Evaluation of Bite Force, Quality of Life, and Patients' Satisfaction
Condition: Edentulous Jaw; Patient Satisfaction
MeSH terms: Jaw, Edentulous; Mouth, Edentulous
Study type: Observational

Summary: 
      Objectives: The purpose of this study is to evaluate bite force (BF), oral health-related
      quality of life (OHRQoL), and patient satisfaction in 2-implant-supported overdentures. In
      addition, the effects of clinical parameters such as age, gender, implant length, implant
      diameter, locator attachment height, attachment color, and interimplant distance were also
      evaluated.

      Material and Methods: A total of 51 patients were included in the study. BFs were measured
      with a force meter in complete dentures and implant-supported overdentures. OHRQoL was
      assessed with the Oral Health Impact Profile (OHIP-14) and patient satisfaction was assessed
      with the Visual Analog Scale (VAS).
    

Detailed description: 
      New complete dentures with bilateral balanced occlusion were fabricated for the patients. The
      patients wore the prosthesis for at least 8 weeks to allow the muscles to adapt. After
      adaptation to the dentures, 2 dental implants (Astra Tech Implant System, Dentsply Sirona)
      were placed in the interforaminal region of the mandible. A minimum of 3 months was waited
      for the dental implants to osseointegrate. After osseointegration, a clinical examination of
      the prostheses was performed. The clinical examination evaluated the accuracy of the
      prostheses in terms of occlusion and vertical dimension, their adaptation to the tissue, and
      the health of the soft tissue. If cracks or fractures were present, the prosthesis was
      repaired, and if a defect in tissue adaptation was detected, the prostheses were idealized by
      relining. The OccluSense® computerized occlusion analysis system (Dr. Jean Bausch GmbH & Co.
      KG, Cologne, Germany) was used to check occlusion evaluation, masticatory force distribution,
      and premature contact due to wear. In the case of premature contact, contacts were eliminated
      and the first bite force (BF) values of patients with correct occlusion were measured. The
      maximum BF was measured with a forcemeter (Akson, Istanbul, Turkey). The intraoral sensor of
      the device was placed unilaterally at the level of the 1st molar. To ensure stability, a bite
      block of the same thickness was placed in the contralateral dental arch. Patients were seated
      in a comfortable position with the Frankfurt horizontal plane parallel to the horizontal
      plane. Patients were asked to bite hard for 3 seconds and the measurement was repeated 3
      times. To obtain a reliable value, patients rested for 1 minute after each measurement. The
      maximum BF was accepted as the highest value among the three bite forces. The mean value of
      the unilateral right and left measurements was used for data analysis. After measurement, the
      dentures were attached to the Locator Attachments (Zest Anchors LLC, Escondido, USA).
      Patients had to wait at least 8 weeks to adapt to the implant-supported overdentures. After
      the adaptation period, the second BF values of the patients wearing complete dentures in the
      maxilla and implant-supported overdentures in the mandible were measured.

      Oral health-related quality of life and patients satisfaction In this phase, patients were
      asked to complete the OHIP-14 questionnaires to assess their quality of life and VAS forms to
      assess patient satisfaction. To assess the impact of clinical parameters, age, gender,
      implant lengths, implant diameters, locator attachment height, attachment color, and
      interimplant distance were also recorded.

      OHRQoL was assessed using the Turkish version of the Oral Health Impact Profile (OHIP-14).
      Patients were asked to indicate how often the corresponding OHIP parameter occurred in the
      past month. OHIP-14 contains 14 questions related to 7 different main topics. The 7 main
      themes are functional limitations, physical pain, psychological discomfort, physical
      disability, psychological disability, social disability, and handicap. Patients answered the
      questions as 0 = Never, 1 = Rarely, 2 = Occasionally, 3 = Quite often, and 4 = Frequently.
      Scoring was based on 7 main categories and 8 data as the sum of all these categories. The
      total score of the OHIP-14 is at least 0 and the highest score is 56. A low score at the end
      of the test indicates a positive impact on OHRQoL, while a high score indicates a negative
      impact.

      Patient satisfaction was measured with the questionnaire VAS. The questions in the
      questionnaires evaluated the comfort of the prosthesis, convenience in chewing, aesthetics,
      speech, stability, and ease of cleaning. Patients answered the questions with 5=Totally
      satisfied, 4=Satisfied, 3=Adequate, 2=Not satisfied, 1=Not at all satisfied. Higher scores
      indicate higher patient satisfaction.
    

Intervention name(s): complete denture
Intervention type(s): Device
Intervention description(s): Bite force was measured with a bite force measuring device. Quality of life and patient satisfaction were evaluated with questionnaires.
Observational model: Case-Control
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        Adult patients who were completely edentulous were included in the study.
      
Keywords: bite force; complete denture; implant supported overdentures; patient satisfaction; quality of life