BIOMECHANICS OF

EDENTULOUS STATE

Guided by- Dr. Mallika S. Shetty

Presented by- Dr. Snigdha Saha
CONTENTS

• INTRODUCTION

• DEFINITIONS

• CLINICAL IMPLICATIONS

i. Modifications in the areas of support

ii. Functional and para functional considerations
iii. Changes in morphologic face height and TMJ
iv. Cosmetic changes and adaptive responses
• IMPLANT PROSTHODONTICS

• SUMMARY
• REFERENCES
 INTRODUCTION

• The edentulous state represents a compromise in the integrity of the

masticatory system.

• It is frequently accompanied by adverse functional and aesthetic sequelae,

which are varyingly perceived by the affected patient.

• Consequently, the required treatment addresses a range of biomechanical

problems that involve a wide range of individual tolerances and perceptions.
 DEFINITIONS

• The application of mechanical laws to living structures, specifically

the locomotor systems of the body.

• The study of biology from the functional viewpoint.

• An application of the principles of engineering design as implemented

in living organisms; synonym : DENTAL BIOMECHANICS

GPT-9
EDENTULOUS STATE

• A condition in which the mouth is without teeth or lacking teeth.

• It may be partially edentulous or completely edentulous.

GPT-9
What is Biomechanics in Prosthodontics?

• Application of mechanical principles on the biological tissues while

studying biology from a functional viewpoint and then using these
principles to design a stable prosthesis.
 CLINICAL IMPLICATIONS
Modifications in areas of support (natural dentition vs
complete denture)

Functional and para-functional considerations

Changes in morphologic face height, and TMJ

Cosmetic changes and adaptive responses.

MODIFICATIONS IN AREAS OF
SUPPORT

Natural Complete
dentition denture
• SUPPORT- to hold up, serve as a foundation.

• The foundation area on which a dental prosthesis rests; with respect to

dental prostheses, the resistance to forces directed toward the basal
tissue or underlying structures
• Support mechanism for the natural dentition:

The masticatory system is made up of

closely related morphological,
functional, and behavioural
components. Their interactions are
affected by changes in the mechanism
of support for a dentition when
natural teeth are replaced by
prosthetic ones.
Teeth function properly only if adequately supported, and this support is provided by
the periodontium, an organ composed of soft and hard connective tissues. The
periodontium attaches the teeth to the bone of the jaws, providing a resilient
suspensory apparatus resistant to functional forces. It allows the teeth to adjust their
position when under stress.
• Through normal function the periodontal structures in a healthy
dentition undergo characteristic mechanical stress.

• The most prominent feature of physiologic occlusal forces is their

INTERMITTENT, RHYTHMIC and DYNAMIC nature.
FORCES ACTING ON THE TEETH:
• The greatest forces acting on the teeth are normally produced during
mastication and deglutition, that are essentially vertical in direction.

• Loads of a lower order but longer duration are produced throughout

the day by the tongue and perioral musculature. And these are
predominantly horizontal in direction.
• Calculation of total time during 24 hours associated with direct
functional occlusal force application to periodontal tissues:-
CHEWING
Actual chewing time per meal 450 sec
4 meals a day (450 x 4) 1800 sec
Each chewing second – 1 chewing stroke 1800 strokes
Duration of each stroke 0.3 sec
TOTAL CHEWING FORCES PER DAY 540 sec = 9 mins

SWALLOWING
MEALS
Duration of 1 deglutition movement 1 sec
During chewing – 3 deglutitions per 1800s*(30min) x 3/3 = 30s
minute
BETWEEN MEALS
Daytime (25/hour) – 16 hours 400 sec = 6.6 mins
Sleep (10/hour) – 8 hours 80 sec = 1.3 mins
• Graf (1969) calculated that the total time during which the teeth are
subjected to functional forces of mastication and deglutition during an
entire day amounts to approximately 17.5 minutes.

