A Clinical Study To Compare The Hematological

Parameters Of Patients Utilizing Conventional

Complete Dentures And Implant Supported
Overdentures: An In Vivo (Original Research)
Study

Bushra Vasim1, Ajay Kumar Dubey2, Bazeela Imtiyaz3, Maitreyi4, Jasmine Rajpal5, Sahba Hassan6

1Post Graduate Student, Department of Prosthodontics and Crown & Bridge, Rama Dental College Hospital & Research Centre, Kanpur, Uttar
Pradesh, India
2Post Graduate Student, Department of Prosthodontics and Crown & Bridge, Rama Dental College Hospital & Research Centre, Kanpur, Uttar

Pradesh, India
3Post Graduate Student, Department of Prosthodontics and Crown & Bridge, Rama Dental College Hospital & Research Centre, Kanpur, Uttar

Pradesh, India
4Assistant Professor, Department of Microbiology, School of Dental Sciences, Sharda University, Greater NOIDA, India

5BDS, PGDHM (Hospital Administration), Patient Care Executive, School of Dental Sciences, Sharda University, Greater NOIDA, India

6Post Graduate Student, Department Of Prosthodontics and Crown & Bridge, School Of Dental Sciences, Sharda University, Greater NOIDA, India

Corresponding Author: Bushra Vasim, Post Graduate Student, Department of Prosthodontics and Crown & Bridge, Rama Dental College
Hospital & Research Centre, Kanpur, Uttar Pradesh, India
Email ID: Khanbushra0918@gmail.com
DOI: 10.47750/pnr.2022.13.S07.842

Aim: The exclusive aim of this study was to assess and compare blood parameters in patients using conventional complete dentures
and implant supported overdentures.
Materials & Methods: The study included total 40 complete denture wearers with 20 patients with conventional complete denture
(Group 1) and 20 patients (Group 2) with implant supported complete dentures (overdenture). All patients were in the age range of
41 years to 60 years with 25 male patients and 15 female patients. Blood levels of hemoglobin and other entities were assessed and
compared. Results and data was compiled in table and sent for basic statistical analysis. P value less than 0.05 was considered
significant (p< 0.05).
Statistical Analysis and Results: Statistical analysis was completed by using statistical software Statistical Package for the Social
Sciences version 21. All patients were in the age range of 41 to 60 years with maximum 16 patients in the age group of 46-50 years
and minimum 3 patients in the age range of 56-60 years. P value was very significant for the age range of 51-55. For group 1, mean
Hemoglobin level was 139.82 and mean RBC count was 4.09. P value was highly significant for (0.02) Hemoglobin level. For
group 2, mean Hemoglobin level was 141.22 and mean RBC count was 4.22. P value was highly significant for (0.01) Hemoglobin
level. The degree of freedom by one-way ANOVA was 122.13 for cumulative assessment. The level of significance for overall
comparison was highly significant (0.001).
Conclusion: Authors concluded that nutritional status of both the groups was fairly comparable wherein mean hemoglobin level
and mean RBC count was slightly higher in the patients wearing implant supported overdentures. Additionally, authors suggested
careful clinical correlation of these inferences before applying.

Keywords: Complete Dentures, Prosthodontics, Implant, Overdenture, Hematology.

Introduction
Journal of Pharmaceutical Negative Results ¦ Volume 13 ¦ Special Issue 7 ¦ 2022 6956
Complete denture is the first choice of complete dental rehabilitation for most of the completely edentulous patients.
With the ever increasing life expectancy and technological advancements, newer therapeutic options are now available
for such patients. Predominantly dental implant has been widely utilized with this respect worldwide. 1 Many of the
researchers have showed long term success rate for implant s after their prosthetic loading. Complete dentate wearers
have also got benefited with the implants since the dentures can be fixed to the underlying bone through them. 2 This
stands true particularly in case of highly resorbed mandibular or maxillary alveolar ridges. In the south East Asian
regions, edentulous people are still facing issues with loose denture due to lack of awareness of implant supported
dentures. Economical factors also play a significant role in this regards.3 The nutritional status of these patients is also
correlated with the eating habit and eating comfort with conventional and implant supported dentures. Therefore, it is
actually important to assess the overall nutritional status of these two groups. Many pioneer workers have studied all
these factors in the recent past and concluded very significant outcomes. 4 Hence keeping all these appealing factors
in the mind, this study was planned to assess and compare blood parameters in patients using conventional complete
dentures and implant supported overdentures.

