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Section 35 - Masticatory Efficiency
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Abstracts

001. Kapur, K. K., Soman, S. and Stone, K. The effect of denture factors on masticatory performance.


a. Part I: Influence of denture base extension. J Prosthet Dent 15:54-64, 1965.
b. Part II: Influence of polished surface contour of denture base. J Prosthet Dent 15:231-240, 1965.
c. Part III: The location of food platforms. J Prosthet Dent 15:451-462, 1965.
d. Part IV: Influence of occlusal patterns. J Prosthet Dent 15:662-670, 1965.
e. Part V: Food platform area and metal inserts. J Prosthet Dent 15:857-866, 1965.

002. Yurkstas, M. J. The masticatory act: A review. J Prosthet Dent 15:248-260, 1965.

003. Thompson, M. J. Masticatory efficiency as related to cusp form in denture prosthesis. JADA and Dental Cosmos 24:207-219, 1937.

004. Trapozzano, V. R. Testing of occlusal patterns on the same denture bases. J Prosthet Dent 9:53-69, 1959.

005. Wayler, A. H. and Chauncey, H. H. Impact of complete dentures and impaired natural dentition on masticatory performance and food choice in healthy aging men. J Prosthet Dent 49:427-433, 1983.

006. Rissin, L., House, J. E., Manly, R. S. and Kapur, K. K. Clinical comparison of masticatory performance and electromyographic activity of patients with complete dentures, overdentures, and natural teeth. J Prosthet Dent 39:508-511, 1978.

007. Gibbs, C. H., et al. Occlusal forces during chewing influences of biting strength and food consistency. J Prosthet Dent 46:561-567, 1981.

008. Kapur, K. K. and Garrett, N. R. 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 52:408-413, 1984.

009. Gunne, H. J. Masticatory efficiency and dental state. Acta Odontol Scand 43:139-146, 1985.

010. Gunne, H. J. and Wall, A. K. The effect of new complete dentures on mastication and dietary intake. Acta Odontol Scand 43:257-268, 1985.

011. Sandstrom, B. and Linquist, L. W. The effect of different prosthetic restorations on the dietary selection in edentulous patients. Acta Odontol Scand  45:423-428, 1987.

012. Michael, C.G. et al. Biting strength and chewing forces in complete denture wearers. J Prosthet Dent 63:549-553, 1990.

013. Wesley, R. C., Ellinger, C. W. and Somes, G. W. Patient response to variations in denture techniques, Part VI: Mastication of peanuts and carrots. J Prosthet Dent 51:467-469, 1984.

014. Gunne, H. J. The effect of removable partial dentures on mastication and dietary intake. Acta Odontol Scand 43:269-278, 1985.

015. Carlsson, G.E. Ten-Year Longitudinal Study of Masticatory Function in Edentulous Patients Treated with Fixed Complete Dentures on Osseointegrated implants. Int J Pros 7:448-453, 1994.

Section 34: Masticatory Efficiency


(Handout)


I. Definitions:

GPT-7; the effort required achieving a standard degree of comminution:

GPT-7: Masticatory Apparatus: see Masticatory system: The organs and structures primarily functioning in mastication. These include the teeth with their supporting structures, craniomandibular articulations, mandible, positioning and accessory musculature, tongue, lips, cheeks, oral mucosa, and the associated neurologic complex.

Gunne H-SJ: Masticatory efficiency has been defined as the capacity to grind food or a test material and is consequently only one component of mastication.



II. Muscles of Mastication:

These consist of the masseter, temporalis, lateral pterygoid, and medial pterygoid muscles.



Masseter Muscle

Action: Raises the mandible to occlude the teeth in mastication. Elevates the mandible, protracts the mandible with its superficial section and retracts the mandible with its deep section.

Nerve supply: Masseteric nerve of the mandibular division of the trigeminal (CN5)

Temporalis

Action: The anterior fibers elevate the mandible; the posterior fibers retract (retrude) the mandible.

Nerve supply: Posterior deep temporal branches of the mandibular division of the trigeminal nerve.

Lateral Pterygoid

Action: The Lateral pterygoid when assisted by the hyoid muscles contributes to jaw opening. All motion is by contraction of muscles: Bilateral contraction, the jaw is protracted and with unilateral contraction, the chin moves toward the opposite side. The left lateral pterygoid muscle moves the chin to the right as it pulls the left condyle forward.

Nerve supply: From anterior branches of the mandibular division of the trigeminal nerve.

Medial Pterygoid

Action: Assists in elevating the mandible

Nerve supply: Motor branch of the mandibular division of the trigeminal nerve.

Kapur: Comparison of masseter muscle activity, masticatory performance and salivary secretion between denture (AD) and natural dentition (ND) groups. Chewing a viscous food, like raw carrots, requires a horizontal chewing stroke with a grinding action and a greater activity of the elevator muscles, such as the masseter during vertical chewing strokes applied to peanuts. Although the muscle effort varied with the test food for ND group, denture wearers showed similar amounts of masseter muscle activity for chewing peanuts and carrots. Limitations? Reduced muscle force applied by denture patients. %

Was there a significant difference b/t the satisfactory denture group Vs the unsatisfactory group when carrots were chewed? No. Both were in the 51% range.

