Effect of adaptation time on the occlusal

force at denture dislodgement with or

without denture adhesive
Gregory Polyzois, DDS, Dr Dent, MScD,a
Christos Partalis, DDS, MSc,b
Panagiotis Lagouvardos, DDS, Dr Dent,c and Hector Polyzoisd
University of Athens, Athens, Greece; University of Brighton,
Brighton, UK
Statement of problem. The effect of denture adhesives on the occlusal forces at the dislodgement (OFD) of new complete
dentures during the adaptation period has not been previously studied.

Purpose. The purpose of this study was to investigate the OFD of dentures after their insertion and 3 months later, with or
without denture adhesives.

Material and methods. Thirteen volunteers with edentulism were enrolled in the study. Each participant had new complete
maxillary and mandibular dentures. The occlusal forces (N) at denture dislodgement were assessed with or without 2 ad-
hesives by using an electronic gnathodynamometer in the incisal and premolar regions on the existing denture, the new
denture immediately after fitting, 45 days later, and 90 days later. The statistical analysis included the Wilcoxon and Kruskal-
Wallis tests, repeated measures ANOVA, and the Pearson coefficient at a¼.05.

Results. Repeated measures ANOVA for new dentures showed that the OFD in the incisal or premolar region were signifi-
cantly different between adaptation periods (P<.05) but not between adhesives. OFDs of dentures with and without ad-
hesives correlated highly at all adaptation periods (0.912 to 0.995).

Conclusions. The adaptation period does affect the OFD of new dentures, but the 2 adhesives were found to have the same
effect on the OFD. (J Prosthet Dent 2014;111:216-221)

Clinical Implications
The adaptation period of individuals to new complete dentures as
measured by stabilized occlusal dislodgement forces is shorter for the
incisal and longer for the posterior regions, and the use of denture
adhesives does not change this pattern.

Denture adhesives or fixatives are
widely used by millions of denture
wearers as an over-the-counter rem-
edy.1-4 They are accepted as useful ad-
juncts to denture treatment and are
considered by users as improving den-
ture function.5-7 Currently, 2 types of
denture adhesives are commercially
available: insoluble and soluble. Insol-
uble products, called denture cushions
or pads, are prefabricated disposable
devices made of wax-impregnated
cotton cloth with an adhesive ingredient
such as sodium alginate or ethylene
oxide polymer. Soluble products include
creams, powders, and strips. They use a
blend of fast solubility and low solubility
polymer carboxy-methyl-cellulose and
poly(methyl vinyl ether/maleic acid) or
mixed partial salts of sodium, calcium,
and magnesium, with or without zinc as
adhesive ingredients.6,8
Recent literature reflects the clinical
indications and benefits of the appli-
cation of denture adhesives in well-
fitting dentures,6,9-16 and a number
of objective methods have been used
to evaluate the effectiveness of denture
adhesives. These include the Kapur
Index,17 occlusal force,9-14 electro-
myography,18 and kinesiography to
measure denture retention, stability,
and dislodgement,19 or masticatory

a
Associate Professor, Department of Prosthodontics, Dental School, University of Athens.
b
Clinical Associate, Department of Prosthodontics, Dental School, University of Athens.
c
Associate Professor, Department of Operative Dentistry, Dental School, University of Athens.
d
Pharmacy student, School of Pharmacy and Biomolecular Sciences, University of Brighton.