• He concluded that this total time and the range of forces seem to be
well within the tolerance level of healthy periodontal tissues.
• In the literature, it has been stated that complete dentures are
mechanical devices subjected to the Principles of Physics (mechanics)
1. Inclined plane
2. Lever

Annals of Prosthodontics & Restorative Dentistry, July-September 2016:2(3):63-68

INCLINED PLANE

• The inclined planes tend to deviate forces and thus produce instability.
When the direction of force is at right angles to the support, there is no
inclined plane action to wreck stability.

Jacobson TE, Krol AJ. A contemporary review of factors in complete denture retention, stability and support, Part- II: Stability. J Prosthet Dent1983;49:165-172.
• The effect of the inclined plane is determined by the direction of the
force as related to the supporting surface.

• Centric position is on the arc of closure made by the mandible when it

is pivoting about its axis in its most unstrained retruded position.

Jacobson TE, Krol AJ. A contemporary review of factors in complete denture retention, stability and support, Part- II: Stability. J Prosthet Dent1983;49:165-172.
MUSCLE ACTION ON TEETH AND
DENTURE BASES

• The buccal, labial and lingual surfaces of the denture bases (together
with corresponding sides of the teeth- polished surface) can behave as
inclined planes either to stabilize or dislodge the dentures according to
the design or use made by them.

Scott BJ, Hunter RV. Creating complete dentures that are stable in function. Dent Update. 2008;35:259- 267.
• Proper positioning of teeth in the zone
of equilibrium along with contoured
polished surfaces of dentures will enable
the associated muscles to contact at an
angle to push the dentures into place

Scott BJ, Hunter RV. Creating complete dentures that are stable in function. Dent Update. 2008;35:259- 267.
Articular surface of glenoid fossa

• The backward facing articular surface of the glenoid fossa may confer
to act as an inclined plane along which the mandibular condyle glides
posteriorly under upward muscle pull on the mandible. The inclined
plane action remains till the condyle meets the resistance of the joint

Annals of Prosthodontics & Restorative Dentistry, July-September 2016:2(3):63-68

• Precise recording of vertical and
horizontal relations that can establish
an appropriate condyle-fossa relation.

Annals of Prosthodontics & Restorative Dentistry, July-September 2016:2(3):63-68

LEVERAGE

• Leverage means lifting of an object from its base.

• Lever system- It consists of the resistance arm and the effort arm.

• Whenever the effort arm is longer than the resistance arm, the
mechanical advantage is in favour of the effort arm.

Annals of Prosthodontics & Restorative Dentistry, July-September 2016:2(3):63-68

Areas of leverage related to complete dentures are:

• Anteroposterior point of application of muscle pull on mandible

• Mandibular condyle as the fulcrum

• Distance of occlusal areas from the support

Annals of Prosthodontics & Restorative Dentistry, July-September 2016:2(3):63-68

Zarb Hobkirk Eckert Jacob. Prosthodontic treatment for edentulous patients: Complete Dentures and Implant-Supported Prosthesis. 13 th ed.
Biomechanical Considerations

• Direction, duration, magnitude and frequency of the stress being

applied onto the denture and the denture bearing area

• Capacity of these areas to resist these forces/ stress.

• Changes due to resistance over time.

Direction and duration of the stress
DIRECTION DURATION AND
FREQUENCY
MASTICATION Mainly vertical Intermittent and light
diurnal only

PARA FUNCTION Frequently horizontal Prolonged, possibly

as well as vertical excessive
Both diurnal and
nocturnal
Magnitude of the stress

• The maximum biting force in a natural dentition is found to be about

200N.