Does age or wearing dentures reduce salivary flow rate? No. Discuss



III. Masticatory function:

Yurkstas: The function of mastication is to prepare food for swallowing and the chewing ability to particle size a person was willing to swallow was called the "swallowing threshold." Do patients with diminished masticatory function chew their food longer to compensate for their handicap or perhaps on a preferred side?

First molars provided 36.7% of total effective masticatory area in complete dentures, 28% for the 2nd molars, 1st and 2nd premolars were 8% each of the total area. If one knows the occlusal contact area, is it possible to predict the masticatory performance with relative degree of certainty?

Kapur Part I: Denture retention ultimately lies in the degree to which it helps to restore functions. Two schools of thought:

(1) The denture should be extended as far as the physiologic tissue movements will allow. What was this concept based upon? Greater retention can be achieved through covering a larger area and creating a border seal. Stress is distributed over a larger area.

(2) That the denture border should be thin and sharp. Border seal and maximum extension is not necessary and maximum retention is not essential. What was essential? A point of optimum retention, which they say, can be reached through proper denture adaptation.

What did Kapur find? Reduction in the extension of the upper and lower denture bases failed to affect the chewing ability. Performance was reduced when extensive reductions were made on the lower denture base Vs both. Optimal retention can be achieved without an extreme peripheral extension of the denture bases for the border seal. However, additional retention seemed to provide greater confidence and security. Previous denture wearers showed a better ability to chew.

Kapur part II: Flat, concave and convex denture base contour modifications were made. Was there a significant difference found between them? No. All subjects chewed with a similar degree of effectiveness, regardless of the contour of the polished surface. Subjects with good ridges appeared to chew the food to a finer particle size for swallowing than subjects with poor ridges.

Kapur part III: There is a widespread controversy in the location of food platforms. Masticatory efficiency when chewing peanuts was reduced from 69 to 42% when upper and lower platforms were moved 4-mm. bucally to their original position on the crest of the ridge in patients with good ridges Vs patients with flat ridges. How do we explain this? In patients with good ridges, the dentures with a buccal location of posterior teeth exert masticatory forces outside the crest of the ridge which becomes used as a fulcrum with a longer leverage arm, this tends to unseat the denture on the side opposite to that of the chewing side. The dentures become unstable and patients feel like the denture lifts on the opposite side or that food slips underneath the denture base on the opposite side during chewing.

Kapur part IV: Kapur investigated the performance of 12 different occlusal patterns. What did determine?

Posterior teeth with occlusal markings were more effective in pulverizing the test foods than those with no occlusal markings. The presence of a longitudinal groove on the occlusal surfaces of the lower teeth opposed by teeth with transverse or oblique grooves significantly improved the patients ability to pulverize raw carrots. Peanuts showed no masticatory differences whereas carrots distinguished from the occlusal markings that resulted in improved performance. Performance ratios were higher in the experienced denture wearer and in the good ridge group Vs poor ridge group. That the occlusal design of natural teeth may secure three important functions: (1) Buccal lingual cusp inclines confine food, (2) the same cusp inclines provide resistance against displacement of food during mastication and, (3) the mesial and distal cusp inclines seem to provide stability for the mandible when pressure is exerted during closure.

Kapur part V: Food platform area and metal inserts. Improved cutting efficiency of non-anatomic teeth with metal inserts (Hardy advocated) were investigated. What did Kapur confirm from his findings? Masticatory efficiency improved when the metal inserts were exposed.



IV. Masticatory forces:

Gibbs: Force changes throughout the chewing series from the time the food entered the mouth until it is swallowed. Foods of different consistencies were compared separately to give additional insight into the masticatory system’s adaptation to variations in the consistency of the bolus.

What did Gibb find in the three phases (closing, occlusal IP, and opening phases) demonstrated?

Comparison of biting strength with lowest occlusal force (55-120 lb.) to subjects with greatest occlusal force (210-280) showed that the strong group used more force in the occlusal phase 92.1 Vs 43 lbs. But forces in the closing and opening phases showed no significant differences. Forces were greater for hard foods than for soft foods, but decreased throughout the chewing series. Haraldson reported that chewing forces in complete dentures were 1/5 of that produced by natural dentition.

Michael: Maximum bite strength of denture wearers averaged 35lb, with a range of 22-47lb and states that denture wearers have only about 1/5th the bite strength as compared to natural dentition. Was there any significant difference in the chewing forces between the 0 and 30 degree posterior tooth forms? No.

What did he find during closure on the working side force? Chewing forces were 8 times greater on the working side than the non-working side for both hard and soft foods. Forces were greater for hard food peanuts and carrots than for soft foods (cheese).

Carsson, Rissin, Gunne,: How does mastication forces of natural teeth compare to , RPD, OVD, CD and CDOIs?

