CLINICAL RESEARCH

Assessment of masticatory function in older individuals with

bimaxillary implant-supported fixed prostheses or with a
natural dentition: A case-control study
George Homsi, DDS,a Abhishek Kumar, BDS, PhD,b Nabeel Almotairy, BDS, MSc, PhD,c Elena Wester, DDS,d
Mats Trulsson, DDS, PhD,e and Anastasios Grigoriadis, DDS, PhDf

Masticatory function is an ABSTRACT

important contributor to a safe Statement of problem. A clinical assessment of the masticatory performance of edentulous people
swallowing process, digestion treated with bimaxillary implant-supported fixed prostheses is lacking.
kinetics, and nutrition.1,2 Poor
Purpose. The purpose of this case-control study was to compare the masticatory performance of
masticatory function affects
edentulous people treated with bimaxillary implant-supported fixed prostheses to that of those
the nutrient intake, leading to with a natural dentition by using a simplified comminution test with hard viscoelastic test food
deterioration of the nutritional and a mixing ability test.
status and affecting the gen-
Material and methods. Thirty-six participants were recruited and divided into 2 equal groups
eral health of older in- (n=18) based on their dental status. The experimental group (7 women, mean ±standard
3-5
dividuals. In addition, deviation age=69.8 ±7.5 years) had bimaxillary implant-supported fixed prostheses, and the
malnutrition and undernutri- control group (9 women, mean ±standard deviation age=68.3 ±5.6 years) had a natural
tion are more often repre- dentition. A hard viscoelastic food comminution test and a mixing ability test with 2-colored
sented among edentulous chewing gum were performed in both groups. The number and total area of the particles during
people.6,7 People with com- the comminution test and the variance of hue during the mixing ability test were measured. The
plete dentures often take an data were analyzed with the parametric (paired t test) and nonparametric (Mann-Whitney U)
tests to assess differences between the groups (a=.05).
increased number of mastica-
tion cycles and a longer Results. The experimental group exhibited significantly fewer pieces in the food comminution test
mastication sequence than than the control group (P=.001). The experimental group also showed significantly higher variance
of hue values than the control group (P<.001).
people with a natural denti-
8
tion. However, the number of Conclusions. Patients treated with bimaxillary implant-supported prostheses had reduced
cycles and the duration of the masticatory performance in comparison to those with a natural dentition, despite having been
mastication sequence have provided with satisfactory and well-functioning prostheses. (J Prosthet Dent 2023;129:871-7)
been reported to be similar
between people with natural dentition and people with of functional impairments caused by advanced atrophy of
implant-supported fixed prostheses.9-11 Also, people the mandibular alveolar crest and masticatory muscles.12
with complete dentures typically alter their diet because Complete denture wearers often consume less meat, fruit

Supported by the research grant from Stockholm County Council and Karolinska Institutet (SOF: Styrgruppen för Odontologisk Forskning).
a
Doctoral student, Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Huddinge, Sweden.
b
Researcher, Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Huddinge, Sweden.
c
Assistant professor, Department of Orthodontics and Pediatric Dentistry, College of Dentistry, Qassim University, Buraidah, Saudi Arabia.
d
Private practice, Huddinge, Sweden.
e
Professor, Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Huddinge, Sweden.
f
Associate professor, Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Huddinge, Sweden.

