A Randomized Controlled Trial of Mastication with Complete

Dentures Made by a Conventional or an Abbreviated Technique

Cristiane Machado Mengatto, DDS, MSc, PhD1/Gustavo Hauber Gameiro, DDS, MSc, PhD2/
Mario Brondani, DDS, MSc, MPH, PhD3/C. Peter Owen, BDS, MScDent, MChD, FCD(SA)4/
Michael I. MacEntee, LDS(I), FRCD(C), FCAHS, PhD5

Purpose: The aim of this randomized clinical trial was to test the hypothesis that there are
no statistically significant differences after 3 and 6 months in masticatory performance or
chewing ability of people with new complete dentures made by an abbreviated or a conventional
technique. Materials and Methods: The trial included 20 edentulous participants at a dental
school in Brazil assigned randomly to receive dentures made by either a conventional technique
involving six clinical sessions or by an abbreviated technique involving three clinical sessions. At
baseline with old dentures and at 3 and 6 months with new dentures, masticatory performance
was measured by counting the number of chewing strokes and the time before participants
had an urge to swallow and by calculating the medium particle size of a silicone material after
20 chewing strokes and at the urge to swallow. On each occasion, the participants recorded
on visual analog scales their ability to chew five food textures. Statistical significance (P ≤ .05)
of changes in masticatory performance and chewing ability during the trial were analyzed
with generalized estimating equations. Results: Both techniques improved masticatory
performance between baseline and 6 months and the ability to bite and chew all foods apart from
hard apples. Conclusion: There were no significant differences in masticatory performance
or chewing ability after 6 months between complete dentures made by a conventional or
an abbreviated technique. Int J Prosthodont 2017;30:439–444. doi: 10.11607/ijp.4741

T here are many edentulous people with restricted

access to dentists who do not benefit from com-
plete dentures.1–4 The time required to deliver a set of
complete dentures is typically at least six clinical ses-
sions,5 which can be difficult to accommodate when
dentists provide domiciliary care or temporarily work
in remote regions. Many different clinical techniques
are used to make impressions of residual ridges, re-
cord jaw relations, and develop occlusal schemes,6–8
1Professor, Division of Prosthodontics, Department of Conservative
Dentistry, School of Dentistry, Federal University of Rio Grande do Sul
(UFRGS), Porto Alegre, Brazil.
2Professor, Department of Physiology, Institute of Basic Health Sciences,
Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
3Associate Professor, Department of Oral Health Sciences, Faculty of Dentistry,
University of British Columbia, Vancouver, British Columbia, Canada.
4Professor Emeritus, Department of Oral Rehabilitation, School of Oral
Health Science, Faculty of Health Science, University of the
Witwatersrand, Parktown, South Africa.
5Professor Emeritus, Department of Oral Health Sciences, Faculty of Dentistry,
University of British Columbia, Vancouver, British Columbia, Canada.
Correspondence to: Prof C.M. Mengatto, Department of
Conservative Dentistry, School of Dentistry, Federal University of
Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre,
Rio Grande do Sul, Brazil, 90035-003. Fax: (+55) 51 33085010.
Email: cristianemach@yahoo.com.br
©2017 by Quintessence Publishing Co Inc.
but few attempts have been made to extend the reach
of prosthodontic services beyond the office-based
clinical practice. Kawai et al,9 for example, tested a
simplified five-session technique in a randomized
clinical trial by eliminating the second impression,
facebow, and articulator-remount after processing,
and reported that the eliminated procedures did not
disturb the overall general satisfaction of participants
nor the judgment of the prosthodontists who as-
sessed the dentures. Others made similar changes to
deliver dentures in four clinical sessions without dis-
turbing chewing effectiveness or the masticatory abil-
ity of the denture wearers.7,10 Owen and MacEntee11
described an abbreviated method of making complete
dentures for people who have difficulty accessing the
typical denture services available from dentists that
complies with the minimum accepted protocol for
complete dentures (Fig 1).12 Essentially, it constructs
and delivers the dentures over three clinical sessions
and offers at least one postdelivery session for clinical
adjustments at the discretion of the patient.
Problems with appearance and chewing dominate
the concerns of many denture wearers; however,
the reality of coping with dentures rests on an ar-
ray of poorly understood physical, psychologic, and
social phenomena.13–15 The reconstruction of nor-
mal appearance, for example, is a major objective of

