Impact of removable partial denture prosthesis on chewing efficiency
Identifieur interne : 002F76 ( Pmc/Corpus ); précédent : 002F75; suivant : 002F77Impact of removable partial denture prosthesis on chewing efficiency
Auteurs : Marion Bessadet ; Emmanuel Nicolas ; Marine Sochat ; Martine Hennequin ; Jean-Luc VeyruneSource :
- Journal of Applied Oral Science [ 1678-7757 ] ; 2013.
Abstract
Removable partial denture prostheses are still being used for anatomic, medical and economic reasons. However, the impact on chewing parameters is poorly described.
The objective of this study was to estimate the impact of removable partial denture prosthesis on masticatory parameters.
Nineteen removable partial denture prosthesis (RPDP) wearers participated in the study. Among them, 10 subjects were Kennedy Class III partially edentulous and 9 with posterior edentulism (Class I). All presented a complete and full dentate opposing arch. The subjects chewed samples of carrots and peanuts with and without their prosthesis. The granulometry of the expectorated boluses from carrot and peanuts was characterized by median particle size (D50), determined at the natural point of swallowing. Number of chewing cycles (CC), chewing time (CT) and chewing frequency (CF=CC/CT) were video recorded.
With RPDP, the mean D50 values for carrot and peanuts were lower [Repeated Model Procedures (RMP), F=15, p<0.001] regardless of the type of Kennedy Class. For each food, mean CC, CT and CF values recorded decreased (RMP, F=18, F=9, and F=20 respectively, p<0.01). With or without RPD, the boluses' granulometry values were above the masticatory normative index (MNI) determined as 4,000 µm.
RPDP rehabilitation improves the ability to reduce the bolus particle size, but does not reestablish fully the masticatory function.
This study encourages the clinical improvement of oral rehabilitation procedure.
Url:
DOI: 10.1590/1679-775720130046
PubMed: 24212983
PubMed Central: 3881838
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PMC:3881838Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Impact of removable partial denture prosthesis on chewing
efficiency</title><author><name sortKey="Bessadet, Marion" sort="Bessadet, Marion" uniqKey="Bessadet M" first="Marion" last="Bessadet">Marion Bessadet</name></author><author><name sortKey="Nicolas, Emmanuel" sort="Nicolas, Emmanuel" uniqKey="Nicolas E" first="Emmanuel" last="Nicolas">Emmanuel Nicolas</name></author><author><name sortKey="Sochat, Marine" sort="Sochat, Marine" uniqKey="Sochat M" first="Marine" last="Sochat">Marine Sochat</name></author><author><name sortKey="Hennequin, Martine" sort="Hennequin, Martine" uniqKey="Hennequin M" first="Martine" last="Hennequin">Martine Hennequin</name></author><author><name sortKey="Veyrune, Jean Luc" sort="Veyrune, Jean Luc" uniqKey="Veyrune J" first="Jean-Luc" last="Veyrune">Jean-Luc Veyrune</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24212983</idno><idno type="pmc">3881838</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881838</idno><idno type="RBID">PMC:3881838</idno><idno type="doi">10.1590/1679-775720130046</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">002F76</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002F76</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Impact of removable partial denture prosthesis on chewing
efficiency</title><author><name sortKey="Bessadet, Marion" sort="Bessadet, Marion" uniqKey="Bessadet M" first="Marion" last="Bessadet">Marion Bessadet</name></author><author><name sortKey="Nicolas, Emmanuel" sort="Nicolas, Emmanuel" uniqKey="Nicolas E" first="Emmanuel" last="Nicolas">Emmanuel Nicolas</name></author><author><name sortKey="Sochat, Marine" sort="Sochat, Marine" uniqKey="Sochat M" first="Marine" last="Sochat">Marine Sochat</name></author><author><name sortKey="Hennequin, Martine" sort="Hennequin, Martine" uniqKey="Hennequin M" first="Martine" last="Hennequin">Martine Hennequin</name></author><author><name sortKey="Veyrune, Jean Luc" sort="Veyrune, Jean Luc" uniqKey="Veyrune J" first="Jean-Luc" last="Veyrune">Jean-Luc Veyrune</name></author></analytic><series><title level="j">Journal of Applied Oral Science</title><idno type="ISSN">1678-7757</idno><idno type="eISSN">1678-7765</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Removable partial denture prostheses are still being used for anatomic, medical and
economic reasons. However, the impact on chewing parameters is poorly described.</p><sec><title>Objectives</title><p>The objective of this study was to estimate the impact of removable partial