THE JOURNAL OF PROSTHETIC DENTISTRY 871

872
Clinical Implications
In clinical practice, the outcome of prosthetic
treatment is not typically assessed through
objective evaluation. Therefore, it could be
important to evaluate masticatory performance
after oral rehabilitation procedures to identify
individuals with impaired masticatory performance.
with seeds, nuts, carrots, and celery and prefer softer and
overcooked food, leading to more refined carbohydrate
intake and fewer micronutrients.13 Therefore, it is criti-
cally important to evaluate masticatory function and
assist people in optimizing their masticatory behavior
after oral rehabilitation.14,15
Complete denture wearers have a lower masticatory
efficiency than those with mandibular implant-retained
overdentures.16-18 However, whether implant-
supported fixed prostheses in both the mandible and
the maxilla compensate for impaired masticatory per-
formance is not clear. Previous studies have emphasized
the importance of periodontal mechanoreceptors in the
regulation of occlusal forces and jaw movements during
mastication.9,11 People with implant-supported fixed
prostheses show impaired adaptation to food hardness
compared with people with natural teeth19 because
absence of sensory information from the periodontal
mechanoreceptors as in patients with bimaxillary
implant-supported prostheses impairs oral motor control
and jaw function.9,11,14,20 Therefore, while dental im-
plants have certainly improved the retention of the
prosthesis, problems associated with sensorimotor
regulation persist. While previous studies have assessed
masticatory performance in individuals with complete
removable dentures in the maxilla and implant-
supported fixed prosthesis in the mandible,21,22 the au-
thors are unaware of studies that reported masticatory
performance in patients treated with bimaxillary fixed
implant-supported prostheses.
The objective evaluation of masticatory function is a
challenging task.23 Masticatory performance has been
defined as “a measurement of the comminution of food
achievable under standardized testing conditions.”24
Food comminution tests are focused on evaluating the
breakdown of the test specimen into smaller pieces. The
test specimen in question can either be natural food
substances such as carrots25 or nuts26 or artificial test
substances such as silicone-based Optosil cubes27 or
fuchsin beads.28 Previous studies have also used hard
viscoelastic test food to study jaw muscle activity and
adaptation to food hardness in children,29 young
adults,14,30 and older individuals.11 The hard viscoelastic
test food has been perceived as mechanically challenging
THE JOURNAL OF PROSTHETIC DENTISTRY
Volume 129 Issue 6
and requires high occlusal forces and a higher degree of
sensorimotor control to breakdown the food.31 Therefore,
this test food should be good to evaluate mastication
difficulty, especially in older individuals with compro-
mised dentition and decreased sensorimotor regulation.
Hence, the main aim of the current case-control study
was to evaluate the masticatory performance of in-
dividuals with bimaxillary implant-supported fixed
prostheses with a simplified and less time-consuming
food comminution test by using a hard viscoelastic test
food and mixing ability test. The null hypothesis was that
no difference in masticatory performance would be found
between individuals treated with bimaxillary implant-
supported fixed prostheses and people with a natural
dentition.
MATERIAL AND METHODS
The study was conducted following the Declaration of
Helsinki II and was approved by the regional Ethical
Review Board (D nr 2018/1963-31). The participants were
only recruited if they agreed to provide verbal and written
informed consent. The study was conducted in 2 phases,
an explorative and a comparative phase.
The explorative phase was performed in young
healthy adults to determine the approximate number of
masticatory cycles needed and to ensure the reliability of
the food comminution test. Accordingly, 22 volunteers
(mean ±standard deviation age=24.6 ±4.7 years, age
range: 19 to 39, 14 women and 8 men) were enrolled.
The participants were free from functional or gross
malocclusions and had at least 28 natural teeth. All
participants self-reported good general health without a
history of chronic systemic disease or a neurological
disorder associated with oral function. In addition, no
participant reported orofacial pain, temporomandibular
disorders, or previous endodontic or prosthodontic
treatments.
The comparative phase was conducted on 36 partic-
ipants who were recalled for their regular dental exami-
nation. A sample size calculation was performed a priori
to detect a medium effect size of Cohen d=0.5 with 90%
power (a=.05, 2-tailed). The sample size calculation
showed that a minimum of 17 participants per group
(N=34) in an independent samples t test would be
needed. The recruited 36 participants were divided into
an experimental group (n=18, mean ±standard deviation
age=69.8 ±7.5 years, age range: 53 to 78 years, 7 women
and 11 men) and a control group (n=18, mean ±standard
deviation age=68.3 ±5.6, age range: 61 to 78 years, 9
women and 9 men). All the participants in the experi-
