Comparison of Treatment Outcomes in Partially

Edentulous Patients with Implant-Supported Fixed

Prostheses and Removable Partial Dentures
Toshifumi Nogawa, DDS, PhD1/Yoshiyuki Takayama, DDS, PhD2/
Keita Ishida, DDS3/Atsuro Yokoyama, DDS, PhD4

Purpose: The aim of this study was to compare masticatory performance, occlusal force, and oral health
related quality of life (OHRQoL) in patients with mandibular distal-extension edentulism between those
with implant-supported fixed prostheses (ISFPs) and those with removable partial dentures (RPDs), and to
evaluate relationships among them. Materials and Methods: Subjects were recruited from patients using
ISFPs or RPDs for mandibular distal-extension edentulism. Masticatory performance was evaluated based
on the glucose extracted from chewed gummy jelly. Occlusal force was measured with a pressure-sensitive
sheet, and data were subjected to computer analysis. The Japanese version of the Oral Health Impact Profile
(OHIP-J) was used to evaluate OHRQoL. The masticatory performance, occlusal force, and OHIP-J scores of
the ISFP and RPD groups were compared using the Wilcoxon rank-sum test. The relationships among the
variables were analyzed using the Spearman rank correlation coefficient test. Multivariate logistic regression
analysis was employed with the OHIP-J score as a dependent variable. Results: Nineteen patients with ISFPs
and 25 patients with RPDs participated in this study. No significant difference was observed between the two
groups with regard to masticatory performance and occlusal force. The OHIP-J score was significantly lower
in the ISFP group than in the RPD group. The OHIP-J score had no significant correlation with masticatory
performance, but was significantly correlated with occlusal force and the prosthetic method. Multivariate
logistic regression analysis showed that younger age, RPDs, and lower occlusal force were significantly
associated with a higher OHIP-J summary score. Conclusion: The present results suggest that the difference
in masticatory performance and occlusal force between ISFPs and RPDs is small, but ISFPs are superior
to RPDs with regard to OHRQoL in patients with mandibular distal-extension edentulism. In addition, there
appears to be a slight correlation between the OHIP-J and occlusal force in these patients. Int J Oral
Maxillofac Implants 2016;31:13761383. doi: 10.11607/jomi.4605

Keywords: implant-supported fixed prostheses, mandibular distal-extension edentulism, masticatory

performance, oral healthrelated quality of life, removable partial dentures

1 Assistant Professor, Clinical Research and Medical Innovation
Center, Hokkaido University Hospital; Department of Oral
Functional Prosthodontics, Division of Oral Functional
Science, Graduate School of Dental Medicine, Hokkaido
University, Sapporo, Japan.
2 Assistant Professor, Oral Rehabilitation, Hokkaido University
Hospital, Sapporo, Japan.
3Graduate Student, Department of Oral Functional
R
emovable partial dentures (RPDs) and implant-sup-
ported fixed prostheses (ISFPs) are commonly used
for the treatment of partially edentulous patients. In
general, ISFPs are considered to be superior to RPDs in
terms of oral function and esthetics.19
Although many studies have compared implant-

Prosthodontics, Division of Oral Functional Science, Graduate

School of Dental Medicine, Hokkaido University, Sapporo,
Japan.
4Professor, Department of Oral Functional Prosthodontics,
Division of Oral Functional Science, Graduate School of Dental
Medicine, Hokkaido University, Sapporo, Japan.
Correspondence to: Dr Toshifumi Nogawa, Department of Oral
Functional Prosthodontics, Division of Oral Functional Science,
Graduate School of Dental Medicine, Hokkaido University,
Kita 13, Nishi 7, Kita-ku, Sapporo, 060-8648, Japan.
Fax: +81(11)-706-4903. Email: t.nogawa@den.hokudai.ac.jp
2016 by Quintessence Publishing Co Inc.
supported complete dentures with conventional com-
plete dentures in relation to oral function,1017 few
studies have compared ISFPs with RPDs in partially
edentulous patients. Some studies reported that oral
healthrelated quality of life (OHRQoL), one of the sub-
jective evaluations of oral function, was significantly
better in patients with distal-extension edentulism
having ISFPs than in ones wearing RPDs.1821 However,
it remains unclear whether there are any differences
between ISFPs and RPDs in the objective treatment ef-
fects in partially edentulous patients. Only a few stud-
ies have compared objective treatment outcomes such

