Edentulous position of the temporomandibular joint

Liu Hongchen, MD, PhD,a Zhou Jilin, DDS,b and Liu Ning, MScMC
Postgraduate Medical College and General Hospital of Chinese PLA, Beijing, China

Two bilateral &huller’s position radiographs were made of 10 edentulous patients

with complete dentures. In one radiograph, the complete dentures were in place in
centric occlusion. For the other radiograph, the complete dentures were removed
and the maxillary and mandibular residual ridges approximated as closely as
possible. This position is referred to as the edentulous position of the temporoman-
dibular joint (TMJ). Findings indicate that in the edentulous position the average
size of the upper and posterior TMJ spaces and the distance from the center of the
condyle to the center of the glenoid fossa on the Y axis of the TMJ are smaller than
measurements in the intercuspal position. The size of the anterior space and the
distance between the two centers on the X axis are larger in the edentulous
position. Because vertical dimension is reduced in the edentulous position, the
mentum is in a superior and protrusive position. The study indicates that when the
maxillary and mandibular residual ridges are approximate there is a pathologic
position of the TMJ and the mandible caused by the loss of all teeth. The study
shows that the condyle has the potential to move backward and upward exces-
sively. As a result of the study, the concept of the edentulous position of TMJ is
introduced. This concept is important in determining the proper position of the
condyle in the glenoid fossa and the correct vertical and horizontal jaw relationship
of an edentulous patient when complete dentures are made. (J PROSTHET DENT
1992;67:401-4.)

T he relationship between the condyle and the

Line A

glenoid fossaof the temporomandibular joint (TM& has Line C

usually been studied with natural teeth in place. This re-
lationship has rarely been studied in edentulous patients
especially when the residual ridges are approximated.
The purpose of this study is to identify the spatial rela-
tionship within the TMJ in edentulous patients when (1)
a complete denture is occluded at the correct vertical and
horizontal position and (2) the maxillary and mandibular
residual ridges are approximated as closely as possible.
This study evaluates (1) the positional change of the
condyle in the glenoid fossa;(2) changesin the upper, an-
terior, and posterior joint spaces;and (3) the relationship
between the maxillary and mandibular residual ridges. Line

MATERIAL AND METHODS Fig. 1. Location of anterior, upper, and posterior joint
Ten edentulouspatients, six womenand four men, 57 to spaces.
79years of age,were studied. Their teeth were absentfrom
5 to 33 years (average 10.1 years), and complete dentures
had beenusedfor 3 months to 33 years (average9.5 years). tient in the two positions, occlusalvertical and overclosed.
In five patients, the residual ridges were markedly ab- Schuller’s position adjuststhe head to place the midsagit-
sorbed. tal plane parallel to, and the interpupillary line perpendic-
Schuller’s positional radiographs were made of each pa- ular to, the plane of the film. The beamis placed at a 25”
caudal angleto enter the upper parietal region and exit in
the TMJ areaadjacent to the film. The overclosedposition
aAssociate Professor, Department of Stomatology.
bProfessor, Department of Stomatology.
wasreferred to asthe edentulousposition of the TMJ. With
CPostgraduate student, Department of Stomatology. the jaws maintained in this position, the relationship of the
10/1133878 central points of the residualridgeswere noted horizontally