denture prosthesis on masticatory parameters.</p></sec><sec><title>Material and Methods</title><p>Nineteen removable partial denture prosthesis (RPDP) wearers participated in the
study. Among them, 10 subjects were Kennedy Class III partially edentulous and 9
with posterior edentulism (Class I). All presented a complete and full dentate
opposing arch. The subjects chewed samples of carrots and peanuts with and without
their prosthesis. The granulometry of the expectorated boluses from carrot and
peanuts was characterized by median particle size (D50), determined at the natural
point of swallowing. Number of chewing cycles (CC), chewing time (CT) and chewing
frequency (CF=CC/CT) were video recorded.</p></sec><sec><title>Results</title><p>With RPDP, the mean D50 values for carrot and peanuts were lower [Repeated Model
Procedures (RMP), F=15, p<0.001] regardless of the type of Kennedy Class. For
each food, mean CC, CT and CF values recorded decreased (RMP, F=18, F=9, and F=20
respectively, p<0.01). With or without RPD, the boluses' granulometry values
were above the masticatory normative index (MNI) determined as 4,000 µm.</p></sec><sec><title>Conclusion</title><p>RPDP rehabilitation improves the ability to reduce the bolus particle size, but
does not reestablish fully the masticatory function.</p></sec><sec><title>Clinical relevance</title><p>This study encourages the clinical improvement of oral rehabilitation
procedure.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Aras, K" uniqKey="Aras K">K Aras</name></author><author><name sortKey="Hasanreiso Lu, U" uniqKey="Hasanreiso Lu U">U Hasanreisoğlu</name></author><author><name sortKey="Shinogaya, T" uniqKey="Shinogaya T">T Shinogaya</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Decerle, N" uniqKey="Decerle N">N Decerle</name></author><author><name sortKey="Nicolas, E" uniqKey="Nicolas E">E Nicolas</name></author><author><name sortKey="Hennequin, M" uniqKey="Hennequin M">M Hennequin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Grigoriadis, A" uniqKey="Grigoriadis A">A Grigoriadis</name></author><author><name sortKey="Johansson, Rs" uniqKey="Johansson R">RS Johansson</name></author><author><name sortKey="Trulsson, M" uniqKey="Trulsson M">M 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T">T Kanno</name></author><author><name sortKey="Carlsson, Ge" uniqKey="Carlsson G">GE Carlsson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lassauzay, C" uniqKey="Lassauzay C">C Lassauzay</name></author><author><name sortKey="Peyron, Ma" uniqKey="Peyron M">MA Peyron</name></author><author><name sortKey="Albuisson, E" uniqKey="Albuisson E">E Albuisson</name></author><author><name sortKey="Dransfield, E" uniqKey="Dransfield E">E Dransfield</name></author><author><name sortKey="Woda, A" uniqKey="Woda A">A Woda</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Levin, B" uniqKey="Levin B">B Levin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mishellany Dutour, A" uniqKey="Mishellany Dutour A">A Mishellany-Dutour</name></author><author><name sortKey="Renaud, J" uniqKey="Renaud J">J Renaud</name></author><author><name sortKey="Peyron, Ma" uniqKey="Peyron M">MA Peyron</name></author><author><name sortKey="Rimek, F" uniqKey="Rimek F">F Rimek</name></author><author><name sortKey="Woda, A" uniqKey="Woda A">A Woda</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="N Gom, Pi" uniqKey="N Gom P">PI N'gom</name></author><author><name sortKey="Woda, A" uniqKey="Woda A">A Woda</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nicolas, E" uniqKey="Nicolas E">E Nicolas</name></author><author><name sortKey="Veyrune, J" uniqKey="Veyrune J">J Veyrune</name></author><author><name sortKey="Lassauzay, C" uniqKey="Lassauzay C">C Lassauzay</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nicolas, E" uniqKey="Nicolas E">E Nicolas</name></author><author><name sortKey="Veyrune, Jl" uniqKey="Veyrune J">JL Veyrune</name></author><author><name sortKey="Lassauzay, C" uniqKey="Lassauzay C">C Lassauzay</name></author><author><name sortKey="Peyron, Ma" uniqKey="Peyron M">MA Peyron</name></author><author><name sortKey="Hennequin, M" uniqKey="Hennequin M">M Hennequin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Peyron, Ma" uniqKey="Peyron M">MA Peyron</name></author><author><name sortKey="Lassauzay, C" uniqKey="Lassauzay C">C Lassauzay</name></author><author><name sortKey="Woda, A" uniqKey="Woda A">A Woda</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Veyrune, Jl" uniqKey="Veyrune