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as the masticatory performance of ISFPs and RPDs. In
a randomized controlled study, Kapur22 reported that
there was no significant difference in masticatory per-
formance between ISFPs and RPDs in Kennedy Class I
and II partially edentulous mandibles. Gonalves et al23
showed that there was a significant difference among
removable dental prostheses, implant-supported re-
movable dental prostheses, and implant-fixed dental
prostheses. However, there has been no report on the
relationship between objective and subjective evalu-
ations in patients with mandibular distal-extension
edentulism.
The aim of this study was to compare masticatory
performance, occlusal force, and Oral Health Impact
Profile (OHIP) scores in patients with mandibular dis-
tal-extension edentulism between those with ISFPs
and those with RPDs, and to evaluate the relationships
among them.
MATERIALS AND METHODS
Subjects
Subjects were recruited from among the patients us-
ing ISFPs or RPDs for mandibular distal-extension
partial edentulism at the Clinic of Removable Prosth-
odontics, Hokkaido University Hospital from April 2012
to November 2014. The inclusion criteria were: (1) age
40 to 70 years; (2) mandibular partially edentulous arch
of Kennedy Class I or II with no modification or with all
of the edentulous spaces restored by fixed prostheses
except for mandibular distal-extension edentulism;
(3) full dental arch or the dental arch restored by fixed
prostheses in the maxilla; (4) inserted implant-fixed
prostheses in the maxilla; and (5) more than 6 months
since the insertion of the ISFPs or RPDs.
Exclusion criteria included severe periodontal dis-
ease, temporomandibular disease, orofacial pain, dry
mouth, RPDs with remaining teeth under the denture
base or retainers other than clasps, and prosthodontic
treatment with both RPDs and ISFPs. The protocol of
this study was approved by the Institutional Review
Board of Hokkaido University Hospital for Clinical Re-
search (011-0272). All subjects received a detailed ex-
planation of the nature of this research and provided
their written informed consent prior to enrollment.
Masticatory Performance24,25
Subjects were instructed to sit in a dental chair with
the Frankfurt plane parallel to the floor and relax with
their heads not fixed, and were asked to chew gummy
jelly (GC) unilaterally for 20 seconds. After chewing,
the subjects were asked to rinse their mouths with 10
mL of distilled water and to spit into a cup. The cup
containing the chewed gummy jelly and saliva was
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Nogawa et al
then filtered, and the filtrate was collected. For the
evaluation of masticatory performance, the glucose
concentration in the filtrate was measured with a glu-
cose-testing device (Gulucosensor GS-1, Fujita Medical
Instruments). Measurements were performed three
times each for left and right unilateral chewing alter-
nately. The mean of measurements was used as an in-
dication of masticatory performance.
Occlusal Force2628
Occlusal force was measured with a pressure-sensitive
sheet (Dental Prescale 50H type R, GC). The patients
sat in a dental chair with the occlusal plane parallel
to the floor. The sheet was placed along the maxillary
dentition. They were instructed to clench on the sheet
with maximum force in the intercuspal position for 3
seconds. Then, the occlusal force was analyzed using
a computerized imaging scanner (Occluzer FPD-705,
Fuji Film). The occlusal force test was performed three
times, and the mean of the results was used for the
analysis.
The thickness of the Dental Prescale sheets was 97
m. When the sheets were clenched, microcapsules
containing a color-developing material were broken
by occlusion pressure. The contact area turned red by
chemical reaction. Occlusal force was calculated by the
degree of coloring.
Oral HealthRelated Quality of Life
OHRQoL was measured using the Japanese version of
the Oral Health Impact Profile (OHIP-J).29 The OHIP-J
uses 54 items that are divided into eight subdomains:
functional limitation, physical pain, psychologic dis-
comfort, physical disability, psychologic disability, so-
cial disability, handicap, and additional Japanese items.
Statistical Analysis
The Student t test and Fisher exact test were used
to examine the correlation of the method of prosth-
odontic treatment for mandibular partially edentulous
spaces with sex, age, and the number of missing teeth
in those spaces.
The mean masticatory performance and occlusal
force in ISFPs and RPDs were compared using the Stu-
dent t test. Comparisons between groups were also
performed after stratification by the Kennedy classifi-
cation. OHIP-J scores in ISFPs and RPDs were compared
using the Wilcoxon rank sum test. The masticatory per-
formance and occlusal force on the prosthesis side in
two groups were compared using the Student t test.
In the patients with unilateral distal-extension partial
edentulism, the masticatory performance and occlusal
force of the natural dentition side and the prosthesis
side were compared using the paired t test. Logis-
tic regression analysis was employed with objective
The International Journal of Oral & Maxillofacial Implants 1377
Nogawa et al

