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Effect of Artificial Tooth Material on Mandibular Residual Ridge Resorption
• Paul • François

Mercier, DDS, FRCD(C) • Bellavance, PhD •

A b s t r a c t
Purpose: In this 10-year longitudinal study we evaluated the amount of mandibular residual ridge resorption for 2 groups of subjects with complete dentures, one group with porcelain artificial teeth and the other with acrylic resin teeth. Methods: One hundred and nine patients who had undergone ridge extension procedures with skin graft and prosthetic rehabilitation with porcelain or acrylic resin teeth were investigated for mandibular bone loss. Measurements were made on serial cephalograms. Results: There were no significant differences between the groups in terms of their baseline characteristics (age, period of edentulousness, period of observation, vertical facial morphology, sex, severity of atrophy or presence of bruxism). Similarly, there were no statistically significant differences in amount of bone loss in relation to baseline characteristics. Conclusion: The view that acrylic resin teeth should be preferred to prevent bone resorption of the mandibular residual ridge is not supported by these data. Further research concerning soft denture-lining material should be undertaken to elucidate the potential role of denture pressure in ridge resorption.
MeSH Key Words: alveolar bone loss; denture, complete, lower; tooth, artificial
© J Can Dent Assoc 2002; 68(6):346-50 This article has been peer reviewed.

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ateral cephalometric measurements obtained in long-term studies after dental extraction have shed some light on residual ridge resorption.1-3 This process is slow, gradual and inevitable. Loss of bone beneath dentures follows a decreasing exponential curve. The loss is rapid in the first years after placement of dentures, then continues at a slower pace, continuing even after 25 years. Great variations in the degree of bone loss are seen, especially in the anterior region of the mandible,4 which is 4 times more affected than the maxillary ridge, which benefits from the presence and support of the palate and from a larger denture-bearing area. A variety of factors are involved in residual ridge resorption, some local, others systemic.5,6 For example, compressive forces are known to be harmful to bone. Zarb,7 in the most recent edition of Boucher’s textbook on prosthodontics, stated, “Many dentists have been tempted to equate the prevalent residual ridge reduction in the edentulous
June 2002, Vol. 68, No. 6