The Journal of Prosthetic Dentistry Polyzois et al

March 2014
performance18 as indicators of masti-
catory efficiency. Since the early
1980s, studies have investigated the
occlusal forces needed to dislodge a
denture with or without denture ad-
hesives by using various types of elec-
tronic gnathodynamometers.15,16,18-26
More recently, disposable gnath-
ometers have been used for the same
purposes.9-14,27
Occlusal forces at denture dis-
lodgement (OFD) after the renewal or
relining of complete dentures over the
adaptation period have rarely been
investigated. Müller et al28 reported the
maximum occlusal forces of existing
and new dentures by using a central
bearing point device immediately after
insertion and up to 10 months. They
described a nonsignificant drop in
occlusal forces during the first week
after insertion of new dentures. This
trend reversed rapidly during the first
month and progressively thereafter up
to 10 months. More recently, Wöst-
mann et al29 investigated the OFD with
a disposable gnathometer for new or
optimized dentures immediately after
insertion, 1 week, and 1 and 6 months
later. The investigators reported a sig-
nificant increase in occlusal forces after
optimizing dentures (relining and/or
renewal), with the greatest increase
occurring again within 1 week after
fitting. Lindquist et al30 reported a sig-
nificant increase in forces after 2
months of adaptation but not after 6
months. Better results tended to occur
after 2 months of adaptation rather
than after 6 months. A longer adapta-
tion period did not lead to improved
functional results.
The effect of denture bases and
bearing tissues, and the application of
denture adhesives to new dentures on
the OFD during the adaptation period
has not been investigated. The pur-
pose of the present study was to
investigate the OFD on existing and
new dentures after insertion and up to
3 months later, with or without 2
different denture adhesives, by using
an electronic gnathodynamometer.
The null hypotheses tested were that
the adaptation period does not affect
Polyzois et al
the OFD with or without denture ad-
hesive, that no differences will be
found in the OFD between denture
adhesives.
MATERIAL AND METHODS
Fifteen volunteers with edentulism,
ranging in age from 59 to 79 years,
participated in the study based on an a
priori sample size estimation obtained
from software (G* Power v3.1.5; Uni-
versität). A medium effect size was
chosen (0.25) at a¼0.05, 1-b¼0.95
and with a correlation among repeated
measures of 0.50. All the participants
were selected for complete denture
replacement in both arches at the
Comprehensive Dental Care Clinic of
Athens Dental School.
The inclusion criteria were that
participants should have existing com-
plete maxillary and mandibular den-
tures at least 1 year old and be seeking
their replacement, that they should
have good health with no serious
medical problems that would contra-
indicate participation in the study, and
that they should be in full compliance
with the study’s protocol and objec-
tives. The patients were informed about
the aim of the study, and consent was
obtained from each before the study
procedures began. The study was
reviewed and approved by the institu-
tional review board at the Dental
School of Athens.
Each participant had complete
dentures fabricated by senior-year stu-
dents under the supervision of pros-
thodontists and according to the
standard protocol used in the Division
of Removable Prosthodontics. This
protocol includes preliminary impres-
sions with modeling plastic impression
compound (Sybron/Kerr), and defini-
tive impressions with zinc oxide eugenol
(SS White; Prima Dental Group) paste
materials after border molding,
recording of the maxillomandibular
relationship and transfer to a semi-
adjustable articulator (Hanau H2; Whip
Mix Corp) by using a mounting device,
and a centric relation record (Blue
Mousse; Parkell Inc). The denture
217
bases were designed with a posterior
palatal seal and acrylic resin teeth (SR-
Vivodent PE; Ivoclar Vivadent AG) in a
bilateral balanced occlusal scheme and
were fabricated with heat-polymerized
acrylic resin (ProBase Hot; Ivoclar
Vivadent AG). Once fabricated, a clin-
ical remounting procedure was used
to adjust occlusion, tested on the pa-
tients for accuracy adjustments, and
delivered.
A cushion and strip type of denture
adhesive was used. The strip type was
Super Poligrip Comfort Seal Strips;
Polyethylene glycol (PEG-90), micro-
crystalline wax, polybutene, cellulose
gum, (GlaxoSmithKline Consumer
Healthcare) and the cushion Protefix
Adhesive; sodium alginate, viscose
fiber, polypropylene fiber (Queisser
Pharma). Denture adhesives were
applied to maxillary and mandibular
dentures according to manufacturer
instructions.
The occlusal force (N) required to
dislodge the denture (OFD) was
assessed with an electronic gnatho-
dynamometer of the pressure gauge
transducer type (Miniature bite-force
recorder; Kleven). Technical details,
calibration procedures, and clinical
application have been described by
Polyzois et al,15 Fløystrand et al,31
Bakke et al,32 and Fløystrand and
Orstavik.33 Its accuracy was 1 N,33
and its precision in terms of co-
efficient of variation was lower
than 4%.31
Occlusal forces were measured in
the incisor area with central incisors in
an edge-to-edge position and in the
premolar region (left, right). The gna-
thodynamometer was inserted between
the teeth in each region, and the patient
occluded slowly and evenly until
dislodgement of the dentures occurred.
A 60-second period was allowed be-
tween each recording so that the
participant could reposition the den-
ture, and the OFDs were calculated as
an average of 4 recordings. For the
adhesive tests, the dentures were
seated, and the OFD recordings were
made after 15 minutes of adhesive
application.
218 Volume 111 Issue 3
The sequence of the OFD recordings 150
for each participant was as follows:
existing denture, new immediately after 100
+1.96 SD
insertion (baseline), 45 days later, and