Table 1 Characteristics of Subjects with force using a stepwise method with a significance level
ISFPs and RPDs of P < .2,30 as independent variables.
All statistical analyses were performed using JMP 10
Variables ISFPs (n = 19) RPDs (n = 25) P value
(SAS Institute) with a significance level of .05.
Sex
Male 4 5
Female 15 20 > .999**
RESULTS
Age (y) 60.2 7.1 63.3 5.9 .116*
Mean period of Subjects
51.2 41.0 33.4 27.2 .095*
wearing (mo)
In total, 101 patients (34 ISFPs and 67 RPDs) who re-
Mean No. of teeth 23.4 1.6 21.9 2.5 .026* ceived prostheses for mandibular distal-extension
Missing side partial edentulism at the Removable Prosthodontics
Right 8 3
Clinic, Hokkaido University Hospital, were recalled dur-
Left 6 5 .014**
Both 5 17 ing the study period. Eventually, 19 patients with IS-
No. of missing
FPs (mean age, 60.2 years) and 25 patients with RPDs
teeth in partially 3.4 1.7 4.4 2.0 .0904* (mean age, 63.3 years) satisfied the eligibility criteria,
edentulous spaces gave consent, and underwent objective and subjective
Chewing side evaluations. Their characteristics are shown in Table 1.
Right 11 13
Left 8 12 .766**
Comparison Between ISFPs and RPDs
Eichner classification Table 2 shows the comparison of the mean mastica-
B1 13 6
B2 3 12
tory performance and occlusal force between the ISFP
B3 2 7 .008** group and the RPD group. There was no significant dif-
B4 1 0 ference between the two groups in masticatory per-
*Student t test. formance and occlusal force. The occlusal force of the
**Fisher exact test. ISFP group was significantly higher than that of the
RPD group in Kennedy Class I, while there was no sig-
Table 2 Comparison of Objective Evaluations nificant difference between the two groups in the mas-
Between ISFPs and RPDs ticatory performance in patients with Kennedy Class I
and II (Table 3).
ISFPs RPDs
Twenty-two patients had unilateral distal-extension
Mean SD Mean SD P value*
edentulism (ISFPs: 14 patients; RPDs: 8 patients). In uni-
Masticatory 161.7 49.8 159.3 43.3 .865 lateral distal-extension edentulism with ISFP, there was
performance (mg/dL)
no significant difference in masticatory performance
Occlusal force (N) 742.2 360.8 605.1 307.9 .181 and occlusal force between the natural dentition side
The masticatory performance and occlusal force was the mean of and the prosthesis side. However, there was a signifi-
both sides.
*Student t test. cant difference between the sides in the unilateral dis-
tal extension with RPD (Table 4).
There was no significant difference between ISFPs
and RPDs in masticatory performance and occlusal
evaluations of the prosthesis side as the dependent force of the prosthesis side in patients with Kennedy
variable and the variables selected from sex, age, pros- Class I and II (Table 5).
thetic method, the number of missing teeth in the However, the OHIP-J summary score and all subdo-
edentulous spaces, period of wearing the prosthesis, main scores were significantly lower in the ISFP group
habitual chewing side, and Kennedy classification as than in the RPD group (Table 6).
independent variables selected by the stepwise meth-
od with a significance level of P < .2.30 Multivariate Analysis in the Prosthesis Side
The relationships among the variables were calcu- Sex, prosthetic method, Kennedy classification, and
lated using the Spearman rank correlation coefficient habitual chewing side were selected as independent
test. variables by stepwise methods. Masticatory perfor-
Multivariate logistic regression analysis was em- mance and occlusal force were categorized into two
ployed with the OHIP-J score as a dependent variable groups based on median scores. The variables female
and the variables, selected from sex, age, the prosthet- and nonhabitual chewing side were significantly asso-
ic method, the number of missing teeth in the eden- ciated with lower masticatory performance (less than
tulous spaces, masticatory performance, and occlusal 154 mg/dL) and lower occlusal force (less than 303 N).

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Table 3 Masticatory Performance and Occlusal Force of ISFPs and RPDs in Patients with Kennedy
Class I and II
MP OF
Kennedy N Mean SD P value* Mean SD P value*
Class I ISFPs 5 157.3 54.4 884.6 508.7
.772 .038
RPDs 17 150.7 41.4 515.5 201.7
Class II ISFPs 14 163.3 50.1 705.6 308.4
.508 .5681
RPDs 8 177.6 44.0 795.4 413.6
MP = masticatory performance (mg/dL); OF = occlusal force (N).
*Student t test.
The masticatory performance and occlusal force was the mean of both sides.