population with increased stresses imposed on these ridges.” Pressure exerted by dentures on mucous membranes would interfere with blood flow, upsetting the metabolism of the tissues involved. Although not proven, it is tempting, as Zarb mentions, to include parafunctional habits such as bruxism as possibly significant variables affecting the magnitude of ridge reduction. Therefore, efforts should be directed to developing permanent lining material that will lessen the pressure on the supporting tissues. In this context of forces transmitted to the residual ridge the question arises of whether a material with a higher coefficient of elasticity, such as that used in acrylic resin artificial teeth, would be less harmful to the residual ridges. This 10-year longitudinal study was undertaken to compare the amount of mandibular ridge resorption between 2 groups of subjects with complete dentures, one group with porcelain artificial teeth and the other with acrylic resin artificial teeth.
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3 ± 7.6.8 Bioblend (Dentsply of bruxism) were compared between the 2 groups with Canada Limited. severity of atrophy and presence stability and retention of the denture. Montreal.1 0.899a plane (Fig. and % female) 53 (77) 30 (75) 0.8 ± 1. Maximal period of observation. team made up of 1 prosthodontist and 2 dentists. SAS Institute Inc. Vol.).179b measurement to the superior SD = standard deviation crestal point. Prosthetic rehabilitation with the vertical facial morphology is measured from points complete dentures was carried out at the Maxillary Atrophy Ar (articular). Cary.3 18. No. characteristics were evaluated with one-way analysis of The observation periods for clinical and radiographic variance (ANOVA) or Pearson correlation coefficients as examinations were set at 1. 6 347 . Woodbridge. 68. These heights were measured from the lower border to the summit of the Table 1 Baseline characteristics of patients with complete dentures crest. 3. standard deviation 10 years) were part of a large database of patients who had undergone reconstructive surgery for atrophy of the residual mandibular ridge. visit.12. by a prosthodontic Baseline characteristics (age..7 ± 10. The relationships anatomic teeth made of acrylic resin were used when space between bone loss after 10 years of observation and baseline was lacking in the posterior regions or at the patient’s request.756b posed on the radiograph. All Lateral cephalometric measurements were taken with analyses were conducted with SAS software for Windows the same cephalostat before surgery and at each clinical (Version 6. Mary’s Hospital. the Light 8 (12) 6 (15) lower border of the superimModerate 38 (55) 18 (45) Severe 16 (23) 12 (30) posed upper border was used Very severe 7 (10) 4 (10) as the starting point for Presence of bruxism (no. All patients in the database who had not received ridge augmentation with alloplastic material or bone grafts and who had a minimum of 3 sequential cephalograms were included in the study.8 years (standard lar to methods used in other studies. Ht20 and Ht30). and %) 19 (28) 16 (40) 0.9 It is based on reproducible points and is simi1-3 Linear measureThe mean observation period was 8. period of edentulousness. 1).3 0.0 ± 10.1 ± 9.8 8. This choice was dictated measurements for each group were compared at each mainly by socioeconomic considerations (since these teeth have greater durability than other types).Effect of Artificial Tooth Material on Mandibular Residual Ridge Resorption Methods The study population consisted of 109 patients with complete dentures: 69 with porcelain anatomic teeth and 40 with acrylic anatomic teeth. 7 and 10 years.9 ± 2.884a Mean ArGoMe angle ± SD (degrees) 129.7 127. N. sex.) anatomic porcelain t-tests or chi-square tests as appropriate. The height teeth were preferred at this clinic. appropriate. The surgical procedure used to improve ridge form was a total lowering of the floor of the mouth with vestibuloplasty.1 0. and %) 0. a (n = 69) (n = 40) tangent of pogonion (pog) at Mean age ± SD (years) 49. mandible (at Ht10. The technique of measurement has been described Results previously.1 0. The level of significance was set at 5%.6 ± 5.068a Whenever the 2 lower Sex (no. facial morphology with regard to use of lingual undercuts obtained by surgery provides degree of bite opening.C. Mean period of observation ± SD (years) 8. A split-thickness skin graft was applied to cover the Figure 1: Technique of measurements of mandibular bone height on extended ridge that had been freed from the interference cephalograms of muscle attachments.9 years).0 ± 10. The angle of the a t-test b Chi-square test mandibular plane that defines Journal of the Canadian Dental Association June 2002. Ont. Go and Me. 20 and 30 mm made of porcelain or acrylic resin artificial teeth from point 0 on the Go-Me Variable Porcelain Acrylic resin p value (gonion-menton) plane. 5. The 83 women and 26 men (mean age 49 years. Clinic of St. 75 (69%) of the patients reached the ments were taken at 3 different sites on the body of the 10-year observation point. at 10.831b borders were not superimSeverity of atrophy (no.654a right angles to the Go-Me Mean period of edentulousness ± SD (years) 19. Conventional observation point by means of a t-test. deviation 1.9 48.

