Biting and chewing in overdentures, full dentures, and natural dentitions

Journal of Dental Research
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Biting and Chewing in Overdentures, Full Dentures, and Natural Dentitions
F.A. Fontijn-Tekamp, A.P. Slagter, A. Van Der Bilt, M.A. Van 'T Hof, D.J. Witter, W. Kalk and J.A. Jansen
J DENT RES 2000 79: 1519
DOI: 10.1177/00220345000790071501

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-I.

F.A. Fontiin-Tekampl4*, A.P. Slagterl 4,
A. Van Der BiMO, M.A. Van 'T Hof3, Biting and Chewing in
D.J. Witter1, W. Kalk1 5, and J.A. Jansen2
Unit of Oral Function and Prosthetic Dentistry, Departments of
Overdentures, Full Dentures,
'Occlusal Reconstruction and Oral Function and 2Biomaterials,
3Department of Medical Statistics, University ofNijmegen;
4Department of Oral-Maxillofacial Surgery, Prosthodontics and
and Natural Dentitions
Special Dental Care, University Medical Center Utrecht,
P.O. Box 80.037, 3508 TA Utrecht; and 5Department of Oral
Function, University of Groningen, The Netherlands;
*corresponding author, F.A.Fontijn(med.uu.nl
J Dent Res 79(7): 1519-1524, 2000

ABSTRACT INTRODUCTION
It has been suggested that the provision of dental The provision of dental implants to subjects with severely resorbed
implants can improve the oral function of subjects I mandibles significantly improves subjective oral function. Subjects with
with severely resorbed mandibles, possibly dental implants have fewer complaints, feel more satisfied, and rate their
restoring function to the level experienced by chewing comfort and ability more highly (Lindquist and Carlsson, 1985;
satisfied wearers of conventional complete Boerrigter et al., 1995; Geertman et al., 1996a,b; Kapur et al., 1998; Meijer
dentures. Nevertheless, a quantitative comparison et al., 1999). Also, objective oral function improves after treatment with oral
has never been made and can be drawn from the implants, as can be seen from an increased bite force and masticatory
literature only with difficulty, since studies differ function (Lindquist and Carlsson, 1985; Haraldson et al., 1988; Geertman et
greatly in methodology. To make such a al., 1994; Fontijn-Tekamp et al., 1998; Pera et al., 1998). According to
comparison, we measured bite force and chewing Lindquist and Carlsson (1982, 1985) and Haraldson et al. (1988), the
efficiency by using identical methods in subjects improvement in objective function seems to depend on the type of implant
with overdentures, complete full dentures, and support for the mandibular denture. However, more recent studies revealed
natural dentitions. Our results indicated that bite no such differences, either for chewing efficiency (Geertman et al., 1994) or
forces achieved with overdentures on dental for unilateral and bilateral bite force (Fontijn-Tekamp et al., 1998).
implants were between those achieved with It has been suggested that the provision of dental implants to subjects with
artificial and natural dentitions. Chewing severely resorbed mandibles can restore objective oral function to the level
efficiency was significantly greater than that of experienced by satisfied wearers of conventional full dentures (Geertman et
subjects with full dentures (low mandible), but al., 1994). We must emphasize, however, that a comparative quantification of
was still lower than that of subjects with full such improvement has never been made and cannot be drawn from the
dentures (high mandible) and overdentures on literature, since available studies are difficult to compare, because of variations
bare roots. Differences in the height of the in the study design (the age of the population studied, the male-to-female
mandible revealed significant differences in ratio), outcome measures used, clinical setting in which the implant therapy
chewing efficiency between the two full-denture was provided, oral status of subjects included, and the type of implant therapy
groups. Furthermore, subjects with a shortened provided (Locker, 1998). To obtain outcome measures, chewing efficiency
dental arch exerted bite forces similar to those of tests and bite force measurements are performed amongst other tests. In the
subjects with a complete-natural dentition, but chewing efficiency tests, the types of test foods (natural foods, e.g., peanuts,
their chewing efficiency was limited due to the carrots, almonds, gummy bears, and gelatin, or artificial test foods such as
reduced occlusal area. For all groups combined, a Optosil, Optocal, and Cutter Sil) vary, as do the amounts of test foods, the
significant correlation was found between sieving method, and the methods for analysis of the results can be used (van
maximum bite force and chewing efficiency. der Bilt et al., 1993a). For evaluating the bite force, several equipment designs
Nearly half of the variation in chewing efficiency can be used (see Fontijn-Tekamp et al., 1998).
was explained by bite force alone. In view of the above, the aim of the current study was to compare,
quantitatively, the oral function of three groups of subjects with (a)
KEY WORDS: chewing efficiency, bite force, overdentures, (b) full dentures, and (c) natural dentitions. Furthermore, we
dental implants, (over)dentures, dentate. investigated correlations between maximum bite forces and chewing efficiency.
In addition, we inclusded a group of younger subjects with a complete-natural
dentition to provide information about more optimal oral function.