mental group were edentulous and had implant-
supported fixed prostheses in both the maxilla and
mandible, replacing 12 teeth in each arch. The prostheses
had been fabricated according to a standardized method
Homsi et al
June 2023
of a metal framework and acrylic resin teeth arranged in a
mutually protected occlusion. All the participants atten-
ded regular follow-up visits at the clinic. When needed,
the acrylic resin teeth were replaced to maintain
adequate occlusion and function. In addition, a regular
radiographic assessment by an independent oral and
maxillofacial radiologist ascertained that no progressive
bone destruction could be seen around the implants. The
participants in the experimental group were only
included if they had been using the implant-supported
prostheses for at least 1 year and had no complaints
with the prostheses. A chairside clinical examination
revealed that none of the participants showed visible
defects or signs of obvious problems related to mastica-
tion. Overall, all the participants in the experimental
group reported satisfaction with the implant-supported
prostheses. Similarly, the participants in the control
group were people with a natural dentition without
complaints regarding mastication. In addition, none of
the participants in either group reported orofacial pain,
temporomandibular disorders, a history of systemic or
chronic disease, or a neurological disorder related to the
masticatory system.
The experimental session for the explorative phase of
the study lasted for about 1 hour. First, for the commi-
nution test, the participants were asked to “eat” 5 pieces
of standardized, hard viscoelastic, test food prepared in
the laboratory. Briefly, gelatin of 250 bloom (41.5 g) was
mixed with glucose (132 g), sugar (111 g), water (84 g),
and citric acid. The gelatinous mixture was prepared in an
80  C water bath for 4 hours and colored with food
coloring. The mixtures were then poured into Ø20×10-
mm cylindrical Plexiglas molds and kept for 24 hours
before storing in an airtight box for 72 hours before
use.9,14,29,30 The participants masticated the test food and
were abruptly asked to spit-out all the masticated pieces
after 4, 8, 12, 16, and 20 masticatory cycles. The partici-
pants also performed the mixing test with 2-color
chewing gum in accordance with the previous
studies.32,33 The 8×20×12-mm 2-color, sugar-free,
chewing gum (Hue-Check Gum; Orophys GmbH Muri
b) pieces were wetted with water and gently put
together. The participants were then asked to put the
chewing gum in their mouth and masticate on their
preferred side. The participants were stopped and asked
to spit out the chewing gum after 20 masticatory cycles.
The number of masticatory cycles was silently counted by
the examiner (G.H.) during both the tests.
The experimental session of the comparative study
lasted for about 15 minutes. The participants first per-
formed 3 trials of the food comminution test. The food
comminution and the mixing ability tests were performed
similarly to the explorative study except that the partici-
pants ate the entire first test food, while they were
abruptly asked to spit out the second and third test food
Homsi et al
873
after 10 masticatory cycles. The entire session of the food
comminution test was video recorded, thus allowing the
analysis of the swallowing events, including counting the
number of cycles and the duration between the first
swallow and the final swallow while the participants ate
the first test food.
For the food comminution test, the participants were
asked to spit out the test food along with the remnants (if
any) into a white Petri dish. Then, 30 mL of water was
added, and the pieces were gently separated. Finally, a
photograph of the Petri dish was made under standard
lighting conditions with a mobile phone camera (iPhone
XR; Apple Inc) fixed into a tripod at 11 cm from the
specimen at a resolution of 4032×3024 pixels. The image
was analyzed with an image processing and analysis
software program (ImageJ; Image Processing and Anal-
ysis in Java). The number of particles and the total area of
the particles were considered as the markers of masti-
catory performance. The higher the number of particles
or larger the total area of the comminuted particles, the
better the masticatory performance.
For the mixing ability test, the specimens were scan-
ned as in previous studies.32,33 The participants expec-
torated the masticated gum on a cellophane paper, and
the gum was flattened to a 1-mm-thick wafer with a
custom template guide. The flattened chewing gum
specimens were then scanned from both sides (Epson
Perfection V700 Scanner; Epson) with a resolution of 300
dots per inch and 24-bit color depth. The images were
saved in the Joint Photographic Experts Group (jpg)
format and later analyzed with an analysis software
program (ViewGum; dHAL Software). The software
program transformed the images into hue saturation
intensity color space, and the variance of hue was
calculated. A larger variance of hue indicated inadequate
mixing.
The data were analyzed with statistical software
programs (IBM SPSS Statistics for Windows, v25; IBM
Corp, Statistica; TIBCO Software Inc). The mean number
of pieces and the total area from all the participants