Left PR - Right PR
50 72,3
90 days later (adaptation period). On
each occasion, recordings were made 0 Mean
with and without adhesive by the same –7,1
–50
calibrated investigator (CP). The testing –1.96 SD
order of the adhesives and regions –100 –86,5
was randomized among the participants
to avoid biased results. Examiner’s –150
measuring consistency in terms of
–200
intraclass correlation coefficient was 0 50 100 150 200 250 300 350 400
estimated at 0.988. Average of Left PR and Right PR
The differences in OFD between the 1 Bland-Altman plot of differences between left and right
existing and new dentures were statis- premolar region in occlusal forces at dislodgement.
tically analyzed with the Wilcoxon Continuous line represents mean difference (e7.1 N),
matched pairs signed rank test; the dashed lines just outside mean represent confidence inter-
differences between the existing den- val and outer dashed lines at mean 1.96 SD represent
tures with and without adhesives were limits of agreement.
analyzed with the Kruskal-Wallis test
(a¼.05). To investigate the effects of 50
the adaptation time and the adhesives
on the OFD, 2-way repeated measures 40
ANOVAs were used separately for each
area, because measurements at ad-
Percentile

aptation periods represent repeated
recordings of dislodgement forces.
The Kolmogorov-Smirnov and Levene
tests were applied to test distribution
normality and equality of variances.
The Levene test indicated equal vari-
ances (P>.05), but most distributions
were found to be abnormal (P<.05).
The data were log transformed to meet
normality (P>.05), and then 2-way
repeated measures ANOVAs were per-
formed at a¼.05 with a statistical
package (MedCalc 10.2; MedCalc
Software).
RESULTS
Two participants withdrew from the
study (1-b¼.928), which left 13 in-
dividuals (7 men and 6 women) with a
mean age of 68.2 years. Initial data
indicated a difference between left and
right OFD that was statistically signifi-
cant (P¼.031). However, the difference
of 7.1 N in relation to the limits of the
agreement shown in the Bland-Altman
plot (Fig. 1) was not considered clini-
cally important for the sample. Both
regions could be used interchangeably
The Journal of Prosthetic Dentistry
30
20
10
0
–200 –150 –100 –50
Left PR - Right PR
2 Mountain plot (folded cumulative distribution),
showing difference of dislodgement forces between left and
right premolar region. Mean difference is centered over
zero, which indicates close agreement of two.
to record premolar dislodgement
forces, as the Mountain plot graphically
illustrates (Fig. 2), and, for this reason,
the mean values of the left and right
premolar regions were combined and
compared statistically with the incisal
region (Table I).
Analysis of the data showed that the
OFD values for new dentures increased
with time or adhesives in relation to the
existing ones (Table I). However, statis-
tical analyses revealed that the OFD
of new and existing dentures were