Table 4 Masticatory Performance and Table 5 Masticatory Performance (mg/dL)

Occlusal Force in Kennedy Class II and Occlusal Force (N) of Prosthesis
D side P side Side in Patients with Kennedy Class
Objective P
evaluation Mean SD Mean SD value* I and II
MP ISFPs 167.6 48.8 159.0 55.2 .284 MP OF
RPDs 196.3 62.0 159.0 28.3 .032 P P
OF ISFPs 371.5 145.2 334.1 193.0 .358 n Mean SD value* Mean SD value*
RPDs 496.0 346.7 299.6 128.0 .126 ISFPs 24 158.3 53.1 370.9 223.5
.729 .144
MP = masticatory performance (mg/dL); OF = occlusal force (N); RPDs 42 152.3 41.4 263.5 125.6
D side = natural dentition side; P side = prosthesis side; D-P =
difference between D side and P side. The number of subjects: MP = masticatory performance (mg/dL); OF = occlusal force (N).
ISFPs = 14, RPDs = 8. *Student t test.
*Paired t test.

Table 6 Comparison of ISFPs and RPDs Using

There was no significant association between pros- the OHIP-J
thetic method and objective evaluation (Table 7). ISFPs RPDs P
Mean SD Mean SD value*
Correlation Among the Variables OHIP-J summary score 15.3 19.6 39.3 25.9 < .001
Masticatory performance and occlusal force were sig-
1. Functional limitation 4.5 4.1 9.0 4.9 .001
nificantly correlated with sex ( = 0.40, P = .0069; and
2. Physical pain 2.6 4.2 7.3 4.2 .001
= 0.54; P = .0001, respectively). In addition, there
was a significant correlation between masticatory per- 3. Psychologic discomfort 1.6 2.3 4.0 3.6 .006
formance and occlusal force ( = 0.43, P = .0036). The 4. Physical disability 2.3 3.2 6.4 4.5 < .001
OHIP-J summary score had no significant correlation 5. Psychologic disability 1.1 2.2 3.0 3.3 .020
with sex, age, the number of teeth in partially edentu- 6. Social disability 0.5 1.6 2.1 2.5 .011
lous spaces, or masticatory performance, but was sig- 7. Handicap 0.9 2.0 2.9 3.3 .012
nificantly correlated with the type of prosthesis in the 8. Japanese version 1.8 2.4 4.4 2.9 .004
edentulous space ( = 0.52, P = .0003; Table 8). *Wilcoxon rank sum test.

Multivariate Analysis for OHIP

Sex, age, the prosthetic method, the mean mastica-
tory performance, and occlusal force of both sides
were selected as independent variables by the step-
wise method. The OHIP-J summary scores were cat-
egorized into two groups based on the median score31
(lower OHIP: 0 to 25; higher OHIP: > 25). Multivariate
logistic regression analysis showed that a younger age
(odds ratio = 0.78, P = .003), RPDs (RPDs/ISFPs odds
ratio = 22.27, P = .001) and lower occlusal force (odds
ratio = 0.99, P = .001) were significantly associated
with a higher OHIP-J summary score, indicating lower
OHRQoL (Table 9).
DISCUSSION
In this study, patients with Kennedy Class I and II man-
dibular partial edentulism with no modifications were
selected. Since these types of partial edentulism are
frequent and the prosthodontic treatment commonly
involves either ISFP or RPD, the influence of the loca-
tion and the distribution of missing teeth were consid-
ered to be minimized. It was assumed that the effect of
the opposing dental arch was small, because the pa-
tients had a full dental arch or the dental arch restored
by fixed prostheses in the maxilla.

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Nogawa et al

Table 7 Logistic Regression Analysis with Masticatory Performance and Occlusal Force of the
Prosthesis Side in Patients as Dependent Variable (n = 66)
Masticatory performance Occlusal force
Independent
variables Odds ratio 95% CI P value Odds ratio 95% CI P value
Sex
Female 6.27 1.4135.28 .015 34.84 4.87754.51 .0001
Male 1.00 1.00
Prosthesis
RPD 0.80 0.212.78 .724 2.43 0.62310.41 .202
ISFP 1.00 1.00
Kennedy
Class I 3.79 0.9616.75 .0565 1.41 0.306.53 .658
Class II 1.00 1.00
Chewing side
C side 1.00 1.00
NC-side 3.96 1.1915.29 .025 5.44 1.5722.39 .007
Dependent variable: masticatory performance (MP) < 154 / 154; R2 = 0.1549; P = .0088.
Dependent variable: occlusal force (OF) < 303 / 303; R2 = 0.2524; P = .0001.