Natural dentition: (Carrots) 90% performance


CD/RPD: Varied between 80 and 83% efficiency
CD/OVD: Carrots 79% performance
CD/CD: Carrots 59%
CD/CDOI: Tissue integrated prosthesis showed significant improved performance
CDOI/CDOI: Same performance as CD/CDOI but patient was convinced they were fully rehabilitated
Did the CD/CDOI patient after receiving a maxillary CDOI have a greater ability to function? No. Psycho…

V. Chewing efficiency:

Thompson: Tooth selection may effect the quality of the patient’s ability to effectively masticate food, what did Thompson believe to be important? In the selection of artificial teeth we should never select tooth form on what we are comfortable with or what may be easier to fabricate. It is necessary to understand the fundamentals of posterior tooth selection based on efficiency both from the tooth selected and the patient capabilities. Teeth with poorly carved occlusal surfaces will not give the patient satisfaction and ease of mastication. Many believe that the non-anatomic teeth produce less lateral pressure upon the ridges and thus the alveolar rides are preserved for longer periods of time. Has this been proven? No. Controversy

Trapozzano: Greater efficiency with 20 degree posterior teeth during mastication indicated that sharpness of the occluding surfaces was the determining factor, and more patients preferred the 20 degree teeth over the Hall’s posterior teeth. The Hall’s posterior teeth produced more soreness during the adjustment period and indicated that the more blunt surfaces and lack of spillways, necessitated a greater amount of lateral forces applied by the patient to penetrate and grind the food to a finer size. How could this effect the alveolar ridges?

What did they like about the Hall’s posterior teeth? They felt better/smoothness of the occluding surfaces, but they were not the patient’s final choice in denture selection.

It was significant that all the patients who showed preference for the 20-degree teeth had ridges that were unfavorable. Preference for the 20-degree teeth may be attributed to the greater ease of mastication because of the relative sharpness of the teeth to grind and ultimately produce fewer forces to the alveolar ridges.

VI. Nutrition/Dietary intake:

Wayler: The swallowing Threshold Test Index (masticatory performance) score indicated that dental integrity was the prime regulator of performance. Impaired mastication was due to complete dentures or unreplaced missing teeth, resulting in lower performance scores. Did age alter functional capability of patients with complete dentures? No. People chew preferentially to compensate for a decline in masticatory function. Denture wearers may prefer softer, easier to chew foods, which may or may not meet daily nutritional needs. But how often do we hear our patients say that they want to eat normal foods and not be restricted to just eating soft foods? Often…

Sandstrom: Observation of dietary intake before treatment and new CD/CD showed no significant differences in dietary intake. After treatment of TIPs there was a slight increase in the consumption of fresh fruit and crisp bread. Did the treatment received influence the diet to any considerable extent? No.

Gunne: Dentures with good retention/stability and balanced occlusion/articulation increase the masticatory ability of the patient. Did the new dentures have an influence on dietary factors as well? No. See Table 1 on page 259 for discussion.

Improved masticatory ability did not motivate patients to change their dietary intake and low masticatory efficiency was not an indicator that dietary intake was below the recommended values.

Old proverb say: If there is a will there is a way, to chew even the most difficult foods, when the patient wants to eat it badly enough!

- Abstracts –

34-001a. Kapur, K.K., Soman, S. and Stone, K. The effect of denture factors on masticatory performance. Part I: Influence of denture base extension. J Prosthet Dent 15:54-64, 1965.



Purpose: To evaluate the effect of reducing the denture extension (ultimately the retention) on masticatory performance.
Method and Materials: 12 edentulous patients had CD/CD fabricated with non-anatomic acrylic resin teeth on a flat plane. After all the dentures had been adjusted and no problems were noted, the variables for the test began. Autopolymerized denture acrylic was used to modify the denture base forms in 16 different ways. The test subjects were seen once a week and masticatory tests were done on the form the patient wore that week, denture restored to original form, and the denture form to be worn the following week. These tests were conducted 13 times.
Results: The masticatory performance did not show significant differences with control denture form over the different settings. One weeks use of a denture base form did not affect the masticatory performance. The change in denture form did not influence the chewing ability or the size of the food particles swallowed. Subjects did chew better on their preferred side than the right side, but was not statistically significant. Subjects did not chew more strokes to compensate for poor masticatory efficiency, personality and habitual patterns may have been the influence. Poor ridge formation did not significantly effect the results. Previous denture wearing experience did have an effect on performance. Extensive reduction in the denture base failed to effect the chewing ability.
Conclusions: Significant reductions in performance occurred only when the lower denture base extension was severely modified with no modification done to the upper denture. Previous denture wearing experience did have an effect on masticatory performance.

34-001b. Kapur, K K et al. The effect of denture factors on masticatory performance. b. Part II: Influence of polished surface contour of denture base. J Prosthet Dent 15: 231-240, 1965.



