Influence of body mass index and the time of edentulousness on the residual alveolar ridge resorption in complete denture wearers

Alveolar bone loss (RRR) is a continuous process following tooth extraction, more pronounced during the first few months after the tooth extraction than later. The RRR in the mandible is twice that of the maxilla during a 1-year period and the mandibular: maxillary resorption ratio increases further to 4:1. So far, the etiology of RRR has not been elucidated. It has been speculated that both systemic and local factors contribute. The aim of this study was to analyse the rate of RRR in five different regions of both jaws on lateral cephalograms of 100 complete denture wearers during a one-year period and to compare the rate of RRR between patients being edentulous over a different period of time and between patients with different body mass index. The height of residual ridges was measured on 5 different sites at the delivery of the dentures and a year later using a calibrated grid. The results revealed significant RRR in a one year period. Body mass index had no significant influence on the rate of RRR on any of the five examined sites of the maxilla or the mandible (p > 0.05), while the period of edentulousness had a significantly higher rate of resorption in first 3 sites of measurement (anteriorly) in patients being edentulous less than 1 year than in patients being edentulous for 1-10 years or for over 10 years (ANOVA, p < 0.05).     

Responses of jawbone to pressure

Objective: To provide a literature review of bone resorption of edentulous jaws focusing on responses to pressure. Background: After the extraction of all teeth in a jaw there is a continuous reduction of the residual ridge. The individual variation of bone resorption is great, and the aetiology is complex and not yet well understood. Materials and methods: A search of the literature published up to May 2003 on bone resorption and pressure was performed using PubMed/Medline. Results: Animal studies have demonstrated that excessive and constant pressure induces bone resorption. Recent experimental research has indicated that bone resorption is a pressure‐regulated phenomenon with a lower threshold for continuous than for intermittent pressure. Clinical studies have suggested that residual ridge resorption is due more to the effects of denture wearing than to disuse atrophy. However, the results of leaving out dentures at night are not conclusive. Nor does the literature offer any strong evidence for the so‐called combination syndrome, which has been described as a result of unfavourable loading. Clinical studies using multivariate analyses indicate that female gender and systemic factors may be of greater importance than oral and denture factors. Implant‐supported prostheses have a bone preserving effect rather than the continuing resorption under complete dentures. Conclusions: The best way to reduce bone resorption is to avoid total extraction, preserve a few teeth and fabricate overdentures. In edentulous jaws, placement of implant‐supported prostheses will lead to less bone loss and may even promote bone growth. To increase our knowledge of residual ridge resorption extended experimental, clinical and statistical methods will be needed, preferably including collaboration between dental and medical researchers.     

Residual ridge atrophy in complete denture wearers and relationship with densitometric values of a cervical spine: a hierarchical regression analysis

doi: 10.1111/j.1741‐2358.2011.00589.x Residual ridge atrophy in complete denture wearers and relationship with densitometric values of a cervical spine: a hierarchical regression analysis Background: The rate of residual ridge atrophy (RRR) and its association with mineral density of other bones have not yet been fully explained. Objective: To measure RRR over a 5‐year period in complete denture wearers and relate it to the density of a cervical spine (CSBD). Materials and methods: Sixty‐two patients (different gender, age, body mass index, duration of edentulousness (DE) and different denture‐wearing habits) participated. A copper stepwedge was attached to the cassette, and 50 lateral radiograms met the criteria to be included. Results: A significant decrease in vertical height was observed in all measured sites. The amount of RRR was highest in frontal areas of both jaws and decreased gradually towards lateral regions. Hierarchical regression analysis revealed that the amount of RRR in the maxillary frontal area could be explained up to 48.4% by the variable DE and only up to 6.1% by the CSBD, while gender had almost no influence (1%). Similar results were obtained for the lateral maxillary RRR (33.9%; 7%; 2%), frontal mandibular RRR (40; 8.4; 0.4%) and lateral mandibular RRR (31.5%; 3.4%; 7.7%). Conclusion: Skeletal bone density, reflecting systemic and hereditary factors, is weakly related to RRR (3.4–8.4%).     