during the food comminution test were calculated for 4
(C4), 8 (C8), 12 (C12), 16 (C16), and 20 (C20) masticatory
cycles and subjected to linear regression analysis. The
data were assessed for normality with the histogram
plots and Shapiro-Wilk test. Logarithmic transformations
of the data were performed if they were not normally
distributed. The total number of pieces and the total area
of the particles from all the participants during the 4, 8,
12, 16, and 20 masticatory cycles were subjected to a 1-
way repeated measures analysis of variance (ANOVA).
The data for the comparative study were evaluated
with the Mann-Whitney U test to assess differences in
the number and duration of masticatory cycles in the first
and final swallow between the experimental and control
groups. The normally distributed data pertaining to the
THE JOURNAL OF PROSTHETIC DENTISTRY
874
50
40
Food Particles (n)
30
20 * swallow (N)
10
0
1200
1000 *
Total Area (AU)
800
600
400
200
0
C4 C8
Number of Mastication Cycles
Figure 1. A, Mean and standard error of mean (SEM) of no of food
particles. B, Mean and standard error of mean (SEM) of total area of food
particles. Values obtained during food comminution test with hard
viscoelastic test food. *Significant differences (P<.05).
food comminution test, such as the number of particles
and the total area of the particles, were analyzed with an
independent sample t test. The data from the mixing
ability test were analyzed with the Mann-Whitney U test
(a=.05).
RESULTS
From the explorative study, a positive correlation was
found between the number of particles and total area and
the number of masticatory cycles, indicating that the
number of particles and total area increased with an
increased number of masticatory cycles (r=0.873, P<.001;
r=0.744, P<.001, respectively). Furthermore, there was a
significant difference in the number of pieces (F (4)
=161.4, P<.001) and the total area (F (4)=67.11, P<.001).
A post hoc analysis showed significant differences be-
tween the number of pieces during all masticatory cycles
(P<.011) except between C16 and C20 (P<.732) (Fig. 1A).
The post hoc analysis of the total area showed significant
differences between all the masticatory cycles (P<.014)
except between C12 and C16 (P=.983) and between C16
and C20 (P=.086) (Fig. 1B). These results imply that the
number of particles increased with the increased number
of masticatory cycles and resulted in a smaller particle
size.
THE JOURNAL OF PROSTHETIC DENTISTRY
Volume 129 Issue 6
Table 1. Mastication behavior of participants in experimental and
control groups while eating hard viscoelastic test food
* Experimental
Group Control Group P
* Number of cycles to first 21.5 ±6.4 20.9 ±6.9 .824
swallow (N)
Number of cycles to final 26 ±8.3 31.4 ±14.1 .295
Duration to first swallow (sec) 20.6 ±8.0 18.3 ±4.1 .557
Duration to final swallow (sec) 25.4 ±10.4 29.4 ±12.6 .401
Number of particles (N) 10.2 ±4.0 17.3 ±7.4 <.001
Total area (AU) 589 147.2 ±81 963.5 663 722.3 ±191 056.5 .137
A
Variance of hue 0.21 ±0.12 0.08 ±0.03 <.001
*
The descriptive statistics (means, standard deviation)
of the comparative study are presented in Table 1. No
significant differences were found in the number of
masticatory cycles to either the first (U=155, P=.824) or
the final (U=129, P=.295) swallow between the 2 groups.
Also, no significant difference was found in the duration
of mastication to either the first (U=143, P=.557) or the
C12 C16 C20 final (U=135, P=.401) swallow between the 2 groups. The
particles during the comminution test from the 2 trials
B were averaged and compared between the 2 groups. The
results of the analysis showed a significantly lower
number of particles in the experimental group than in the
control group (t (34)=-3.554, P<.001) (Fig. 2A), indicating
poor performance in the comminution test. However, no
significant differences were found in the total area be-
tween the 2 groups (t=(34)=-1.552, P=.137) (Fig. 2B).
Similarly, the results of the mixing ability test also
showed significant differences between the groups, with
significantly higher variance of hue values in the exper-
imental group than those in the control group (U=46,
P<.001) (Fig. 2C), indicating poor performance.
DISCUSSION
The null hypothesis was rejected as a significant differ-
ence was found in masticatory performance between
individuals with a natural dentition and edentulous pa-
tients treated with bimaxillary implant-supported fixed
prostheses. Specifically, the results showed no significant
difference in the number of masticatory cycles and the
duration of masticatory sequence between the 2 groups.
Yet, the experimental group exhibited a significantly
reduced masticatory performance in comparison to the
individuals with a natural dentition, despite having been
provided with satisfactory and well-functioning
prostheses.
In order not to interfere with natural food bolus for-
mation, the participants were instructed to eat the test
food and then abruptly asked to spit out the pieces of test
food after 10 masticatory cycles. This method should not
compromise or interfere with the natural rhythm of
mastication. However, the current test only evaluates the
Homsi et al
June 2023 875