J">JL Veyrune</name></author><author><name sortKey="Miller, Cc" uniqKey="Miller C">CC Miller</name></author><author><name sortKey="Czernichow, S" uniqKey="Czernichow S">S Czernichow</name></author><author><name sortKey="Ciangura, Ca" uniqKey="Ciangura C">CA Ciangura</name></author><author><name sortKey="Nicolas, E" uniqKey="Nicolas E">E Nicolas</name></author><author><name sortKey="Hennequin, M" uniqKey="Hennequin M">M Hennequin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Veyrune, Jl" uniqKey="Veyrune J">JL Veyrune</name></author><author><name sortKey="Mioche, L" uniqKey="Mioche L">L Mioche</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Veyrune, Jl" uniqKey="Veyrune J">JL Veyrune</name></author><author><name sortKey="Ope, S" uniqKey="Ope S">S Opé</name></author><author><name sortKey="Nicolas, E" uniqKey="Nicolas E">E Nicolas</name></author><author><name sortKey="Woda, A" uniqKey="Woda A">A Woda</name></author><author><name sortKey="Hennequin, M" uniqKey="Hennequin M">M Hennequin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Witter, Dj" uniqKey="Witter D">DJ Witter</name></author><author><name sortKey="Van Elteren, P" uniqKey="Van Elteren P">P van Elteren</name></author><author><name sortKey="K Yser, Af" uniqKey="K Yser A">AF Käyser</name></author><author><name sortKey="Van Rossum, Mj" uniqKey="Van Rossum M">MJ van Rossum</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Woda, A" uniqKey="Woda A">A Woda</name></author><author><name sortKey="Foster, K" uniqKey="Foster K">K Foster</name></author><author><name sortKey="Mishellany, A" uniqKey="Mishellany A">A Mishellany</name></author><author><name sortKey="Peyron, Ma" uniqKey="Peyron M">MA Peyron</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Woda, A" uniqKey="Woda A">A Woda</name></author><author><name sortKey="Nicolas, E" uniqKey="Nicolas E">E Nicolas</name></author><author><name sortKey="Mishellany Dutour, A" uniqKey="Mishellany Dutour A">A Mishellany-Dutour</name></author><author><name sortKey="Hennequin, M" uniqKey="Hennequin M">M Hennequin</name></author><author><name sortKey="Mazille, M N" uniqKey="Mazille M">M-N Mazille</name></author><author><name sortKey="Veyrune, J L" uniqKey="Veyrune J">J-L Veyrune</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Appl Oral Sci</journal-id><journal-id journal-id-type="iso-abbrev">J Appl Oral Sci</journal-id><journal-id journal-id-type="publisher-id">J. Appl. Oral. Sci.</journal-id><journal-title-group><journal-title>Journal of Applied Oral Science</journal-title></journal-title-group><issn pub-type="ppub">1678-7757</issn><issn pub-type="epub">1678-7765</issn><publisher><publisher-name>Faculdade de Odontologia de Bauru da Universidade de São
Paulo</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24212983</article-id><article-id pub-id-type="pmc">3881838</article-id><article-id pub-id-type="doi">10.1590/1679-775720130046</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Articles</subject></subj-group></article-categories><title-group><article-title>Impact of removable partial denture prosthesis on chewing
efficiency</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>BESSADET</surname><given-names>Marion</given-names></name></contrib><contrib contrib-type="author"><name><surname>NICOLAS</surname><given-names>Emmanuel</given-names></name><xref ref-type="corresp" rid="c01"></xref></contrib><contrib contrib-type="author"><name><surname>SOCHAT</surname><given-names>Marine</given-names></name></contrib><contrib contrib-type="author"><name><surname>HENNEQUIN</surname><given-names>Martine</given-names></name></contrib><contrib contrib-type="author"><name><surname>VEYRUNE</surname><given-names>Jean-Luc</given-names></name></contrib><aff>Clermont Université, Université d'Auvergne, Centre de Recherche en Odontologie Clinique; CHU Clermont-Ferrand, Service d'Odontologie, Hôtel-Dieu France,Clermont-Ferrand, France.</aff></contrib-group><author-notes><corresp id="c01"><bold>Corresponding address:</bold> Dr. Emmanuel Nicolas - UFR Odontologie, CROC - 11
bd Charles de Gaulle - 630000 Clermont - Ferrand, France - Phone: 04 73 17 73 82 -
Fax: 04 73 17 73 88 - e-mail: <email>emmanuel.nicolas@udamail.fr</email></corresp></author-notes><pub-date pub-type="ppub"><season>Sep-Oct</season><year>2013</year></pub-date><volume>21</volume><issue>5</issue><fpage>392</fpage><lpage>396</lpage><history><date date-type="received"><day>16</day><month>1</month><year>2013</year></date><date date-type="rev-recd"><day>03</day><month>6</month><year>2013</year></date><date date-type="accepted"><day>04</day><month>7</month><year>2013</year></date></history><permissions><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 which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the