Table 8 Spearman Rank Correlation Coefficient ()

Period of No. of
Variables Age Prostheses wearing missing teeth MP OF OHIP-J
Sex 0.05 0.01 0.25 0.29 0.40** 0.54** 0.04
Age 0.22 0.07 0.25 0.05 0.01 0.16
Prostheses 0.22 0.27 0.02 0.22 0.52**
Period of wearing 0.13 0.12 0.07 0.13
No. of missing teeth 0.08 0.22 0.22
MP 0.43** 0.08
OF 0.32*
*P < .05; **P< .01.
MP = masticatory performance; OF = occlusal force.
The masticatory performance and occlusal force was the mean of both sides.

Table 9 Multivariate Logistic Regression Because the salivary flow rate influences mastica-
Analysis tory performance, patients who reported dry mouth
were excluded.32
P
Independent variables Odds ratio 95% CI value
The characteristics of the patients are shown in
Table 1. There was no significant difference between
Sexa
Male 12.84 0.69608.9 .090 the ISFP group and RPD group in sex, age, and the
Female 1.00 period of insertion of the ISFP or RPD. Although there
Age (y)b 0.78 0.620.93 .003 was a significant difference in the number of remain-
Prosthesesa ing teeth between the groups, there was no significant
RPDs 65.46 4.723517.6 .001 difference in the number of missing teeth in partially
ISFPs 1.00 edentulous spaces. Therefore, it was considered that
Kennedy Classificationa the number of missing teeth had little influence on ob-
Class I 0.02 0.00030.21 .176 jective functional evaluation.32,33
Class II 1.00
There are so many methods for evaluating masti-
Occlusal force (N)b 0.99 0.980.997 .001 catory performance, such as the sieving method,34,35
Masticatory 1.02 1.0011.05 .041 silicone,36 color-changeable chewing gum,37 glucose
performance (mg/dL)b extraction from chewed gummy jelly,38 and so on. In
Dependent variable: OHIP-J summary score 25< / 0-25; particular, the sieving method with peanuts was oc-
R2 = 0.3817, P = .001.
aCategorical variable. casionally used as a standard for the evaluation of
b Continuous variable.
masticatory performance. Kobayashi et al39 compared

