新しく製作された可撤式義歯が客観的・主観的な咀嚼機能に与える影響について

The impact of a newly constructed removable denture on the objective and subjective masticatory function.

抄録

目的 本研究では，可撤式補綴物の更新が咀嚼機能に与える影響を主観的・客観的尺度で検討し，咬合支持の種類によるその変化を調べた。方法 本研究では，新たに製作された可撤式義歯患者78名が参加した。客観的評価としては，試験用グミゼリーを用いて咀嚼能力を測定した．主観的評価には，食物の受容性と口腔保健関連QOL（OHRQoL）に関する標準化された質問票を使用した．挿入前と挿入後の評価は，各被験者について行った．被験者は、後方咬合によって3群に分けられた：後方咬合あり（w/PO）、後方咬合なし（w/o PO）、無歯顎である。各評価の治療前と治療後の測定値の比較には，Wilcoxonの符号付き順位検定を使用した．共分散分析および多重比較により，新製義歯の効果および咬合支持による差異を評価した． 結果 新製義歯の装着により，補綴治療後の咀嚼能力，OHRQoLおよび食事受容性は有意に改善された．咀嚼能率は群間で相対的に差があった．無歯顎者の咀嚼能力改善率は有歯顎者の2倍であった．OHRQoLは，PO群および無歯顎群では，PO群に比べ有意に低下した．結論 義歯装着による咀嚼能力の向上は，咬合支持の種類によって異なることが示唆された．無歯顎患者の咬合支持の再確立は，患者のOHRQoLの回復と食物の受容性の向上に役立つ可能性がある．

Purpose This study investigated the impact of the renewal of a removable prosthesis on the masticatory function by subjective and objective measures and its variation among the types of occlusal support.Methods Seventy-eight patients who received newly fabricated removable denture patients participated in this study. For the objective assessment, masticatory performance was measured using test gummy jelly. For the subjective assessment, standardized questionnaires about food acceptability and the oral health-related quality of life (OHRQoL) were used. Pre- and post-insertion assessments were performed for each subject. Subjects were divided into three groups according to their posterior occlusion: with posterior occlusion (w/PO), without posterior occlusion (w/o PO) and edentulous. Wilcoxon's signed rank test was used to compare the pre- and post-treatment measurements of each assessment. The analysis of covariance and a multiple comparison were used to assess the effect of new dentures and differences due to occlusal support.Results The masticatory performance, OHRQoL and food acceptability following prosthodontic treatment were significantly improved by new denture insertion. The masticatory performance among groups varied to a relative degree. The rate of masticatory performance improvement for edentulous subjects was twice that in w/PO subjects. The OHRQoL was significantly lower in the w/o PO and edentulous groups with old denture than patients w/PO. The food acceptability improved most markedly in the edentulous group.Conclusions The improvement in the masticatory performance by new denture insertion varied among types of occlusal support. Re-establishing the occlusal support of edentulous patients may help restore their OHRQoL and improve food acceptability.