original work is properly cited. </license-p></license></permissions><abstract><p>Removable partial denture prostheses are still being used for anatomic, medical and
economic reasons. However, the impact on chewing parameters is poorly described.</p><sec><title>Objectives</title><p>The objective of this study was to estimate the impact of removable partial
denture prosthesis on masticatory parameters.</p></sec><sec><title>Material and Methods</title><p>Nineteen removable partial denture prosthesis (RPDP) wearers participated in the
study. Among them, 10 subjects were Kennedy Class III partially edentulous and 9
with posterior edentulism (Class I). All presented a complete and full dentate
opposing arch. The subjects chewed samples of carrots and peanuts with and without
their prosthesis. The granulometry of the expectorated boluses from carrot and
peanuts was characterized by median particle size (D50), determined at the natural
point of swallowing. Number of chewing cycles (CC), chewing time (CT) and chewing
frequency (CF=CC/CT) were video recorded.</p></sec><sec><title>Results</title><p>With RPDP, the mean D50 values for carrot and peanuts were lower [Repeated Model
Procedures (RMP), F=15, p<0.001] regardless of the type of Kennedy Class. For
each food, mean CC, CT and CF values recorded decreased (RMP, F=18, F=9, and F=20
respectively, p<0.01). With or without RPD, the boluses' granulometry values
were above the masticatory normative index (MNI) determined as 4,000 µm.</p></sec><sec><title>Conclusion</title><p>RPDP rehabilitation improves the ability to reduce the bolus particle size, but
does not reestablish fully the masticatory function.</p></sec><sec><title>Clinical relevance</title><p>This study encourages the clinical improvement of oral rehabilitation
procedure.</p></sec></abstract><kwd-group><kwd>Rehabilitation</kwd><kwd>Removable partial denture</kwd><kwd>Mastication</kwd></kwd-group></article-meta></front><body><sec><title>INTRODUCTION</title><p>According to some studies, dentists often overestimate the functional consequences of
edentulous areas. In 1974, Levin<sup><xref ref-type="bibr" rid="r08">8</xref></sup>described the "28 teeth syndrome", which led to systematically replacing any missing
teeth. Subsequently, studies tended to emphasize the shortened arch concept, which
corresponds to a denture comprising 3 to 5 functional units (a functional unit being
established by a pair of premolars or molars in occlusion) and some authors still tend
to defend this concept<sup><xref ref-type="bibr" rid="r06">6</xref>,<xref ref-type="bibr" rid="r17">17</xref></sup>. According to Käyser, 12 anterior teeth
and 8 premolars would be necessary and sufficient to ensure the mandibular stability
required for secure deglutition without aspiration, provided that these teeth are
efficient<sup><xref ref-type="bibr" rid="r06">6</xref>,<xref ref-type="bibr" rid="r17">17</xref></sup>. However, increasing the masticatory surface is not the
only argument for absent tooth replacement: esthetics and wedging of opposing and
neighboring teeth are also important, and thus reasons that lead both patients and
practitioners to replace missing teeth. It also raises the question about preserving the
integrity of temporomandibular joints.</p><p>In the case of partial edentulism, and based on clinical examination, rehabilitation of
the oral function can be obtained with fixed or removable prosthodontics. The removable
partial denture prosthesis (RPDP) must be able to restore the chewing function,
esthetics and phonetics. It compensates for partial edentulism<sup><xref ref-type="bibr" rid="r06">6</xref></sup>. Understanding of the biomechanics involved (appreciation
of the tissue's double nature - teeth and oral tissue - and thus of different behaviors)
allows the practitioner to design a removable partial denture prosthesis satisfying the
requirement of balance during the function, or in other words establishing and
maintaining lift, stabilization and retention (the Housset triad). With these
imperatives taken into account, and depending on the number of teeth lost and the type
of edentulous areas (bounded by remaining teeth or without posterior tooth support), the
constraints on the prosthesis will be different and functional rehabilitation altered.