Purpose: To determine what influence the configuration of the polished surface of the denture has on the denture efficiency.
Materials and Methods: Ten (5 men, 5 women) edentulous subjects were selected from the Tufts University dental clinics. 5 patients had prior denture experience and 5 did not. Hardy technique with a final wax-up modification was used for denture fabrication. Each patient was seen for a period of 2-3 weeks after delivery of dentures, and after dentures were comfortable the occlusion was rechecked with an intraoral central bearing point. Casts were poured in the upper and lower dentures, and the borders of dentures were carefully registered. Flat and convex acrylic resin forms with steel pins which could be overlayed on the original denture surface, p were constructed in segments for the buccal, labial, and lingual surfaces of the dentures. Grooves were made in a segment of denture base and steels pins were inserted. Sprinkled resin was placed on top and denture was refined with acrylic finishing points. Two sets of 9 acrylic resin forms (1 set with a flat contour, and 1 set with a convex contour ) were made for each subject. The upper denture could be completed altered with 5 overlays, and the lower with 4 overlays. A protocol was used for testing where 840 masticatory performance tests were conducted for these 10 patients.
Conclusions: No significant variations appeared in the ability of subjects to chew with different denture forms. However, evidence of marked improvement in masticatory performance appeared among individual subjects with different denture forms. This suggested that polished surface denture contour may be an important factor influencing the efficacy of the food transporting mechanism and thereby affecting masticatory function. Subjects with good ridges performed better than subjects with poor ridges.

34-001c. Kapur, KK, Soman, S, and Stone, K. The effect of denture factors on masticatory performance. Part III: The location of food platforms. J Prosthet Dent 15:451-462, 1965.



Purpose: To evaluate the influence of the location of the food platform on the masticatory performance of dentures.
Methods & Materials: 1480 masticatory performance tests were performed on 12 denture wearers to determine the effect of 9 positions of food platforms in the dentures on their chewing efficiency. Positions of the food platforms varied in three positions: buccal-lingual, superior-inferior, and anterior-posterior inclinations. All possible combinations were tested. Carrots and peanuts were used as the food source.
Results: The most effective location was on the crest of the ridge, at the height of the lower canine, and parallel to the flat portion of the mandibular ridge. The least efficient position was buccal to the crest of the ridge and this was found to be more detrimental to the patients with good ridges.
Conclusion: The most effective position is the one recommended by Sears and Hardy who position the teeth on the crest of the lower ridge, parallel to the ridge, and at the height of the lower canine.

34-001d. Kapur, K., The Effect of Denture Factors on Masticatory Performance, Part IV. Influence of Occlusal Patterns. J Prosthet Dent 15:662-670, 1965.



Purpose: to determine the influence of occlusal patterns on the masticatory performance of complete dentures.
Fifteen different occlusal patterns were tested. Peanuts and raw carrots were used.
     Subjects performed the masticatory tests for each pattern on the right and left sides separately.
      Variations between the performance ratios of the right and left side tests are insignificant. The denture wearers were able to chew food on their two sides with equal effectiveness. The average masticatory performance ratio for peanuts is hardly affected by different occlusal patterns.
     Certain occlusal patterns are more effective than others in comminuting raw carrots.
     With each pattern, performance ratios of the good ridge group were slightly higher than those of the poor ridge group. The variations between the two groups were insignificant.
     Performance ratios were slightly higher for the experienced group of denture wearers than for the inexperienced group. However, the variations in the performance ratios between the two groups were statistically insignificant.
     Three of the four most effective patterns in this study, showed a longitudinal groove either on the upper or the lower occlusal surface and were always opposed by a grooved pattern. It is possible that the longitudinal groove provides resistance against buccal and lingual displacement of the food from the food platform during the completion of the masticatory stroke. The occlusal markings do not seem to act as cutting edges, as there appeared to be no correlation between patterns having a greater number of cutting edges(grooves) and the masticatory performance ratio.
     The findings of this study support the thinking of those clinicians who recommend recarving occlusal anatomy on posterior teeth after occlusal equilibration.
Summary: Posterior teeth with markings on the occlusal surfaces were found to be more effective in improving masticatory performance than teeth without occlusal markings. The presence of a longitudinal groove on the occlusal surfaces of the lower teeth and opposed by teeth with transverse or oblique grooves significantly improved the subjects ability to pulverize raw carrots.

34-001e. Kapur KK, Soman S., Stone K. The effect of denture factors on masticatory performance. Part V: Food platform area and metal inserts. J Prosthet Dent 15: 857-866, 1965.



Purpose: to study the effect of masticatory performance of denture factors such as food platform area, contour of buccal and lingual surfaces of the teeth and the use of occlusal metal inserts
Materials and Methods: Sixteen denture wearers who took part in the previous study also participated in this study, and they wore their complete dentures for 14 or more weeks. These dentures had as their posterior teeth , designed resin blocks with flat occlusal surfaces. Two sets of variables were tested, the first dealt with the food platform area and contour of the buccal and lingual surfaces, and the second involved the occlusal metal inserts. All changes involved both sides of the upper and lower dentures.
Results and Discussion: Contrary to natural teeth, changes in the anteroposterior position of the food platform area did not affect the average masticatory performances of dentures wearers. The denture wearers were able to masticate their food with equal effectiveness, regardless of food platform areas of 2, 3, or 4 posterior teeth. It seems that denture wearer can masticate their food more effectively when the food platform area is limited. The contouring of buccal and lingual surfaces in monoplane teeth, did not improve the masticatory effectiveness, The presence of occlusal markings (in the form of grooves or inserts) on posterior teeth significantly increased their ability to chew raw carrots. When the subocclusal surface of the metal inserts was reduced, there was a significant reduction of masticatory performance with peanuts.
     The findings in this study seem to indicate that the ability of the denture wearer to place the food on the food platform during chewing is more important than the mechanical cutting ability of the chewing element. It seems that the limitations in chewing ability of denture wearers is not due to substitution of artificial teeth but because the dentures make the food transporting system of the oral cavity less effective.