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the peanut sieve method with the amount of glucose
extraction during gummy jelly chewing, and indicated
that gummy jelly was associated with objective evalu-
ations of masticatory function. It is easy to standardize
the shape and characteristic of gummy jelly, so it was
effective for measuring masticatory performance. Ad-
ditionally, it was similar to chewing daily food.
In the present study, the occlusal force was mea-
sured by Dental Prescale, which could also display
the distribution of the occlusal force and the area of
occlusal contact. Therefore, the symmetry of occlusal
force and contacts before functional evaluation could
be confirmed.
Masticatory performance and occlusal force were
assessed objectively. There was no significant differ-
ence between ISFPs and RPDs in objective evaluations.
In addition, there was no significant difference be-
tween the two groups in the masticatory performance
and occlusal force of the prosthesis side. However, the
occlusal force of patients with ISFPs in Kennedy Class I
was significantly higher than that of those with RPDs.
Meena et al40 reported that there was no significant
difference between the occlusal force of completely
dentate subjects and that of shortened dental arch
subjects with an ISFP replacing the mandibular first
molar. This result indicated that the occlusal force with
ISFP was almost equal to that of natural dentition. Aras
et al26 found that insertion of distal-extension RPDs
did not improve masticatory performance, and the
RPD group demonstrated lower occlusal force than the
complete dentate group. This finding suggested that
RPDs could not improve occlusal functions to the level
of natural dentition. Since the objects of their study
had bilaterally missing molars, it was reasonable that
the results were similar to this study in Kennedy Class I.
This study showed that the masticatory perfor-
mance did not differ significantly between the pa-
tients with ISFPs and those with RPDs in Kennedy Class
I and II. This result was similar to the study of Kapur.22
Gonalves et al23 compared masticatory performance
and occlusal force among removable dental prosthe-
ses, implant-supported removable dental prostheses,
and implant-fixed dental prostheses and indicated
that the performance of implant-fixed dental prosthe-
ses was the highest. However, since removable den-
tal prostheses were always inserted and evaluated at
first, followed by implant-supported removable dental
prostheses and implant-fixed dental prostheses, their
results might be due to the adaptation to opposing
maxillary complete dentures.
In the patients with unilateral RPDs, the mastica-
tory performance of the prosthesis side was worse
than that of the natural dentition side. This result was
in agreement with the reports of Tumrasvin et al41
and Al-Omiri et al.42 The difference in masticatory
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Nogawa et al
performance between the natural dentition side and
the prosthesis side in ISFP patients was smaller. Thus,
ISFPs were considered to improve the masticatory
performance and occlusal force of the prosthesis side
as well as that of the natural dentition. This difference
between prostheses was due to the large difference in
the displacement of prostheses in function. Because of
osseointegration into the jawbone, the displacement
of the ISFP under occlusal force was considered to be
2 to 5m,43 which is tens or hundreds of times smaller
than that of the RPD.
In this study, the lack of a significant difference of
the masticatory performance and occlusal force be-
tween RPDs and ISFPs might be due to the larger
standard deviation of objective evaluations, ie, small
sample size and accuracy of measurement of objective
evaluations. However, these results suggested that
the habitual chewing side, which was associated with
higher objective evaluation, was a confounding factor
to objective evaluations.
The result of this study showed that the ISFPs were
superior to RPDs in terms of improving OHRQoL. There
are many studies comparing the OHRQoL of patients
with implant-supported overdentures and conven-
tional complete dentures.1017 They concluded that
the OHRQoL with implant-supported overdentures
was higher than that with conventional complete
dentures. Also, there are numerous studies in which
OHRQoL in partially edentulous patients with ISFPs
and RPDs was compared. These studies revealed that
ISFPs improved OHRQoL more than RPDs.1821 RPDs
might reduce OHRQoL in partially edentulous patients
because of the pain or functional limitations caused by
the little movement in the oral cavity. The major and
minor connecters, retainers, and resin bases might
give the patients a foreign-body sensation. In addi-
tion, differences in the social background among the
patients may affect the results, because, in Japan, ISFPs
are far more expensive than RPDs.
Ikebe et al44 reported that the OHIP-14 score had no
association with masticatory performance and occlu-
sal force, and indicated that the OHIP-14 was mainly
determined by psychologic and social outcomes. In
this study, the OHIP-J, which also contains questions
about physical pain, and functional limitations as
well as psychologic and social outcomes, was used
to evaluate the OHRQoL. There was no significant re-
lationship between the OHIP-J score and masticatory
performance. However, there was a weak correlation
between the OHIP-J score and occlusal force. Multi-
variate analysis showed that the odds ratio of mastica-
tory performance and occlusal force was almost one.
It suggested that objective functional evaluations
slightly affected the OHIP-J score. In this study, the
prosthetic method influenced the OHRQoL more than
The International Journal of Oral & Maxillofacial Implants 1381
Nogawa et al
the objective factors such as masticatory performance
and occlusal force. Moreover, there was no significant
difference between ISFPs and RPDs in the objective
evaluations. These results suggested that psychologic
and social factors regarding the prosthetic methods
influenced the OHRQoL evaluated by the OHIP-J more
than the recovery of oral function with the prostheses.
In other words, the higher subjective evaluation for
ISFPs was probably more influenced by characteristics
such as comfort, than objective functional evaluation
such as masticatory performance and occlusal force.
This study may not accurately demonstrate the
treatment effects of the prosthetic methods, as there
may have been bias in selection of the prosthesis. How-
ever, strict inclusion and exclusion criteria were used
in an attempt to ensure that the results of this study
were accurate in evaluating the treatment effects. It is
necessary to increase the sample size and to perform
prospective cohort studies or randomized clinical trials
to obtain further evidence.
CONCLUSIONS
Within the limitations of this study, the mean value of
occlusal functions such as masticatory performance
and occlusal force did not significantly differ between
the prosthetic methods, but implant-supported fixed
prostheses were superior to removable partial den-
tures with relation to the OHRQoL in patients with
mandibular distal-extension edentulism. These results
suggest that the difference in objective functional
evaluation between the prosthetic methods was
small, while subjective evaluation was influenced by
prosthetic methods. In addition, there was a weak rela-
tion between OHIP and occlusal force in patients with
mandibular distal-extension edentulism restored by
an implant-supported fixed prosthesis or removable
partial denture.
ACKNOWLEDGMENTS
The authors reported no conflicts of interest related to this
study.
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