The role of progressive oral implant rehabilitation in mastication, cognition and oral health‐related quality of life outcomes—A pilot to define the protocol

Abstract

Background The implications of oral rehabilitation after tooth loss require further investigation. Objectives To conduct a pilot study to investigate: (a) changes in masticatory performance with progressive oral implant rehabilitation (POR); (b) association between POR and neurocognitive function using functional magnetic resonance imaging (fMRI); and (c) oral health‐related quality of life (OHQoL) outcomes. Methods Four completely edentulous patients (mean age: 73 ± 1.4 years) participated. Each received new complete removable dental prostheses (RDPs) transitioned to mandibular two implant‐retained RDPs (IR‐RDP). Assessments were performed at 4 time points for neurocognitive skills, fMRI with functional tasks (jaw clenching, working memory and sustained attention, inhibition), masticatory performance with colour‐changing gum and OHQoL. Assessments were performed with new complete RDPs (T0 as baseline data) and IR‐RDPs at 1 week (T1), 6 weeks (T2) and 12 months (T3) post‐insertion. Data analyses were based on intra‐patient and inter‐patient results. Results Masticatory performance and QoL improved with an IR‐RDP at each time point. FMRI jaw clenching sensory and motor cortical activity decreased at T1, with motor cortical activity increasing to T0 levels at T2. For cognitive fMRI activation tasks, cortical activity decreased from T0 to T1 across all regions of interests (ROI) and increased at T2 throughout the cognitive brain regions. Neurocognitive skills declined at T1, followed by improvement to or beyond T0 levels at T2. Conclusion Improvements in masticatory performance and OHQoL occurred from complete RDPs to IR‐RDP. Prosthetic adaptation was associated with neurocognitive changes to pre‐insertion activity levels or greater after 6 weeks. These pilot data suggest both behavioural and neural associations between POR and cognition; however, larger study numbers are required.

The impact of tooth loss on cognitive function

“…The current lack of knowledge in this cause-effect association likely derives from the fact that there is a paucity of well-conducted prospective clinical studies investigating the association between edentulism and cognition. In our assessment of the literature in this particular topic, we have been able to identify only one pilot study [41], and two protocols for clinical studies, one set in Sweden published in 2021 [42] and the other one, registered in 2016 and still ongoing, by our own group in Spain [43].…”

Cognitive changes and neural correlates after oral rehabilitation procedures in older adults: a protocol for an interventional study

“…Confounding factors such as sarcopenia, adaptive capacities and adjustments of diet consistency due to loss of teeth can influence the secondary outcome parameters. However, a recent preliminary study with similar study objectives has with a smaller sample shown promising results [59]. Successive studies will be planned to consider all the major confounding factors reflecting on the results of the current study and perhaps follow the participants in the current study for a longer duration.…”

Tooth Loss-Associated Mechanisms That Negatively Affect Cognitive Function: A Systematic Review of Animal Experiments Based on Occlusal Support Loss and Cognitive Impairment

“…Many clinical studies have shown that chewing exercise can be considered as a preventive method for cognitive impairment (Ono et al, 2010;Tada and Miura, 2017;Chuhuaicura et al, 2019). Corresponding results appeared after the use of implants or dentures to repair the missing teeth, patients' cognitive level can be improved (Ki et al, 2019;Tan et al, 2020). Avivi-Arber et al (2015) have proved that the neural plasticity of the facial primary motor cortex (FACE-M1) and the adjacent primary somatosensory cortex (FACE-S1) of rats was enhanced after the implantation.…”