THE JOURNAL OF PROSTHETIC DENTISTRY 401


Center of Glenoid Fosso
/-
Posterior
X Axis
IY Axis
Fig. 2. Location of centers of condyle and glenoid fossa.
and the vertical dimension recorded between a point on the
chin and the junction of the philtrum and the columella.
A piece of acetate paper was placed over the completed
radiograph and a tracing of the condyle and the glenoid
fossa was made. All locations and measurements were re-
corded.
For measurement of the joint space between the condyle
and the glenoid fossa the method suggested by Zhang
Zhenkangl was used (Fig. 1). A reference line was drawn
parallel with the Frankfort horizontal plane and tangent to
the most superior aspect of the glenoid fossa. Through the
highest point of the glenoid fossa, line A was drawn
perpendicular to the reference line. Line B was drawn at a
45degree angle to the reference line across the thinnest
part of the anterior joint space. Line C was also drawn at
45degrees to the reference line passing through line A and
line B . Line C also passes through the posterior joint space.
The length of lines A, B, and C between the condyle and the
glenoid fossa represented the width of the upper anterior
and posterior joint spaces.
The center of the condyle and the center of the fossa were
located as suggested by Brewka,2 Willis,3 and Hatjigiorgis4
(Fig. 2). Line 1 was made parallel to the reference line and
tangent to the highest point of the condyle. Line 2 was
drawn perpendicular to line 1 and tangent to the most an-
terior aspect of the condyle. Line 3 was drawn parallel to
line 2 and tangent to the most posterior aspect of the
condyle. Line 4 was drawn parallel to line 1 and at a dis-
tance to line 1 equal to that between line 2 and line 3. The
four lines formed a square. The intersection point of the
two diagonals of this square represented the center of the
condyle.
Line E -F was drawn parallel to the reference line and
tangent to the crest of the articular eminence. The line
representing the X axis was then drawn midway between
and parallel to line E-F and the reference line. The line
402
HONGCHEN, JILIN, AND NING
perpendicular to the reference line at the point where the
reference line intersected the height of the fossa repre-
sented the Y axis. The point of intersection of the X and
Yaxes indicated the center of the glenoid fossa (Fig. 2). The
distance from the center of the condyle to the center of the
glenoid fossa on the X axis and the Y axis was measured
and recorded.
RESULTS
Analysis of the data obtained in the study showed no
statistical difference (at the 5% level) between the values
of the left and right TMJs in all measurements (Tables I
and II). When the values of both sides were combined,
those in the intercuspal position and the edentulous posi-
tion were compared.
The average values of upper and posterior joint spaces
and the distance from the center of the condyle to the cen-
ter of the glenoid fossa on the Y axis were statistically nar-
rower in the edentulous position than those in the inter-
cuspal position. The average values of the anterior space
and the distance between the two centers on the X axis
were found to be larger in the edentulous position than
those in the intercuspal position. The statistical t-test of
these two independent values showed no statistical differ-
ence at the 5% level of significance (Table III).
In the intercuspal position, the vertical dimension was
6.75 * 0.55 cm (x f SD) and, in the edentulous position,
it was 5.50 f 0.34 cm (x f SD). At rest position in 17 pa-
tients, the relationship of the residual ridges did not show
protrusion of the mandible. In the edentulous position,
three of 17 residual ridges could be approximated tightly
without protrusion of the mandible and the other 14
patients showed protrusion of 3.36 + 1.86 mm (x + SD).
In seven patients, the maxillary and mandibular residual
ridges could be approximated tightly and, in another seven
patients, a space of 4.6 t 1.52 mm (x + SD) was noted
between the maxillary and mandibular residual ridges.
DISCUSSION
After the loss of all teeth in one or both dental arches, the
intercuspal position and the retruded contact position dis-
appear. When the maxillary and mandibular residual
ridges approach, the position of the condyle in the glenoid
fossa may change. Because this changed condylar position
may be a pathologic one, it is referred to as the edentulous
position of the TMJ. In this position, the upper and pos-
terior joint spaces are obviously reduced. The distance on
the Y axis between the center of the glenoid fossa and the
center of the condyle is shortened, indicating that the
condyle may move upward and backward after the loss of
natural occlusal stops.
The anterior joint space and the distance between the
center of the glenoid fossa and the center of the condyle on
the X axis does not increase significantly, indicating that
MARCH 1992 VOLUME 67 NUMBER 3
EDENTULOUS POSITION OF THE TMJ

Table I. Comparison between right and left average measurements (mm) of the TMJ in the edentulous position of 10
edentulous patients
Left Right

x SD x SD t P

Anterior space 1.73 0.713 1.51 0.137 0.848 >0.05

Upper space 2.47 0.618 2.58 0.820 1.173 >0.05
Posterior space 1.18 0.207 1.50 0.499 1.328 >0.05
X axis -2.23 1.385 -2.39 1.245 0.314 >0.05
Y axis -4.13 1.480 -4.65 1.163 0.110 >0.05

