Assessment of swallowing and masticatory performance in obturator wearers: a clinical study
Identifieur interne : 002F08 ( Pmc/Corpus ); précédent : 002F07; suivant : 002F09Assessment of swallowing and masticatory performance in obturator wearers: a clinical study
Auteurs : Nungotso Vero ; Niraj Mishra ; Balendra Pratap Singh ; Kamleshwar Singh ; Sunit Kumar Jurel ; Vijay KumarSource :
- The Journal of Advanced Prosthodontics [ 2005-7806 ] ; 2015.
Abstract
To assess function by identifying changes in swallowing and masticatory performance in maxillary obturator prosthesis wearers.
Sixty subjects were recruited for the study, of which 20 were obturator wearers, 20 were completely dentulous and 20 had removable partial/complete dentures with similar Eichner's Index. Swallowing ability was evaluated with and without obturator using the "Water Drinking Test"; Masticatory performance was evaluated with the Sieve test; and maximum occlusal force was recorded with the help of a digital bite sensor. The data was analyzed using the Statistical Package for Social Science version 15.0 with a confidence level at 95%.
Profile, behavior of drinking and time taken to drink were significantly improved (
Swallowing ability was significantly improved after wearing obturator but masticatory performance was not significantly different from those having similar occlusal support zone in their dentition.
Url:
DOI: 10.4047/jap.2015.7.1.8
PubMed: 25722831
PubMed Central: 4341192
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PMC:4341192Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Assessment of swallowing and masticatory performance in obturator wearers: a clinical study</title><author><name sortKey="Vero, Nungotso" sort="Vero, Nungotso" uniqKey="Vero N" first="Nungotso" last="Vero">Nungotso Vero</name><affiliation><nlm:aff id="A1">Department of Prosthodontics, Faculty of Dental Science, King Georges Medical University, Lucknow, India.</nlm:aff></affiliation></author><author><name sortKey="Mishra, Niraj" sort="Mishra, Niraj" uniqKey="Mishra N" first="Niraj" last="Mishra">Niraj Mishra</name><affiliation><nlm:aff id="A1">Department of Prosthodontics, Faculty of Dental Science, King Georges Medical University, Lucknow, India.</nlm:aff></affiliation></author><author><name sortKey="Singh, Balendra Pratap" sort="Singh, Balendra Pratap" uniqKey="Singh B" first="Balendra Pratap" last="Singh">Balendra Pratap Singh</name><affiliation><nlm:aff id="A1">Department of Prosthodontics, Faculty of Dental Science, King Georges Medical University, Lucknow, India.</nlm:aff></affiliation></author><author><name sortKey="Singh, Kamleshwar" sort="Singh, Kamleshwar" uniqKey="Singh K" first="Kamleshwar" last="Singh">Kamleshwar Singh</name><affiliation><nlm:aff id="A1">Department of Prosthodontics, Faculty of Dental Science, King Georges Medical University, Lucknow, India.</nlm:aff></affiliation></author><author><name sortKey="Jurel, Sunit Kumar" sort="Jurel, Sunit Kumar" uniqKey="Jurel S" first="Sunit Kumar" last="Jurel">Sunit Kumar Jurel</name><affiliation><nlm:aff id="A1">Department of Prosthodontics, Faculty of Dental Science, King Georges Medical University, Lucknow, India.</nlm:aff></affiliation></author><author><name sortKey="Kumar, Vijay" sort="Kumar, Vijay" uniqKey="Kumar V" first="Vijay" last="Kumar">Vijay Kumar</name><affiliation><nlm:aff id="A2">Department of Surgical Oncology, King Georges Medical University, Lucknow, India.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25722831</idno><idno type="pmc">4341192</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4341192</idno><idno type="RBID">PMC:4341192</idno><idno type="doi">10.4047/jap.2015.7.1.8</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">002F08</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002F08</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Assessment of swallowing and masticatory performance in obturator wearers: a clinical study</title><author><name sortKey="Vero, Nungotso" sort="Vero, Nungotso" uniqKey="Vero N" first="Nungotso" last="Vero">Nungotso Vero</name><affiliation><nlm:aff id="A1">Department of Prosthodontics, Faculty of Dental Science, King Georges Medical University, Lucknow, India.