not significantly different (P¼.872,
Wilcoxon test). The OFD of existing
0 50 100 150
dentures with and without adhesives
also did not differ significantly (P¼.211,
Kruskal-Wallis test).
In the incisal region, repeated mea-
sures ANOVA (with Greenhouse-Geisser
correction due to sphericity violation,
E¼0.631) for new dentures showed
that dislodgement forces were signifi-
cantly different between adaptation
periods (P¼.04) but not between ad-
hesives, (Padh¼.758) (Fig. 3). Pairwise
comparisons with the Bonferroni
correction revealed that dislodgement
forces at 45(P45-0¼.026) and 90 days
(P90-0¼.035) were significantly higher
Polyzois et al
March 2014 219
Table I. Dislodgement forces (N) on premolar (combined left and right) significantly compared with existing
and incisal region of dentures, with or without denture adhesive, at different dentures (P¼.02) but not with adhesive
adaptation periods (0 day, 45 day, 90 day) (n¼13) (P¼.077). The Wilcoxon test revealed
that the OFDs of new dentures were
Protefix
significantly different from those of the
No Super Poligrip Adhesive existing dentures (P¼.021). The Kruskal-
Adhesive, Comfort Seal Cushions, Wallis test also showed that the OFDs of
Region Denture mean (SD) Strips, mean (SD) mean (SD) existing dentures with adhesives did not
differ from those without adhesives
Premolar Existing 80.0 31.7 110.0 43.2 102.0 40.2 (P¼.077). Repeated measures ANOVA
New-0 d 102.1 52.8 117.3 46.0 116.2 47.0 (with Greenhouse-Geisser correction,
New-45 d 103.3 45.1 130.0 60.6 132.1 66.6 E¼0.745) showed that dislodgement
New-90 d 118.0 60.7 147.0 83.0 140.0 76.7 forces were significantly different be-
tween adaptation periods (P¼.001) but
Incisal Existing 29.6 14.3 44.7 21.2 41.4 24.1
not between adhesives (Padh¼.433),
New-0 d 36.2 34.6 45.6 40.9 44.0 43.3 similar to the incisal region (Fig. 3).
New-45 d 44.1 31.4 52.5 40.6 49.6 37.5 Pairwise comparisons with Bonferroni
New-90 d 44.8 35.1 51.4 39.5 50.3 39.0 correction revealed that dislodgement
forces at 0 and 45 days were significantly
different from those at 90 days
(P0-90¼.0006, P45-90¼.0013), with no
180
Estimated Marginal Means of OFD on Premolar Region (Newton)

Incisal No Premolar No difference between 0 and 45 days

Incisal SPo Premolar SPo (P0-45¼.230). Trend analysis, showed a
160 Incisal PRo Premolar PRo significant positive linear trend of
dislodgement forces with adaptation
140 periods (P<.001).
The Pearson correlation coefficients
between the OFD indicated a significant
120 correlation among all pairs. These r
values were almost perfect for the pair
100 45-90 days for all adhesive groups
(0.915-0.990), very good for the pair
0-45 days (0.793-0.883), and moderate
80
for the pair existing and new dentures
without adhesive (0.565-0.715). A highly
60 significant and almost perfect correlation
of the OFD in dentures with and without
40 adhesive also was found (0.912-0.995) in
all adaptation periods.