Materials & Methods

The study was planned and executed logically wherein total 40 complete denture wearers included. The study
participants were selected on the basis of their mode of rehabilitation. 20 patients with conventional complete denture
(Group 1) and 20 patients (Group 2) with implant supported complete dentures (overdenture) were selected by
systematic sampling procedure. All selection procedure for both groups was done after 2 months of successful wearing
of the respective prosthesis. For both of the study groups, all clinical and laboratory works have been done in the
department itself. Surgical part (osteotomy) and associated prosthetic part was also attempted and completed in the
department of Prosthodontics. All participants have been informed about the objectives of the study and informed
consents were obtained. Since our study involves evaluation of blood parameters, the study protocol was presented to
institutional ethical committee for their clearance. Following their approval, the study initiated carefully. Patients in
the age range of 41 years to 60 years were selected. Also, patients reported to the department for complete denture
fabrication were included (similar geographical region). 25 male patients and 15 female patients were studied for
predefined objectives. Patients with any sort of follow up issue were excluded from the study. Patients with any kind
of ongoing medication for any other disease were also excluded from the study as it can interfere with the accuracy of
the results. We have planned to check actual differences in the nutritional status of patients of both groups after using
the above two types of dentures. For this, blood parameters were tested logically and compared for both the groups.
Venous blood were drawn and collected for all 40 patients and sent for laboratory for further investigations. The
laboratory analysis included complete blood count, hemoglobin levels, RBCs count, WBCs count, serum albumin
levels, ferritin and carotene, plasma B12 levels and folic acid. The privacy, self rule and other related human rights of
the patients along with their freedom of expression were kept entirely confidential even after completion of the study.
Results and data was compiled in table and sent for basic statistical analysis. P value less than 0.05 was considered
significant (p< 0.05).

Statistical Analysis and Results

All relevant findings and details were sent for statistical analysis using statistical software Statistical Package for
the Social Sciences version 21 (IBM Inc., Armonk, New York, USA). Appropriate statistical tests were also utilized
to obtain p values, mean, standard deviation, chi- square test, standard error and 95% CI. Table 1 and Graph 1
showed that out of 40 patients, males were 25 and females were 15. All participants were also grouped according
to their age in to 4 groups. All subjects were falling exactly in the age range of 41 to 60 years. Maximum 16 patients
were in the age group of 46-50 years. Minimum 3 patients were seen in the age range of 56-60 years. P value was
very significant for the age range of 51-55. It was 0.01. Table 2 denotes about basic statistical explanation with
level of significance evaluation using pearson chi-square test [for group 1]. The mean Hemoglobin level was 139.82
and mean RBC count was 4.09. p value was highly significant for (0.02) Hemoglobin level. The mean WBC count
was 6.96 with standard deviation of 0.543 and standard error of 0.634. P value was highly significant for this

Journal of Pharmaceutical Negative Results ¦ Volume 13 ¦ Special Issue 7 ¦ 2022 6957

parameter. It was 0.01. The mean Albumin was 38.90 with standard deviation of 0.384 and standard error of 0.610.
The mean Cholesterol was 6.02 with standard deviation of 0.738 and standard error of 0.736. Table 3 represents
about basic statistical explanation with level of significance evaluation using pearson chi-square test [for group 2].
The mean Hemoglobin level was 141.22 and mean RBC count was 4.22. p value was highly significant for (0.01)
Hemoglobin level. The mean WBC count was 7.19 with standard deviation of 0.079 and standard error of 0.055. P
value was not significant for this parameter. It was 0.09. The mean Albumin was 39.20 with standard deviation of
0.553 and standard error of 0.340. The mean Cholesterol was 5.82 with standard deviation of 0.862 and standard
error of 0.256. The mean Ferritin was 147.82 with standard deviation of 0.736 and standard error of 0.033. P value
was highly significant for (0.01) Ferritin level. Table 4 shows about comparison among the studied groups by one-
way ANOVA. The degree of freedom was 122.13 for cumulative assessment, while it was 2.321 and 6.324 for
calculations between groups and within groups respectively. The level of significance for overall comparison was
highly significant (0.001).

