Effect of implant-supported mandibular overdentures versus reline on masticatory performance and salivary flow rates in very old adults-A randomized clinical trial.

PURPOSE: To compare the masticatory efficiency (ME), maximum voluntary bite force (MBF), masseter muscle thickness (MMT), and salivary flow rates (SFR) in completely edentulous dependent elders treated either with a conversion of their existing mandibular complete removable dental prostheses (CRDPs) into a two-implant overdenture (IOD) or a conventional reline of the CRDP. MATERIAL AND METHODS: Participants were randomly allocated into intervention (IG) and control (CG) groups. The IG received two implants in the mandibular canine regions, and their CRDPs were transformed into IODs. The CG received a conventional reline of their mandibular CRDPs. Outcomes were recorded at each recall visit (baseline, immediately, 3 months, 12 months after intervention, and subsequently on an annual basis). Statistical analyses used mixed linear regression models (level of significance: p < 0.05). RESULTS: The IG comprised 16 participants (age = 85.0 ± 6.2 years), while the CG comprised 16 (age = 84.8 ± 5.4 years), with a mean follow-up of 2.7 ± 2.2 years (range: 3 months-7 years). A significant increase of MBF in the IG was observed with an overall gain of 80 N (p < 0.001) compared with the reline group. There were no significant long-term changes in SFR, MMT, or ME within/between groups. CONCLUSION: Since dependent elders with mandibular IODs present a significant gain in MBF, but no relative increase in SFR, MMT, and ME, it seems that this increased capacity of MBF is not exploited by the elders during their habitual chewing.

Tooth loss, chewing efficiency and cognitive impairment in geriatric patients.

BACKGROUND: Patients with dementia have poorer oral health and fewer teeth than their peers without cognitive impairment. OBJECTIVE: The hypothesis of this study is that the number of natural teeth and the chewing efficiency are associated with cognitive functioning. METHODS: This cross-sectional study included 29 patients diagnosed with dementia aged 75 years or older and 22 controls who were either cognitively normal (n = 19) or with mild cognitive impairment (n = 3). Neuropsychological, nutritional and dental assessments were performed. The chewing efficiency was evaluated with a two-colour mixing test. RESULTS: Demented patients and controls presented with a mean of 4.9 and 6.5 teeth, respectively (n.s.). The number of natural teeth was not associated with dementia (p = 0.553). Same results were found for age (p = 0.746) and sex (p = 0.901). The chewing efficiency by visual inspection proved worse in participants with dementia than in the controls (p < 0.011) and explained 9.3% of the variance in the diagnosis of dementia. Neither dental state nor chewing efficiency was related to the nutritional state. CONCLUSION: Chewing efficiency seems stronger associated with cognitive impairment than the number of teeth. Hence, in a more holistic approach for the geriatric assessment, the dental examination may be complemented by a chewing efficiency test.

Short Dental Implants Retaining Two-Implant Mandibular Overdentures in Very Old, Dependent Patients: Radiologic and Clinical Observation Up to 5 Years.

PURPOSE: To describe the survival rate and peri-implant bone loss in very old patients dependent for their activities of daily living (ADL), treated with mandibular two-implant overdentures (IODs) in the context of a previously reported randomized controlled trial. MATERIALS AND METHODS: A total of 19 patients received two interforaminal Straumann implants (Regular Neck, 4.1 mm diameter, 8 mm length) that were subsequently loaded with Locator attachments, transforming their preexisting inferior conventional denture into an IOD. The primary outcome measures were implant survival rate and radiographically assessed peri-implant bone loss. Secondary outcome measures included peri-implant probing depth and Plaque Index scores, as well as implant mobility. Nutritional state (body mass index and blood markers) and cognitive state (Mini-Mental State Examination) were also analyzed. RESULTS: The patient cohort comprised eight men and 11 women with a mean age of 85.7 ± 6.6 years. The implant survival rate up to 5 years was 94.7%, with one early and one late implant failure. The mean loss of peri-implant bone height was 0.17 mm per year (95% confidence interval: 0.09 to 0.24; P < .001). Peri-implant probing depth and Plaque Index scores were low and stable during the first 2 years, and thereafter increased continuously. Correlation analysis suggests that a reduced cognitive function and nutritional state are not a particular risk factor for accelerated peri-implant bone loss. CONCLUSION: The high implant survival and acceptable peri-implant health suggest that neither age nor dependency for the ADLs is a contraindication for the placement of implants. Nevertheless, close monitoring of the patients concerning a potential further functional decline precluding denture management and performing oral hygiene measures is advised.

Dental appearance and personality trait judgment of elderly persons.

PURPOSE: The study aimed to investigate the personality judgments made by observers of elderly individuals with different dental appearances. MATERIALS AND METHODS: A random sample of 120 elderly (57 men, 63 women; third age: n = 51, mean age: 68.6 ± 5.0 years; fourth age: n = 69, mean age: 85.8 ± 3.0 years) and 120 young (54 men, 66 women; mean age: 24.9 ± 3.5 years) subjects were included. Decayed, natural, and ideal dental appearances were simulated on photographs of an elderly man and woman. Participants were asked to judge the personality traits of two randomly selected photographs. Univariate and multivariate analyses were performed. RESULTS: Both groups judged the photographs similarly by attributing a higher social class to the individuals with an ideal dental appearance (elderly group: P = .0295 for the male subject, P = .0420 for the female subject; young group: P = .0003 for the male subject, P = .0042 for the female subject). This difference was less obvious when only the third-age participants were analyzed; they attributed a higher social class to the photograph of the man with a natural dental appearance than to the man with decayed and ideal appearances (P = .0322 and P = .0092, respectively) and lower intellectual capacities to the woman with a decayed appearance (P = .0351). The fourth-age subgroup made no such distinction. CONCLUSIONS: Personality judgments made by young and elderly persons are influenced by dental appearance. However, in the very old subgroup, no such influence could be verified. Dental esthetics should not be neglected in dental care for elderly patients.

The effect of mandibular denture abstention on masseter muscle thickness in a 97-year-old patient: a case report.

This case report describes the effect of complete denture abstention and subsequent rehabilitation with mandibular implant-supported overdentures (IOD) on masseter muscle thickness (MMT) in a 97-year-old patient. MMT was measured bilaterally using an ultrasound scanner during 1 year of wearing a conventional denture, after 101 days of voluntary denture abstention, and 3, 6, and 12 months after delivery of the IOD. MMT decreased by 17% during denture abstention following repeated implant surgery, and returned to 100% during the 12 months with the mandibular IOD. This case suggests that muscle bulk may be related to denture function.