20 DISCUSSION

0 The results of this study support

0 45 90 rejection of the first null hypothesis that
Adaptation Periods (days)
the adaptation period does not affect
3 Estimated marginal means of occlusal forces at the OFD of newly inserted dentures
dislodgement in newtons, applied on incisal (I) and premolar with or without denture adhesives and
(P) region, for adhesive groups (No-No adhesive, SPo-Super
support not rejecting the second that
Polygrip Comfort Seal strips, PRo-Protefix Adhesive cushions)
there were no differences between the
at adaptation periods.
denture adhesives in OFD. The appa-
ratus used to measure the dislodgement
than at 0 day and, with no difference linear trend of the dislodgement forces forces was accurate and precise. The
between them (P45-90¼.989). Trend with time (P¼.011). reported precision was confirmed in the
analysis (tests of within subjects con- In the premolar region, the OFD present study during calibration proce-
trasts) showed a significant positive values of new dentures increased dure (CV¼1.1%-3.4%), even though
Polyzois et al
220
participants’ variability doubled the
overall CV of the measurements (7.9%).
The results (Table I) show that the
OFD of new dentures at the incisal re-
gion ranged from 36.2 to 52.5 N.
These findings are within the ranges re-
ported by other researchers15,16,20-25 by
using various electronic gnathodyna-
mometers. OFD on the premolar region
ranged in the present study from 102.1
to 147.0 N, and these are within the
ranges reported by similar studies15,18,26
for the premolar-molar region. Munoz
et al16 reported incisal occlusal forces of
approximately 50 N by using a strain
gauge transducer and Super Poligrip
Comfort Seal Strips, which corroborates
with the findings in the present study for
the same adhesive (43-55 N). The results
of the present study showed increased
and significantly different OFDs between
existing and new dentures, only for the
premolar region, as other studies have
shown.15,18
Both adhesives used in the present
study increased equally but not signifi-
cantly either existing or new denture’s
OFD. Because no interaction was found
between the adhesives used in new den-
tures and adaptation periods, the adhe-
sives do not seem to alter the positive
linear effect of adaptation time to OFD.
Grasso et al23 also reported no significant
increase in OFD after adhesive ap-
plication in existing or new dentures,
which is in agreement with the results of
the present study. However, the findings
are not in agreement with several other
studies,9-16,18,20-27 possibly because
of the high individual variability of
OFD, which may suppress significant
differences.
Analysis of the results indicated a
significant influence of adaptation time
on dislodgement forces for incisal and
premolar region, with a significant pos-
itive linear trend. These findings are
in general agreement with other
studies28,29 but with some differences.
Nicolas et al34 reported that using den-
ture adhesive for 3 months improved the
participant’s ability to manage conven-
tional dentures, enhanced their oral
quality of life and led to improvements in
function, pain or discomfort, and
The Journal of Prosthetic Dentistry
psychological levels, as described by the
General Oral Health Assessment Index.
The functional field of the General Oral
Health Assessment Index highlights a
progressive and significant improvement
in functional scores derived from various
factors such as occlusal forces. Veyrune
et al35 also used the General Oral Health
Assessment Index to study the effect of
denture treatment on oral quality of
life and reported that, after placing
new complete dentures, it is approxi-
mately 90 days before any measurable
improvement is seen.
Analysis of the data shows that the
adaptation period of 90 days is ade-
quate because most of the changes in