* performance, taking into account that this was approxi-

20
mately half the number of masticatory cycles required to
eat (21.5 ±6.4) the test food yet minimizing the risk of
16 swallowing pieces of the test food.
Food Particles (n)

In contrast to individuals with a complete denture8

12 and similar to individuals with bimaxillary implant-
supported prostheses,9-11 no significant difference was
8
found in the number of masticatory cycles and duration
of masticatory sequence between the control and
experimental groups in the present study. The main
4 purpose of mastication is probably to produce a soft bolus
ready for swallowing. Some people can prepare this in a
0 few mastication strokes, while others take slightly longer.
Experimental Control
In the present study, people in the experimental
A
group were unable to divide the test food into a greater
700 number of pieces than in the control group. However, the
results of the present study also show no significant
600
difference in the number of masticatory cycles and the
500 duration of masticatory sequence until the first and final
Total Area (AU)

swallow between the 2 groups. Hence, individuals in the

400 implant group did not masticate longer than individuals
in the control group to achieve a swallowable bolus but
300
rather swallowed larger pieces of food. Particle size has
200 been reported to be an important determinant of energy
and nutrient bioavailability.35 Hence, the inability to
100 adequately comminute food could compromise nutrition
0
and should be an important determinant in the outcomes
Experimental Control of oral rehabilitation. Evaluating and assisting patients to
B optimize their mastication behavior after oral rehabilita-
* tion is important.15,36-39
0.25
In clinical practice, the outcome of prosthetic treat-
ments has been routinely assessed through subjective
0.2 evaluation. Normally, this is done by asking patients if
they are satisfied with the treatment, with a positive
0.15 response indicating a successful treatment. Accordingly,
VOH

in the present study, the participants were asked if they

0.1
0.05
0 groups in the masticatory performance tests. Further-
Experimental Control
C
Figure 2. Mean and standard error of mean (SEM) for experimental and
control group. A, Number of food particles. B, Total area of food particles
during food comminution test. C, Variance of hue (VOH) values for
mixing ability test. *Significant differences (P<.05).
crushing or breakdown of food morsels into pieces and
not the bolus formation. The authors believe that bolus
formation should be evaluated, perhaps with a separate
test or a set of tests by using one or more test specimens
as previously suggested.34 Therefore, it was decided to
use 10 masticatory cycles as the threshold of masticatory
were satisfied with their prostheses. The routine clinical
assessments and the radiographic evaluations did not
show any signs of bone loss or any indication of failure of
the treatment. Despite this, the results of the present
study showed significant differences between the 2
more, even though previous studies have reported that
patients with implant overdentures and fixed implant
prostheses perform better in the masticatory efficiency
test than those with conventional dentures, they do not
perform on par with people with a natural dentition.40
These observations suggest that more steps may be
needed to optimize oral rehabilitation procedures.14,20
The multiple sieve method is a robust technique used
to determine masticatory performance.41 In comparison,
the comminution test used in the present study is a 2-
dimensional evaluation of a 3-dimensional object (food
particle) and represents a limitation as the third dimen-
sion is not quantified. Furthermore, it was difficult to