34-002. Yurkstats, M.J. The Masticatory Act: A Review. J Prosthet Dent 15:248-260, 1965.



Purpose: A review of the act of mastication and laudatory available as to specific aspects.

Discussion: Effect of impaired masticatory function: Dental restorative procedures should be designed to maintain the maximum amount of masticatory capacity.
     Reduction of particle size of foods: Different emphasis as to the mechanism of reduction of particle size of foods in preparation for swallowing.
     Quality of test foods: There were a lot of questions as to which food is best to determine the chewing ability, some food can be easily handled by denture such as salami, others may be more difficult.
      Mouth as a double organ: Stems from the discussion of two jaws, and the fact that chewing can be done on one side then another as well as only on one side.
     Chewing efficiency of each side of the mouth: 50 individuals were used to evaluate preference for chewing side. Most preferred to use the more efficient side, however if pathosis or discomfort was found on the more efficient side they would shift to the more comfortable side.
     Range of performance: Considerable discussion as to why one half of the dentition was more efficient than the other. The more missing teeth, the more difficult it is to guess how the remaining teeth will function. Loss of teeth generally resulted in a decrease in the average of masticatory performance, by tremendous variability was occurred.
     Occlusal contact area: occlusal contact area is the most important factor controlling masticatory performance with natural teeth. In evaluation of 100 subject great variability of occlusal contact area was noted with same numbers of teeth.
Conclusion: Mastication is dependent upon many variable and each may react differently in each individual.

34-003. Thompson, M.J. Masticatory efficiency as related to cusp form in denture teeth. JADA and Dental Cosmos 24:207-219, 1937.



Purpose: Most denture tooth tests looked at the function in relation to the cuspal form. This study concentrated on the efficiency with which various cusp forms masticate.
     Most denture tooth tests looked at the function in relation to the cuspal form. This study concentrated on the efficiency with which various cusp forms masticate.
Methods and materials: Two patients were made four dentures. The first denture had anatomic teeth and was first made to fit poorly. The first denture was then rebased to fit the ridges fairly accurately and re-tested. Finally, the first denture was modified to exhibit proper balance and coordination and tested once again. The second denture had 20 degree teeth, the third, cusp-less teeth and the fourth, Sears channel teeth. Five tests with six different foods (carrots, lettuce, cabbage, ham, celery, and apples) were run with each denture. The patient was allowed to chew ten times and the food particles were expectorated into a series of sieves. The sieves had varying degrees of fineness to the mesh. Efficiency was measured by the ability of the food particles to pass through successively smaller meshes.
Results: The first denture, unbalanced and in an incorrect CR, was very uncomfortable and thus inefficient for the patients. Efficiency improved 77% as the balance and base stability increased. The 20 degree teeth were only slightly less efficient than the 33 degree. The Sears channel teeth were frustrating to the patients as they felt they couldn’t grasp the food with them. The cusp-less teeth were very favorable besides being less esthetic and having some food collect in the occlusal surfaces.
Conclusion: Maximum chewing efficiency was attained when pressure was equally distributed over the ridges and the cutting edges of the cusps were coordinated with the opposing cusps. 33 degree, 20 degree and rational teeth all had favorable efficiency. Natural teeth have five times the crushing power but artificial teeth can provide nearly 75% of the efficiency of natural teeth. Denture tooth designs should concentrate on efficiency as well as function.

34-004. Trapozzano, V.R. Testing of Occlusal Patterns on the same Denture Base. J Prosthet Dent 9: 53-69,1959.



Purpose: To test patient reaction to and the relative efficiency of two types of posterior occlusal patterns: (1) the 20 degree posterior tooth and (2) the Hall’s posterior tooth. This investigation was setup to make a controlled study of he tooth forms.
Materials & Methods: Test denture bases with interchangeable inserts with two types of posterior teeth were made. Subjective observations of the 8 patients were recorded along with objective observations, chewing efficiency tests, and a correlation with the ridge conditions.
Results:
1. The subjective responses of the patients indicated that there was a greater preference for the 20-degree than the Hall’s teeth.
2. A substantial number of the patients liked the feel of he Hall’s teeth even though their final choice was the 20-degree teeth.
3. The Hall’s teeth produced more soreness during the adjustment period than did the 20-degree teeth.
4. The 20-degree teeth showed a definite indication of greater efficiency when chewing peanuts. When the overall diet was considered, the 20 degree teeth dad the greater efficiency.
Conclusions:
1. The relatively greater efficiency of the 20 degree posterior teeth during mastication indicates that sharpness of the occluding or masticating surfaces was the determining factor, and probable the reason for the greater number of patients who preferred this type of tooth.
2. The fact that the Hall’s posterior teeth felt better to a significant number of patients at times other than when they were engaged in the mastication of food, and even though the Hall’s teeth were not their final choice, it indicates that the relative smoothness in the occluding surface was probably the responsible factor.

34-005. Wayler, A.H., and Chauncey, H.H., Impact of complete dentures and impaired natural dentition on masticatory performance and food choice in healthy aging men. J Prosthet Dent 49:427-433, 1983.