MATERIALS & METHODS
Subjects
Tests were performed in seven groups of female subjects: two overdenture
Received July 12, 1999; Last revision January 31, 2000; groups, two full-denture groups, and three groups with natural dentitions. All
Accepted February 8, 2000 edentulous subjects had a full maxillary denture and, in the mandible, either: (1)
Downloaded from jdr.sagepub.com by guest on March 1, 2011 For personal use only. No other uses without permission. 1519

1520 Fontijn-Tekamp et al. J Dent Res 79(7) 2000
Table. Characteristics of the treatment groups, numbers of chewing strokes needed to halve the food (N'/2), and The ethics committee of the
correlation coefficients (r) between maximum bite force and N1/2 Nijmegen University had
given its approval for this
Age' Bone Number Occlusal study.
Treatment Groups n (yrs) Heightab of Teeth' Unitsa' N1,2 r
Unilateral Bite Force
Overdentures: Unilateral bite forces were
Implants 40 58.3 (8.8) 13.6 (1.6) 56 0.17 measured with a miniature
Root-overlay 19 59.7 (8.5) 28.7 (3.6) 32 -0.59** strain-gauge bite-force
Full dentures: transducer with a vertical
Low bone height 13 59.0 (6.6) 14.1 (1.1) 106d -0.28 height of 3.8 mm. Calibration
Higher bone height 24 59.0 (8.7) and validation procedures
23.4 (5.2) 36 -0.34* were as described in a
Natural dentitions: previous study by Fontijn-
Shortened arch 14 58.1 (11.0) 21.1 (1.3) 3.6 (0.5) 32 -0.80** Tekamp et al. (1998). For the
Completearch 14 54.1 (6.4) 28.2(1.1) 12.1 (1.2) 16 -0.67** dentate groups, we protected
Complete arch 19 22.7 (1.5) 28.4 (2.8) 12.8 (2.2) 14 -0.52** teeth by covering both sides
of the transducer with 1.5-
Total group -0.62** mm-thick rubber plates
(DrufosoftR, Oudheusden
Data are presented as Mean (SD). Dental BV, Zeist, The
Mandibular symphyseal bone height in mm as measured on a standardized lateral encephalogram Netherlands) attached by
(Satow et al., 1998). double-sided adhesive tape.
CNumbers of occluding pairs of teeth, with 1 premolar contact = 1 occlusal unit and 1 molar contact = 2 occlusal units Subjects were instructed
(Witfer eta!., 1988). to bite on two force levels:
dFor four subjects, N, was set at 200 strokes, since their calculated values were larger than 200 strokes. (1) one they thought to be
eCorrelation coefficients were significant at * p < 0.005 and ** p < 0.001. equivalent to the force they
use when chewing; and (2)
their maximum force.
an implant-retained overdenture (implant group) on either a
transmandibular implant (n = 18) according to Bosker (1986) or on 150
two permucosal, cylindrical IMZ implants (n = 22; Kirsch and -+implants
Mentag, 1986); (2) an overdenture on at least 2 functional, natural *0* full dentures (low)
a full dentures (high)
bare roots in the mandible (root-overlay group); (3) a 125
root-overlay
conventional, full denture with a mandibular symphyseal bone - 0- shortened arch
height between 9 and 15 mm (full-denture group-low mandible); - A- complete arch (old)
100 - A- complete arch (young)
or (4) a conventional, full denture with a mandibular symphyseal
bone height of 16 mm and over (full-denture group-high man- z
dible). Subjects from the implant and full-denture groups (low 0i
2 75-
0
mandible) were selected from a randomized clinical trial 5,
(Geertman et al., 1994, 1996b). Subjects from the root-overlay and
full-denture groups (high mandible) were patients from the 50
Nijmegen Dental School. Subjects in this full-denture group were
edentulous for a maximum period of 20 years and were included
only if their mandibular bone height was 16 mm or more, as 25
...
measured on a standardized lateral cephalogram (Satow et al.,
1998). 0-
Subjects in the three natural-dentition groups had either: (1) a (pre) molars canines incisors
shortened dental arch with all anterior teeth present and 3 or 4
occluding pairs of premolars (shortened-arch group); (2) a Figure 1. Unilateral bite forces at the force level 'as when chewing' for
complete-natural dentition and ages comparable with those of the the seven groups between central incisors, canines, and first molars
groups described previously (complete-arch group-old); or (3) a (denture groups) and second premolars (dentate groups). Numbers of
complete-natural dentition group composed of dental students; subjects in each group are presented in the Table. For each data
(complete-arch group-young). Subjects from the shortened-arch point, the standard error of the mean (SEM) is presented. Data points
From corresponding groups are connected only for the sake of clarity.
and complete-arch (old) groups were from a cohort study which For all 3 bitin positions, t tests on log-transformed data showed: (1)
investigated subjective oral function in subjects with shortened implant vs. full denture with a low mandible (ns: p-values > 0.05); (2)
dental arches (Witter et al., 1994). The Table presents the implant vs. root-overlay (ns); (3) implant vs. full denture with a high
characteristics of all groups described above. Informed consent had mandible (p-values < 0.001); (4) full dentures low vs. high (ns); (5)
been obtained from all participants prior to their entry into the study.
complete arches old vs. young (ns); and (6) older complete vs.
shortened arch (ns).