• This force reduces five to six times in a completely edentulous patient

with the highest biting force being around 60-80N with the average
being even lesser.
Zarb Hobkirk Eckert Jacob. Prosthodontic treatment for edentulous patients: Complete Dentures and Implant-Supported Prosthesis. 13 th ed.
Capacity To Resist The Forces

Area of support

Residual ridge

Psychologic effect on retention

Zarb Hobkirk Eckert Jacob. Prosthodontic treatment for edentulous patients: Complete Dentures and Implant-Supported Prosthesis. 13 th ed.
Area of support :

• Watt (1961) has computed the mean denture bearing area to be

22.96 cm2 in the edentulous maxilla
12.25 cm2 in an edentulous mandible

• His estimate of the areas of periodontal membrane of natural teeth is

approximately 45 cm2 in each jaw.

Zarb Hobkirk Eckert Jacob. Prosthodontic treatment for edentulous patients: Complete Dentures and Implant-Supported Prosthesis. 13 th ed.
SNOW-SHOE PRINCIPLE

• The basic “snowshoe principle” of maximal extension is applied for

support. It states that given a constant occlusal force, a
broader denture-bearing area decreases the stress/unit area under
the denture base. decreases tissue displacement & reduces denture-
base movement.

Zarb Hobkirk Eckert Jacob. Prosthodontic treatment for edentulous patients: Complete Dentures and Implant-Supported Prosthesis. 13 th ed.
• It must be remembered that the denture bearing area becomes
progressively smaller as the residual ridges resorb.

• Furthermore, the mucosa itself demonstrates little tolerance or

adaptability to denture wearing, a disadvantage worsened by the
presence of systemic diseases such as anemia, hypertension, or
diabetes, as well as nutritional deficiencies.

Zarb Hobkirk Eckert Jacob. Prosthodontic treatment for edentulous patients: Complete Dentures and Implant-Supported Prosthesis. 13 th ed.
Primary stress bearing area
oPosterior lateral slopes of the

hard palate
Secondary stress bearing area
oRugae area
oResidual alveolar ridge
Hard palate
• Median palatine raphe (midline palatine suture)

1. A bony midline structure

2. May require relief when covered by a denture

Essentials of Complete Denture Prosthodontics. Edited by Sheldon Winkler, 3 rd edition

• So as the ridge resorbs, pressure increases over the palate and when it
becomes prominent in the mid palatal region it acta as a fulcrum point
around which the denture will rotate.

• So, no stress to be placed on this region otherwise soreness, pain can

occur and the denture tends to rock over the centre of palate with this
suture acting as fulcrum.

Essentials of Complete Denture Prosthodontics. Edited by Sheldon Winkler, 3 rd edition

• The posterolateral slopes of the hard palate is considered as the
primary stress bearing area:
1. The overlying epithelium is firmly attached to the underlying
periosteum
2. The cortical plates forming this part of the hard palate are more
resistant to resorption
3. They are placed at right angles to the forces generated during
function and para-function
Essentials of Complete Denture Prosthodontics. Edited by Sheldon Winkler, 3 rd edition
• Since the crest of the ridge is subjected to resorption, there is lack of
smooth cortical bone, so it is considered to be a secondary supporting
structure.

Essentials of Complete Denture Prosthodontics. Edited by Sheldon Winkler, 3 rd edition

Rugae

• Irregularly shaped mucosal rolls in the anterior part of the palate.

• This area resists anterior displacement of the denture and is a

secondary stress bearing area (palate is at an angle to the residual
ridges)

Essentials of Complete Denture Prosthodontics. Edited by Sheldon Winkler, 3 rd edition

• The posterior surface of maxillary body end inferiorly as a convexity
termed the maxillary tuberosity.

• BIOMECHANICAL CO-RELATION- The medial and lateral walls

resist the horizontal and torquing forces that would move the denture
base in a lateral or palatal direction.

Essentials of Complete Denture Prosthodontics. Edited by Sheldon Winkler, 3 rd edition

 Primary stress bearing area
oBuccal shelf area
Secondary stress bearing area
oResidual alveolar ridge

Essentials of Complete Denture Prosthodontics. Edited by Sheldon Winkler, 3 rd edition

BUCCAL SHELF AREA

• It is the area between buccal frenum

• And anterior border of masseter muscle.