Homsi et al THE JOURNAL OF PROSTHETIC DENTISTRY

876
reliably count the crushed and comminuted test food
pieces if the pieces were relatively small and not
completely isolated. However, the food comminution
method is straightforward, easy to perform, and could be
developed as a routine clinical test. Prosthesis satisfaction
was not extensively assessed in the present study, and
the participants were only included if they had no com-
plaints with the prosthesis and if there were no radio-
logical or clinical signs of obvious problems related to
mastication with the prostheses. This could be a limita-
tion of the study. Therefore, future studies may be
designed with a questionnaire for the evaluation of
perceived satisfaction and more closely evaluate the
correlation between the subjective and objective assess-
ments of treatment of individuals treated with bimaxillary
implant-supported fixed prostheses.
Masticatory function is important for safe swallowing,
digestion kinetics, and nutrition.42-45 Poor masticatory
function affects nutrition and may affect the nutritional
status among older individuals.4,5 For instance, malnu-
trition and undernutrition are more often represented
among edentulous people.6,7 For these reasons, it would
be interesting to study the nutritional status among in-
dividuals treated with bimaxillary implant-supported
fixed prostheses.
CONCLUSIONS
Based on the findings of this case-control study, the
following conclusions were drawn:
1. Patients with bimaxillary implant-supported fixed
prostheses showed signs of masticatory impairment
in comparison with individuals with a natural
dentition.
2. This difference was found despite satisfactory and
well-functioning prostheses and assumed
improvement of masticatory function with fixed
prostheses.
3. More efforts may be needed to rehabilitate the oral
processing of food in patients with extensive pros-
theses so that these patients can optimize prosthesis
usage and adapt to their altered oral environment.
REFERENCES
1. Furuta M, Komiya-Nonaka M, Akifusa S, Shimazaki Y, Adachi M,
Kinoshita T, et al. Interrelationship of oral health status, swallowing function,
nutritional status, and cognitive ability with activities of daily living in Japa-
nese elderly people receiving home care services due to physical disabilities.
Community Dent Oral Epidemiol 2013;41:173-81.
2. Avoglio JLV. Dental occlusion as one cause of tinnitus. Medical Hypotheses
2019;130:109280.
3. Kossioni AE. The association of poor oral health parameters with malnutri-
tion in older adults: a review considering the potential implications for
cognitive impairment. Nutrients 2018;10:1709.
4. Nordenram G, Ljunggren G, Cederholm T. Nutritional status and chewing
capacity in nursing home residents. Aging (Milan, Italy) 2001;13:370-7.
5. Kwok T, Yu CNF, Hui HW, Kwan M, Chan V. Association between func-
tional dental state and dietary intake of Chinese vegetarian old age home
residents. Gerodontology 2004;21:161-6.
THE JOURNAL OF PROSTHETIC DENTISTRY
Volume 129 Issue 6
6. Ervin RB, Dye BA. Number of natural and prosthetic teeth impact nutrient
intakes of older adults in the United States. Gerodontology 2012;29:
e693-702.
7. Savoca MR, Arcury TA, Leng X, Chen H, Bell RA, Anderson AM, et al. Severe
tooth loss in older adults as a key indicator of compromised dietary quality.
Public Health Nutr 2010;13:466-74.
8. Veyrune JL, Lassauzay C, Nicolas E, Peyron MA, Woda A. Mastication of
model products in complete denture wearers. Arch Oral Biol 2007;52:
1180-5.
9. Grigoriadis A, Johansson RS, Trulsson M. Adaptability of mastication in
people with implant-supported bridges. J Clin Periodontol 2011;38:395-404.
10. Grigoriadis A, Johansson RS, Trulsson M. Temporal profile and amplitude of
human masseter muscle activity is adapted to food properties during indi-
vidual chewing cycles. J Oral Rehabil 2014;41:367-73.
11. Grigoriadis A, Trulsson M. Excitatory drive of masseter muscle during
mastication with dental implants. Sci Rep 2018;8:8597.
12. van Kampen FM, van der Bilt A, Cune MS, Fontijn-Tekamp FA, Bosman F.