</nlm:aff></affiliation></author><author><name sortKey="Mishra, Niraj" sort="Mishra, Niraj" uniqKey="Mishra N" first="Niraj" last="Mishra">Niraj Mishra</name><affiliation><nlm:aff id="A1">Department of Prosthodontics, Faculty of Dental Science, King Georges Medical University, Lucknow, India.</nlm:aff></affiliation></author><author><name sortKey="Singh, Balendra Pratap" sort="Singh, Balendra Pratap" uniqKey="Singh B" first="Balendra Pratap" last="Singh">Balendra Pratap Singh</name><affiliation><nlm:aff id="A1">Department of Prosthodontics, Faculty of Dental Science, King Georges Medical University, Lucknow, India.</nlm:aff></affiliation></author><author><name sortKey="Singh, Kamleshwar" sort="Singh, Kamleshwar" uniqKey="Singh K" first="Kamleshwar" last="Singh">Kamleshwar Singh</name><affiliation><nlm:aff id="A1">Department of Prosthodontics, Faculty of Dental Science, King Georges Medical University, Lucknow, India.</nlm:aff></affiliation></author><author><name sortKey="Jurel, Sunit Kumar" sort="Jurel, Sunit Kumar" uniqKey="Jurel S" first="Sunit Kumar" last="Jurel">Sunit Kumar Jurel</name><affiliation><nlm:aff id="A1">Department of Prosthodontics, Faculty of Dental Science, King Georges Medical University, Lucknow, India.</nlm:aff></affiliation></author><author><name sortKey="Kumar, Vijay" sort="Kumar, Vijay" uniqKey="Kumar V" first="Vijay" last="Kumar">Vijay Kumar</name><affiliation><nlm:aff id="A2">Department of Surgical Oncology, King Georges Medical University, Lucknow, India.</nlm:aff></affiliation></author></analytic><series><title level="j">The Journal of Advanced Prosthodontics</title><idno type="ISSN">2005-7806</idno><idno type="eISSN">2005-7814</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>PURPOSE</title><p>To assess function by identifying changes in swallowing and masticatory performance in maxillary obturator prosthesis wearers.</p></sec><sec><title>MATERIALS AND METHODS</title><p>Sixty subjects were recruited for the study, of which 20 were obturator wearers, 20 were completely dentulous and 20 had removable partial/complete dentures with similar Eichner's Index. Swallowing ability was evaluated with and without obturator using the "Water Drinking Test"; Masticatory performance was evaluated with the Sieve test; and maximum occlusal force was recorded with the help of a digital bite sensor. The data was analyzed using the Statistical Package for Social Science version 15.0 with a confidence level at 95%.</p></sec><sec><title>RESULTS</title><p>Profile, behavior of drinking and time taken to drink were significantly improved (<italic>P</italic><.001) in subjects after wearing obturator. Masticatory performance was not significantly different (<italic>P</italic>=.252) in obturator wearer when compared with dentulous or removable partial/complete denture wearer, but significantly (<italic>P</italic><.001) high inter group difference in maximum occlusal force existed. Correlation between masticatory performance and maximum occlusal force was not significant (<italic>P</italic>=.124).</p></sec><sec><title>CONCLUSION</title><p>Swallowing ability was significantly improved after wearing obturator but masticatory performance was not significantly different from those having similar occlusal support zone in their dentition.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Minsley, Ge" uniqKey="Minsley G">GE Minsley</name></author><author><name sortKey="Warren, Dw" uniqKey="Warren D">DW Warren</name></author><author><name sortKey="Hinton, V" uniqKey="Hinton V">V Hinton</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Okay, Dj" uniqKey="Okay D">DJ Okay</name></author><author><name sortKey="Genden, E" uniqKey="Genden E">E Genden</name></author><author><name sortKey="Buchbinder, D" uniqKey="Buchbinder D">D Buchbinder</name></author><author><name sortKey="Urken, M" 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Adv Prosthodont</journal-id><journal-id journal-id-type="iso-abbrev">J Adv Prosthodont</journal-id><journal-id journal-id-type="publisher-id">JAP</journal-id><journal-title-group><journal-title>The Journal of Advanced Prosthodontics</journal-title></journal-title-group><issn pub-type="ppub">2005-7806</issn><issn