BIOMECHANICS

OF THE
EDENTULOUS
STATE
MEHER S SOOD
PG 1
DEPARTMENT OF
PROSTHODONTICS AND CROWN
AND BRIDGE
 • Definition

• Introduction

• Reasons of edentulousness

• Modifications in the area of support

CONTENT • Functional and Para Functional considerations

S • Changes in Face height and TMJ

• Cosmetic Changes

• Adaptive Responses

• Review of Literature
 Biomechanics-
1.the application of mechanical laws to living structures,
specifically the locomotor systems of the body;
DEFINITIO 2. the study of biology from the functional viewpoint;
3. an application of the principles of engineering design as
N implemented in living organisms;

(According
to GPT-9) Dental biomechanics -
the relationship between the biologic behavior of oral
structures and the physical influence of a dental restoration
 INTRODUCTION

The transition from a completely dentulous state to a partially edentulous and completely
edentulous state is considered as a posing hazard for a greater mutilation – destruction of the
facial skeleton and distortion of the morphology and function of soft tissues.
 INTRODUCTION
• The face is one of the most fundamental parts of the body for self-recognition.

• Any change in the facial appearance of a person is perceived by the person himself as well as
those around him as a negative one.

• Therefore, when we treat such patients we not only treat the biomechanical aspect but more
importantly their individuality, the way they look and feel about themselves.
 REASONS OF EDENTULISM

• Caries
• Periodontal Disease
• Non dental factors such as attitude
towards dental treatment, previous dental
history , socioeconomic status
The clinical implications of an edentulous stomatognathic system are
considered under the following factors:-

Morphological Cosmetic
Modification in Functional and
changes in changes and
the area of para functional
facial height & adaptive
support considerations
TMJ responses
MODIFICATION IN
THE AREA OF
SUPPORT
Natural V/S Complete
dentition Denture
 Natural dentition

• teeth function to the optimum capability only

if adequately supported.
• maximum support from the periodontium
which surrounds the teeth.
• provides a resilient suspensory apparatus
resistant to functional forces.
• allows the teeth to adjust their position when
under stress.
• means by which force exerted on the tooth is
transmitted to the bone that supports it.
VERTICAL FORCES (MASTICATORY FORCES)

Forces that act parallel to the long

axis of the tooth.
Act for approximately 17.5 mins/day

HORIZONTAL FORCES (NON-MASTICATORY

FORCES)

Forces which are created by the perioral

musculature and the tongue
Rest position - these forces cancel out each
other
Swallowing - inward forces < outwards
forces
 Complete Denture

• The area of mucosa available to receive the load from

complete dentures is limited when compared with the
corresponding areas of support available for natural
dentitions

• Presence of systemic diseases such as anemia,

hypertension, or diabetes, as well as nutritional
deficiencies.-- leading to inflammation and intolerance.
 Complete Denture

Complete dentures, unlike natural teeth rests completely

over the mucosa

Factors to be considered
i. Magnitude of masticatory forces
ii. Area over which these forces are distributed
iii. Residual ridge
iv. Psychological Interactions
 Complete Denture
The magnitude of masticatory load
• Natural dentition – 44lb (20kgs)
• Complete denture – 13-16lb (6-8kgs)

The area of force distribution

• Natural dentition – 45 cm2 in each jaw
• Edentulous maxilla – 22.96 cm2
• Edentulous mandible – 12.25 cm2
 Complete Denture

Residual Ridge-
• That part of alveolar process which is left behind after
the teeth have been lost.
• Consists of the mucosa, submucosa, the periosteum and
the residual alveolar bone.

• Receives vertical, diagonal, and horizontal loads applied

by a denture with a surface area much smaller than the
total area of the periodontal ligaments of all the natural
teeth that had been present
 Complete Denture
• Denture wearing almost invariably accompanied by an
undesirable and irreversible bone loss.

• magnitude of this bone loss is extremely variable- further

complicated complete dentures move in relation to the
underlying bone during function

• Brill(1967) stated that- two physical factors involved in

denture retention that are under the control of the dentist:-

1) maximal extension of the denture base and

2) maximal intimate contact of the denture base and its
basal seat
 MUSCULAR FORCES

• Orbicularis oris, Buccinator and the intrinsic and

extrinsic muscles of the tongue are the key
muscles that the dentist harnesses to achieve this
objective by means of impression techniques.