• BOUNDARIES:

o Medially- the crest of the ridge

o Distally- the retromolar pad

o Laterally- the external oblique ridge

Essentials of Complete Denture Prosthodontics. Edited by Sheldon Winkler, 3 rd edition
• The mucous membrane covering the buccal shelf area is loosely
attached, less keratinized and contains a thick submucosa overlying a
cortical plate.

• CLINICAL SIGNIFICANCE-
It lies at right angles to the vertical occlusal force. This makes it suitable as a
primary stress bearing area for lower denture.

Essentials of Complete Denture Prosthodontics. Edited by Sheldon Winkler, 3 rd edition

 RESIDUAL ALVEOLAR RIDGE

• The edentulous mandible may become

flat, due to resorption; which results in

outward inclination and progressively

widening of mandible.

• It is the reason for edentulous patients

to have prognathic appearance.

Essentials of Complete Denture Prosthodontics. Edited by Sheldon Winkler, 3 rd edition
• The slopes of the residual alveolar ridge have thin plate of cortical bone.
The slopes of the ridge are at an acute angle to the occlusal forces.

• Hence, it is considered as a secondary stress bearing area.

• Since the crest of the ridge has cancellous bone, it is not favorable as
primary stress bearing area.

Essentials of Complete Denture Prosthodontics. Edited by Sheldon Winkler, 3 rd edition

Ev alu atio n o f M a xim um Bi te F orc e in P ati ents w ith Co mp let e D ent ure s

• AIM- This study aimed to evaluate maximum bite forces (mBF) in

dominant (DS) and non-dominant sides (NDS) at certain time periods
after the insertion of new complete dentures based on prior experience
and gender.
• RESULT- The average mBF values increased during the
observational period, both on the DS and NDS, with significant
difference in DS, which was greater.

• CONCLUSION- mBF represents a significant discriminating variable

of the level of functional adaptation of new complete denture wearers
(nCDWs) about the initial measurements.
 Residual ridge :
• The residual ridge consists of
denture-bearing mucosa,
 the submucosa and periosteum
underlying residual alveolar bone.

Divaris K, Ntounis A, Marinis A, Polyzois G, Polychronopoulou A. Loss of natural dentition: multi‐level effects among a geriatric population. Gerodontology. 2012 Jun;29(2):e192-
9.
• When the alveolar process is made edentulous by the loss of teeth, the
alveoli that contained the roots of the teeth fill in with new bone.

• This alveolar process becomes the residual ridge, the foundation for
the dentures.

Zarb Hobkirk Eckert Jacob. Prosthodontic treatment for edentulous patients: Complete Dentures and Implant-Supported Prosthesis. 13 th ed.
• The loss of teeth and their periodontal support results in a change in
the loading pattern of the alveolar bone from

Tensile to
compressive forces

Forces that are

predominantly
vertical as well as
horizontal
Zarb Hobkirk Eckert Jacob. Prosthodontic treatment for edentulous patients: Complete Dentures and Implant-Supported Prosthesis. 13 th ed.
 b
a

a
b

a- refers to the bone height following extractions

b- shows the bone level several years later.
Risk factors for mandibular bone resorption in complete denture
wearers.

• AIM- This study aimed to evaluate the impact of factors related to the
patient (age, sex, bruxism, and general health) or prosthesis (use of old
dentures, duration of denture wear, and nocturnal wear) on the
mandibular ridge resorption rate (RRR) of complete denture (CD)
wearers.
• RESULTS- Of the factors evaluated, age, previous use of CDs, and
bruxism history were statistically significant for the mandibular RRR.
The RRR was greater among patients older than 60 years, those who
had been wearing old CDs, and those who reported bruxism.