pub-type="epub">2005-7814</issn><publisher><publisher-name>The Korean Academy of Prosthodontics</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25722831</article-id><article-id pub-id-type="pmc">4341192</article-id><article-id pub-id-type="doi">10.4047/jap.2015.7.1.8</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Assessment of swallowing and masticatory performance in obturator wearers: a clinical study</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Vero</surname><given-names>Nungotso</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Mishra</surname><given-names>Niraj</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Singh</surname><given-names>Balendra Pratap</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Singh</surname><given-names>Kamleshwar</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Jurel</surname><given-names>Sunit Kumar</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Kumar</surname><given-names>Vijay</given-names></name><xref ref-type="aff" rid="A2">2</xref></contrib></contrib-group><aff id="A1"><label>1</label>Department of Prosthodontics, Faculty of Dental Science, King Georges Medical University, Lucknow, India.</aff><aff id="A2"><label>2</label>Department of Surgical Oncology, King Georges Medical University, Lucknow, India.</aff><author-notes><corresp>Corresponding author: Balendra Pratap Singh. Department of Prosthodontics, Faculty of Dental Science, King Georges Medical University, Lucknow, India. Tel. 98 3912 1151, <email>balendra02@yahoo.com</email></corresp></author-notes><pub-date pub-type="ppub"><month>2</month><year>2015</year></pub-date><pub-date pub-type="epub"><day>17</day><month>2</month><year>2015</year></pub-date><volume>7</volume><issue>1</issue><fpage>8</fpage><lpage>14</lpage><history><date date-type="received"><day>13</day><month>2</month><year>2014</year></date><date date-type="rev-recd"><day>12</day><month>9</month><year>2014</year></date><date date-type="accepted"><day>07</day><month>11</month><year>2014</year></date></history><permissions><copyright-statement>© 2015 The Korean Academy of Prosthodontics</copyright-statement><copyright-year>2015</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><sec><title>PURPOSE</title><p>To assess function by identifying changes in swallowing and masticatory performance in maxillary obturator prosthesis wearers.</p></sec><sec><title>MATERIALS AND METHODS</title><p>Sixty subjects were recruited for the study, of which 20 were obturator wearers, 20 were completely dentulous and 20 had removable partial/complete dentures with similar Eichner's Index. Swallowing ability was evaluated with and without obturator using the "Water Drinking Test"; Masticatory performance was evaluated with the Sieve test; and maximum occlusal force was recorded with the help of a digital bite sensor. The data was analyzed using the Statistical Package for Social Science version 15.0 with a confidence level at 95%.</p></sec><sec><title>RESULTS</title><p>Profile, behavior of drinking and time taken to drink were significantly improved (<italic>P</italic><.001) in subjects after wearing obturator. Masticatory performance was not significantly different (<italic>P</italic>=.252) in obturator wearer when compared with dentulous or removable partial/complete denture wearer, but significantly (<italic>P</italic><.001) high inter group difference in maximum occlusal force existed. Correlation between masticatory performance and maximum occlusal force was not significant (<italic>P</italic>=.124).</p></sec><sec><title>CONCLUSION</title><p>Swallowing ability was significantly improved after wearing obturator but masticatory performance was not significantly different from those having similar occlusal support zone in their dentition.</p></sec></abstract><kwd-group><kwd>Masticatory performance</kwd><kwd>Obturator</kwd><kwd>Swallowing</kwd><kwd>Mastication</kwd><kwd>Occlusal force</kwd><kwd>Maxillectomy</kwd></kwd-group></article-meta></front><body><sec sec-type="intro"><title>INTRODUCTION</title><p>Maxillary defects are created by surgical treatment of benign or malignant neoplasm or by trauma.