6 17.0 ± 3.8 ± ± ± ± ± ± ± ± ± ± ± ± ± ± 3.5 0. severity of atrophy. Ht20 and Ht30 (Table 2).4 16. A review of complete-denture textbooks revealed that the question of ridge resorption in relation to the material and the mean of Ht10.8 3.774 bility. There was no statistically significant relationship between bone loss and sex.9 4. Ht30.0 ± 4. we have frequently observed porcelain dentures with almost-intact cusps after 10 years of use.818).8 3.4 16.8 1.2 0. stand 1 year 64 14.0 3.994 0.4 17.718 The great popularity of acrylic 10 years 48 13.940 10 years 47 15.9 summary.779 recognized in particular for its dura5 years 58 16.Mercier.5 28 2. as were the distribution of severdural research in clinical investigations.2 16. at Ht10 after 10 years was 2.3 16.0 0.612 acrylic.787 out as the main factors for the choice 5 years 59 13. However.6 ± 3. Similar results were observed for Ht20.977 0.294.5 17.6 39 14.3 17.1 25 15.9 16.3 29 13. For example.5 2.4 p valuea 0.955 0.4 39 16.545 0.7 4. (p = 0. Vol. a statistically significant negative relationship was found between bone loss and period of edentulousness (r = –0. whether a the acrylic denture group (p = 0.5 mm for the porcelain denture Unfortunately.473).7 ± 4.1 33 15.2 37 14.0 2.4 28 15.895 a survey of North American dental Mean of Ht10. In 348 June 2002. Similarly. bruxism.8 4.0 36 16.601 0.9 29 1.6 ± 4.8 3.1 0. 68. Variations in denture technique that may affect bone loss The mean pretreatment measurement of Ht10 was have been investigated. which is superior to that of 7 years 49 15.6 3.8 2.010).2 16.5 3.8 2. mean period of edentulousness.2 4. age or mandibular plane angle (Table 3).7 ± 1. mean period of observasent an amalgamation of original prosthodontic philosotion and facial morphology in terms of mean mandibular phies. porcelain Pretreatment 68 17.7 ± 4.5 3.2 ± 2.473 0.1 2.8 17.818 0.4 1.831 0.727 0.855 of these teeth by most clinicians.837 3 years 59 14.5 4.3 4. the authors of the study did not specify group and 2.7 ± 1.7 ± 4.2 ± 3. there were no statistically significant differences in height measurements between the 2 groups over the entire study period.8 17. There was no significant difference between the 2 study Jacob12 has recently stated that today’s clinical techgroups in terms of baseline characteristics.647 opment of highly cross-linked acrylic at-test resins that are less susceptible to wear bPretreatment measurement — measurement at 10 years than conventional ones.2 16.8 4.7 3. Bellavance Table 2 Comparison of ridge resorption at different levels of the mandible for patients with complete dentures made of porcelain or acrylic resin artificial teeth Porcelain Mean height ± SD n (mm) Acrylic resin Mean height ± SD n (mm) 40 39 36 34 25 29 29 40 39 37 34 25 28 28 18.10 The simplicity of adjustments to acrylic teeth.3 3.1 ± 3.0 ± 3.517 0.5 0.4 mm for the acrylic resin denture group whether the teeth were made of acrylic or porcelain.0 0.808 0.9 ± 4.4 18. Discussion Grant has summarized the advantages and disadvantages of porcelain and acrylic resin artificial teeth (Table 4).5 0.3 17.827 1 year 64 16.5 ± 3. which can be ground without any severe effect on their adhesion to the denture base.239 Variable and observation period Ht10 Pretreatment 1 year 3 years 5 years 7 years 10 years Bone loss after 10 yearsb Ht20 Pretreatment 1 year 3 years 5 years 7 years 10 years Bone loss after 10 yearsb 68 68 59 58 50 47 47 69 67 59 59 52 49 49 18.3 15.877 and polishing after adjustments.7 16. as Ht30 well as the ease of denture fabrication Pretreatment 69 14.724 0.0 1.4 ± ± ± ± ± ± ± ± ± ± ± ± ± ± 4.2 ± 3. despite progress in the develBone loss after 10 yearsb 47 2.4 mm for icance were found in the amount of bone lost. the percentage of women and their scientific bases. She deplored the paucity of procewas similar in the 2 groups.0 ± 4.11 Nevertheless.2 ± 4.9 2.4 3.5 40 17. specifically mean niques and judgements in complete-denture therapy repreage. in our hospital-based clinic.996 remains an outstanding material.0 ± 4.3 0.2 17.7 ± 3.9 0.0 2.0 0.3 4.9 mm for the porcelain denture group and 18.0 16.4 0.9 18. 7 years 51 13.9 ± 3.8 4.3 25 13.7 ± 3.1 ± 3. No.9 ± 3. including approaches to the fabrication of dentures plane angle (Table 1).8 0.1 ± 4.2 2. Ht20 and Ht30 schools.928 0.13 No differences of statistical signif18.2 33 14. ity of atrophy and the percentage of patients with bruxism.2 17.9 ± 3.0 ± 1.9 40 15.5 0.7 ± 3.485 b resin teeth was also acknowledged in Bone loss after 10 years 48 1. The mean bone loss simple or a conventional denture technique was used.1 0.7 17. 6 Journal of the Canadian Dental Association . p = 0. 3 years 58 16.