• CONCLUSION- the study concluded that advanced age, bruxism and

old dentures had a negative impact on residual ridge resorption.
• There are two concepts concerning the inevitable loss of residual
bone:
One contends that it is a direct consequence of loss of
periodontal structures.

The other maintains that residual bone loss is not an inevitable

consequence of tooth removal but depends on a series of other
factors.
• The compromised support is further complicated because complete
dentures move in relation to the underlying bone during function.

• So the construction of complete denture should be formulated to

minimize the force transmitted to the supporting structure or to
decrease the movement of the prosthesis in relation to them.
• Brill (1967) pointed out following three factors involved in complete
denture retention that were under the control of the dentist:
Maximal extension of the denture base
Maximal area of contact between the mucous membrane and the
denture base.
Intimate contact of the denture base and its basal seat.
EXTENSION OF THE DENTURE BASE
• The oral mucous membrane varies in structure from area to area and
demonstrates “adaptation to function” very clearly.

• For example, on the hard palate, which has to withstand the forces
developed during the mastication of rough foods, the epithelium is
keratinized. While the floor of the mouth is non keratinized.
 Non-keratinized mucosa

Keratinized mucosa
• From the Prosthodontist’s point of view, it must be realized that there
is a wide range in the consistency of the oral mucous membrane from
patient to patient.

• Moderate extension of a denture flange in one patient will produce

little discomfort, no ulceration, and perhaps a hyperplastic response. In
another there will be early ulceration and little attempt at repair.
• Muscular factors can be used to increase retention and stability of the
dentures.

• The buccinator, the orbicularis oris, 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.
Evaluation of masticatory muscles of edentulous patients by
computed tomography and electromyography

• AIM- To evaluate the influence of the long edentulous period by CT on the

structure of the main masticatory muscles 

• CONCLUSION- Long edentulous period is visible not only in the

functioning of the masticatory muscles, in terms of decreased EMG
activity, but also as decreased density of the muscles which implies muscle
atrophy, as seen by CT in the masseter and medial pterygoid muscles.
Psychologic effect on retention :

• The dentures may have an adverse psychologic effect on the patient,

and the nervous influence that may affect the salivary secretion and
thus affect retention.

• Eventually, the patients acquire an ability to retain their dentures by

means of their oral musculature.
DEVELOPMENT
Healthy adult dentition
Deteriorating adult dentition
The edentulous state
ADAPTATION
Dental adaptation (wearing, drifting, extrusion)
Bone adaptation is reparative
Learned protective reflexes and functional
adaptation
Partial edentulism
Periodontal disease
Diminished dental reflex adaptation
Risk of maladaptive prosthesis-wearing
experience
Residual ridge resorption
Compromised reflex adaptability
Possible increase in parafunctional movements
Increased risk of maladaptive denture-wearing
experience.
FUNCTION: MASTICATION AND OTHER MANDIBULAR
MOVEMENTS

• 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.
• The pronounced differences between persons with natural
teeth and patients with complete dentures are:
The mucosal mechanism of support as opposed to support by the
periodontium
The movements of the dentures during mastication
The progressive changes in maxillomandibular relations and the
eventual migration of dentures
 The different physical stimuli to the sensor motor systems.
• Swoope and Kydd (1966) suggested that the effects of the frequency
and duration of tooth contacts while swallowing may be significant in
denture base deformation.

• They believe that swallowing may contribute to a greater accumulated

transfer of energy from the denture base to the underlying mucosa in
the course of a day than mastication does.
• Dentures move during mastication because of the dislodging forces of
the surrounding musculature. These movements manifest themselves
as displacing, lifting, sliding, tilting or rotating of the prosthesis.

• Opposing tooth contacts occur with both natural and artificial teeth
during function and parafunction when the patient is both asleep and
awake.
I n flu enc e o f th e h eig ht of th e m an di bul ar ridg e o n t he ma s ti cato ry fun ct ion du ring th e fu nc tio nal ada pta tio n w ith ne w c om ple te de ntu res

• OBJECTIVE- This clinical trial evaluated the influence of the height of mandibular
ridge on the masticatory function of complete denture (CD) wearers during the
adaptation period.