Masticatory function with implant-supported overdentures. J Dent Res
2004;83:708-11.
13. Millwood J, Heath MR. Food choice by older people: the use of semi-
structured interviews with open and closed questions. Gerodontology
2000;17:25-32.
14. Grigoriadis A, Kumar A, Aberg MK, Trulsson M. Effect of sudden deprivation of
sensory inputs from periodontium on mastication. Front Neurosci 2019;13:1316.
15. Kumar A, Kothari M, Grigoriadis A, Trulsson M, Svensson P. Bite or brain:
implication of sensorimotor regulation and neuroplasticity in oral rehabili-
tation procedures. J Oral Rehabil 2018;45:323-33.
16. Elsyad MA, Shawky AF. Masticatory function with ball and resilient tele-
scopic anchors of mandibular implant-retained overdentures: a crossover
study. Quintessence Int 2017;48:615-23.
17. Elsyad MA, Khairallah AS. Chewing efficiency and maximum bite force with
different attachment systems of implant overdentures: a crossover study. Clin
Oral Implants Res 2017;28:677-82.
18. Elsyad MA, Hegazy SA, Hammouda NI, Al-Tonbary GY, Habib AA.
Chewing efficiency and electromyographic activity of masseter muscle with
three designs of implant-supported mandibular overdentures. A cross-over
study. Clin Oral Implants Res 2014;25:742-8.
19. Grigoriadis J, Trulsson M, Svensson KG. Motor behavior during the first
chewing cycle in subjects with fixed tooth- or implant-supported prostheses.
Clin Oral Implants Res 2016;27:473-80.
20. Grigoriadis J, Kumar A, Svensson P, Svensson KG, Trulsson M. Perturbed
oral motor control due to anesthesia during intraoral manipulation of food.
Sci Rep 2017;7:46691.
21. Mendonca DB, Prado MM, Mendes FA, Borges TeF, Mendonça G, do
Prado CJ, et al. Comparison of masticatory function between subjects with
three types of dentition. Int J Prosthodont 2009;22:399-404.
22. Vieira RA, Melo AC, Budel LA, Gama JC, de Mattias Sartori IA, Thomé G.
Benefits of rehabilitation with implants in masticatory function: is patient
perception of change in accordance with the real improvement? J Oral
Implantol 2014;40:263-9.
23. Pedroni-Pereira A, Marquezin MCS, Araujo DS, Pereira LJ, Bommarito S,
Castelo PM. Lack of agreement between objective and subjective measures in
the evaluation of masticatory function: a preliminary study. Physiol Behav
2018;184:220-5.
24. The glossary of prosthodontic terms. Ninth edition. J Prosthet Dent
2017;117(5S):e1-105.
25. Leischker AH, Kolb GF, Felschen-Ludwig S. Nutritional status, chewing
function and vitamin deficiency in geriatric inpatients. Eur Geriatr Med
2010;1:207-12.
26. Grundy MML, Grassby T, Mandalari G, Waldron KW, Butterworth PJ,
Berry SEE, et al. Effect of mastication on lipid bioaccessibility of almonds in a
randomized human study and its implications for digestion kinetics, metabo-
lizable energy, and postprandial lipemia. Am J Clin Nutr 2015;101:25-33.
27. Flores-Orozco EI, Tiznado-Orozco GE, Osuna-Gonzalez OD, Amaro-
Navarrete CL, Rovira-Lastra B, Martinez-Gomis J. Lack of relationship be-
tween masticatory performance and nutritional status in adults with natural
dentition. Arch Oral Biol 2016;71:117-21.
28. Sánchez-Ayala A, Farias-Neto A, Vilanova LS, Costa MA, Paiva AC,
Carreiro Ada F, et al. Reproducibility, reliability, and validity of fuchsin-
based beads for the evaluation of masticatory performance. J Prosthodont
2016;25:446-52.
29. Almotairy N, Kumar A, Grigoriadis A. Effect of food hardness on chewing
behavior in children. Clin Oral Investig 2021;25:1203-16.
30. Peyron M, Lassauzay C, Woda A. Effects of increased hardness on jaw
movement and muscle activity during chewing of visco-elastic model foods.
Exp Brain Res 2002;142:41-51.
31. Ravosa MJ, Scott JE, McAbee KR, Veit AJ, Fling AL. Chewed out: an
experimental link between food material properties and repetitive loading of
the masticatory apparatus in mammals. Peer J 2015;3:e1345.
32. Schimmel M, Christou P, Herrmann F, Muller F. A two-colour chewing gum
test for masticatory efficiency: development of different assessment methods.
J Oral Rehabil 2007;34:671-8.
Homsi et al
June 2023 877

