Doctoral student, Graduate Program in Dentistry, Federal University of Pelotas (UFPel), Pelotas, Brazil.
Postdoctoral Research Fellow, Piracicaba Dental School, State University of Campinas (FOP-UNICAMP), Piracicaba, Brazil.
J Prosthet Dent. 2019 Mar;121(3):432-439. doi: 10.1016/j.prosdent.2018.05.018. Epub 2018 Nov 30.
The degree of mandibular bone atrophy can guide and determine the choice of prosthetic treatment. Although several methodologies have been proposed for classifying atrophy, the clinical and radiographic parameters considered for the classification of mandibular bone atrophy should be standardized.
The purpose of this clinical study was to evaluate the influence of methodologies of mandibular bone atrophy categorization on the masticatory function in complete denture (CD) wearers and to verify the relationship between these parameters according to the retention and stability of the mandibular CD.
CD wearers were radiographically and clinically evaluated to determine the mandibular bone atrophy levels. Three classifications were adopted: the Cawood and Howell criteria, the Wical and Swoope criteria, and the Kapur classification. CD retention and stability were scored based on the Sato et al method. The masticatory function was evaluated by the multiple sieve method using optical test food to determine the masticatory performance (MP) indexes (median particle size, MP X50; homogeneity index, MP B) and the masticatory efficiency (sieves 4 and 2.8).
In this sample of 63 individuals (mean age of 67.4 years), atrophic participants presented significant differences in all radiographic parameters (Mann-Whitney test, P<.05) with both the Cawood and Howell and Wical and Swoope methodologies. No differences in masticatory function were found, except for atrophic participants classified by Wical and Swoope criteria, who had worse MP X50 (P=.047) than nonatrophic participants, with a medium effect size of 0.7. The retention of the mandibular CD significantly affected the masticatory outcomes, with higher values for MP X50 (P=.012) and MP B (P=.040) and lower values for masticatory efficiency, 2.8 (P=.008) for atrophic participants. The presence of mandibular bone atrophy showed an association with poor retention (P=.04) and poor stability (P=.002) when the Cawood and Howell criteria were adopted (Fisher exact test, P<.05).
The Kapur classification confirmed the clinical condition of the participants' atrophy, and the most clinically atrophic participants showed poor retention and stability of the mandibular CD. Only the poor retention directly affected the masticatory function. Radiographic evaluations alone did not provide sufficient data to determine the predictability of CD treatment regarding the participants' masticatory function. Radiographically, atrophic participants with poor retention had impaired mastication.
下颌骨萎缩的程度可以指导和决定修复治疗的选择。尽管已经提出了几种分类方法，但下颌骨萎缩分类的临床和影像学参数应标准化。
本临床研究的目的是评估下颌骨萎缩分类方法对全口义齿（CD）佩戴者咀嚼功能的影响，并根据下颌 CD 的保留和稳定性验证这些参数之间的关系。
对 CD 佩戴者进行影像学和临床评估，以确定下颌骨萎缩水平。采用三种分类方法：Cawood 和 Howell 标准、Wical 和 Swoope 标准以及 Kapur 分类。根据 Sato 等人的方法对 CD 的保留和稳定性进行评分。使用光学测试食物通过多重筛法评估咀嚼功能，以确定咀嚼性能（MP）指数（中值粒径，MP X50；均匀性指数，MP B）和咀嚼效率（筛 4 和 2.8）。
在这 63 名参与者（平均年龄 67.4 岁）的样本中，使用 Cawood 和 Howell 以及 Wical 和 Swoope 方法时，所有影像学参数均存在明显差异（Mann-Whitney 检验，P<.05）。除了 Wical 和 Swoope 标准分类的萎缩参与者外，咀嚼功能无差异，他们的 MP X50 较差（P=.047），非萎缩参与者的 MP X50 较大，具有 0.7 的中等效应大小。下颌 CD 的保留显著影响咀嚼结果，MP X50（P=.012）和 MP B（P=.040）值较高，2.8 咀嚼效率（P=.008）值较低。当采用 Cawood 和 Howell 标准时，下颌骨萎缩的存在与较差的保留（P=.04）和稳定性（P=.002）相关（Fisher 确切检验，P<.05）。
Kapur 分类法证实了参与者萎缩的临床状况，最具临床萎缩的参与者表现出下颌 CD 保留和稳定性差。只有保留不良直接影响咀嚼功能。单独的影像学评估并不能提供足够的数据来确定 CD 治疗对参与者咀嚼功能的可预测性。影像学上，保留不良的萎缩参与者咀嚼功能受损。