• After subjects received the CD, a period of 3 months was necessary for achieving
better Maximal Occlusal Bite Force, Masticatory performance, and self-perceived
comfort with the mandibular denture, regardless of the height of the mandibular ridge.
PARAFUNCTIONAL CONSIDERATIONS
• Parafunctional habits involving repeated or sustained occlusion of the
teeth can be harmful to the teeth or other components of the
masticatory system.

• Teeth clenching is common and is a frequent cause of the complaint of

soreness of the denture-bearing mucosa.
• Patients tend at first to frequently occlude the teeth of new dentures.
This is perhaps to strengthen confidence in retention until the
surrounding muscles become accustomed to their presence.

• A strong response of the lower lip and mentalis muscle has been
observed electromyographically in long-term complete denture
wearers with impaired retention and stability of the lower denture.
 DIRECTION DURATION &
MAGNITUDE

MASTICATION Mainly vertical Intermittent and light

diurnal only

PARA FUNCTION Frequently horizontal as Prolonged, possibly

well as vertical excessive
Both diurnal and
nocturnal
CHANGES IN THE MORPHOLOGICAL
FACE HEIGHT AND THE TMJ
Morphological changes in the maxilla and mandible occur slowly over a period
of years and depend on the balance of osteoblastic and osteoclastic activity.
The articular surfaces of the TMJs also are involved, and at these sites, growth
and remodelling are mediated through the proliferative activity of the articular
cartilages.

Zarb Hobkirk Eckert Jacob. Prosthodontic treatment for edentulous patients: Complete Dentures and Implant-Supported Prosthesis. 13 th ed.
• Resorption of the residual ridges supporting complete dentures and the
consequent reduction in the vertical dimension of occlusion tend to
cause a decrease in the total face height and a resultant mandibular
prognathism.

Zarb Hobkirk Eckert Jacob. Prosthodontic treatment for edentulous patients: Complete Dentures and Implant-Supported Prosthesis. 13 th ed.
• Complete dentures are placed in an environment that retains
considerable potential for change.

• While jaw relations are not unchangeable, the use of centric relation
has its physiologic justification.

Zarb Hobkirk Eckert Jacob. Prosthodontic treatment for edentulous patients: Complete Dentures and Implant-Supported Prosthesis. 13 th ed.
• Centric relation-

A maxillomandibular relationship, independent of tooth contact, in

which the condyles articulate in the anterior-superior position against
the 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
• In vast majority unconscious swallowing is carried out with mandible
at or near centric relation.

• This unconscious reflex swallow is important in developing dentition,

as it influences the movement of teeth within the muscle matrix and
this movement determines tooth position and occlusal relations.

Zhao K, Mai QQ, Wang XD, Yang W, Zhao L. Occlusal designs on masticatory ability and patient satisfaction with complete denture: a systematic review. Journal of
dentistry. 2013 Nov 1;41(11):1036-42.
• The occlusion of complete denture is designed to harmonize with its
primitive reflex of patient’s unconscious swallow.

• Complete denture occlusions must be compatible with the forces

developed during deglutition to prevent disharmonious occlusal
contacts that could cause trauma to the basal seats of the dentures.

Zhao K, Mai QQ, Wang XD, Yang W, Zhao L. Occlusal designs on masticatory ability and patient satisfaction with complete denture: a systematic review. Journal of
dentistry. 2013 Nov 1;41(11):1036-42.
Discriminating Masticatory Performance and OHRQoL
according to facial morphology in complete denture wearers

• AIM- to evaluate the influence of facial type and anterior-posterior

skeletal discrepancy of complete denture wearers on residual height,
masticatory performance, oral health related quality of life (OHRQoL)
and satisfaction levels.