Table II. Comparisonbetween right and left average measurements(mm) of the TMJ in the intercuspal position of 10
edentulouspatients
Left Right

x SD s SD t P

Anterior space 1.38 0.838 1.47 0.603 0.341 >0.05

Upper space 3.05 0.836 3.18 1.104 0.279 >0.05
Posterior space 2.18 0.793 2.45 1.011 1.096 >0.05
X axis -2.02 1.131 -1.95 0.842 0.217 >0.05
Y axis -5.29 1.052 -5.39 1.216 0.808 >0.05

Table III. Comparison of the average measurementsof the TMJ between the intercuspal position (IP) and the
edentulous position (EP) of 10 Edentulous Patients (mm)
EP IP

TI SD x SD t P

Anterior space 1.62 0.715 1.43 0.712 1.896 >0.05

Upper space 2.63 0.709 3.12 0.955 3.795 <O.Ol
Posterior space 1.39 0.406 2.32 0.895 5.866 <O.Ol
X Axis -2.31 1.284 -1.99 0.971 1.286 >0.05
Y Axis -4.48 1.307 -5.34 1.107 5.987 <O.Ol

the condyle and the mandible as a whole do not move up-
ward and backward. In the edentulousposition of the TMJ,
the condyle may rotate upward and backward with the an-
terior mandible moving forward and upward. This rotation
is alsodemonstrated by the protrusive relationship of the
mandibular residual ridge to the maxillary residual ridge
by decreasingthe vertical dimension of occlusionin eden-
tulous patients. The potential for rotation suggeststhat
the condyle has some adaptability to tooth abrasion or
loss.
This study suggeststhat it is important to correctly de-
termine the vertical dimensionof occlusionand the inter-
cuspalposition not only for the function and esthetic value
of a denture, but alsofor the proper position of the condyle
within the glenoid fossa to prevent TMJ disorders. This
study confirms that the mandible movesforward and up-
ward as abrasion of the natural teeth or artificial teeth
occurs. If an edentulous patient has not had a complete
denture for a long time, the symphysis may be somewhat
protrusive and the condyle may be in a backward and up-
ward position. When a denture is madefor such a patient,
the position of the condyle in the glenoid fossaand the re-
lationship of the maxilla to the mandible should be
improved.
SUMMARY AND CONCLUSION
When edentulous patients approximate maxillary and
mandibular residual ridges, the upper and posterior joint
spacesand the distance from the center of the condyle to
the center of the glenoid fossaon the Y axis will decrease.
The anterior joint spaceand the distance from the center
of the condyle to the center of the glenoid fossaon the X
axis doesnot increasesignificantly. The mandibular resid-
ual ridge is often found in a forward and upward position

THE JOURNAL OF PROSTHETIC DENTISTRY 403

 HONGCHEN, JILIN, AND NING

which is referred to as “the edentulous position of the Willis BH. Tomographic study of the relationship between the man-
dibular condyle and glenoid fossa in patients with temporomaudibular
TMJ.” In this position, the mandible rotates, the condyle joint dysfunction [Master’s thesis]. Washington DC: Georgetown Uni-
moves upward and backward, and the symphysis of the versity, 1982.
mandible moves upward and forward. Hatjigiorgis CG. A tomographic study of the temporomaudibular joint
of edentulous patients. J PROSTHET DENT 1987;57:354-358.

We thank Mr. Wang Zhaowu of General Hospital of Chinese Reprint requests to:
DR. LIU HONGCHEN
P.L.A., Dr. Alfred0 Rossi of George Eastman Hospital of Italy, and
POSTGRADUATE MEDICAL COLLEGE AND GENERAL
Mrs. Margaret Cappelli-Perciballi for their help to this article. HOSPITAL OF CHINESE P.L.A.
28 FUXIN ROAD
REFERENCES BEIJING
CHINA
1. Zbang Zhenkang. A tomographic study of the temporomandibular joint
in normal adults. Chin Med J 1975;2:130-132.
2. Brewka RE. Pantograpbic evaluation of cepbalometric binge axis. Am
J Orthod 1981;79:1-19.

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