp?2018/8/5/416/242863
| Introduction|| |
Many people have been affected by teeth loss which causes physiological and functional disorders, so rehabilitation treatments with an adequate prosthesis are indicated.
Nearly 30% of patients with complete dentures have complaints. They suffer from various problems with their dentures, particularly regarding the mandibular denture, such as decreased stability, retention, and pain during mastication.
Studies have shown that when compared with natural dentition subjects, denture wearers suffer from a decline in masticatory performance.,, When people age, their muscles undergo functional changes mainly through atrophy and tooth loss.
Considering the constant increase in elderly people all over the world, it has become essential to evaluate bite force and muscle changes associated with age.,
Bite force is an important variable to investigate oral function. Maximum bite force (MBF) also directly influences diet choice, which has an important role in the maintenance of masticatory function. The old people with fewer or no teeth avoid fibrous foods resulting in reduced food intake and leaving out various sources of proteins, fibers, minerals, and vitamins.,
Selecting less nutritious food leads to high risk of malnutrition and consequently the potential for cardiovascular disease and cancer.,
In dental field, bite force acts as an important parameter to evaluate of masticatory system efficacy. Different devices with different designs have been used to record bite force.
Jeong et al. studied the relationship between mandibular tori and bite force and they found that the size of torus mandibularis increased significantly in proportion to the bite force and thus it can be used to clinically assess occlusal stress.
In fact, the masticatory force of completely edentulous patients is 20%–40% of that of healthy dentate persons. Therefore, complete denture wearers need up to seven times more chewing strokes to reduce food particle than do dentulous subjects.,
The chewing forces used by denture wearers may be limited by the discomfort and the pain that happens when one or both of the dentures lose their retention or even by the fear of such pain. MBF that can be exerted by denture wearers on objects placed between their dentures has also been shown to be considerably lower than that observed in dentate persons.
The provision of two mandibular implants significantly improves bit force and quality of life for completely edentulous patients., Telescopic distal extension removable partial dentures with cantilevered extensions were found to be associated with improved MBF.
Three principal factors, i.e., retention, stability, and support should be considered for successful complete dentures. Treatment alternatives that aid in increasing retention and stability for improving denture function should be considered when conventional denture therapy is inadequate. One of these alternatives is using thermoplastic denture base materials.
Even though retention and alveolar ridge height which could influence the results were not evaluated, the present study is one of the few studies comparing MBF in complete denture wearers with a thermoplastic denture base versus conventional acrylic one, at the time of new denture placement and after 6 months.
| Materials and Methods|| |
This cross-sectional, prospective study was conducted from June 2016 to June 2017 at College of Dentistry, Aljouf University, Saudi Arabia. The study group comprised randomly selected 100 completely edentulous patients with an average age of 52 years. Based on standard deviation from pilot study and previous studies, it was found that 50 cases are enough for conducting the research at power 0.80, confidence interval 0.95, and alpha level 0.05.,,,
All the patients studied have no psychiatric disease or movement disorders. The study protocol was approved by the Ethics Committee at Aljouf University (ethical approval letter no. 2016\18). Informed consent was obtained from all patients after an explanation of the methodology before enrolment in the study.
The patients were randomly allocated into two groups (each group consisted of 50 individuals) according to line of treatment:
- Group I (control group): Patient received a conventional heat-cured acrylic complete denture (Vertex™ Regular, Vertex-Dental B.V., The Netherlands)
- Group II (experimental group): Patient received a thermoplastic complete denture (Vertex™ ThermoSens, Vertex-Dental B.V., The Netherlands).
All patients received new complete dentures, with even occlusion and free from discomfort.
Bite force recordings
Measurements were made with the patient in an upright position at the time of new prosthesis placement and after 6 months of denture use.
MBF was measured bilaterally at the first molar region by an occlusal force meter which involves a hydraulic pressure device and a disposable polyvinyl cap (17 mm in width and 5.4 mm in height). The measuring range was 0–1000 N with an accuracy of ± 1 N [Figure 1] (GM10, Nagano Keiki, Tokyo, Japan). The instrument was placed such that all bite forces were directed to the center.
The patients were instructed to bite as powerfully as possible three times per side at maximum intercuspation, with a rest time of 2 min in between. The maximum occlusal force recorded in Newtons (N) was recorded. The highest of the three records was considered to be the patient's MBF.
The difference in bite force after 6 months was calculated, and the mean of two groups was compared. Statistical analysis was completed using SPSS 20 (IBM, Armonk, NY, USA).
| Results|| |
MBF with different denture base materials in completely edentulous patients was evaluated.