• The design of the labial buccal and lingual

polished surface of the denture - considered in
balancing the forces generated by the tongue and
perioral musculature.
 Complete Denture

Psychological Interactions
• Dentures may have an adverse psychological
effect

• May influence salivary secretions and thus affect

retention
 VISCOELASTIC BEHAVIOR OF THE
ALVEOLAR MUCOSA

• oral mucosa is displaced under load about 10 times more than the periodontium.

• mucosa has less elasticity than the PDL.

• A slower recovery

rate to sustained loads.

• Time required for recovery

increases with age.

Kydd WL. The thickness measurement of masticatory mucosa in vivo. Int. Dent. J.. 1971;21:430-41
FUNCTIONAL AND
PARAFUNCTIONAL
CONSIDERATIONS
 FUNCTIONAL CONSIDERATIONS

The masticatory system appears to function best in an environment of continuing

functional equilibrium (Moyers, 1969)

Functional aspects to be considered are-

1. Occlusion
2. Mastication and swallowing
 Occlusion

There are three primary components

of occlusion namely-
1. The dentition
2. The neuromuscular system
3. The craniofacial structures
 MASTICATION AND SWALLOWING

• Mastication consists of a rhythmic separation and apposition of the jaws and involves
biophysical and biochemical processes, including the use of the lips, teeth, cheeks, tongue,
palate, and all the oral structures to prepare food for swallowing.

• During masticatory movements, the tongue and cheek muscles play an essential role in
keeping the food bolus between the occlusal surfaces of the teeth

• Control via Sensory information

 MASTICATION AND SWALLOWING
The pronounced differences between persons with natural
teeth and patients with complete dentures are conspicuous in
this functional context:

(1) the mucosal mechanism of support as opposed to support

by the periodontium

(2) the movements of the dentures during mastication

(3) the progressive changes in maxillomandibular relations

and the eventual migration of dentures

(4) the different physical stimuli to the sensorimotor systems

which influence the mastication
 PARAFUNCTION
• Non-functional or parafunctional forces can be
harmful to the teeth or other components of the
masticatory system.

• Cause additional loading on the denture-bearing

tissues

• Aetiological factors – Emotions or nervous

tension, pain or discomfort, etc

• Bruxism-soreness of the denture bearing mucosa

• the complaint of a sore tongue is related to a habit

of thrusting the tongue against the denture.
 DISTRIBUTION OF STRESS TO THE
DENTURE SUPPORTING TISSUE

• Denture supporting tissue is covered by mucosa which is highly compressible

• Mucosal surface area < Periodontal surface area

• Force in artificial dentition < force in normal dentition

 FORCE PER UNIT AREA ANALYSIS

• Force in Complete denture- 7kgs Force in Natural dentition - 20kgs

• Edentulous mandible area -12.25 cm2 Dentulous area - 45cm2

• Stress acting - 0.56 Stress Acting -0.44

• Increased stress leads to tissue damage by occluding the local circulation. So,care is to be
taken to reduce these stresses.

This can be done by-

• Maximising the denture base coverage & by providing optimum denture occlusion.

• Forces can also be reduced using resilient liners.

The main disadvantage of these materials is that the attract the growth of candida.
 CHANGES IN
MORPHOLOGIC FACE
HEIGHT AND TMJ
 FACE HEIGHT

• Any dimensional changes in morphological face height / the jawbones because of the loss of
teeth are inevitably transmitted to the TMJs

• Any change in the TMJ, causes stimulation of the osteoblastic and osteoclastic activity in the
articular cartilages.

• Articular surfaces undergo a slow but continuous remodelling process throughout life to
maintain the congruity of the opposing articular surfaces
Mandibular Prognathism
 Centric Relation

• “Centric relation is defined as a maxillomandibular relationship, independent of

tooth contact, in which the condyles articulate in the anterior-superior position
against the posterior slopes of the articular eminences; in this position, the
mandible is restricted to a purely rotary movement; from this unstrained,
physiologic, maxillomandibular relationship, the patient can make vertical, lateral
or protrusive movements; it is a clinically useful, repeatable reference position
(GPT 9)”
Natural Dentition Occlusion Complete denture Occlusion
CR & CO do not coincide CR AND CO are made to co
incide
 TMJ CHANGES

A B
COSMETIC CHANGES AND ADAPTIVE
RESPONSES
 ADAPTABILITY

• Acceptance and usage of dentures require adaptation of learning, muscular skills and
motivation.