J Dent Res 79(7) 2000 Comparison of Objective Oral Function 1521
Measurements involved 5 bitingpositions: between first molars
(edentulous groups) or between second premolars (dentate groups) 450
of the right and left sides of the jaw, between canines of both sides --implants
of the jaw, and between central incisors. Measurements were 400 - - full dentures (low)
-C - - full dentures (high)
started at the first right molar following the dentalarch toward the 3--6 root-overlay
left molar, with a one-minute rest between trials, and were repeated 350 -*- shortened arch
X- - complete arch (old)
once. To reduce the number of data for each subject, we calculated 300 --"--complete arch (young)
the mean of 4 measurements on the (pre)molar as well as on the
canine position for 2 force levels. For the incisal position, we 250
calcualted the mean of the 2 measurements. 0
200
Chewing Efficiency
In this study, "chewing efficiency" is defined as the number of t50
strokes needed to achieve a certain particle size reduction (for -1
100
instance, to half of the original particle size), whereas "masticatory
performance" is defined as the particle size distribution of food
particles after a given number of chewing strokes. 50
Chewing efficiency tests were performed with a standardized
artificial test food, Optocal Plus, based upon the silicone (pre) molars canines incisors
component OptosilR Plus (version 1997; Bayer Dental, Leverkusen,
Germany). Food was offered in portions of 17 cubic particles (edge Figure 2. Maximum unilateral bite forces for the seven groups between
size, 5.6 mm), totaling approximately 3 cm3. central incisors, canines, and first molars (denture groups) and second
Particles were collected after 10, 20, 40, and 60 chewing premolars (dentate groups). Numbers of subjects in each group are
strokes for the edentulous groups and after 5, 10, 20, and 40 provided in the Table. For each data point, the standard error of the
mean (SEM) is presented. Data points from corresponding groups are
strokes for the dentate groups. Tests were carried out twice, and connected only for the sake of clarity. For all 3 biting positions, t tests on
particles from corresponding numbers of chewing strokes were log-transformed data showed: (1) implant vs. full denture with a low
pooled. Collected particles were air-dried for at least 1 wk before mandible (p-values < 0.03); (2) implant vs. root-overlay (p-values <
being sieved. Particles were sieved in a stack up to 10 sieves, with 0.004); (3) implant vs. full denture with a high mandible (p-values <
square apertures decreasing from 5.6 to 0.5 mm and a bottom plate, 0.001); (4) full dentures low vs. high (p < 0.04, only for the canines); (5)
complete arches old vs. young (p < 0.005, only for the premolars); and
for 20 min (Laboratory Sieving machine VS1000; F. Kurt Retsch (6) older complete vs. shortened arch (ns: p-values > 0.05).
GmbH & Co. KG, Haan, Germany).
For each number of chewing strokes, median particle sizes
(X50) were determined (Van
der Bilt et al., 1993a). The
median particle size is the
aperture of a theoretical sieve 6.0
through which 50% of the
particles can pass by weight. 5.0
The number of chewing
strokes (N.2) needed to obtain
a median particle size of 2.8 4.0-
kI6 implants
mm (half of the initial edge X 0 full dentures (low)
--
size) was estimated for each - -full dentures (high)
-

