Lecturer, Department of Prosthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
Assistant Professor, Department of Community Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
J Prosthet Dent. 2021 Feb;125(2):287-293. doi: 10.1016/j.prosdent.2020.01.001. Epub 2020 Feb 27.
The masticatory ability of complete denture (CD) wearers can be evaluated subjectively and objectively. Although an objective measure reflects a person's ability to masticate food, it is rarely used in clinical practice. Moreover, the factors associated with subjective and objective masticatory ability of CD wearers remain unclear.
The purpose of this clinical study was to identify subjective and objective measures that better reflect the masticatory ability of CD wearers and to investigate their associating factors.
Masticatory ability was evaluated in 130 CD wearers by using subjective and objective measures. The subjective indicators were oral impact on eating and denture satisfaction based on eating or mastication ability. Masticatory performance was objectively measured by using a median peanut particle size. The maximum occlusal force, number, and area of occlusal contacts were determined from a pressure-sensitive sheet. CD retention and stability were classified into acceptable and unacceptable denture quality following the CU-modified Kapur criteria. The occlusal pattern and oral conditions were examined and recorded. Intraexaminer reliability in determining CD quality and oral condition was shown by a Kappa score of 0.90 to 0.95. Multivariable linear and logistic regressions were performed to analyze the associations between CD quality, maximum occlusal force, and masticatory ability. The Spearman correlation was used to determine the association between subjective and objective measures. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) between subjective and objective measures were calculated.
Unacceptable CD quality was significantly associated with oral impact on eating, eating dissatisfaction, and larger peanut particle size (P<.001). Peanut particle size increased with lower maximum occlusal force, which was related to fewer occlusal contacts and the female sex. The highest to lowest adjusted R values were related to masticatory performance, oral impact on eating, and eating satisfaction models. Among participants with unacceptable CD quality, 16% had higher masticatory performance, 25%, had no oral impact on eating, and 33% reported eating satisfaction. The sensitivity and specificity values of subjective measures in predicting lower masticatory performance were approximately recorded at 74% and 90%, respectively, whereas PPV and NPV were at 90% and 77%, respectively.
CD retention and stability impact objective and subjective masticatory ability. Objective masticatory performance is the best measure for evaluating the masticatory ability of CD wearers, followed by oral impact on eating and eating satisfaction. A 3.6-mm peanut particle size is suggested as a cutoff value for identifying CD wearers with impaired masticatory ability.
全口义齿（CD）佩戴者的咀嚼能力可以通过主观和客观的方法进行评估。虽然客观测量反映了一个人咀嚼食物的能力，但在临床实践中很少使用。此外，CD 佩戴者主观和客观咀嚼能力的相关因素仍不清楚。
本临床研究的目的是确定能更好地反映 CD 佩戴者咀嚼能力的主观和客观测量方法，并探讨其相关因素。
通过主观和客观的方法对 130 名 CD 佩戴者的咀嚼能力进行评估。主观指标为基于咀嚼能力的口腔进食影响和义齿满意度。使用中值花生颗粒大小来客观测量咀嚼性能。通过压力敏感片确定最大咬合力、咬合接触的数量和面积。根据 CU 改良 Kapur 标准，将 CD 保留和稳定性分为可接受和不可接受的义齿质量。检查并记录咬合模式和口腔状况。确定 CD 质量和口腔状况的内部检查者可靠性通过 Kappa 评分 0.90 至 0.95 来显示。使用多元线性和逻辑回归分析 CD 质量、最大咬合力和咀嚼能力之间的关联。使用 Spearman 相关性来确定主观和客观测量之间的关联。计算主观和客观测量之间的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
不可接受的 CD 质量与口腔进食影响、进食不满意和更大的花生颗粒大小显著相关（P<.001）。花生颗粒大小随着较低的最大咬合力而增加，这与较少的咬合接触和女性有关。调整后的 R 值最高到最低依次与咀嚼性能、口腔进食影响和进食满意度模型相关。在 CD 质量不可接受的参与者中，16%的人具有更高的咀嚼性能，25%的人没有口腔进食影响，33%的人报告进食满意。主观测量预测较低咀嚼性能的敏感性和特异性值分别约为 74%和 90%，而 PPV 和 NPV 分别为 90%和 77%。
CD 的保留和稳定性影响客观和主观的咀嚼能力。客观的咀嚼性能是评估 CD 佩戴者咀嚼能力的最佳方法，其次是口腔进食影响和进食满意度。建议将 3.6 毫米的花生颗粒大小作为识别咀嚼能力受损的 CD 佩戴者的临界值。