Effectively, during mastication, natural or artificial teeth are not simple tools that
mechanically reduce the food to particles and mix saliva and the food to produce a
bolus, easy to swallow. They also are essential to the neuromotor control of chewing and
swallowing, through the sensory receptors<sup><xref ref-type="bibr" rid="r10">10</xref></sup>. Any oral disease that affects the numbers, the structure or the
position of the teeth is supposed to have an impact on chewing and, in turn, on
nutrition. A physiological approach is thus necessary to measure to what limits the
edentulous status and their oral rehabilitation could affect the chewing function.
Calculating food bolus granulometry collected before swallowing, associated with
analysis of the kinematic parameters developed to produce this bolus, could help to
distinguish patients with normal mastication from those with seriously impaired
mastication<sup><xref ref-type="bibr" rid="r01">1</xref>,<xref ref-type="bibr" rid="r18">18</xref></sup>. Impaired chewing function leads to an increase of food
bolus particle size, measured by the median particle size of the food bolus at
swallowing. It has been shown that adults with impaired mastication could be
distinguished from those with normal function if the median particle size of the bolus
that they produced when chewing raw carrot reached a cut-off value of 4 mm, called the
masticatory normative indicator (MNI)<sup><xref ref-type="bibr" rid="r19">19</xref></sup>. The adaptation of chewing behavior to food hardness can also
characterize healthy mastication. Adaptation to increasing food hardness results in an
augmented number of chewing cycles and an increase in the chewing sequence duration,
with no modification of the chewing frequency (number of cycles <italic>per</italic>second) in healthy subjects<sup><xref ref-type="bibr" rid="r03">3</xref>,<xref ref-type="bibr" rid="r07">7</xref>,<xref ref-type="bibr" rid="r13">13</xref></sup>. The mean chewing frequency is slowed down in subjects with chewing
deficiencies while eating any type of resistant food. Previous studies on the chewing
ability of dentally impaired subjects showed that a decrease in the number of
functionally paired teeth and oral rehabilitation with removable dentures were linked to
a decrease in CT and CC values and to an increased D50 value<sup><xref ref-type="bibr" rid="r09">9</xref>,<xref ref-type="bibr" rid="r14">14</xref></sup>. Nevertheless,
the physiological impact of RPDM rehabilitation has been seldom studied. Also, the
objective of this work was to estimate the impact of partial edentulous areas
rehabilitation by removable partial denture prosthesis with a metallic frame on chewing
parameters<sup><xref ref-type="bibr" rid="r04">4</xref></sup>.</p></sec><sec sec-type="materials|methods"><title>MATERIAL AND METHODS</title><sec><title>Study design</title><p>The study was prospective and observational, and the subjects functioned as their own
controls. Recruitment extended over 12 months in the Dental Department of the
University Hospital of Clermont-Ferrand, France. The study included voluntary
patients and was approved by the local ethics committee (CECIC, 2010/06; IRB number
5044). Each subject attended two times for mastication evaluation. The first
evaluation was organized without any rehabilitation and the second with RPDP.</p></sec><sec><title>Subjects</title><p>The required sample size was estimated from a previous study that measured the carrot
bolus granulometry in a group of edentulous subjects rehabilitated with implants
procedure<sup><xref ref-type="bibr" rid="r16">16</xref></sup>. The mean D50
values of the carrot bolus decreased from 4,800±1,013 µm (without rehabilitation) to
3,292±1,335 µm (with implant rehabilitation). Calculations with the epiR package
0.9-30 were based on a difference of 1600 µm and a common standard deviation value of
1,100 µm. That indicated the need for at least 9 subjects with Kennedy Class I and 9
patients with Kennedy Class III (α=5%, β=20%). Thus, in 2010, 19 subjects from 24 to
79 years old; 6 men (mean age=50.8±8.1 years) and 13 women (mean age=60.7±11.3 years)
participated in the study. Their prostheses had been in place for at least 2 months
and they were able to eat without difficulty. Among them, 10 were wearing removable
partial dentures prosthesis bounded by remaining teeth replacing at most 4 posterior