0 3.0 - * --root-overlay
individual from the a -*- shortened arch
regression line of X50 and the - - -complete arch (old)

number of chewing strokes c 2.0
- -complete arch (young)
-

(Slagter et al., 1993). When
someone is unable to E
pulverize the test food, N,2 1.0 -
will be very large. In a former
study (unpublished data), 0.0
none of the subjects had used 0 10 20 30 40 50 60 70
over 200 chewing strokes number of chewing strokes
before swallowing.
Therefore, we supposed that Figure 3. Mean median particle sizes (X50) are plotted as a function of thenumber of chewing strokes for the
calculated values over 200 seven groups. For each data point, the standard error of the mean (SEM) is presented. Numbers of subjects in
strokes for N,,2 are not each group are provided in the Table. For all fixed numbers of chewing strokes, t tests on log-transformed data
physiological. For further
showed: (1) implant vs. full denture with a low mandible (p-values < 0.03); (2) implant vs. root-overlay (p-values <
0.001); (3) implant vs. full denture with a high mandible (p-values < 0.001); (4) full dentures low vs. high (p-
calculations, these values values < 0.001); (5) complete arches old vs. young (ns: p-values > 0.05); and (6) older complete vs. shortened
were set at 200 strokes. arch (p-values < 0.004).


1522 Fontijn-Tekamp et al. J Dent Res 79(7) 2000
groups. At the maximum bite force level, subjects with dental
implants exerted, at all biting positions, forces significantly
higher than those of the (1) full-denture group (low mandible; p-
values < 0.03), (2) root-overlay group (p-values < 0.004), or (3)
1- 100 the full-denture group (high mandible; p-values < 0.001).
z
Nevertheless, maximum forces exerted by the implant group
,80-
D
were still lower than those of the dentate subjects. In agreement
a) with the results from the 'as when chewing' level, no differences
2 could be detected between the natural-dentition groups for the
o 60- anterior biting positions. However, forces measured between the
0
(D
0
second premolars differed significantly: The maximum bite
40- force of the younger group was significantly larger than the
0
force of the older group, with 398 N (SD 103) and 292 N (SD
E 94), respectively. The corresponding bite force of the subjects
r_ 20- with a shortened dental arch was 246 N (SD 95).
Chewing Efficiency
100 200 300 400 500 600 700 Fig. 3 shows mean median particle size (X50) as a function of the
maximum bite force - (pre) molars (N) number of chewing strokes for the seven groups. Log-
transformed data revealed a significantly higher reduction of X50
Figure 4. Correlations between maximum bite force and the number of for the implant group compared with the full-denture group (low
chewing strokes needed to reduce the food to half of the original particle mandible) at all chewing strokes (t test, p-values < 0.03). Second,
size (N12). For each subject, N,,2 is plotted against the maximum bite force subjects with natural roots under their overdentures performed
measured between first molars (denture groups) or second premolars significantly better compared with subjects with dental implants
(dentate groups). For each group, data points were curve-fitted by an
exponential function. Numbers oF subjects in each group are provided in (all p-values < 0.001). Also, subjects from the full-denture group
the Table. Except for the implant and full-denture (low mandible) groups, (high mandible) performed better than subjects with dental
