review article
Concept of Shortened Dental Arch: An Overview
Mohit Bansal*, Sunint Singh#, Roohi Jindal@
Shortened dental arch (SDA) serves as a treatment option that ensures oral function by improving oral hygiene,
comfort & possibly reduced cost. The shortened dental arch approach appears to fit well with problem solving ap-
proach in modern dentistry. This paper will highlight the various aspects of shortened dental arch.
Key words: Dentition, shortened dental arch, treatment approach
Introduction
F
or the partially-dentate or edentulous patient,
the dental surgeon has to consider number
of factors such as oral functionality, vertical
dimension and occlusion, maintenance of hard
tissue, temporomandibular joint health, as well as
patient comfort1. Dentists replace missing, damaged,
and severely decayed teeth by fixed or removable
prostheses to restore or improve masticatory
function2. The literature indicates that dental arches
comprising the anterior and premolar regions can meet
the requirements of a functional dentition. ARND
KAYSER was the first to coin the term “shortened
dental arch” in 1981 to describe the concept of
acceptable oral function with partial dentition3.
A shortened dental arch is defined as dentition
where most of the posterior teeth are missing. The
shortened dental arch concept was developed to
avoid complex restorative treatment in posterior
regions of mouth as according to WHO dental arches
comprising the anterior and premolar regions can
meet the requirement of a functional dentition 3.
Classification4
A classification for the shortened dental arch,
suggested by “KAYSER”, according to the number
of teeth remaining in the arch and symmetry of
shortening is as followed:-
*
Senior Resident, Oral Health Sciences Centre,
Post Graduate Institute of Medical Sciences, Chandigarh
#
Lecturer, Department of Prosthodontics,
Swami Devi Dyal Hospital & Dental College, Barwala, Distt. Panchkula.
@
Demonstrator, Department of Prosthodontics
Bhojia Dental College & Hospital Bhud, Baddi, Himachal Pradesh.
Corresponding Author
Dr. Mohit Bansal,
Email : mohit.bansal51@gmail.com
560
Abstract
• Symmetrically Shortened Dental Arch
• Extremely Shortened Dental Arch with asymmetry.
A system considering occlusal units as premolar
equivalents was also developed in which a molar is
equivalent to two premolar units and a premolar is
equivalent to a single occlusal unit. Thus a single
arch of four molars and four premolars would
account for 12 occlusal units.
Effect of Shortened Dental Arch on
Oral Function & Mastication
The masticatory ability is closely related to the
number of teeth, and there is impaired masticatory
ability when the patient has less then 20 well
distributed teeth5. Masticatory efficiency and
masticatory ability are important components of
oral functionality but due to patient’s adaptation to
changes in dental arch length it is not possible to
quantify the minimum number of teeth needed to
satisfy functional demands because these demands
vary from individual to individual.
Studies performed by Kayser et al suggested that
there is sufficient adaptive capacity in patient’s with
shortened dental arches when atleast four occlusal
units are left, preferably in a symmetrical position.
However, the chewing ability deteriorates when
the number of occlusal units is less then four in
symmetrically shortened arches and less then six in
asymmetrically shortened arches 6.
Over all, if the premolar regions are intact and there
is atleast one pair of occluding molars, the authors
concluded that a shortened dental arch does not impair
masticatory efficiency. In contrast, there is severely
impaired masticatory ability when the patient has
reduced number of occluding premolars and / or
Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 4, August-October 2012

asymmetric arches, especially with the hard food.
Impaired masticatory ability and associated changes
or shifts in food selection are manifested only when
there are less than 10 pairs of occluding teeth 7.
Comparision between ADA and
Complete Demta; Arches 8, 9
When subjects with shortened dental arches were
compared with complete dental arches with respect
to occlusal stability it was concluded that –
1. SDAs provided durable stability.
2. Extension base removable partial dentures (RPD) did not
contribute to occlusal stability.
3. SDAs with periodontally involved teeth demonstrated
continuing periodontal break down.
Occlusal stability was accessed by Witter et al 9 with
the following five parameters used as indicators:-
1. Interdental spacing
2. Occlusal contacts
3. Vertical and Horizontal overlap
4. Occlusal tooth wear.
5. Periodontal support.
They found that the occlusal changes were self
limiting and concluded that SDAs can provide long
term occlusal stability.
When oral functionality for patients with shortened
dental arches was compared with that for patients
with dental arches lengthened by distal extension
removable partial dentures, no significant differences
were found in the oral functionality of subjects with
SDAs and those who wore RPDs.