teeth (maxillary or mandibulary, Kennedy Class III) and 9 were wearing posterior
removable partial denture prostheses (Kennedy Class I). All subjects presented a
complete, full dentate opposing arch. Two prosthodontics experts (calibrated to the
evaluation) checked the conformity of the prosthetic design.</p></sec><sec><title>Experimental procedure</title><p>Two natural foods commonly used in mastication studies were used. Subjects were asked
to chew with their prostheses three standardized samples of carrot (cylinders of 2 cm
diameter adjusted in height to reach a weight of 4.0±0.5 g) and non-salted draw
peanuts (selected to reach a weight of 4.0±0.5 g). Afterwards, the subjects were
asked to repeat the operation without wearing their prostheses.</p><p>Video recording was used for evaluation of kinematic parameters<sup><xref ref-type="bibr" rid="r12">12</xref></sup>. A digital camera positioned in front
of the subject (face-on) recorded a video of the face. All subjects were asked to
close their eyes while the experimenter placed the food sample on the tongue so as to
prevent recognition of the food sample. The subjects then had to close the mouth and
teeth without contracting their muscles, keeping the food sample between the tongue
and palate. When prompted by the experimenter, the subjects began chewing as
naturally as possible. The subjects were then asked to chew three replicates of
carrots and peanuts. The first replicate was completely masticated and swallowed for
training. During this sequence, the chewing time was monitored by an investigator and
was the baseline time for the following measurements. For the two other replicates,
the patient was instructed to spit out each bolus when they thought it was ready to
be swallowed. If there was a difference of more than ±5 s between the chewing times
of the swallowed and the two expectorated replicates, the patient was asked to chew a
new piece of the test food.</p></sec><sec><title>Bolus granulometry analysis</title><p>Each chewed bolus (masticate) 100-µm sieve to eliminate saliva, and dried at 80ºC for
30 min. The bolus was then spread onto a transparent A4 sheet. The sheet was scanned
to produce a 600-dpi image (Epson Perfection 4990 photo, Seiko Epson Corporation,
Nagano, Japan). The images were then software-processed to evaluate food particle
size and distribution (Powdershape<sup>®</sup> version 4.3.6 for Windows, 2005,
Innovative Sintering Technologies, Vilters, Switzerland). For each masticate, the
results were expressed in terms of the D50 value, characterizing the theoretical
sieve size that would let through 50% of the particle weights<sup><xref ref-type="bibr" rid="r14">14</xref>,<xref ref-type="bibr" rid="r19">19</xref></sup>. Data were saved directly in an Excel<sup>TM</sup> file. Thus,
D50 value decreased as food boluses contained more small particles. According to a
previous study, the two D50 values recorded for each subject and each natural food
were averaged, and D50 values for carrots above 4 mm were considered as coming from a
subject with impaired mastication<sup><xref ref-type="bibr" rid="r19">19</xref></sup>.</p></sec><sec><title>Kinematic parameters of mastication</title><p>The recorded variables were chewing time (CT: the time in seconds between the moment
the subject started to chew and swallowing, identified by the immediate swallow after
the end of rhythm micro-rotary movements) and number of chewing cycles (CC: number of
chewing actions during the CT period; this included all the rotary patterns, with and
without lip closure). Chewing frequency (CF) was calculated as the ratio CC/CT. The
evaluations of each kinematic parameter required an independent reading of each video
recording by a calibrated observer who watched the recordings in random
order<sup><xref ref-type="bibr" rid="r15">15</xref></sup>. The internal
reliability gave an ICC index ranging between 0.86-0.98 (p<0.01) for chewing time
and 0.92-0.97 for chewing cycles (p<0.01). Calculation of external reliability
gave an ICC index ranging between 0.97-0.98 for chewing time and from 0.90 to 0.97
for number of cycles. The method has previously been validated for healthy, fully
dentate patients and for denture wearers<sup><xref ref-type="bibr" rid="r05">5</xref>,<xref ref-type="bibr" rid="r12">12</xref></sup>.</p></sec><sec><title>Statistical analysis</title><p>Statistical analysis was performed using IBM SPSS<sup>®</sup>20 software.