significant correlations were observed (see Table). implants. Furthermore, subjects from the shortened-arch group
had achieved significantly less particle-size reduction than
Statistical Procedures subjects from the complete-arch group (old), even at 5 chewing
strokes (all p-values < 0.004). Finally, age did not influence
To study effects on bite force and chewing efficiency, we
performed pure comparisons on log-transformed data by t tests. chewing efficiency, since no significant differences were found
between the two complete-arch groups (all p-values > 0.20).
First, we investigated the effects of implants by comparing (i) the The abovementioned differences among the seven groups
implant group with the full-denture group (low mandible), (ii) the are reflected in NA/2. Subjects of the full-denture group (low
implant group with the root-overlay group, and (iii) the implant-
group with the full-denture group (high mandible). Second, we mandible) needed over 7 times more chewing strokes compared
studied the effect of mandibular bone height by comparing two with subjects with a complete natural dentition to reduce the
food to half of the original particle size (Table). The group with
full-denture groups. Third, we examined the effect of age by dental implants needed 50% fewer chewing strokes compared
comparing two complete-arch groups. Fourth, we investigated the with the full-denture group with a low mandible (this is a
effect of reduced occlusal contact area by comparing the complete- reduction of ca. 60 strokes for Ny/2).
arch (old) and the shortened-arch groups. Finally, we calculated
correlation coefficients between maximum bite force and chewing Correlations
efficiency values (N,,2) to explore their relationship. Fig. 4 illustrates the relationship between unilateral maximum
bite force and chewing efficiency (N.) for the subjects of all
RESULTS seven groups. From this Fig., it is evident that a larger maximum
Unilateral Bite Force force accompanies a better chewing efficiency (lower N,/). The
Groups were compared with respect to the 3 biting positions, data points of each group were curve-fitted by an exponential
namely, (pre)molars, canines, and central incisors. For the force function (lines in Fig. 4). All groups, except the implant group
level 'as when chewing' (Fig. 1), forces exerted by subjects with and the full-denture groups (low mandible), showed significant
dental implants were comparable, at all 3 biting positions, with correlations between the maximum bite force and N, (Table).
those of the full-denture (with low mandible) (p-values > 0.08)
and root-overlay groups (p-values > 0.08) but were significantly DISCUSSION
higher than those of the full-denture group with a high mandible
(p-values < 0.001). Nevertheless, no differences could be We conducted the present study to make quantitative
observed between the two full-denture groups (p-values > 0.07). comparisons regarding two oral functions, viz. bite force and
Furthermore, dentate subjects exerted similar bite forces for the chewing efficiency, between different states of natural and
3 biting positions: p-values between the two complete-arch artificial dentition. While we attempted to carry out all
groups and between the complete-arch (old) and shortened-arch measurements with standardized and controlled equipment and
groups were not significant (all p-values > 0.40). procedures, some modifications were necessary.
Fig. 2 shows the maximum bite forces for the different For the bite-force measurements, modifications were made