Purpose: To evaluate the effects of aging, missing teeth and prosthodontic replacements on masticatory efficiency and food selection.
Methods and materials: 814 men were divided into four categories based on dentition and then divided into three age groups as follows: Dentition: 1) intact, 2) partially compromised 3) compromised 4) complete dentures; Age: 1) Under 40 2) 40-49 3) 50+ Masticatory performance was measured using raw carrots chewed to the point of swallowing and the number of chewing strokes required to reach that point. Also, subjective food acceptability was determined by survey using 13 different foods, based on perceived ease of chewing and frequency of ingestion, rated numerically on a scale of 1-4.
Results: The data reveals that age had no effect on masticatory performance and that complete denture patients performed at the lowest level. Partially compromised and compromised patients chew preferentially to compensate for a unilateral decline in masticatory function. The number of chewing strokes increased with the increased number of missing teeth. Subjects with complete dentures had a very low perceived chewing ease response regardless of age or the number of chewing strokes. It appears that a generalized decline in oral sensory perception occurs in the presence of complete dentures ant estimates of food acceptability may be dependent on the textural and tactile characteristics of the food.
Conclusion: There is a decrease in masticatory performance in complete denture subjects as compared to intact and partially dentate subjects. The complete denture subjects' food selection patterns shift to softer and easier to chew foods.

34-006. Rissin, L., House, J. E., Manly, R. S. and Kapur, K. K. Clinical comparison of masticatory performance and electromyographic activity of patients with complete dentures, overdentures, and natural teeth. J Prosthet Dent 39:508-511, 1978.



Purpose: to study whether the proprioception inherent in overdenture patients gives them functional advantages over complete denture patients.
Methods and Materials: 29 veterans divided into three groups. Group I consisted of 10 dentulous patients who ranged from 46 to 58 years of age, with at least 28 natural teeth.
     Group II consisted of 10 edentulous patients who ranged from 43 to 69 years of age, and wore complete upper and lower dentures. Group III consisted of 9 overdenture patients who ranged from 46 to 62 years of age and wore both complete upper dentures and lower overdentures with at least two abutments. The patients were selected on the basis of: (1) satisfaction with the dentures; (2) adequate retention and stability; (3) adequate denture-base extension; (4) flat-plane occlusal scheme with non-anatomic teeth; (5) satisfactory vertical and horizontal relationships; (6) good ridge shape and consistency of soft tissues of the basal seat; (7) no need for denture adhesives; and (8) absence of inflammation or pathologic lesions of the oral tissues. A masticatory performance test using carrots was given to each patient three times by an accepted method.
      The chewing test used electromyograms. Performance was measured by giving each patient 3gm of carrots to be chewed with 40 strokes. The chewed test foods were passed through graduated sieves ranging in mesh size from 5 to 140. Masticatory performance was defined as the ratio of the volume of particles passing through a No. 12 sieve to the total volume of particles recovered.
Results: Patients with natural teeth had the highest score (90%), followed by the overdenture patients (79%), and the complete denture patients (59%).
The physiologic advantages of overdentures are:
1. An increased stability of the prosthesis, which lessens trauma to the supporting soft tissues of the basal seat.
2. The maintenance of periodontal proprioception, giving the patient an increased ability to perceive interocclusal thickness and awareness of maxillomandibular relationships.
3. The preservation of the alveolar process adjacent to the teeth retained under the prosthesis, thereby lessening the rate of resorption of the basal bone used for denture support.
Conclusion: The findings provide sound justification for the extra effort required to retain some natural teeth to provide overdenture services to patients.

34-007. Gibbs, C H, et al. Occlusal Forces during chewing influences of biting strength and food consistency. J Prosthet Dent 46:561-567, 1981.



Purpose: To compare chewing force characteristics in subjects with low and high biting strength values.
Materials and Methods: Occlusal forces during chewing were measured with a sound transmission system. Twenty subjects with good occlusion were given cheese, raisins, bread, beef, carrots, and gum to chew unilaterally then shallow. The data was partitioned into three biting strength groups, 1) low, 2)intermediate, and 3) high; the occlusal force and duration characteristics of chewing were tested statistically between the low and high groups only. The chewing cycle was divided into three phases; 1) closing 2)occlusal contact (IP), and 3)opening.
Results/ Conclusions:
- Forces were greatest during the IP phase of chewing and least during opening.
- Forces during closing and IP were greater for hard foods than for soft foods
- As the chewing series progresses to swallowing, the closing force decreases and the IP force and duration increases.
- The high biting strength subjects demonstrated a higher force in the IP phase and a decreased time duration from closing to IP high force when compared to the low biting strength subjects.

34-008. Kapur, K.K., and Garrett, N. R. 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 52:408-413, 1984.