At the time of new denture insertion, the mean value of MBF with conventional complete denture was 33.7 ± 12.07. The mean value of MBF with thermoplastic complete denture was 34.3 ± 12.25. The independent t-test revealed that there was no statistical difference found in MBF values between both groups (P > 0.01) [Table 1] and [Figure 2].
|Figure 2: Mean bite force comparison at the time of denture placement and after 6 months of denture placement|
Click here to view
After 6 months, for each group, MBF increased considerably after 6 months of denture use and it was higher than MBF recorded at the time of new prosthesis placement in the same group [Table 1] and [Figure 2].
When comparing both groups, the patients who received a conventional heat-cured acrylic complete denture recorded lower MBF values than patients received a thermoplastic complete denture. The independent t-test revealed that there was statistically significant difference in MBF (P < 0.01).
| Discussion|| |
MBF is an important variable for masticatory function evaluation., Bite force varies in different locations in the oral cavity and is highest in the first molar area because nearly 80% of the total bite force is distributed in that area,, and it is easier and faster to measure. Multiple recordings are more reliable than a single recording.
Old patients are more vulnerable to the trauma of oral mucosa and stomatitis due to atrophy with a slow turnover of tissues, an overall increase in the number of elastic fibers. Moreover, an old age people show a decrease in the muscles activity. Consequently, older people tend to have weak neuromuscular control.
Second measurement was done after 6 months of denture insertion as Goiato et al. suggested that >5 months was needed to evaluate patient adaptation and functional capacity with new complete dentures.
The question raised in this study is what denture base material (conventional acrylic resin or a thermoplastic acrylic resin) provides greater bite force in completely edentulous patients.
The thermoplastic material is methyl methacrylate, and therefore, it bonds chemically to the denture base. It is relatively rigid material at mouth temperature but softens in hot water.
At the time of denture insertion, there was no significant difference between patients with a thermoplastic denture and patients with a conventional acrylic denture. It measures 33.7 ± 12.07 N for patients with conventional acrylic denture while it measures 34.3 ± 12.2 N for patients with a thermoplastic denture.
Bite force is increasing considerably after 6 months of denture use in both groups. It measures 39.3 ± 14.8 N and 47.5 ± 11.3 N for the Group I and Group II, respectively. These results match the findings of Roldan. It is important to mention that although there was only 6 months between measurements, significant differences were observed and may be explained by the adaptation period to the new prosthesis., This result is in agreement with the finding of Borie et al. who found that MBF was found to increase significantly after 1 month of use.
The MBF values were considerably higher in patients with a thermoplastic denture than patients with conventional acrylic denture after 3 months of denture use. It measures 61.29 ± 17 N for patients who received conventional acrylic complete denture, while in patients who received thermoplastic denture, it measures 71.35 ± 18.8 N. The higher values observed in patients with a thermoplastic denture may be directly related to better stability and retention obtained with a thermoplastic denture base.
| Conclusion|| |
The rehabilitation of orofacial structures requires the restoration of esthetic and function irrespective of the structure left. The complete thermoplastic denture was found to significantly better MBF values after 6 months of denture use as compared to the conventional methyl methacrylate dentures on the parameters taken in the present study. However, further long-term studies are recommended to evaluate the overall usefulness of the material.
The authors would like to thank Dr. Mohamed Sghireen, Department of Prosthetic Dental Sciences, College of Dentistry, ALjouf University, Sakaka, Saudi Arabia, for his valuable help during the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Rosa LB, Bataglion C, Siéssere S, Palinkas M, Júnior WM, Freitas OD, et al
. Bite force and masticatory efficiency in individuals with different oral rehabilitations. Open J Stomatol 2012;2:21-6.
Luraschi J, Schimmel M, Bernard JP, Gallucci GO, Belser U, Müller F, et al.
Mechanosensation and maximum bite force in edentulous patients rehabilitated with bimaxillary implant-supported fixed dental prostheses. Clin Oral Implants Res 2012;23:577-83.
Kapur KK, Garrett NR. Studies of biologic parameters for denture design. Part II: Comparison of masseter muscle activity, masticatory performance, and salivary secretion rates between denture and natural dentition groups. J Prosthet Dent 1984;52:408-13.
Michael CG, Javid NS, Colaizzi FA, Gibbs CH. Biting strength and chewing forces in complete denture wearers. J Prosthet Dent 1990;63:549-53.
Mohamed GF. Clinical evaluation of the efficacy of soft acrylic denture compared to conventional one when restoring severely resorbed edentulous ridge. Cairo Dent J 2008;24:313-23.
Tatematsu M, Mori T, Kawaguchi T, Takeuchi K, Hattori M, Morita I, et al.
Masticatory performance in 80-year-old individuals. Gerodontology 2004;21:112-9.
Holm-Pedersen P, Schultz-Larsen K, Christiansen N, Avlund K. Tooth loss and subsequent disability and mortality in old age. J Am Geriatr Soc 2008;56:429-35.
Newton JP, Yemm R, Abel RW, Menhinick S. Changes in human jaw muscles with age and dental state. Gerodontology 1993;10:16-22.