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Mastication with Complete Dentures Made by a Conventional or an Abbreviated Technique

Clinic 4
• Optional adjustment

Clinic 3
• Adjust acrylic denture base
• Remount an articulator
Laboratory 2
• Refine occlusal contacts
• Deliver dentures
• Instruct patient on oral healthcare

Clinic 2
• Arrange maxillary anterior
Laboratory 1
teeth
•Record jaw relations

Clinic 1
• Interview
• Clinical examination
• Impressions

Fig 1   The clinical and laboratory sessions for the abbreviated complete denture technique.

complete denture treatments, but the evaluation of
normal appearance defies direct observation and
measurement.16 Consequently, most assessments or
evaluations of complete dentures have focused on
mastication by combining physical measurements of
masticatory or chewing performance with psychomet-
ric measurements of chewing ability.17 Typically, masti-
catory performance is measured by recording the time
and number of chewing strokes before participants
have an urge to swallow and calculating the medium
particle size of a test material after a specific number
of chewing strokes and before the urge to swallow.18,19
Chewing ability, in contrast, is based mostly on self-
assessment related to biting and chewing foods of dif-
ferent textures.20
The aim of this randomized clinical trial was to test
the hypothesis that there are no statistically significant
differences after 3 and 6 months in masticatory perfor-
mance or chewing ability of people with new complete
dentures made by an abbreviated or a conventional
technique.
Materials and Methods
From a total of 48 edentulous patients attending the
dental service of the Federal University of Rio Grande
do Sul, Porto Alegre, Brazil, for new dentures between
September 2012 and April 2013, 20 were selected to
participate in the trial approved by the university’s eth-
ics committee. Participants were included sequentially
in the trial if they: (1) gave their informed consent to
participate; (2) had used complete dentures for at least
1 year and wanted to change their dentures; (3) were
aged older than 55 years; (4) were cognitively compe-
tent; and (5) were free clinically and radiographically
of disorders disturbing jaw movements, saliva, and
mucosa (Fig 2). On acceptance with written informed
consent, randomization software provided the assign-
ments for complete dentures made by the convention-
al technique in five clinical sessions or the abbreviated
technique of three clinical sessions to deliver the den-
tures. The conventional method of complete denture
fabrication typically requires at least five clinical ses-
sions for denture delivery: (1) preliminary impressions
and treatment plan; (2) border molding and final im-
pressions; (3) jaw relationship records and facebow
mounting; (4) clinical trial; (5) denture delivery and ad-
justments; and (6) postdelivery assessment and den-
ture adjustments. The abbreviated method required a
minimum of three clinical sessions for denture delivery
that included: (1) single irreversible hydrocolloid im-
pression using a stock tray as the definitive impression;
(2) record bases and arrangement of the six maxillary
anterior teeth fabricated according to anatomical land-
marks, jaw relationship record, and arbitrary mounting
in an average-value articulator without using facebow
transfer; (3) denture delivery and adjustments; and
(4) post-delivery assessment and denture adjustments
(Fig 1). The abbreviated method was designed from
guidelines for a minimum acceptable protocol for the
construction of complete dentures.12 One dentist fa-
miliar with both techniques performed the clinical
procedures, and one dental technician performed the
laboratory procedures for all dentures. Patients were
treated using either of the two methods at no cost.
At baseline (T0) with old dentures and at 3 (T1) and
6 (T2) months with new dentures, a research assistant,
blinded to the treatment provided, directed the partici-
pants during the physical measurements of swallow-
ing threshold and chewing performance and during

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 Mengatto et al

Eligible (n = 48) Excluded (n = 28)

• Orofacial pain and temporomandibular dysfunction (n = 1)
• Did not use the old dentures (n = 7)
• Radio/chemotherapy in the last 6 months (n = 1)
• Stroke (n = 4)
• Did not want to participate (n = 2)
• Parkinson’s Disease (n = 1)
• Moderate to sever depression (n = 6)
• Neuroleptic-induced dyskinesia (n = 1)
• Neurologic or psychiatric disorder (n = 1)
• Smoker (n = 1)
• Need residual root extraction (n = 1)
• Salivary flow rate < 0.1 mL/min (n = 2)