Table 1: AGE & GENDER BASED DETAILS OF PARTICIPANTS

Age Group (Yrs) Male Female Total P value
41-45 8 7 15 0.09
46-50 12 4 16 0.10
51-55 3 3 6 0.01*
56-60 2 1 3 0.50
*
Total 25 15 40 Significant
*p<0.05 significant

Table 2: BASIC STATISTICAL EXPLANATION WITH LEVEL OF SIGNIFICANCE EVALUATION

USING PEARSON CHI-SQUARE TEST [FOR GROUP 1]
FOR GROUP 1
Pearson
Level of
Std. Std. Chi-
Parameters Mean 95% CI df Significance
Deviation Error Square
(p value)
Value
Hemoglobin
139.82 0.948 0.647 1.96 1.324 1.0 0.02*
(g/L)
RBC count 4.09 0.941 0.504 1.96 2.535 2.0 0.09
WBC count 6.96 0.543 0.634 1.12 2.027 1.0 0.01*
Albumin (g/L) 38.90 0.384 0.610 1.04 1.124 2.0 0.10
Cholesterol
6.02 0.738 0.736 1.73 1.425 1.0 0.50
(mmol/L)
Ferritin (g/L) 141.83 0.903 0.503 1.04 1.530 2.0 0.09
B12 (pmol/L) 276.91 0.593 0.654 1.08 1.426 1.0 0.10
Serum
34.56 0.535 0.631 1.21 1.029 2.0 0.80
Folate (nmol/L)
*p<0.05 significant

Table 3: BASIC STATISTICAL EXPLANATION WITH LEVEL OF SIGNIFICANCE EVALUATION

USING PEARSON CHI-SQUARE TEST [FOR GROUP 2]
FOR GROUP 2

Journal of Pharmaceutical Negative Results ¦ Volume 13 ¦ Special Issue 7 ¦ 2022 6958

 Pearson
Level of
Std. Std. Chi-
Parameters Mean 95% CI df Significance
Deviation Error Square
(p value)
Value
Hemoglobin
141.22 0.847 0.298 1.02 1.536 1.0 0.01*
(g/L)
RBC count 4.22 0.637 0.466 1.96 2.152 2.0 0.08
WBC count 7.19 0.079 0.055 1.94 1.647 1.0 0.09
Albumin (g/L) 39.20 0.553 0.340 1.24 1.103 2.0 0.50
Cholesterol
5.82 0.862 0.256 1.23 1.045 1.0 0.10
(mmol/L)
Ferritin (g/L) 147.82 0.736 0.033 1.52 1.030 2.0 0.01*
B12 (pmol/L) 278.41 0.045 0.004 1.18 1.036 1.0 0.20
Serum
35.94 0.649 0.331 1.61 1.039 2.0 0.70
Folate (nmol/L)
*p<0.05 significant

Table 4: COMPARISON AMONG THE 2 STUDY GROUPS USING ONE-WAY ANOVA [FOR GROUP 1,2]

Level of
Degree of Sum of Squares Mean Sum of
Variables F Significance
Freedom ∑ Squares m∑
(p)
Between Groups 3 2.321 1.738 2.4 0.001*
Within Groups 21 6.324 0.038 -
Cumulative 122.13 12.033 *p<0.05 significant

Graph 1: AGE & GENDER WISE DISTRIBUTION OF PATIENTS

14
12 Male
12
Female
10
8
8 7
6
4
4 3 3
2
2 1
0
41-45 46-50 51-55 56-60

Discussion

Journal of Pharmaceutical Negative Results ¦ Volume 13 ¦ Special Issue 7 ¦ 2022 6959