Martins AP, Schuster AJ, da Rosa Possebon AP, Marcello-Machado RM, Pastorino DA, Pereira E, de Rezende Pinto L, Faot F. Discriminating Masticatory
Performance and OHRQoL According to Facial Morphology in Complete Denture Wearers: A Single-Center Controlled Study. The International journal of
prosthodontics. 2020;33(3):263-71.
• CONCLUSION- Dolichofacial patients had superior masticatory
efficiency as compared to brachyfacial patients. Class III patients
showed a reduced capacity to homogenize the food bolus. Thus,
anterior-posterior skeletal discrepancy seems to be the main
contributing factor in masticatory inefficiency is completely
edentulous patients.

Martins AP, Schuster AJ, da Rosa Possebon AP, Marcello-Machado RM, Pastorino DA, Pereira E, de Rezende Pinto L, Faot F. Discriminating Masticatory
Performance and OHRQoL According to Facial Morphology in Complete Denture Wearers: A Single-Center Controlled Study. The International journal of
prosthodontics. 2020;33(3):263-71.
TEMPOROMANDIBULAR JOINT
CHANGES

Temporal bone

Temporomandibular joint

Mandible
It must be considered that before becoming edentulous many patients have
had a mutilated dentition of varying severity over extensive periods, during
which resultant pathological or adaptive structural alterations or changes in the
TMJ may have occurred.

It has also been reported that impaired dental efficiency resulting from partial
tooth loss, inappropriate prosthodontic treatment or its absence can influence
the outcome of temporomandibular disorders (TMDs)
Dawson PE. A classification system for occlusions that relates maximal intercuspation to the position and condition of the temporomandibular joints.
The Journal of prosthetic dentistry. 1996 Jan 1;75(1):60-6.
• The most common joint pathology affecting the TMJ is degenerative
joint disease, also known as osteoarthrosis or osteoarthritis.

• The process involves joint changes that cause an imbalance in

adaptation and a degeneration that results from alterations in
functional demands or the functional capacity of the joints.

Dawson PE. A classification system for occlusions that relates maximal intercuspation to the position and condition of the temporomandibular joints. The
Journal of prosthetic dentistry. 1996 Jan 1;75(1):60-6.
 The pathological process is
characterized by deterioration
and abrasion of articular
cartilage and local thickening
and remodeling of the
underlying bone. These changes
are frequently accompanied by
the superimposition of secondary
inflammatory changes.
Dawson PE. A classification system for occlusions that relates maximal intercuspation to the position and condition of the temporomandibular joints. The Journal of
prosthetic dentistry. 1996 Jan 1;75(1):60-6.
• Clinical experience and long-term studies indicate that a combination
of adjunctive prosthodontic protocols together with appropriate
pharmacological and supportive therapy are usually adequate to
provide these patients with comfort.

• Because of the necessity for mastication and for the avoidance of

parafunctional habits, soft liners is regarded as a valuable adjunctive
step.
Dawson PE. A classification system for occlusions that relates maximal intercuspation to the position and condition of the temporomandibular joints. The Journal of
prosthetic dentistry. 1996 Jan 1;75(1):60-6.
Prevalence of temporomandibular dysfunction in edentulous
patients of Saudi Arabia

• AIM- This study aimed to determine the prevalence of various

temporomandibular joint dysfunction (TMD) signs in healthy asymptomatic
edentulous individuals and denture wearers.