Borie E, Orsi IA, Fuentes R, Beltrán V, Navarro P, Pareja F, et al.
Maximum bite force in elderly indigenous and non-indigenous denture wearers. Acta Odontol Latinoam 2014;27:115-9.
Iinuma T, Arai Y, Fukumoto M, Takayama M, Abe Y, Asakura K, et al.
Maximum occlusal force and physical performance in the oldest old: The Tokyo oldest old survey on total health. J Am Geriatr Soc 2012;60:68-76.
Moynihan P, Thomason M, Walls A, Gray-Donald K, Morais JA, Ghanem H, et al.
Researching the impact of oral health on diet and nutritional status: Methodological issues. J Dent 2009;37:237-49.
Hildebrandt GH, Dominguez BL, Schork MA, Loesche WJ. Functional units, chewing, swallowing, and food avoidance among the elderly. J Prosthet Dent 1997;77:588-95.
Hämäläinen P, Rantanen T, Keskinen M, Meurman JH. Oral health status and change in handgrip strength over a 5-year period in 80-year-old people. Gerodontology 2004;21:155-60.
Verma TP, Kumathalli KI, Jain V, Kumar R. Bite force recording devices – A review. J Clin Diagn Res 2017;11:ZE01-5.
Jeong CW, Kim KH, Jang HW, Kim HS, Huh JK. The relationship between oral tori and bite force. Cranio 2018;36:1-8.
Fontijn-Tekamp FA, Slagter AP, Van Der Bilt A, Van 'T Hof MA, Witter DJ, Kalk W, et al.
Biting and chewing in overdentures, full dentures, and natural dentitions. J Dent Res 2000;79:1519-24.
Slagter AP, Bosman F, Van der Bilt A. Comminution of two artificial test foods by dentate and edentulous subjects. J Oral Rehabil 1993;20:159-76.
Sharma AJ, Nagrath R, Lahori M. A comparative evaluation of chewing efficiency, masticatory bite force, and patient satisfaction between conventional denture and implant-supported mandibular overdenture: An in vivo
study. J Indian Prosthodont Soc 2017;17:361-72.
] [Full text]
Flanagan D. Bite force and dental implant treatment: A short review. Med Devices (Auckl) 2017;10:141-8.
Elsyad MA, Mostafa AZ. Effect of telescopic distal extension removable partial dentures on oral health related quality of life and maximum bite force: A preliminary cross over study. J Esthet Restor Dent 2018;30:14-21.
Yen CI, Mao SH, Chen CH, Chen CT, Lee MY. The correlation between surface electromyography and bite force of mastication muscles in Asian young adults. Ann Plast Surg 2015;74 Suppl 2:S168-72.
Koç D, Doğan A, Bek B. Effect of gender, facial dimensions, body mass index and type of functional occlusion on bite force. J Appl Oral Sci 2011;19:274-9.
Shinogaya T, Sodeyama A, Matsumoto M. Bite force and occlusal load distribution in normal complete dentitions of young adults. Eur J Prosthodont Restor Dent 1999;7:65-70.
Tortopidis D, Lyons MF, Baxendale RH, Gilmour WH. The variability of bite force measurement between sessions, in different positions within the dental arch. J Oral Rehabil 1998;25:681-6.
Ikebe K, Matsuda KI, Morii K, Hazeyama T, Kagawa R, Ogawa T, et al.
Relationship between bite force and salivary flow in older adults. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:510-5.
Lloyd PM. Complete-denture therapy for the geriatric patient. Dent Clin North Am 1996;40:239-54.
Goiato MC, Garcia AR, Dos Santos DM, Zuim PR. Analysis of masticatory cycle efficiency in complete denture wearers. J Prosthodont 2010;19:10-3.
Abrams S. Complete denture covering mandibular tori using three base materials: A case report. J Can Dent Assoc 2000;66:494-6.
Roldán S, Buschang PH, Isaza Saldarriaga JF, Throckmorton G. Reliability of maximum bite force measurements in age-varying populations. J Oral Rehabil 2009;36:801-7.
Liedberg B, Stoltze K, Owall B. The masticatory handicap of wearing removable dentures in elderly men. Gerodontology 2005;22:10-6.
Müller F, Heath MR, Ott R. Maximum bite force after the replacement of complete dentures. Gerodontology 2001;18:58-62.
[Figure 1], [Figure 2]
|This article has been cited by|
||Masticatory function parameters in patients with removable dental prosthesis
| ||Alexandra Melania Oncescu Moraru,Cristina Teodora Preoteasa,Elena Preoteasa |
| ||Journal of Medicine and Life. 2019; 12(1): 43 |
|[Pubmed] | [DOI]|
| Article Access Statistics|
| Viewed||773 |
| Printed||12 |
| Emailed||0 |
| PDF Downloaded||74 |
| Comments ||[Add] |
| Cited by others ||1 |