occlusal forces occur during the first
4 weeks28,29 after insertion of new or
optimized dentures. The discrepancies
among studies as to the optimum
adaptation time for new dentures are
most probably due to differences in the
evaluated region for the maximum force
at dislodgement (incisal, premolar,
molar, central bearing point) and in the
devices used (disposable gnathometers,
strain gauges, electronic gnathometers).
The present study showed that the OFD
in the incisal region reached a maximum
value in 45 days and in the premolar
region in 90 days. Because adaptation
time depends on the growth of the mus-
cles involved in the mastication pro-
cess,36 adaptation affects the anterior
occlusal region more rapidly because of
the lower forces applied, either because
of the need to minimize anterior occlusal
contacts or to attenuate the muscle ac-
tivity in an incisal occlusion in contrast
to a molar occlusion.37
CONCLUSIONS
The following conclusions can be
drawn within the limitations of this
study:
1. The adaptation period does
affect the OFD of new dentures, which
shows a linear increase of incisal or
premolar values.
2. The use of adhesives seems to
increase insignificantly the mean of
the OFD of new dentures, without
Volume 111 Issue 3
changing the effect of the adaptation
period. The 2 adhesives have almost the
same effect on the OFD.
REFERENCES
1. Coates AJ. Usage of denture adhesives. J Dent
2000;28:137-40.
2. Divaris K, Ntounis A, Marinis A, Polyzois G,
Polychronopoulou A. Loss of natural denti-
tion: multi-level effects among a geriatric
population. Gerodontology 2012;29:e192-9.
3. Polyzois GL, de Baat C. Attitudes and usage
of denture adhesives by complete denture
wearers: a survey in Greece and the
Netherlands. Gerodontology 2012;29:
e807-14.
4. Shigli K. Aftercare of the complete denture
patient. J Prosthodont 2009;18:688-93.
5. Slaughter A, Katz RV, Grasso JE. Professional
attitudes toward denture adhesives: a Delphi
technique survey of academic prosthodon-
tics. J Prosthet Dent 1999;82:80-9.
6. Grasso JE. Denture adhesives. Dent Clin
North Am 2004;48:721-33.
7. Koronis S, Pizatos E, Polyzois G,
Lagouvardos P. Clinical evaluation of three
denture cushion adhesives by complete
denture wearers. Gerodontology 2012;
29:e161-9.
8. Polyzois G, Stefaniotis T, Papaparaskevas J,
Donta C. Antimicrobial efficacy of
denture adhesives on some oral malodor-
related microbes. Odontology 2013;101:
103-7.
9. Özcan M, Kulak Y, de Baat C, Arikan A,
Ucankale M. The effect of a new denture
adhesive on bite force until denture
dislodgement. J Prosthodont 2005;14:122-6.
10. de Baat C, van’t Hof M, van Zeghbroeck L,
Ozcan M, Kalk W. An international multi-
center study on the effectiveness of a denture
adhesive in maxillary dentures using dispos-
able gnathometers. Clin Oral Invest 2007;11:
237-43.
11. Pradies G, Sanz I, Evans O, Martnez F,
Sanz M. Clinical study comparing the effi-
cacy of two denture adhesives in complete
denture patients. Int J Prosthodont
2009;22:361-7.
12. Wang YB, Chen YY. Adhesive-mediated
enhancement of occlusal force measurements
in patients with existing and new complete
dentures: a pilot study. Int J Prosthodont
2010;23:155-7.
13. Hong G, Maeda T, Hamada T. The effect of
denture adhesive on bite force until denture
dislodgement using a gnathometer. Int Chin J
Dent 2010;10:41-5.
14. Tarib NA, Bakar MT, Abd Murat MDT,
Ahmad M, Kamarudin KH. Masticatory effi-
cacy and bite force in complete dentures: a
study of denture adhesive. Hong Kong Dent J
2010;7:67-73.
15. Polyzois G, Lagouvardos P, Frangou M,
Stefaniotis T. Efficacy of denture adhesives in
maxillary dentures using gnathodynamom-
etry: a comparative study. Odontology
2011;99:155-61.
Polyzois et al
March 2014
16. Munoz CA, Gendreau L, Shanga G,
Magnuszewski T, Fernandez P, Durocher J.
A clinical study to evaluate denture adhesive