J Dent Res 79(7) 2000 Comparison of Objective Oral Function 1 523
with regard to (1) the thickness of the device and (2) the biting were capable of exerting relatively high bite forces but were unable
position in the (pre) molar area. Of course, teeth of dentate subjects to comminute food properly.
had to be protected during measurements. The rubber material, Significant differences in bite force between the implant and
DrufosoftO, leads to an increase in vertical dimension, which is root-overlay groups existed only for the maximum force level.
known to have a negative effect on bite force (Waltimo and This is in contrast to results from a study by Mericske-Stem et al.
Kononen, 1993, 1995). Nevertheless, this increase was limited, (1993). They observed a tendency for higher maximum bite forces
since teeth can easily compress Drufosoft'. Furthermore, the only in subjects with dental implants compared with a group with
subjects' mouth-openings did not exceed an incisal separation over natural roots. In their study, overdentures were attached by gold
28 mm, which is within the range of the most favorable opening for copings. Perhaps differences between the two groups in our study
bite-force measurements (Paphangkorakit and Osbom, 1997). would have been smaller if overdentures in the root-overlay group
Bite force measurements were carried out with the had been retained by precision attachments.
transducer between first molars (edentulous groups) and between The full-denture group (high mandible) needed 50% fewer
second premolars (dentate groups). All full (over)dentures in this strokes to halve the test food than did the other full-denture
study had been prepared according to the lingualized occlusion group with a lower mandibular bone height. Differences in bite
concept, with one premolar and two molars in each segment force existed only for the maximum level in frontal regions.
(Becker et al., 1977; Lang and Razzoog, 1992). Consequently, These regions are not particularly loaded during chewing, since
the position of the first molar in these dentures corresponded to food is predominantly chewed between the (pre)molars. For
that of a second premolar in the natural dentition. chewing efficiency, the full-denture group (high mandible) may
A final remark deals with the age of the complete-arch have benefited from a more favorable bone height of 23.4 + 5.2
group (old). The mean age of this group is 4 years younger than mm (vs. 14.1 ± 1.1 mm in the CD-low group). At the same
those of the implant, the root-overlay, the two full-denture, and time, this bone height is more often associated with a knife-
the shortened-arch groups. It can be assumed that this difference edge ridge form with its inherent painful stimuli when loaded.
influenced oral function. However, comparisons between the This may have particularly limited this group's ability to exert
two complete-arch groups revealed that age affected only the bite forces. More advanced stages of resorption-as, for instance,
maximum bite force between the second premolars. The in the full-denture group (low mandible)-are infrequently
observation that an age difference of over nearly three decades accompanied by such a painful, knife-edge ridge.
hardly affected bite force and chewing efficiency allows for the Edentulous groups were clearly less efficient than subjects
comparison of the slightly younger complete-arch group (old) from the natural-dentition groups in breaking down the test
with the other groups without the need for an age correction. food. Although the edentulous groups had not chewed the food
It appeared that maximum bite forces in the implant group for 5 strokes, reductions in particle size after 10 chewing
were between those of the artificial- and natural-dentition groups. strokes were still so limited that one can infer that the dentate
Obviously, the improved retention and support of the mandibular groups were already way ahead in comminuting their food after
denture by dental implants allowed subjects to exert higher forces. 5 chewing strokes. Limitations in bite force, as well as stability
In subjects from the two full-denture groups, bite forces may have and retention problems of the denture, may explain the poor
been limited, due to the mandibular denture-bearing tissues being selection process in the denture wearers compared with the
more subject to compression, denture shifting, and resultant painful dentate subjects (Slagter et al., 1993).
irritation. In addition, subjects in the root-overlay group may have Chewing efficiency of the shortened-arch group was
received negative feedback from periodontal receptors as well as significantly less than that of the two groups with a complete
painful compression of the marginal gingiva of the remaining roots. natural dentition, although bite forces (maximum as well as during
The results of the chewing efficiency tests in subjects with chewing) in these three groups were comparable. The shortened-
mandibular implant-retained overdentures did not quite parallel the arch group's chewing efficiency data were in the same range as
bite-force data. Their chewing efficiency was even less than that of those from the full-denture (high mandible) and the root-overlay
subjects in the full-denture (high mandible) or root-overlay groups. groups. The impaired chewing efficiency of the shortened-arch
They probably had more problems with the process of particle group should be explained by the reduced occlusal contact area,
selection, since food comminution is the combined process of which reduces the quantity of food particles trapped between the
selection and breakage (van der Bilt et al., 1987; van der Glas et al., teeth. The loss of opposing posterior teeth significantly reduces
1987). This selection process may be disturbed by the depth of the chewing efficiency in a linear relationship to the number of
vestibular folds combined with the presence of a large bulky occlusal units (Van der Bilt et al. 1993b).
denture to compensate for the alveolar bone loss and restore the For the total group (all seven groups combined), chewing
vertical dimension of occlusion. Upon re-collection of the test food, efficiency significantly increased when higher bite forces were
particles were often retrieved from the mandibular buccal folds in exerted. A higher bite force leads to a better fragmentation of
the molar area. These particles may have escaped buccally from the the food particles trapped between the posterior teeth. The
occlusal surface during the chewing process to migrate further into correlation between maximum bite force and chewing efficiency
the depths of the buccal folds beyond control of the tongue. After (N 2) was significant for all groups combined. In the total group,
being chewed, particles were also found to remain labially under nearly half of the variation in chewing efficiency can be
the border of the mandibular denture and in the "dead space" that explained by bite force alone. In the separate groups, this
accommodates the bar-clip attachment. Furthermore, the efficiency correlation cannot be found for the implant and the full-denture
of subjects with mandibular implant-retained overdentures can also (low mandible) groups. In the implant group, a large variation
be limited by retention and stability problems of the maxillary exists in chewing efficiency as well as bite force (Fig. 4). Most
denture. This phenomenon was observed in several subjects who of the implant subjects have enough force to pulverize the food,