33. Schimmel M, Christou P, Miyazaki H, Halazonetis D, Herrmann FR, 45. Matsuo K, Palmer JB. Coordination of mastication, swallowing and breathing.
Muller F. A novel colourimetric technique to assess chewing function Jpn Dent Sci Rev 2009;45:31-40.
using two-coloured specimens: validation and application. J Dent 2015;43:
955-64. Corresponding author:
34. Abe R, Furuya J, Suzuki T. Videoendoscopic measurement of food bolus
Dr Abhishek Kumar
formation for quantitative evaluation of masticatory function. Journal of
Section of Oral Rehabilitation
prosthodontic research 2011;55:171-8.
Department of Dental Medicine
35. Grundy MM-L, Lapsley K, Ellis PR. A review of the impact of processing on
Karolinska Institutet
nutrient bioaccessibility and digestion of almonds. Int J Food Sci Technol
Alfred Nobels Allé 8
2016;51:1937-46.
Box 4064
36. Kumar A, Castrillon E, Trulsson M, Svensson KG, Svensson P. Fine motor
141 04 Huddinge
control of the jaw following alteration of orofacial afferent inputs. Clin Oral
SWEDEN
Investig 2017;21:613-26.
Email: abhishek.kumar@ki.se
37. Kumar A, Grigoriadis J, Trulsson M, Svensson P, Svensson KG. Effects of
short-term training on behavioral learning and skill acquisition during Acknowledgments
intraoral fine motor task. Neuroscience 2015;306:10-7. The authors thank the Global Health Partner (GHP) Specialisttandläkarna, Nacka,
38. Kumar A, Svensson KG, Baad-Hansen L, Trulsson M, Isidor F, Svensson P. and Tandvården Sergel, Praktikertjänst, Stockholm, Sweden, for their generous
Optimization of jaw muscle activity and fine motor control during repeated support.
biting tasks. Arch Oral Biol 2014;59:1342-51.
39. Kumar A, Tanaka Y, Grigoriadis A, Grigoriadis J, Trulsson M, Svensson P.
Training-induced dynamics of accuracy and precision in human motor con- CRediT authorship contribution statement
trol. Sci Rep 2017;7:6784. George Homsi: Investigation, Methodology, Software, Validation, Writing e
40. Müller F, Hernandez M, Grütter L, Aracil-Kessler L, Weingart D, original draft. Abhishek Kumar: Conceptualization, Formal analysis, Data
Schimmel M. Masseter muscle thickness, chewing efficiency and bite force curation, Writing e review & editing, Supervision, Project administration. Nabeel
in edentulous patients with fixed and removable implant-supported pros- Almotairy: Software, Validation, Resources, Visualization, Writing e review &
theses: a cross-sectional multicenter study. Clin Oral Implants Res 2012;23: editing. Elena Wester: Methodology, Validation, Software, Writing e review &
144-50. editing. Mats Trulsson: Conceptualization, Funding acquisition, Supervision,
41. van der Bilt A, Fontijn-Tekamp FA. Comparison of single and multiple sieve methods Writing e review & editing. Anastasios Grigoriadis: Conceptualization, Meth-
for the determination of masticatory performance. Arch Oral Biol 2004;49:193-8. odology, Investigation, Writing e review & editing, Supervision, Project
42. Cadden SW, Orchardson R. Mastication and swallowing: 2. control. Dent administration.
Update 2009;36:390-392, 394-396, 398.
43. Park HS, Kim DK, Lee SY, Park KH. The effect of aging on mastication and
Copyright © 2021 The Authors. Published by Elsevier Inc. on behalf of the
swallowing parameters according to the hardness change of solid food.
J Texture Stud 2017;48:362-9. Editorial Council for The Journal of Prosthetic Dentistry. This is an open access
44. Maffei C, Mello MM, Biase NG, Pasetti L, Camargo PA, Silvério KC, et al. article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
Videofluoroscopic evaluation of mastication and swallowing in individuals nc-nd/4.0/).
with TMD. Braz J Otorhinolaryngol 2012;78:24-8. https://doi.org/10.1016/j.prosdent.2021.08.023

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