smoking and especially teeth clenching is as great as pressure during mastication. which is made of the same material in all cases.4 1. bruxism and the period during which the ridges were submitted to denture pressure. Conclusions This study may serve to enhance future research on the denture-pressure phenomenon and the development of better soft denture-lining material.Effect of Artificial Tooth Material on Mandibular Residual Ridge Resorption Table 3 Relationship between bone loss after 10 years and baseline characteristics among patients with complete dentures Variable Sex Female Male Severity of atrophy Light Moderate Severe Very severe Bruxism No Yes Age Period of edentulousness ArGoMe angle Mean bone lossa n ± SD (mm) 56 19 12 40 20 3 47 28 75 75 75 1.8 1.20. including facial morphology. should have been determinant factors.7 1.25 There is a good chance that a pattern of health-related problems similar to that experienced in the past within more affluent nations will develop. with bone loss and with differences in artificial tooth material. Such a study would be a valuable contribution to knowledge about a phenomenon that will affect an increasing number of people.10. However.24 who has stated that the forces necessary to deform the teeth and thus to bring into play the dampening factor of acrylic resin are greater than those used by patients. does not play an important role in ridge resorption.0 0. 68.1 1.087c –0.8 2.0 –0.34 Can be excellent Difficult to characterize Mechanical bond Considered to transmit all forces Sharp impact sound Acrylic resin May be rapid Will not chip Easy to grind and polish 1.17-19 Journal of the Canadian Dental Association 349 .9 0. could be undertaken to compare the rate of bone loss in a group of patients with soft denture linings and another group with conventional hard denture bases. A longitudinal study starting immediately after extraction.075c 0. represented in this study by mandibular plane angle.6 0. Moreover. our results failed to show any influence of artificial tooth material on mandibular ridge resorption.6 It could be assumed from these studies that the forces exerted by mastication and parafunctional habits on the residual ridge would be dampened by acrylic resin teeth. further steps can be taken to elucidate the situation.525 p value 0.142b SD = standard deviation aDifference between pretreatment value and value at 10 years (mean of Ht10. the stronger the forces exerted on the body of the mandible. speaking or smoking has been observed among patients who report denture soreness. it was remarked in Neil and Nairn’s16 textbook on completedenture prosthetics that the result of masticatory forces on different artificial tooth materials is distributed to the denture base.7 2.23 Patients with bruxism who wear dentures while sleeping exhibited more severe atrophy. the artificial teeth.9 ± 1. Craniofacial morphology is also related to the amount of residual ridge loss. Several authors have found that the magnitude of bite force is related to craniofacial morphology. when ridge resorption is intense.2 ± 1.358b 2.9 ± ± ± ± 1.6 ± 1. Ht20 and Ht30) bOne-way analysis of variance (ANOVA) cPearson correlation coefficient Table 4 Characteristics of porcelain and acrylic resin artificial teeth (adapted from Grant10) Porcelain Very slow May chip More difficult to grind and polish 2.8 ± 2.242b 2.458 0. June 2002.010 0. which have a certain degree of resiliency. A World Health Organization data bank on oral health has revealed an alarming increase in the prevalence of dental caries in the poor nations of Latin America and the former socialist economy countries.14-16 The present study represents an attempt to correlate the baseline characteristics of subjects.294c –0. Masticatory forces.21 It has been pointed out that non-masticatory pressure over the denture base during swallowing. Vol. 6 used in artificial teeth (porcelain or acrylic resin) remains unsolved to date. Since it appears that the intermediate milieu by which forces are transmitted to the denture base.18 Can be excellent Simple to characterize Chemical bond Considered to transmit reduced forces Little sound on contact Characteristic Rate of wear Brittleness Ease of adjustment Density (g/m2) Esthetics Ease of modification Retention to base Transmission of occlusal force Noise during use The smaller the mandibular plane angle or the closer the bite. No.22 Stress-induced muscle activity that prolongs tooth contact during swallowing. the inconclusive results of this study support the opinion of Sharry. The effect of using different materials for the teeth would thus be marginal.3 1.7. Although pressure causing resorption might still be an important if as-yet-unproven factor.

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