<xref rid="B1" ref-type="bibr">1</xref> The local and regional spread of disease is controlled with maxillary and palatal resection, but it results in open communication between the oral and nasal cavities.<xref rid="B2" ref-type="bibr">2</xref>,<xref rid="B3" ref-type="bibr">3</xref> Traditionally, obturator prostheses have been used to occlude areas of the palate that have been resected to restore esthetics and to diminish difficulties associated with mastication, swallowing and speech intelligibility.<xref rid="B4" ref-type="bibr">4</xref></p><p>The advantages of obturator prosthesis include immediate rehabilitation and less procedure time. The surgical site can be easily examined after removing obturator prosthesis, and tumor recurrence, if any, may be detected in time. Obturator prosthesis may therefore still be the privileged treatment modality after maxillectomy.<xref rid="B5" ref-type="bibr">5</xref>,<xref rid="B6" ref-type="bibr">6</xref></p><p>It is clinically important to evaluate the oral function such as mastication, swallowing and estimate the improvement provided by obturators.<xref rid="B7" ref-type="bibr">7</xref> Eating is known to be a complex function that consists of taking food, mastication, forming boluses, and swallowing. Various studies has been conducted to assess the swallowing ability of patient who have undergone resection of tongue or floor of mouth,<xref rid="B8" ref-type="bibr">8</xref>,<xref rid="B9" ref-type="bibr">9</xref>,<xref rid="B10" ref-type="bibr">10</xref> but it has been observed that evidence are lacking in maxillectomy subjects. Also, most of the studies on mixing ability test and mastication were subjective in nature and compared with completely edentulous subjects.<xref rid="B11" ref-type="bibr">11</xref> Hence this study was planned to assess the swallowing ability in obturator prosthesis wearers and to compare the masticatory performance with similar occlusal support control group.</p></sec><sec sec-type="materials|methods"><title>MATERIALS AND METHODS</title><p>Subjects were selected and recruited in this study amongst patients and their attendant who visited department of Prosthodontics of the medical university from June 2011 to December 2012. Selected samples were explained about the need and procedures to be employed in this study and were requested to sign a written consent form to indicate their acceptance and willingness to participate. Ethical approval was taken from the institutional ethical committee.</p><p>Twenty subjects were obturator wearer in case group. Two control groups were selected. Control group 1 included twenty healthy completely dentate subjects from patient attendants or matched subjects. Control group 2 had twenty removable partial denture/complete denture wearer having similar natural (as Eichner's index)<xref rid="B12" ref-type="bibr">12</xref> occlusal support zone from removable Prosthodontics clinic of department. Eichner's index is based on the number of occlusal support zones in posterior contact area. There were four occlusal support zones (two premolar and two molar zones) if contact occurs with the opposing arch. This index includes three main groups (A, B, and C) and subgroups A1-A3, B1-B4, C1-C3 (<xref ref-type="table" rid="T1">Table 1</xref>).</p><p>Inclusion criteria for case group were</p><p><list list-type="order"><list-item><p>Patients who had undergone maxillectomy and were obturator wearers</p></list-item><list-item><p>Patients undergoing maxillectomy who would require obturator</p></list-item><list-item><p>Age group of 18 years and above</p></list-item><list-item><p>Class I to VI maxillectomy defect<xref rid="B13" ref-type="bibr">13</xref></p></list-item></list></p><p>Exclusion criteria were</p><p><list list-type="order"><list-item><p>Maximum jaw opening of 15 mm or less because the superolateral extension of the obturator may be limited, compromising the seal<xref rid="B14" ref-type="bibr">14</xref></p></list-item><list-item><p>Physical and mental disability that would interfere with the study</p></list-item></list></p><p>Fabrication of obturator and tests were done by a qualified prosthodontist who has more than eight years of clinical experience. Open top design of obturator was preferred.