With the ever increasing awareness and expectancy, dental implants have gained tremendous popularity in the recent
past. Dental implants are widely used not only for restoring missing teeth but for anchoring the existing complete
dentures also.5 Implants have opened newer avenues for hopeless situations like poor alveolar ridges. Nutritional and
related health status is an all time problem being faced by the edentulous patients. 6 Even after rehabilitated by new set
of artificial denture, patients are unable to eat food especially in the first few months of denture usage. 7 Hamdan and
colleagues have studies about the role of implant overdentures in improving dietary intake of edentulous patients.
They conducted a randomized clinical trial for assessments of these parameters. They found that patients with implant
supported denture showed improved overall health. However their study was restricted to a closed geographical region.
This could make a serious concern since educational and awareness levels also play significant role in it.8 Zelig and
associates also presented similar clinical recommendations in their study. 9 Few of the recent studied conducted in the
year 2022 also explored about the nutrition literacy of completely edentulous patients and their outcomes.10,11 Iyer and
associates stated that complete denture patients are always at a high risk of malnutrition than healthy populace. They
recommended for periodic checks of nutritional status of complete denture patients. It is very crucial since it put off
diseases and clinical problems related with undernourishment. Therefore, dietary psychotherapy and examination must
be included into the treatment protocol of conventional denture and implant supported overdentures. 12

Conclusion

Within the limitations of the study authors concluded that nutritional status of both the groups was fairly comparable.
The Hemoglobin level and RBC count was slightly higher in the patients wearing implant supported overdentures.
Also, there was a clear decline noticed in the mean blood Cholesterol level in patients wearing implant supported
overdentures. Therefore, patients with implant supported overdentures showed slightly elevated nutritional status
compared to the conventional denture wearer. Nevertheless, these inferences should be clinically correlated before
applying. Since blood parameters are very subjective and depends on numerous other factors also, authors expect
some other studies to be performed with larger samples size and in-depth analysis.

References
1. Joaquim AMC, Wyatt CCL, Aleksejuniene J, Greghi SLA, Pegoraro LF, Kiyak H A. A comparison of the dental health of Brazilian and
Canadian independently living elderly. Gerodontology. 2010;27:258–265.
2. Wostmann B, Michel K, Brinkert B, Meichheier-Weskott A, Rehmann P, Balkenhol M. Influence of denture Improvement on the
nutritional status and quality of life on geriatric patients. J Dent. 2008;36:816–821.
3. Hung HC, Walter W, Ascherio A, Rosner B, Rimm E, Joshipura KJ. Tooth loss and dietary intake. JADA. 2003;134:1185–1192.
4. Bartlett DW, Maggio B, Targett D et al. A preliminary investigation into the use of denture adhesives combined with dietary advice to
improve diets in complete denture wearers. J Dent 2013;41:143–7.
5. Gjengedal H, Dahl L, Lavik A et al. Randomized clinical trial comparing dietary intake in patients with implant-retained overdentures
and conventionally relined denture. Int J Prosthodont 2012;25:340–7.
6. Awad MA, Morais JA, Wollin S et al. Implant overdentures and nutrition: a randomized controlled trial. J Dent Res 2012;91:39–46.
7. Mazaki T, Martiniuk AL, Irie K, Sokejima S, Lee CM. Does a mandibular overdenture improve nutrient intake and markers of nutritional
status better than conventional complete denture? A systematic review and meta-analysis. BMJ Open. 2016;6(8):e011799.
8. Hamdan NM, Gray-Donald K, Awad MA, Johnson-Down L, Wollin S, Feine JS. Do implant overdentures improve dietary intake? A
randomized clinical trial. J Dent Res. 2013;92(12Suppl):146S–53S.
9. Zelig R, Goldstein S, Touger-Decker R, Firestone E, Parrott JS. Tooth loss and nutritional status in older adults: a systematic review
and meta-analysis. JDR Clin Transl Res. 2022;7:4–15.
10. Aihemaitijiang S, Ye C, Halimulati M, Huang X, Wang R, Zhang Z. Development and validation of nutrition literacy questionnaire for
the Chinese Denture Wearers. Nutrients. 2022;14:1005-9.
11. Felix Gomez GG, Cho SD, Varghese R, Rajendran D, Eckert GJ, Bhamidipalli S, Gonzalez T, Khan BA and Thyvalikakath TP.
Nutritional Assessment of Denture Wearers Using Matched Electronic Dental-Health Record Data. J Prosthodont 2022;31:e53-e65.
12. Iyer MS, Madarapu S, Swamy KNR. Geriatric Nutrition in Denture Wearers: Revisited. J Oral Health Comm Dent 2018;12(2):47-50.

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