Biomechanics of the

Edentulous State

Dr Balendra pratap singh

BDS, MDS, MAMS, FISDR, FPFA, FAAMP, ICMR-IF
Assistant Professor
Deptt. of Prosthodontics
 Table of content
 Support mechanism for natural teeth.
 Support mechanism for complete denture.
 Functional and parafunctional considerations
 Changes in Morphological face height and the
TMJ.
 Esthetic, Behavioural, and Adaptive
responses.
 Conclusion
Support mechanism for natural teeth
• The principal functions
of the periodontium are
support and positional
adjustment of teeth
together with secondary
and dependent function
of sensory perception
and osteogenetic
regulation potential.
 Periodontium as a supporting
element
Soft tissue: PDL +Gingiva Hard tissue: bone+ cementum

 Highly organized and  Cementum resorbs rarely.

oriented.
 Bone well vascularized.
 Highly vascularized (three
 Normally bone receive
sources).
tensile loads.
 Highly innervated( touch,
 Provide excellent medium
pain &pressure).
for PDL attachment.
 Contain elastic fibers.
 Approximately uniform
thickness.
 Support mechanism for complete
denture
Alveolar mucosa
Uneven thickness-thinnest
in mid palatal region.
Uneven attachment
&resiliency.
Less vasularization &
innervations.
Diminished
proprioceptive nerve
endings.
Reduced elasticity.
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.
 Support mechanism for complete
denture
Alveolar bone
Receive vertical,
diagonal & horizontal
loads.
Undesirable and
irreversible bone loss.
 Concepts of bone loss
• As a normal sequalae of loss of PD
structure-disuse atrophy.
• Not necessary a consequence of tooth loss
but depends on a series of poorly
understood factors. Local bone resorbing
factors-endotoxins from plaque, PGs,
OAF etc. Systemic factors include all
those that influence the balance b/w
normal bone formation & bone
resorption.
Factors influencing mucosal support
• Total surface area: 22.96 cm2 edentulous maxilla
12.25 cm2 edentulous mandible
45 cm2 PDL
• Tolerance and adaptability: reduced by
systemic and metabolic disease.
• Masticatory loads: 44Ib(20 kg) natural teeth
13 to 16 Ib(6 to 8 kg) complete denture.
 Function
Parafunction

DENTULOUS STATE
Tooth support :
PERIODONTIUM

EDENTULOUS STATE
CD support : MUCOSA

Morphological face height Cosmetic perceptions

& TMJ changes & adaptive responses
DIAGRAM OF MASTICATORY SYSTEM SHOWING THE POSSIBLE INTERACTIONS OF ITS
COMPONENTS IN THE CONTEXT OF CHANGE IN OCCLUSAL SUPPORT MECHANISM
 Functional and parafunctional
considerations
• Functional: occlusion
mastication& swallowing
mandibular movements
• Parafunctional: bruxism
denture induced
 Occlusion
The primary components of human
dental occlusion:
1- dentition
2- neuromuscular system
3- craniofacial structures
 Developing 1-development of motor skills&
dentition neuromuscular learning.
▼ 2- dental , alveolar, craniofacial adaptability

Healthy adult dentition 1-dental adaptation (wear, drift, extrusion)

▼ 2-bone adaptation is reparative.
3-learned protective reflexes.

Deteriorating adult dentition 1-partial edentulism.

▼ 2-periodontal disease.
3-diminished dental reflex adaptation.

The edentulous state 1-residual ridge reduction..

2-compromised reflex.
3-increase in parafunctional movements.
 Mastication, swallowing & other
mandibular movements
• Mastication consists of a rhythmic
separation and apposition of the jaws
and involves biophysical and
biochemical processes including lips,
teeth, tongue ,palate and all the oral
structure to prepare food for
swallowing.
 Mastication
• duration per stroke 0.3 sec.
• 1800 stroke/ day
• occur during meals
•Each thrust is short duration.
•stress transmitted through
bolus of food to the opposing
teeth. These forces increase
steadily , reach a peak and
abruptly to zero
• directed principally
perpendicular to occlusal plane
with some horizontal
component.
Deglutition
• duration is 1 sec.
• 500 times/day
• occur at meals & in-between
( daytime 400sec, sleep 80
sec)
• tooth contacts are usually of
longer duration than chewing
and are fleeting in nature.
• mainly vertical in direction
with slight horizontal
component by surrounding
musculature
 Important facts on Mastication
• 25% masticatory efficiency is adequate for
complete digestion of food .
• Maximal biting force for complete denture
wearers is 5-6 times less than natural biting
force for complete denture :100N at molar
region and 40N anteriorly.
• Tendency to chew at premolar-molar region.
 MANDIBULAR MOVEMENTS