<xref rid="B15" ref-type="bibr">15</xref>,<xref rid="B16" ref-type="bibr">16</xref> Extension along posterior and lateral margins of defect was emphasized to enhance retention, stability, and support. Vertical extension in the postero-medial region of the defect was carefully designed to minimize leakage.<xref rid="B17" ref-type="bibr">17</xref>,<xref rid="B18" ref-type="bibr">18</xref> Swallowing ability and masticatory performance was checked under supervision of a qualified otolaryngologist.</p><p>Swallowing ability was evaluated by "Water drinking test" in obturator wearers with and without wearing the obturator. In water drinking test, subjects were instructed to drink 30 mL of water in one swallow with 5 seconds as cut-off point for normality and their profile were evaluated with combination of time required for drinking water (from pouring of water in mouth to original position of larynx was return back) and incidence of cough reflex while drinking. The test was done with and without wearing the obturator.<xref rid="B7" ref-type="bibr">7</xref> The profile of each subject was categorized in accordance with specific criteria as followed:</p><p><list list-type="bullet"><list-item><p>Normal: Able to drink in one swallow within 5 seconds without a cough reflex</p></list-item><list-item><p>Suspected disability: Able to drink in one swallow in >5 seconds without a cough reflex, or able to drink in several swallows without a cough reflex</p></list-item><list-item><p>Disability: Unable to drink without experiencing a cough reflex</p></list-item></list></p><p>Behavior of drinking was observed as natural drinking, sucking, holding, compulsory drinking, careful drinking and episode of drinking as drooling and nasal leakage; and characterized as</p><p><list list-type="bullet"><list-item><p>Natural drinking: Able to drink water without problems</p></list-item><list-item><p>Sucking: Sucking water (sip and/or sucking)</p></list-item><list-item><p>Holding: Holding water in the mouth</p></list-item><list-item><p>Compulsory drinking: Drinking water compulsorily with unnatural head posture</p></list-item><list-item><p>Careful drinking: Drinking water carefully</p></list-item><list-item><p>Drooling: Drooling water from the mouth</p></list-item><list-item><p>Natural drinking: Leaking water into the nose</p></list-item></list></p><p>Subjects who exhibited natural drinking without any compensatory behavior and peculiar episodes were categorized as "normal" and the ones who exhibited at least one of the above mentioned behaviors and episodes were categorized as "abnormal".<xref rid="B7" ref-type="bibr">7</xref></p><p>Chewing function was assessed by evaluating masticatory performance and maximum occlusal force. In masticatory performance, obturator wearers were compared with completely dentate (control group 1) and removable partial or complete dentures wearers of similar Eichner's index<xref rid="B12" ref-type="bibr">12</xref> (control group 2). Masticatory performance was obtained by sieve method using Agar hydrocolloid as a test material of one cm<sup>3</sup>.</p><p>In this test, subjects were asked to chew the test material for 10 and 20 strokes. After completion of each chewing session, a glass of water was given to the subject to rinse his/her mouth and expectorate the chewed or masticated particles onto 1.70 and 1.40 mm mesh sieves respectively. Particles smaller than the sieve mesh was washed away in running tap water and remaining bigger particles in the sieve were counted. The counting was done three times for each subject, and masticatory performance was calculated by the formula:<xref rid="B19" ref-type="bibr">19</xref></p><p>Masticatory performance = [B - A]/10</p><p>Where, A = number of particles collected in 10 strokes B = number of particles collected in 20 strokes</p><p>Maximum occlusal force was measured with a digital Gnathodynamometer (Load Master, Model: BT 100, Sl. no 014831211, and Load Master Digital Indicator Model: LI450, Sl. no 014841. Bangalore, India) at subject's best biting location within the parameters of Eichner's classification of occlusal support zones as per mentioned in the table below.