Purpose: Determine the influence of muscle activity on masticatory performance and salivary secretion rates by comparing the masseter muscle activity of denture wearers with that of subjects with natural teeth while they chewed test foods or a test material.
Method & Materials: 18 complete denture patients (9 with satisfactory dentures and 9 unsatisfactory dentures) and 8 fully dentate patients were compared. EMG readings of right and left masseter muscles were taken; masticatory tests were made for right and left chewing peanuts and carrots, and parotid gland secretions rate tests were done.
Results: The denture quality did not significantly effect the masticatory performance, salivary secretion rates, or EMG activity. EMG activity was higher in the dentate group than the denture group. Right side chewing had higher ipsilateral muscle activity per chewing stroke than the left side chewing in all the groups. Whole saliva secretion rates were higher in the dentate patients but it was not statistically significant. Denture wearers applied 22-39 % of the muscle force applied by the dentate patients to chew peanuts or carrots.
Conclusions: Dentate patients tend to chew peanuts in a vertical stroke which causes EMG readings to be steep, short lasting and high in amplitude. Carrots are usually chewed in a horizontal stroke. Denture wearers tend to chew foods in a vertical stroke to seat the dentures and are taught to chew bilaterally. These chewing differences may have influenced the data. Saliva rates may have been influenced by the presence of the dentures despite the decreased muscle activity and loss of periodontal ligament receptors.

34-009. Gunne, H.J. Masticatory Efficiency and Dental State. Acta Odontol Scand 43: 139-146, 1985.



Purpose: To measure the masticatory efficiency of individuals with different dental status utilizing two methods.
Materials & Methods:
1. Materials consisted of four groups: Group A and D had full natural dentition; Group B had a maxillary denture opposing a lower RPD (Kennedy Class I); group C had a complete set of dentures.
2. Masticatory efficiency was measured in 2 ways: (1) masticated almonds were fractionated in a sieve system. (2) A 22mm gelatin cube, after mastication, was assessed by calculating the area of gelatin particles through diffusion of a water-soluble dye into the gelatin. The ratio of dye absorption to area was calculated by placing gelatin particles with known area in the dye solution.
3. Test subjects were in the upright position when chewing on 10 test pieces of gelatin. The number of chewing strokes until swallowing was calculated as was the chewing time.
4. When almonds were chewed, the first one was chewed and swallowed. The second, third and fourth were chewed for 10,20, and 40 seconds, respectively.
5. Group D was tested one week later using the same testing methods as on the first testing occasion.
Results:
1. Gelatin
- the chewing efficiency, regardless of the number of chewing strokes, found Group A> Group B> Group C.
2. Almonds - the chewing efficiency for Group A and D > Group B> Group C.
Conclusion:
1. Complete dentures and removable partial dentures cannot re-establish masticatory efficiency to the level of fully dentate individuals.
2. Patients try to compensate for the impaired efficiency by chewing longer.
3. Subjects with removable partial dentures compensated for the decreased masticatory efficiency by more chewing strokes.
4. Complete denture wearers often use 30 strokes before they feel ready to swallow.

34-010. Gunne, H. J., Wall, A. K. The Effect of New Complete Dentures on Mastication and Dietary Intake. Acta Odontol Scand 43:257-268, 1985.



Purpose: To investigate how transition from old to new complete dentures affects masticatory efficiency, the subjective experience of masticatory performance, and the dietary intake and to analyze the relationships between these variables.
Materials and Methods: 43 subjects, who were provided with new complete dentures, were tested on three occasions: with the old complete dentures, with the new complete dentures when free from symptoms, and with new complete dentures approximately 4 months after insertion. Masticatory efficiency was evaluated using two different types of test materials:
1. gelatin hardened with Formalin
2. almonds.

The subjective experience of masticatory performance was assessed by two methods:


1. In the clinic, the subjects chewed four foodstuffs (apple, carrot, hard bread, almond) and a piece of gelatin.
2. The subjects were asked how they assessed the chewing of 45 listed foodstuffs in a questionnaire.

A 4-day dietary record was kept by the subjects, who were carefully instructed to note all intake of food.



Results: Masticatory efficiency and the subjective experience of masticatory performance increased significantly when the subjects were provided with new dentures. No changes were noted in the dietary intake.
Conclusion: Prosthetic treatment with new complete dentures implies better chewing comfort, but it does not seem to be enough to change the dietary habits of the subjects, at least not in the short-term perspective studied in this investigation.

34-011. Sandstrom, B. and Lindquist, L.W. The effect of different prosthetic restorations on the dietary selection in edentulous patients. Acta Odontol Scand 45:423-428; 1987.



Purpose: To compare the diet of the complete denture patient with the diet of the same patient treated with a tissue integrated prosthesis.
Subject: A longitudinal study of patients initially treated with complete dentures and finally with tissue integrated prostheses.
Methods and materials: Twenty-three patients were initially given complete upper and lower dentures for at least one year. Each was then treated with a tissue integrated implant prosthesis for the lower jaw. Seven different food recordings were made for each patient throughout the treatment regimen. Changes in dietary selection were evaluated from 4-day records obtained before prosthetic treatment, and on six occasions up to 78 months after treatment.
Results: No significant changes in food selection were recorded during the rehabilitation period, except for a slight increase in intake of crisp bread and fresh fruit after treatment with tissue integrated prosthesis in the mandible.
Conclusion: Improved oral function will not in itself lead to a change in dietary selection. Dietary changes probably require professional and individually given dietary advice by a trained dietitian.

34-012. Michael, C.G. Javid, N.S., Colaizzi, F.A., Gibbs, C.H. Biting strength and chewing force in complete Denture wearers. J Prosthet Dent 63:549-553, 1990.