Participants (n = 20)

Baseline (T0) evaluation

(with old dentures)

Random distribution of denture techniques

Conventional (n = 10) Abbreviated (n = 10)

Withdrew due
to myocardial
Evaluation 3 months (T1) after placement (n = 10) Evaluation 3 months (T1) after placement (n = 9)
infarction (n = 1)

Evaluation 6 months (T2) after placement (n = 10) Evaluation 6 months (T2) after placement (n = 9)

Fig 2   Recruitment, exclusion, and random distribution of participants to the conventional denture and abbreviated denture techniques at baseline
(T0), 3 months (T3), and 6 months (T2).

the psychometric measurements of chewing ability.
Each participant chewed a portion (17 cubes; 3 g total
weight) of Optocal (Optosil PlusR. Heraeus Kulzer), a
condensation silicone modified for chewing with com-
plete dentures for tests of swallowing thresholds and
masticatory performance.21,22 The assistant recorded
the time and number of chewing strokes from the start
to when participants reported the urge to swallow.21
After clearing the mouth, each participant received
a second portion to chew for 20 strokes. At the urge
to swallow and after 20 chewing strokes, the chewed
particles were collected from the mouth, washed,
dried for 20 hours at 60°C, and passed for 5 minutes
through a stack of 10 sieves with 5.6 to 0.7 mm2 mesh
(Bertel Industria e Metalurgica) to calculate the me-
dium particle size in millimeters (X50).22,23 X50 rep-
resents chewing performance calculated with the
Rosin-Rammler equation and is described as the mesh
size of a theoretical sieve through which 50% of the
particles by volume-weight can pass.24 Finally, the par-
ticipants graded their ability to chew five different food
textures on visual analog scales (VAS).23
The sample size of nine participants per group
for a type I error of .05 and power of 80% to detect a
25% difference in X50 was estimated from a previous
study of complete denture wearers who produced an
X50 of 4.9 ± 0.9 mm for masticatory performance test
with Optocal after 15 chews.25 An extra participant al-
lowed for one withdrawal from each group without los-
ing power (Fig 2). Statistical analyses used generalized
estimating equations with maximum likelihood tests to
estimate the effects of time on repeated measurements
with a small sample size.26 All P values were based on
Wald chi-square at 5% significance and Bonferroni test
for post hoc comparisons.
Results
One participant withdrew from the abbreviated tech-
nique group following a myocardial infarction, and all
the others completed the 6-month trial as planned.
There were no statistically significant differences in
the distribution of participants’ characteristics be-
tween the groups at baseline (Table 1). Both groups
required significantly less time to chew and fewer
chewing strokes before the urge to swallow at 3
months compared to baseline, but there was no sig-
nificant change in chewing performance between 3
and 6 months (Table 2). The chewed particles from the
abbreviated technique were significantly smaller than
particles from the conventional technique at 3 but not
at 6 months. Participants in both groups felt that their

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Mastication with Complete Dentures Made by a Conventional or an Abbreviated Technique

Table 1   Participant Characteristics

Denture technique (SD)
Characteristic Abbreviated Conventional Pa
Sex (n)
 Women 9 7 .62
 Men 1 3 .32
Age (y)
 Mean 68.3 67.8 .88
 Range 58–81 55–79
Residual ridge resorptionb
 Ratio 1.5 (0.2) 1.3 (0.2) .08
Duration of complete tooth loss (y)
 Maxilla 38.0 (14.2) 35.9 (15.1) .75
 Mandible 31.8 (15.5) 23.9 (16.1) .28
Time using existing dentures (y)
 Maxillary 13.3 (9.4) 11.6 (11.9) .75
 Mandibular 16.8 (13.80) 10.0 (10.7) .24
Level of general satisfaction with existing dentures on a 10-cm VAS
 Maxillary 0.60 (0.38) 0.64 (0.19) .72
 Mandibular 0.22 (0.20) 0.14 (0.21) .50
VAS = visual analog scale.
aStatistical inference using independent t test at 5% significance.
bRatio of mandibular residual ridge height to distance from inferior border of mandible to the lower border of mental foramen on a panoramic radiograph.