<xref rid="B20" ref-type="bibr">20</xref>,<xref rid="B21" ref-type="bibr">21</xref></p><p><list list-type="bullet"><list-item><p>Case group: Between artificial IInd Premolar and natural IInd premolar except class III and IV where it was measured between natural IInd premolar teeth</p></list-item><list-item><p>Control group 1: Between natural IInd premolar teeth</p></list-item><list-item><p>Control group 2: Between natural and artificial IInd premolar (removable partial denture) and between artificial IInd premolar (complete denture)</p></list-item></list></p><p>The measurements were done three times in every participant and the mean maximum occlusal force was derived by:</p><p>Maximum occlusal force = Total of three recordings/3</p><p>The data was analyzed using the Statistical Package for Social Sciences Version 15.0. Values have been shown as frequencies and proportions for categorical data. Data was assessed for distribution. Data that were parametric has been represented as Mean and standard deviation and analyzed by analysis of variance (ANOVA) and "t"-test; for non-parametric data Mann-Whitney U test and Wilcoxon signed rank test have been used. The confidence level of the study was kept at 95%.</p></sec><sec sec-type="results"><title>RESULTS</title><p>Prevalence of Class I and II defects were higher (60%) as compared to that of Class V and VI defects (15%). Total of five (25%) patients classified as Aramany's Class III and IV (<xref ref-type="table" rid="T1">Table 1</xref>). Maximum numbers of cases were from Group B (70%), while minimum were from Group A (10%) Eichner's index (<xref ref-type="table" rid="T1">Table 1</xref>).</p><p>Subject's profile during water-drinking test while wearing obturator was significantly improved than without wearing obturator (<italic>P</italic><.001)(<xref ref-type="table" rid="T2">Table 2</xref>). Mean drinking time with and without wearing prostheses was significantly shortened after wearing obturator (<italic>P</italic><.001) from 6.60 ± 1.39 to 5.20 ± 0.52 (<xref ref-type="table" rid="T2">Table 2</xref>). A significant change in behavior and episode of drinking was observed (<italic>P</italic><.001). Majority subjects were of careful (30%) and compulsory (30%) drinking, whereas rest of the subjects showed drooling/holding/sucking (40%)(<xref ref-type="table" rid="T2">Table 2</xref>).</p><p>Masticatory performance ranged from 0.09 to 1.33 in different groups. Mean masticatory performance was maximum in control group 1 (1.06 ± 0.09) and minimum in obturator wearer (case group)(0.96 ± 0.20). Mean masticatory performance in control group 2 was 1.01 ± 0.23 (<xref ref-type="table" rid="T3">Table 3</xref>). Analysis of variance and box plot thereafter showed no statistically significant inter-group difference in masticatory performance in different groups (F=1.41; <italic>P</italic>=.252). Masticatory performance values in different groups were overlapping in nature (<xref ref-type="fig" rid="F1">Fig. 1</xref>). Maximum difference was observed between case group and control group 1 while minimum difference was observed between case group and control group 2. There was no statistically significant difference between groups (<italic>P</italic>>.05).</p><p>Analysis of variance and box plot showed a statistically significant inter-group difference in maximum occlusal force (F=67.95; <italic>P</italic><.001)(<xref ref-type="table" rid="T4">Table 4</xref>). It was observed that subjects in case group had lower order of occlusal force whereas subjects in control group 1 had the highest order of occlusal force followed by control group 2. No overlapping interquartile values were observed on the box plot (<xref ref-type="fig" rid="F2">Fig. 2</xref>). Maximum difference was observed between case group and control group 1 while minimum difference was observed between case group and control group 2. All differences between groups were statistically significant (<italic>P</italic><.001).</p><p>None of the correlations between masticatory performance and maximum occlusal force were statistically significant (<xref ref-type="table" rid="T5">Table 5</xref>)(<xref ref-type="fig" rid="F3">Fig. 3</xref>).</p></sec><sec sec-type="discussion"><title>DISCUSSION</title><p>The direct effect of maxillary defects, which were created by surgical intervention of neoplasm has a profound impact on the functional abilities of a patient.