Advantages of Shortened Dental Arch
Although restoration of dental arches upto second
molars is desirable both by patient and clinicians,
it is not always possible for all the patients and
can be limited by financial reasons and surgical
complications. Furthermore, the current accepted
level of oral health is retention of a functional,
esthetic, natural dentition of not less than 20 teeth
and not requiring the use of prosthesis.
Financially, the shortened dental arch concept is
acceptable to the patient as molars are more prone
to be lost by both dental caries and periodontal
diseases and are considered being the most costly
teeth to preserve.
Restoration of a shortened dental arch meets the
characteristics of current theories of an acceptable
Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 4, August-October 2012
Review Article
occlusion by terminating occlusal platform at the
second premolar region. It also provides a high
standard of care and minimal cost by avoiding
restorative treatment for the posterior regions of
mouth. This is beneficial for the potential implant
patient since no posterior implants are needed
which eliminates both the surgical implant and final
restorative procedures thus reducing cost 8.
When the oral comfort for shortened dental arches
patients was compared with that for SDAs and distal
extension RPD and for subjects with complete dental
arches, no significant were found between the three
groups with respect to pain or distress. While SDAs
can compromise oral comfort to a small extent, it
is still acceptable to the patient, and there were no
indication that providing distal extension RPDs
enhanced oral comfort for SDA patient 10.
According to Armellini and Vonfraunhofer SDA may
be beneficial for immunosuppressed patients and
those undergoing radiotherapy or chemotherapy as
complete dental arch restoration may be inadvisable
for those patients. With restoration of shortened
dental arches the patient reported satisfaction in
terms of oral comfort, absence of pain or distress,
masticatory ability, appearance of the teeth and ease
of performing daily oral hygiene procedures 8.
Disadvantages of Shortened
Dental Arches
Although restoration of shortened dental arches in
partially edentulous patients offers advantages, some
disadvantages have also been found associated with
SDAs. It seems that most people can functionally
accept a shortened dental arch, but this is not true
for everyone, many people with an SDAs found that
their chewing ability is hindered or that they had to
change food preparation practices 1.
Some patients with shortened dental arches reported
the prevalence of temporomandibular joint (TMJ)
problems. A study performed by Witter et al showed
that there is greater prevalence of joint sounds with
subjects having only unilateral posterior support
and those with no posterior support. However, there
were no differences in pain, mandibular mobility,
maximum mouth opening or clicking / crepitation of
the joints for SDA and control groups. While there
was no evidence that SDAs provoke TMJ problems,
it was noted that the risk for pain and joint sounds
561
 Review Article
increased when unilateral or bilateral support is
missing 11.
Shortened dental arch may be associated with
greater tooth migration and interdental spacing,
although migration was deemed small and clinically
insignificant. An SDA may also be associated with
greater over eruption of teeth. People with SDAs
have been found to have more mobile teeth and lower
alveolar bone levels. The combinations of increased
occlusal loading and existing periodontal disease
represent a risk factor for further loss of teeth in those
people. Patient with SDA probably also represent a
high risk group in term of periodontal disease 12.
Oocclusal and TMJ Loads in
Shortened Dental Arches 13
To determine whether shortened dental arches
(SDAs) cause functional over loading of the
teeth and the temporomandibular joint, which
has been implicated in periodontal diseases and
temporomandibular disorders, the influences of
SDA on occlusal and joint loads were investigated.
The finding of the studies provide no evidence that
shortened dental arch causes overloading of the teeth
and the joints, which suggests that neuromuscular
regulatory system are controlling maximum
clenching strength under various occlusal conditions.
A possible explanation for these findings which deny
a relation between temporomandibular disorder
and shortened dental arch is that neuromuscular
regulatory mechanisms protect the joints from
overloading. Because the sensory innervations
of this joint is limited mainly to the joint capsule,
retrodiscal area and the posterior band of disk, neither
the mechanoreceptors nor the nocireceptors in the
joint are well suited for detecting excessive load
during clenching. The neuromuscular regulatory
system thus seems designed to control the clenching
strength so as not to exceed the critical limit of the
load bearing capacity of periodontal tissues.
Conclusion
The Shortened dental arch concept does not
contradict current occlusion theories and appears to
fit well with the problem solving approach. It offers
some important advantages one of which is decrease
emphasis on restorative treatments for the posterior
regions of mouth. However, functional demands, and
the number of teeth to satisfy such demands vary
562 Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 4, August-October 2012
from individual to individual hence they should be
treated according to each individual need and adaptive
capability. SDA may avoid risk of overtreatment of
the patient while still providing a high standard of care
and minimizing cost. It may therefore be concluded
that this concepts deserves serious consideration in
treatment planning for partially edentulous patients.
However, ongoing changes in dental health and
economy, the concept require continuing research,
evaluation and discussion.
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