The mandibular movement patterns in denture

wearing patients are similar to those with natural
teeth .
 Parafunctions
• Parafunctions related to complete denture
Tongue thrusting against denture.
Tendency to occlude teeth frequently.
Strong response of the lower lip and mentalis to lower
labial flange
• The main problem with the parafunctional
habits are that they impose undesirable stresses
on underlying mucosal tissues resulting in
soreness due to interruption or diminution in
blood flow which in turn upsets the
metabolism of involved tissues.
 DURATION
DIRECTION AND
OF FORCE MAGNITUDE OF
FORCE
Mainly Intermittent and
MASTICATION vertical light.
Diurnal only
Frequently Prolonged and
PARAFUNCTION horizontal as excessive.
well as Both diurnal and
vertical nocturnal
 WHAT WE CAN DO?
• All possible methods should be undertaken to ensure continued tissue
health by minimizing the potential traumatic effects of complete
dentures.
FUNCTION AND
PARAFUNCTION NOT UNDER DENTIST’S CONTROL
GENERATE

PRESSURE = FORCE * TIME

CONTROLLED BY: CONTROLLED

1)ADEQUETE PREPARATION OF SUPPORTING PARTIALLY BY
HARD AND SOFT TISSUES. NOCTURNAL
2)COMPLETE DENTURE BASE EXTENSION WITHIN TISSUE REST
MORPHOLOGIC AND FUNCTIONAL LIMITS.
3)REDUCTION OF THE AREA OF OCCLUSAL TABLE.
4)USE OF RESILIENT DENTURE BASE LINING
MATERIALS.
5)DEVELOPING OPTIMAL DENTURE OCCLUSION
6)PATIENT INSTRUCTED TO HANDLE
PARAFUNCTIONAL HABITS BTHROUGH
EDUCATION AND UNDERSTANDING.
 CHANGE IN MORPHOLOGICAL FACE
HEIGHT & TMJ CHANGES
• The skeletal growth terminated 20-25y of age.
• It is recognized that growth and remodeling
continues throughout adult life and such growth
accounts for dimensional changes in adult facial
skeleton.
• TALLGREN,1957 found that morphological face
height (MFH)increases with age in persons with
intact dentition.
• However, a premature reduction in MFH occurs with
attrition & abrasion of teeth and this reduction is
even more conspicuous in edentulous and complete
denture wearing patients.
• Any changes in MFH as result of teeth loss are
inevitably transmitted to TMJs.

• In
l CD wearers, mean reduction in height of

mandibular process in ant.region is 6.6 mm,approx.4

times greater than mean reduction in maxilla.

• This reduction in residual ridges tends to cause a

resultant reduction in total face height & an increase
in mandibular prognathism.

• Longitudinal studies and cephalometric observations

support the hypothesis that the vertical dimension of
rest change throughout life.
• Thus concepts of reproducible & relatively
unchangeable maxillo-mandibular
relationships may not identically apply to
edentulous patients as they do to those with
healthy dentitions.

• However ,the recognition that jaw relations are

not immutable does not invalidate the clinical
requirement of using CR record as a starting
point for developing a prosthetic occlusion.
 Centric relation
• CR is the most posterior relation of the mandible to the
maxilla at the established vertical dimension.
• The occlusion of complete denture is designed to
harmonized with the primitive unconditioned reflex of
swallowing, that is mandatory to prevent disharmonious
occlusal contacts.
• Centric occlusion position is the most functional and
physiologic position for occlusion however it could not be
recorded accurately in edentulous subjects.
• The coincidence of CR &CO is the proper solution as well.
• CR is subjected to change with alteration in face height,
and morphological change in the TMJs.
 TMJ changes
• Most of edentulous patients experience a spectrum
variation as a result of mutilated dentition.
• In the course of such periods, pathological and/or
adaptive structural alterations may take place.
• Appearance of cartilage cells and GAG occur as
response of additional forces to TMJ by teeth loss.
• Continued loading beyond adaptive capability of the
articular tissues may lead to osteoarthritis.
• TMJ could undergo degenerative joint disease,
however other investigators consider it as a process
rather than disease entity.
 COSMETIC CHANGES AND
ADAPTIVE RESPONSES
Esthetic changes :
• Deepening of the nasolabial groove.
• Loss of labiodental angle.
• Narrowing the lips.
• Increase in columella philtral angle.
• Prognathic appearance.
• Decrease in horizontal labial angle.
 Adaptability
• Acceptance and usage of dentures require
adaptation of learning, muscular skills and
motivation.
• Learning mean 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 process occurred.
• Habituation is the gradual diminution of
responses to continued or repeated stimuli.
• The oral cavity is richly innervated which
receive various stimuli from the prosthesis as a
foreign body.
• After repeated stimuli ,the tissue response
decrease due to information storage.
• The habituation process reduced with
advancing age due to progressive atrophy of
elements in the cerebral cortex.
• The tactile stimuli should be specific and identical
to achieve habituation.

• Patient’ motivation dictates the speed with which

adaptation to denture takes place.

• Connection exists between emotional problems

and denture problems.

• Emotional and psychological factors also should

not be neglected.
 CONCLUSION
• The edentulous state represents a compromise in
the integrity of masticatory system ,which is
frequently accompanied by adverse functional,
behavioural and cosmetic consequences, which
are varyingly percieved by the patient.
• So, 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.