• Learning means the acquisition of a new activity or change of an existing one.

• Muscular skill refers to the capacity to coordinate muscular activity to execute movement.

• As a result, habituation occurs.

 ADAPTABILITY

• Glaser (1966) defines habituation as a “gradual diminution of responses to continued or repeated

stimuli.”

• Edentulous patients expect, indeed are often expected, to adapt to their dentures instantaneously.

• That adaptation must take place in the context of the patient’s oral, systemic, emotional, and
psychological states.

• Dentists must train themselves to reassure the patient, to perceive their wishes, and to know how and
when to limit the patient’s expectations.
 Review
of
Literature
 ROL 1 - Jeong-Ki Joo , Young-Jun Lim , Ho-Beom Kwon & Sug-Joon
Ahn (2013)

• The aim of the present study was to analyse the changes in the gonial angle, ramus height,
condyle height and cortical bone thickness in relation to gender and dental status in elderly
patients.

• Edentulous subjects had a larger gonial angle than dentate subjects, while dentate subjects had
greater cortical bone thickness on both sides and left side of condylar height.

Joo JK, Lim YJ, Kwon HB, Ahn SJ. Panoramic radiographic evaluation of the mandibular morphological changes in elderly dentate and edentulous
subjects. Acta Odontol Scand. 2013 Mar;71(2):357-62. doi: 10.3109/00016357.2012.690446. Epub 2012 Jul 10. PMID: 22774938.
 ROL 2 – Tallgreen (1972)
• Measured the amount of reduction in the height of the maxilla and mandible in
complete denture wearers.

• The mean reduction in height of the mandibular process measured in the anterior
region, which was 6.6 mm may be approximately four times greater than the mean
reduction occurring in the maxillary process.

Tallgren A: The continuing reduction of the residual alveolar ridges in complete denture wearers: a mixed-longitudinal study covering 25 years, J Prosthet Dent 27:120-132, 1972.
 CONCLUSION

• The role of a prosthodontist is to gain an understanding of the changes in the form and function
of the mouth and jaws, brought about by the total loss of teeth and the possible social and
behavioral consequences of tooth loss.

• When we are treating edentulous patients, we should take all the aspects into consideration and
we should not only treat the patient for his dental condition but we should treat in the terms of
totality of the individual.
 1. Boucher’s Prosthodontic Treatment for Edentulous Patients – 9th Edition The
C.V. MOSBY COMPANY
2. Glossary of Prosthodontic Terms – 9th Edition
3. Graf, H: Bruxism, Dent. Clin. North Am. 13:659-665,1969
4. Brill N: Factors in the mechanism of full denture retention, Dent.Pract.18:9-
19,1967
5. Prosthodontic treatment of Edentulous Patients; Complete Dentures and
Implant-Supported Prostheses (13th Edition). Zarb, Hopskin Eckert Jacob.
6. Ahlgren, J: Mechanism of mastication. Acta Odontol. Scand .24(Supp.44):1-
109,1966.
REFERENCES 7. Kydd WL. The thickness measurement of masticatory mucosa in vivo. Int.
Dent. J.. 1971;21:430-41.
8. Tallgren A: The continuing reduction of the residual alveolar ridges in
complete denture wearers: a mixed-longitudinal study covering 25 years, J
Prosthet Dent 27:120-132, 1972.
9. Lalit Kumar. Biomechanics and clinical implications of complete edentulous
state. Journal of Clinical Gerontology and Geriatrics. Volume 5, Issue 4,
December 2014, Pages 101-104
10. Joo JK, Lim YJ, Kwon HB, Ahn SJ. Panoramic radiographic evaluation of the
mandibular morphological changes in elderly dentate and edentulous subjects.
Acta Odontologica Scandinavica. 2013 Mar 1;71(2):357-62.
BIOMECHANICS
OF THE
EDENTULOUS
STATE

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