Statistical significance was set at p<0.05. To evaluate the impact of RPDP
rehabilitation on mastication parameters, the mean values of CC, CT, CF and D50
measured during mastication of carrot and peanuts were compared with and without RPDP
by four repeated model procedures (RMP) (dependent factor: CC, CT, CF, D50; fixed
factor: type of food; type of Kennedy Class). Values were expressed as mean±SD.</p></sec></sec><sec sec-type="results"><title>RESULTS</title><sec><title>Bolus granulometry</title><p>With RPDP, the mean D50s were significantly decreased for carrot and peanuts (RMP,
F=15, p<0.001). These variations were independent of the type of Kennedy Class and
type of food (<xref ref-type="fig" rid="f01">Figure 1</xref>). With and without RPDP,
the mean D50 values for carrot are above the MNI value of 4,000 µm.</p><fig id="f01" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Mean variation ± standard deviation of the granulometry of the carrot and
peanut preswallowed bolus (D50, median size of bolus particle) whether a
removable prosthesis was worn or not, and according to the type of edentulous
areas. Repeated measure procedure was used for intergroup comparisons
(***p<0.001, **p< 0.01)</p></caption><graphic xlink:href="jaos-21-05-0392-g01"></graphic></fig></sec><sec><title>Kinematic parameters of mastication</title><p>The mean CC, CT, and CF values measured for carrot and peanuts with and without RPDP
are presented in <xref ref-type="table" rid="t01">Table 1</xref>. When comparing mean
values of CC, CT, and CF, controlling for subject with or without RPDP, significant
decreases in CC, CT and CF mean values were shown (RMP procedure, F=18 for CC, F=9
for CT, and F=20 for CF; p<0.001). These variations were independent of the type
of Kennedy Class and type of food with one exception: the decrease in the chewing
frequency with RPDP was dependent of the type of food (F=7, p<0.05) (<xref ref-type="fig" rid="f02">Figure 2</xref>).</p><table-wrap id="t01" orientation="portrait" position="float"><label>Table 1</label><caption><p>Mean values ± standard deviation of the kinematics parameters of the carrot and
peanut mastication (CC, number of chewing cycles; CT, chewing time; CF, chewing
frequency with CF=CC/CT) with and without removable partial denture (RPD)
rehabilitation and for each type of Kennedy class</p></caption><table frame="hsides" rules="groups"><thead><tr><td colspan="2" align="center" style="background-color:#CCCCCC" rowspan="1"></td><td colspan="2" align="center" style="background-color:#CCCCCC" rowspan="1"><bold>Kennedy Class I</bold></td><td colspan="2" align="center" style="background-color:#CCCCCC" rowspan="1"><bold>Kennedy Class III</bold></td></tr><tr><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"><bold>Without RPD</bold></td><td align="center" rowspan="1" colspan="1"><bold>With RPD</bold></td><td align="center" rowspan="1" colspan="1"><bold>Without RPD</bold></td><td align="center" rowspan="1" colspan="1"><bold>With RPD</bold></td></tr></thead><tbody><tr><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">Carrot</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">CC</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">44.2±26.9</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">38.5±19.6</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">52.7±24.1</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">44.3±15.3</td></tr><tr><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">CT (s)</td><td align="center" rowspan="1" colspan="1">27.3±15.6</td><td align="center" rowspan="1" colspan="1">25.9±12.4</td><td align="center" rowspan="1" colspan="1">33.0±16.1</td><td align="center" rowspan="1" colspan="1">31.3±10.9</td></tr><tr><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1"></td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">CF (s-1)</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">1.59±0.21</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">1.48±0.20</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">1.63±0.29</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">1.44±0.3</td></tr><tr><td align="center" rowspan="1" colspan="1">Peanut</td><td align="center" rowspan="1" colspan="1">CC</td><td align="center" rowspan="1" colspan="1">44.6±23.0</td><td align="center" rowspan="1" colspan="1">39.5±20.5</td><td align="center" rowspan="1" colspan="1">57.0±24.0</td><td align="center" rowspan="1" colspan="1">48.7±12.6</td></tr><tr><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1"></td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">CT (s)</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">28.1±13.4</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">25.5±12.1</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">38.9±16.4</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">32.5±9.9</td></tr><tr><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">CF (s-1)</td><td align="center" rowspan="1" colspan="1">1.60±0.35</td><td align="center" rowspan="1" colspan="1">1.56±0.20</td><td align="center" rowspan="1" colspan="1">1.56±0.20</td><td align="center" rowspan="1" colspan="1">1.53±0.27</td></tr></tbody></table></table-wrap><fig id="f02" orientation="portrait" position="float"><label>Figure 2</label><caption><p>Mean chewing frequency ± standard deviation of the carrot and peanut with and
without removable partial denture prostheses according to the edentulous areas
(Kennedy Class). Repeated measure procedure was used for intergroup comparisons
(***p< 0.001, **p< 0.01)</p></caption><graphic xlink:href="jaos-21-05-0392-g02"></graphic></fig></sec></sec><sec sec-type="discussion"><title>DISCUSSION</title><p>This study aimed at evaluating the impact of rehabilitation with removable partial
denture prosthesis on chewing parameters. The mastication variables used in this study
were chewing frequency and the granulometry measured during the mastication of two test
foods: carrots and peanuts. A decrease in the median particle size of the test foods
boluses and an increase in the chewing frequency were shown. These results were not
dependent of the type of Kennedy Class.</p><p>Some limits of this study could be outlined. In particular, the participants had their
prostheses in place for at least 2 months and reported no difficulty for eating.