<xref rid="B1" ref-type="bibr">1</xref> Maxillary defect which causes functional disability due to oral and sino-nasal cavity communication can be restored by prosthetic replacement with a pressure resistance seal of an obturator bulb against the mucosal lining and skin graft covering the defect.<xref rid="B22" ref-type="bibr">22</xref>,<xref rid="B23" ref-type="bibr">23</xref> Use of artificial substitutes to replace anatomic structures has long been an accepted method of treatment for patients with maxillectomy defects.<xref rid="B21" ref-type="bibr">21</xref> Major goal of cancer therapy is not only to eradicate the disease but also to restore patients to a reasonably normal quality of life.<xref rid="B24" ref-type="bibr">24</xref> Psychological well-being and patient's vitality are an increasing contribution to evaluation of success of maxillectomy patients, and a good obturator function has been previously reported to contribute to the improved quality of life.<xref rid="B25" ref-type="bibr">25</xref></p><p>This study objectively assessed swallowing and found significant improvement in swallowing ability and also significantly reduced drinking time in maxillectomy patients while using an obturator. The reason of significant improvement of drinking with the obturator may be due to the closure of oro-antral communication of the defect. After wearing the obturator, most of the subjects having compensatory behavior could drink naturally whereas 10% subjects still showed compensatory behavior of drinking which may be due to the large size defect (such as class IV), leading to lesser retention and stability in obturator prostheses. Kreeft et al.<xref rid="B11" ref-type="bibr">11</xref> had also found swallowing problems (subjective assessment) in obturator wearer and reason for this he stated was adjuvant radiotherapy complications. Moreno et al.<xref rid="B26" ref-type="bibr">26</xref> have found a comparable swallowing with microvascular free flap reconstruction versus palatal obturator. Few other authors<xref rid="B27" ref-type="bibr">27</xref>,<xref rid="B28" ref-type="bibr">28</xref> also assessed swallowing ability but as a subjective component in Quality of life questionnaire.</p><p>No significant inter group difference was seen in different groups for masticatory performance. This is because masticatory performance may be dependent on occlusal stops and tooth morphology.<xref rid="B21" ref-type="bibr">21</xref> Though studies by Anita Wedel et al.<xref rid="B20" ref-type="bibr">20</xref> have shown poor chewing ability (subjective assessment) in 14% of maxillofacial obturator cases, but in our study 85% subjects were of class I, II, III & IV and 80% were of Eichner's index A & B type so most of the natural teeth are present which help in mastication. It was also documented that preferable chewing side by the patient follow the side where natural teeth are present<xref rid="B29" ref-type="bibr">29</xref> and agar being a material softer than materials used in other studies,<xref rid="B20" ref-type="bibr">20</xref> we have found no significant difference in masticatory performance. Despite this agar was selected because of the advantages of reproducibility, simple routine application and with implication that it can be crushed to the same degree in case and control groups.<xref rid="B19" ref-type="bibr">19</xref>,<xref rid="B30" ref-type="bibr">30</xref>,<xref rid="B31" ref-type="bibr">31</xref>,<xref rid="B32" ref-type="bibr">32</xref></p><p>Occlusal force ranged from 2.44 to 77 kg in different groups. Our study showed statistically significant intergroup difference in maximum occlusal force. This may be explained best by the fact that age variation factor and condition of occlusal support were of major influence for the maximum occlusal force.