• CONCLUSION- The present study showed a high prevalence of signs of

TMD in healthy asymptomatic completely edentulous individuals.
However, the gender difference was not statistically significant.
AlZarea BK. Prevalence of temporomandibular dysfunction in edentulous patients of Saudi Arabia. Journal of International Oral Health.
2017 Jan 1;9(1):1.
ESTHETIC CHANGES
• MORPHOLOGICAL CHANGES ASSOCIATED WITH
EDENTULOUS STATE:

1. Deepening of the nasolabial grove

2. Loss of labiodental angle

3. Decrease in horizontal labial angle

4. Narrowing of lips

5. Increase in columella-philtral angle

6. Prognathic appearance
Friedman N, Landesman HM, Wexler M. The influences of fear, anxiety, and depression on the patient's adaptive responses to complete dentures. Part I. The
Journal of prosthetic dentistry. 1987 Dec 1;58(6):687-9.
BEHAVIORAL AND ADAPTIVE
RESPONSES
• The process whereby an edentulous patient can accept and use
complete dentures is complex, and the patient’s ability and willingness
to learn to do so ultimately determine the degree of success of the
clinical treatment.

Patil MS, Patil SB. Geriatric patient d psychological and emotional consider-
ations during dental treatment. Gerodontology 2009;26:72e7.
• Optimal denture control requires the interpretation of impulses from
both exteroceptors and proprioceptors which are probably affected by
the size, shape, position and mobility of the prosthesis and the
pressure they generate.

• It has been clearly demonstrated that control of the dentures by muscle

activity is reduced if a surface anesthetic is applied to the oral mucous
membrane.
Patil MS, Patil SB. Geriatric patient d psychological and emotional consider-
ations during dental treatment. Gerodontology 2009;26:72e7.
• The acceptance of complete denture is accompanied by a process of
habituation, which is defined as a “gradual diminution of responses to
continued or repeated stimuli.”

• The tactile stimuli that arise from the contact of the prosthesis with the
richly innervated oral cavity are probably ignored after a short time.

Patil MS, Patil SB. Geriatric patient d psychological and emotional consider-
ations during dental treatment. Gerodontology 2009;26:72e7.
• A typical clinical adaptation problem is often encountered in the
patient who has worn a complete upper denture opposing only a few
natural anterior mandibular teeth.

Patil MS, Patil SB. Geriatric patient d psychological and emotional consider-
ations during dental treatment. Gerodontology 2009;26:72e7.
IMPLANT PROSTHODONTICS
• Fabricating a denture that maintains a fixed relationship with the
underlying bone is rarely possible.

• The possibility of linking dental prosthesis to the facial skeleton via an

implanted device could be a way of overcoming the shortcomings of
conventional removable prosthesis.
DISADVANTAGES OF THE COMPLETE
REMOVABLE DENTURE.
Extensive detail required for proper fabrication
Lack of stability (especially in mandible)
Lack of retention (especially in mandible)
Continued loss of alveolar bone leading to further instability and lack of
retention
Patients using such dentures may be led to believe professional dental care
no longer is needed
Lack of chewing function when ill-fitting
Social concerns (slippage, unnatural appearance)
ADVANTAGES OF THE IMPLANT-
SUPPORTED OVERDENTURE.
As few as two to four implants may be used for support
Good stability
Good retention
Improved function
Improved aesthetics
Reduced residual ridge resorption
Simplest implant-supported prosthesis
Possible incorporation of existing denture into the new prosthesis
The implant-supported overdenture as an alternative to the
complete mandibular denture

• A review of recent literature was performed to summarize the reported

success rate of implants used to support a mandibular overdenture.

Doundoulakis JH, Eckert SE, Lindquist CC, Jeffcoat MK. The implant-supported overdenture as an alternative to the complete mandibular denture. The
Journal of the American Dental Association. 2003 Nov 1;134(11):1455-8.
• Conclusion- The literature indicates that implant-supported
overdentures in the mandible provide predictable results with
improved stability, retention, function and patient satisfaction
compared with conventional dentures. Implants placed in the anterior
mandible have a success rate equal to or greater than 95 percent.

Doundoulakis JH, Eckert SE, Lindquist CC, Jeffcoat MK. The implant-supported overdenture as an alternative to the complete mandibular denture. The Journal
of the American Dental Association. 2003 Nov 1;134(11):1455-8.
SUMMARY
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