1 52,4 Fontiin-Tekamp et a/. J Dent Res 79(7) 2000
but are unable to manipulate it adequately between posterior an occlusal scheme for edentulous implant patients. Implant Dent
teeth, which leads to poor chewing efficiency. In the full- 1:204-211.
denture group (low mandible), the correlation was weak, Lindquist LW, Carlsson GE (1982). Changes in masticatory function in
probably due to the small number of subjects and the fact that, complete denture wearers after insertion of bridges on
for four subjects, values of N½ were set at 200 chewing strokes. osseointegrated implants in the lower jaw. In: Clinical applications of
From the present study, we conclude that the provision of biomaterials. Lee AJC, Albrektsson T, Branemark PI, editors.
dental implants cannot restore objective oral function of Chichester: John Wiley and Sons Ltd., pp. 151-155.
subjects with persistent problems wearing conventional Lindquist LW, Carlsson GE (1985). Long-term effects on chewing with
complete dentures to the level enjoyed by satisfied complete- mandibular fixed prostheses on osseointegrated implants. Acta
denture-wearers, as has been suggested. Unilateral bite forces Odontol Scand 43:39-45.
of subjects with overdentures on dental implants are between Locker D (1998). Patient-based assessment of the outcomes of implant
those of subjects with natural and artificial dentitions; chewing therapy: a review of the literature. Int JProsthodont 11:453-461.
efficiency is improved but not to the same level. Meijer HJ, Raghoebar GM, Van't Hof MA, Geertman ME, Van Oort RP
(1999). Implant-retained mandibular overdentures compared with
ACKNOWLEDGMENTS complete dentures; a 5-years' follow-up study of clinical aspects and
This work was supported by the Faculty of Medical Sciences patient satisfaction. Clin Oral Implants Res 10:238-244.
of the University of Nijmegen and The Netherlands Institute Mericske-Stern R, Hoflnann J, Wedig A, Geering AH (1993). In vivo
for Dental Sciences. The authors gratefully acknowledge the measurements of maximal occlusal force and minimal pressure
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