<xref rid="B33" ref-type="bibr">33</xref>,<xref rid="B34" ref-type="bibr">34</xref> Majority of control group 1 (complete dentate) subjects were of lower age compared to control group 2 (removable partial/complete denture) subjects and case group in this study. Between inter-group comparisons; maximum difference was found between case group and control group 1; minimum difference was observed between case group and control group 2. These significant differences may be because of multiple reasons like age, gender, condition of occlusal support, occlusal morphology of the biting location, and varying activity of jaw musculature in the subjects.<xref rid="B35" ref-type="bibr">35</xref>,<xref rid="B36" ref-type="bibr">36</xref>,<xref rid="B37" ref-type="bibr">37</xref></p><p>The present study also found that there is no significant statistical correlation between masticatory performance and maximum occlusal forces since maximum occlusal force was not required by the subject to chew a test material.<xref rid="B29" ref-type="bibr">29</xref>,<xref rid="B38" ref-type="bibr">38</xref> As discussed, masticatory performance has no significant differences in different study groups as it is influenced by the number of existing teeth, morphology of teeth and the number of occlusal supports. Whereas, maximum occlusal force is influenced by age, gender, tooth morphology and jaw musculature with significant variation in different study groups.</p><p>Certain limitations of the present study were short duration of study period (one year) and small sample size due to tertiary referral centre. Inclusion of all different classes of maxillectomy defect and recruitment of irradiated and non-irradiated subjects may have resulted in selection bias. Maximum occlusal force was measured at subject's best biting location at a unilateral single contact area and hydrocolloid chewing material may still not be the ideal test material to assess masticatory performance.</p><p>Therefore, in order to improve upon the accuracy, further elaboration of this study with larger sample size and improvised methodology including other chewing test materials is recommended.</p></sec><sec sec-type="conclusions"><title>CONCLUSION</title><p>Obturator will improve swallowing ability as well as reduce drinking time in maxillectomy subjects. 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position="float"><label>Fig. 1</label><caption><title>Analysis of variance for masticatory performance in different groups.</title></caption><graphic xlink:href="jap-7-8-g001"></graphic></fig><fig id="F2" orientation="portrait" position="float"><label>Fig. 2</label><caption><title>Analysis of variance for occlusal force in different groups.</title></caption><graphic xlink:href="jap-7-8-g002"></graphic></fig><fig id="F3" orientation="portrait" position="float"><label>Fig. 3</label><caption><title>Scatter diagram showing correlation between masticatory performance and maximum occlusal force.</title></caption><graphic xlink:href="jap-7-8-g003"></graphic></fig><table-wrap id="T1" orientation="portrait" position="float"><label>Table 1</label><caption><title>Distribution of patients according to Aramany's classification and Eichner's index</title></caption><graphic xlink:href="jap-7-8-i001"></graphic></table-wrap><table-wrap id="T2" orientation="portrait" position="float"><label>Table 2</label><caption><title>Swallowing ability without and with definite obturator</title></caption><graphic xlink:href="jap-7-8-i002"></graphic></table-wrap><table-wrap id="T3" orientation="portrait" position="float"><label>Table 3</label><caption><title>Comparison of mean masticatory performance, analysis of variance and between group comparisons of masticatory performance in different groups</title></caption><graphic xlink:href="jap-7-8-i003"></graphic></table-wrap><table-wrap id="T4" orientation="portrait" position="float"><label>Table 4</label><caption><title>Analysis of variance for maximum occlusal force and between groups comparison of maximum occlusal forces in different groups (Tukey HSD test)</title></caption><graphic xlink:href="jap-7-8-i004"></graphic></table-wrap><table-wrap id="T5" orientation="portrait" position="float"><label>Table 5</label><caption><title>Showing correlation between masticatory performances and maximum occlusal forces in different study groups</title></caption><graphic xlink:href="jap-7-8-i005"></graphic></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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