Table 2   C
 hewing Performance at Baseline with Old Dentures (T0), and after 3 (T1) and 6 months (T2) with New
Dentures Made by a Conventional or Abbreviated Technique
Difference*
Denture technique (SD) Time Technique Interaction
Time of Conventional Abbreviated Chi- Chi- Chi-
Performance21,22 assessment (mean [SE]) (mean [SE]) square P square P square P
Chewing time in T0 102.81 (12.82)a 82.62 (10.79)a
seconds before T1 72.97 (8.52)b 69.94 (9.80)b 10.90 .004* 0.55 .46 1.90 .38
the urge to swallow T2 72.42 (14.67)b 65.49 (9.70)b
Number of chewing T0 130.5 (16.19)a 109.90 (15.78)a
strokes before the T1 84.1 (10.87)b 94.51 (13.14)b 14.51 .001* 0.01 .92 3.27 .19
urge to swallow T2 72.4 (13.23)b 87.75 (12.30)b
Medium particle size in mm2
At the urge to T0 3.97 (0.33)A,a 4.25 (0.46)A,a
swallow T1 4.68 (0.48)A,b 3.55 (0.19)B,a 0.36 .83 0.54 .46 11.95 .003*
T2 4.05 (0.35)A,a 3.92 (0.44)A,a
After 20 chews T0 7.73 (0.67)a 7.76 (0.62)a
T1 7.12 (0.64)a 7.24 (0.72)a 7.06 .03* 0.37 .54 1.47 .48
T2 6.06 (0.11)b 6.96 (0.55)b
SE = standard error.
*Generalized estimating equations testing the effects of time, technique, and interaction of time vs technique with Wald chi-square at 5% significance.
Different capital letters indicate statistical difference (P ≤ .05) between techniques. Different lowercase letters indicate statistical difference ( P ≤ .05)
between assessment times.

ability to bite and chew fresh lettuce or spinach im-
proved significantly after 3 months, and all other foods
apart from whole fresh apples had improved after 6
months (Table 3). All participants returned for one
postinsertion session, mostly (85%) for adjustments to
a denture-base, and 25% returned again for a second
adjustment. However, there was no significant differ-
ence between the groups (P = .34) in the need for
postinsertion sessions, and no one returned for more
than two postinsertion sessions.

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 Mengatto et al

Table 3   P
 articipants’ Self-Perceived Chewing Ability Measured on a 10-cm VAS at Baseline with Old Dentures (T0), and
after 3 (T1) and 6 months (T2) with New Dentures Made by a Conventional or Abbreviated Technique
Difference*
Mean (SE) VAS score by
technique Time Technique Interaction
Questions on self-perceived Time of Chi- Chi- Chi-
chewing ability23 assessment Conventional Abbreviated square P square P square P
Are you ordinarily, or would you be able to chew or bite:
 Fresh carrot or celery T0 25 (13)a 19 (7)a
sticks? T1 43 (13)a 32 (13)a 7.54 .02* 0.19 .665 0.42 .81
T2 48 (11)b 47 (15)b
  Fresh lettuce or spinach? T0 81 (12)a 82 (8)a
T1 98 (2)b 96 (2)b 7.99 .02* 0.66 .417 3.85 .15
T2 95 (3)a 81 (6)a
 Steaks, chops, or firm T0 36 (13)a 30 (13)a
meat? T1 59 (12)a 38 (11)a 7.36 .02* 2.07 .150 0.82 .66
T2 71 (9)b 47 (13)b
 Boiled peas, carrots, or T0 85 (7)a 81 (7)a
green or yellow beans? T1 99 (1)b 100 (0)b 15.63 < .01* 0.15 .694 1.24 .54
T2 98 (1)b 97 (1)b
 A whole fresh apple T0 20 (13)a 10 (9)a
without cutting? T1 35 (14)a 30 (13)a 3.45 .18 0.49 .485 1.13 .57
T2 39 (14)a 22 (13)a
VAS = visual analog scale; SE = standard error.
*Generalized estimating equations tested the effects of time, technique, and interaction of time vs technique with Wald chi-square at 5% significance.
Different capital letters indicate statistical difference (P ≤ .05) between techniques. Different lowercase letters indicate statistical difference (P ≤ .05)
between assessment times.