Purpose: This study compared occlusal forces during chewing in denture wearers having two interchangeable occlusal schemes of artificial posterior teeth – teeth without cuspal inclines and teeth with 30 degree cuspal inclines. Also to compare chewing forces and the maximum biting strength of complete denture wearers to corresponding measurements in natural dentition subjects.
Material and methods: Five subject with residual ridges of favorable morphology, firm mucosa, and a class I skeletal jaw relationship were chosen. Complete denture with interchangeable segment were 30 degree and rational teeth. A transducer adjacent to the first molar and canine on the right side were wired to the opposite arms of a four-arm bridge so that outputs were additive. EMG data were recorded with surface electrode over the masseter, temporalis, and anterior digastric-mylohyoid muscles. Recording were recorded after the subjects chewed two soft foods (cheese) and two hard foods (one peanut and one carrot).
Results: The maximum biting strength of the five denture wearers averaged 35 lb., with a range of 22 to 47 lb. No statistical difference were found between the two posterior denture tooth types. During closure, the working side force was eight times greater than the force on the non-working side.
Conclusion: Chewing forces were greater for harder food than for softer food. Uncomfortable spots greatly reduced chewing force. The force at occlusion during chewing averaged 9.8 lb. The closing force during chewing averaged 4.6 lb. The biting strength of natural dentition is 162 lb. The biting strength of denture wearers is 29.3 lb.

34-013. Wesley R. Patient response to variations in denture techniques. Part VI: Mastication of peanuts and carrots. J Prosthet Dent 51:467-469, 1984.



Purpose: to determine if significant differences in masticatory performance exist between two groups of persons using dentures made with two different techniques.
Materials and methods:
      Complex technique - teeth arranged in balanced occlusion, lab remount, another CR record, occlusion adjusted on the articulator.
     Standard technique - facebow not used, no attempt to balance, dentures were returned to the articulator and occlusal corrections made in CR.
      64 patients at annual visits chewed peanuts and raw carrots on the left and right sides.
Summary: Statistical analysis of the two groups revealed changes in masticatory ability over the 5 year period. There was no explanation for the apparent rise in percent of food masticated over the first 4 years followed by a drop at year 5. However, no significant statistical differences in masticatory ability existed between the two groups.

34-014. Gunne, HJ. The effect of removable partial dentures on mastication and dietary intake. Acta Odontol; Scand 43:269-278, 1985.



Purpose: To investigate the effects of bilateral mandibular free-end saddle denture on masticatory efficiency (ME), the subjective experience of masticatory performance (SP), and dietary intake (DI).
Materials and Methods: Nineteen patients were treated for a removable partial denture in 1982. All cases were in the lower arch, Kennedy Class I. Masticatory efficiency was measured in two ways, the first method required the patient to chew Formalin-hardened gelatin and the second method involved chewing almonds.
Results and Discussion: Masticatory efficiency improved in a statistically significant manner after insertion of the RPD, the improvement was more obvious with the gelation method than with the chewing of almonds. One of the reasons may be that the texture of almond is hard compared with the gelatin and the patient may have preferred to chew almonds with their front teeth, which has a comparatively small area of occlusal table. These improved results of masticatory efficiency indicated that the patients used their RPDs to a great extent.
     However the improved masticatory ability did not motivate the subjects to change the dietary intake, which seemed to be influenced by other factors.
Conclusion: This study has shown that a bilateral free-end RPD in the lower jaw had a positive effect on the masticatory efficiency and the experience of masticatory performance but did not have much of a effect on dietary intake.

34-015. Carlsson, GE. Ten year longitudinal study of masticatory function in edentulous patients treated with fixed complete dentures on osseointegrated implants. Int J Pros 7:448-453, 1994.



Purpose: To follow a number of edentulous patients over a ten year period after treatment using mandibular fixed complete denture prostheses retained by osseointegrated implants, and to subjectively and objectively evaluate masticatory function at various periods following therapy.
Methods & Materials: 33 edentulous patients who had receive a mandibular fixed complete denture were followed for 10 years. Masticatory ability, occlusal force, masticatory efficiency, and patient satisfaction were evaluated at various recall periods of 3, 6, and 10 years. The patients evaluated masticatory ability as much better, somewhat better, unchanged, or worse. Occlusal force was recorded by an apparatus using strain gauges. Masticatory efficiency was evaluated using almonds for chewing.
Results: Occlusal force increased from a value of 80 N with conventional dentures to 240 N with the fixed restoration. Masticatory efficiency increased with placement of the fixed prosthesis. Subjective evaluation of masticatory efficiency showed an increase after receiving the mandibular fixed restoration.
Conclusion: Placement of a mandibular fixed complete denture on osseointegrated implants in a dissatisfied complete denture wearer led to a rapid and dramatic improvement of masticatory function that was acceptable for many patients. This improvement persisted in the long term perspective. Some patients, however, demanded a further treatment, including a maxillary CDOI, to experience a satisfactory rehabilitation. The gain for the group receiving a maxillary CDOI was mainly psychological, as the functional tests showed only minor improvement after the maxillary implant treatment.


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