use in well-fitting dentures. J Prosthodont
2012;21:123-9.
17. Kapur KK. A clinical evaluation of denture
adhesives. J Prosthet Dent 1967;18:550-8.
18. Fujimori T, Hirano S, Hayakawa I. Effects of
a denture adhesive on masticatory functions
for complete denture wearers consideration
of the denture-bearing tissues. J Med Dent Sci
2002;49:151-6.
19. Grasso J, Gay T, Rendall J, Baker R,
Knippenberg S, Finkeldey J, et al. Effect of
denture adhesive on retention of mandibular
and maxillary denture during function. J Clin
Dent 2000;11:98-103.
20. Tarbet WJ, Silverman G, Schmidt NF.
Maximum incisal biting force in denture
wearers as influenced by adequacy of denture
bearing tissues and the use of an adhesive.
J Dent Res 1981;60:115-9.
21. Kanapka JA. Bite force as a measure of den-
ture adhesive efficacy. Comp Contin Edu
Dent 1984;5(suppl):26-30.
22. Feller RP, Saunders MJ, Kohut BE. Effect of a
new form of adhesive on retention and sta-
bility of complete maxillary dentures. Spec
Care Dent 1986;6:87-9.
23. Grasso JE, Rendell J, Gay T. Effect of denture
adhesive on the retention and stability of
maxillary dentures. J Prosthet Dent 1994;72:
399-405.
24. Ghani F, Likeman PR, Picton DC. An inves-
tigation into the effect of denture fixatives in
increasing incisal biting forces with maxillary
complete dentures. Eur J Prosthodont Rest
Dent 1995;3:193-7.
Polyzois et al
25. Kalra P, Nadiger R, Shah FK. An investigation
into the effect of denture adhesives on incisal
bite force of complete denture wearers using
pressure transducers: a clinical study. J Adv
Prosthodont 2012;4:97-102.
26. Sato Y, Kaiba Y, Hayakawa I. The evaluation
of denture retention and ease of removal
from oral mucosa on a new gel-type denture
adhesive. J Jpn Prosthodont Soc 2008;52:
175-82.
27. Psillakis JJ, Wright RF, Grbic JT, Lamster IB.
In practice evaluation of a denture adhesive
using a gnathometer. J Prosthodont 2004;13:
244-50.
28. Müller F, Heath MR, Ott R. Maximum
bite force after the replacement of com-
plete dentures. Gerodontology 2001;18:
58-62.
29. Wöstmann B, Balkenhol M, Ferger P,
Rehmann P. Changes in occlusal force at
denture dislodgement after refabrication or
optimization of complete dentures. Int J
Prosthodont 2008;21:305-6.
30. Lindquist LW, Carlsson GE, Hedegård B.
Changes in bite force and chewing effi-
ciency after denture treatment in
edentulous patients with denture adapta-
tion difficulties. J Oral Rehabil 1986;13:
21-9.
31. Fløystrand F, Kleven E, Øilo G. A novel
miniature bite force recorder and its clinical
application. Acta Odontol Scand 1982;40:
209-14.
32. Bakke M, Michler L, Han K, Möller E.
Clinical significance of isometric bite force
versus electrical activity in temporal and
masseter muscles. Scand J Dent Res
1989;97:539-51.
221
33. Fløystrand F, Orstavik JS. Retention of com-
plete maxillary dentures as a result of changes
in design. Acta Odontol Scand 1984;42:
327-32.
34. Nicolas E, Veyrune JL, Lassauzay C. A six-
month assessment of oral health-related
quality of life of complete denture
wearers using denture adhesive: a
pilot study. J Prosthodont 2010;19:
443-8.
35. Veyrune JL, Tubert-Jeannin S, Dutheil C,
Riordan PJ. Impact of new prostheses on
the oral health-related quality of life of
edentulous patients. Gerodontology
2005;22:3-9.
36. Goldspink G. Cellular and molecular aspects
of muscle growth, adaptation and ageing.
Gerodontology 1998;15:35-43.
37. Gonzalez Y, Iwasaki LR, McCall WD Jr,
Ohrbach R, Lozier E, Nickel JC. Reliability of
electromyographic activity vs. bite-force from
human masticatory muscles. Eur J Oral Sci
2011;119:219-24.
Corresponding author:
Dr Gregory Polyzois
Department of Prosthodontics
Dental School of Athens
2 Thivon Str, Goudi 115 27
Athens
GREECE
E-mail: grepolyz@dent.uoa.gr
Copyright ª 2014 by the Editorial Council for
The Journal of Prosthetic Dentistry.