Discussion Slow adaptation to new dentures could explain why

This clinical trial demonstrated that there were no
statistically significant differences after 6 months in
chewing performance or ability of participants with
complete dentures delivered by clinical methods re-
quiring either three or five clinical sessions. A multi-
ple sieve rather than a single sieve method was used
to measure chewing performance and swallowing
thresholds, because multiple sieves provided more de-
tailed information on the size of chewed particles after
a set number of chewing cycles and when participants
had an urge to swallow.20 The test material Optocal
contains a condensation-silicone, Optosil PlusR, modi-
fied with alginate powder, petroleum jelly, dental plas-
ter powder, and toothpaste with mint essence to give
it the texture of soft bread, cheese, and boiled veg-
etables, suitable for chewing with dentures. Optosil
PlusR has a texture more like hard apples, carrots,
and peanuts.25 The softer texture of Optocal probably
explains the small individual differences in chewing
performances within the two groups as indicated by
the relatively low standard deviations of particle size
in both groups and in contrast to large differences
among people with natural teeth.20 This chewing tex-
ture allowed the denture wearers to develop interindi-
vidual variance in X50 within 20 chewing strokes and
reduced the sample size needed for adequate statisti-
cal power to test the hypothesis.25
participants were able at 6 months to chew some of
the harder and more fibrous foods that caused diffi-
culties at 3 months.1,2,15 It is also possible that the VAS
scores relating to chewing lettuce and spinach, while
statistically different at 3 months from baseline, are
of no clinical significance. Indeed, the ability to cope
with dentures has received little research and remains
a poorly understood phenomenon that needs further
investigation. Measures such as objective mastica-
tory measurements are likely to identify only part of
the adaptive capacity of people who wear complete
dentures, especially over an adaptive period of only 6
months. It is possible, of course, that a longer adap-
tive period will reveal differences between the two
techniques, although existing evidence suggests that
adaptive experiences with complete dentures improve
rather than deteriorate with time regardless of the
treatment method.5,6,9
Confirmation that complete dentures can be deliv-
ered in three clinical sessions plus an optional adjust-
ment appointment offers the possibility of extending
prosthodontic services beyond the usual dental clinic,
although the effectiveness of delivering dentures ac-
cording to this abbreviated technique in unusual con-
ditions, such as a patient’s home or a geographically
remote region, remains to be tested. The dentist who
made all the dentures performed both techniques
easily and quickly, but how much time clinicians from

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Mastication with Complete Dentures Made by a Conventional or an Abbreviated Technique
other educational and cultural backgrounds will need,
or how they will perform in larger, less monitored
settings, is unknown. Communication between the
clinician and the dental technician is especially criti-
cal in the abbreviated technique, where opportuni-
ties for identifying and correcting errors are limited.
Nonetheless, the trial demonstrated that the abbre-
viated and conventional techniques can deliver den-
tures with equivalent masticatory performance and
chewing ability and opens the possibility of delivering
dentures to many people who currently do not have
access to them.
These observations should be interpreted with cau-
tion, since the selected patient cohort had already ex-
perienced denture wearing and was provided with a
new free service. Moreover, the relationship between
adverse time-dependent changes in complete den-
ture–supporting tissues as a result of employing differ-
ent clinical and laboratory protocols is still unknown.
Another interpretation of this study’s short-term out-
come is that use of different denture protocols may
be inconsequential when prescribed for prosthetically
adaptive patients.
Conclusions
There were no significant differences in the masticatory
performance or chewing ability of edentulous people
wearing complete dentures made by either an abbrevi-
ated or a conventional complete denture technique.
Acknowledgments
The authors are grateful to Dr Richeli Rodrigues, Alexandre da
Silva Tedesco, Rodrigo Kern, Graciela Camargo, Evanise Berggrav,
and Charlene da Silveira Dalberto for the technical support. This
study was funded in part by PROPESQ-UFRGS #91.396/2012 and
PROBIC_FAPERGS #0366-2551/12-0. It was approved by the
Institutional Ethical Committee SISNEP: 05494512.2.0000.5347.
The authors reported no conflicts of interest related to this study.
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