However, the experiment was not strictly standardized for the time of prosthesis use. It
is possible that a person using oral prosthesis for a longer period could be more
adapted, performing oral function better than a person with a recent prosthesis
placement. This aspect should be explored in further clinical studies. Furthermore,
chewing adaptation to food hardness was not assessed in this experiment. According to
previous studies, three viscoelastic model foods, differing in hardness, could be used
to explore if RPDP improves adaptability of mastication<sup><xref ref-type="bibr" rid="r07">7</xref>,<xref ref-type="bibr" rid="r09">9</xref></sup>.</p><p>Granulometry measurement consists in comparing median particle size or D50. In this
study, the D50 value remained above the MNI value, regardless of the type of edentulous
areas, or the presence or not of prosthesis. As showed in preceding studies, this value
improved with prostheses rehabilitation but insufficiently<sup><xref ref-type="bibr" rid="r11">11</xref>,<xref ref-type="bibr" rid="r16">16</xref></sup>. Thus, it was
confirmed, as previously demonstrated in other populations, that the number of
functional units control chewing efficiency<sup><xref ref-type="bibr" rid="r02">2</xref>,<xref ref-type="bibr" rid="r14">14</xref></sup>. Effectively, feedback
controls are necessary for the formation of the food bolus, allowing modulation of
muscular activity. The involvement of these feedback controls varies as a function of
the loss of periodontal sensitivity due to edentulous areas. Nonetheless, a completely
edentulous patient will retain their sensing ability through mucosal, muscular and
temporomandibular joint sensitivity. A previous study showed that wearers of removable
dentures were losing precision in the control force needed to crush food, a loss
directly correlated to the need for a prosthesis<sup><xref ref-type="bibr" rid="r09">9</xref></sup>. In an intermediate situation, partial edentulous subjects with an
impaired dental status could not produce a food bolus with the same particle size
distribution as the fully dented patients<sup><xref ref-type="bibr" rid="r07">7</xref></sup>. The reduction in proprioception due to the lack of dental functional
units could not be fully compensated by mucosal sensitivity re-attained when wearing
prostheses. However, previous studies showed that implant-related proprioception helped
maintaining chewing efficiency<sup><xref ref-type="bibr" rid="r03">3</xref>,<xref ref-type="bibr" rid="r16">16</xref></sup>.</p><p>A second variable contributed to the hypothesis that complete chewing function
rehabilitation cannot be obtained when using RPDP. The chewing frequency of the food
samples in both groups of edentulous subjects (posterior or bounded by remaining teeth)
decreased significantly (p<0.001) when subjects wore removable partial denture
prosthesis. Chewing frequency is the mastication rhythm linked to a particular food.
Some authors specified that chewing frequency is the most reproducible masticatory
parameter between tests on the same individual<sup><xref ref-type="bibr" rid="r15">15</xref></sup>. Consequently, chewing frequency is often used as one of two
parameters used to detect chewing deficiency. A lower chewing frequency is therefore a
sign of a disturbed mastication function. The results of this study are in agreement
with these facts, highlighting a decrease in chewing frequency when missing teeth are
replaced by removable partial denture prosthesis. The prosthesis constitutes an
artificial element that is more or less stable depending on the type of edentulous areas
and the number of missing teeth, as this modifies jaw kinematics.</p></sec><sec sec-type="conclusion"><title>CONCLUSION</title><p>This study showed that RPDP rehabilitation does improve the ability to reduce the bolus
particle size, but is not able to fully restore the masticatory function. The median
bolus granulometry values measured without or with prostheses remained above the
normative values but the chewing frequency continues to be impaired.</p></sec></body><back><ref-list><title>REFERENCES</title><ref id="r01"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Aras</surname><given-names>K</given-names></name><name><surname>Hasanreisoğlu</surname><given-names>U</given-names></name><name><surname>Shinogaya</surname><given-names>T</given-names></name></person-group><article-title>Masticatory performance, maximum occlusal force, and occlusal contact
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