Radiographic evaluation of alveolar ridge heights of dentate and edentulous patients

doi: 10.1111/j.1741‐2358.2010.00391.x Radiographic evaluation of alveolar ridge heights of dentate and edentulous patients Objective: To evaluate the reduction of residual alveolar ridge height on panoramic radiographs and the differences between denture wearers and non‐denture wearers. Materials and methods: The study consisted of 147 individuals (74 men and 73 women) [50 were denture wearers and 50 non‐denture wearers (examination groups) and 47 of them were dentate (control group)]. Individuals having diseases impacting on bone were excluded. Vertical measurements were made at 15 sites (central incisors, first premolars and molars at the left and right of both jaws and the distance between the zygoma/orbit). MANOVA (multi‐variate analysis of variation) was used for the statistical analysis of the results. Results: There were significant differences between the alveolar ridge heights of dentate and edentulous groups (p < 0.001). Between the denture wearer and the non‐denture wearer groups, there was significant difference in the lower jaw (p < 0.001), but no significant difference in the upper jaw (p = 0.635). There were also differences between men and women (p < 0.005) and upper and lower jaws at every measurement sites (p < 0.01). Conclusion: Reduction in residual alveolar ridge height was in close relation with gender, denture usage and edentulousness.     

Augmentation of the atrophic mandible with a vascularized rib graft

A patient with a 29-year history of denture wearing had her mandible augmented with a vascularized rib graft. The rib was contoured to fit the arch of the mandible and vascularized by means of the facial arteries to the intercostal vessels. The nutrient artery was not included in the vascularized bone graft. Cortical cancellous bone chips were packed around the rib to augment the buccal surface of the rib graft. Periosteal perfusion and vascularity of the transferred rib were well documented at 1 week, 1 month, and 6 months postoperatively by radionuclide scintigraphy. It is now 24 months after surgery and the patient began wearing a denture 2 months after the rib transfer. She underwent a split-thickness skin graft vestibuloplasty and floor-of-the-mouth lowering 12 months following the rib transfer with improvement in her denture-wearing capabilities, which has remained constant for 10 months. Vertical resorption of the graft at 3 months was 10 percent, at 6 months 15 percent, and it has stabilized at 25 percent.     

The effect of osteoporosis on residual ridge resorption and masticatory performance in denture wearers

doi: 10.1111/j.1741‐2358.2011.00610.x The effect of osteoporosis on residual ridge resorption and masticatory performance in denture wearers Aim: To compare masticatory performance, masticatory efficiency and residual ridge resorption (RRR) in osteoporotic and non‐osteoporotic edentulous subjects after rehabilitation with complete dentures. Method: Thirty subjects fulfilling the inclusion criteria were enrolled from the patients visiting the Department of Prosthodontics for complete denture fabrication. Two groups consisting of control subjects (group I; N = 15) and osteoporotic subjects (group II; N = 15) were formed. Complete dentures satisfying certain criteria were fabricated for both groups. Masticatory performance and efficiency were measured 6 months after denture insertion. Areal measurements were taken on lateral cephalograms before and 6 months after denture fabrication. The data were then computed to analyse differences between groups I and II using SPSS statistical software version 15.0. Results: Six months after denture fabrication, the masticatory performance and efficiency were significantly higher (p < 0.001) for group I, with a significant decrease in maxillary and mandibular sagittal area seen in both groups. The rate of bone loss was more in group II compared with group I. Conclusion: Greater masticatory function was demonstrated by the non‐osteoporotic group, and the rate of RRR was more in the osteoporotic group compared with the normal group. In this pilot study, osteoporosis leads to greater RRR, decreased masticatory performance and efficiency in edentulous subjects 6 months after denture insertion. Screening for osteoporosis is suggested as a routine procedure for all edentulous subjects undergoing rehabilitation. Recall check‐ups for osteoporotic patients should be more frequent, and these patients may require more frequent denture remakes.     

The influence of age and denture wear on the size of edentulous structures

Objectives : This study was designed to evaluate the influence of age and denture use on the size of arches and residual ridges in edentulous patients. Design : At two nursing homes, maxillary and mandibular stone casts of 302 fully edentulous patients were utilized to measure the size of the arches and residual ridges, according to age and use of complete dentures. Age cohorts were divided into three groups; 60–69, 70–79, and 80–89 years old. Two hundred and forty‐nine denture wearers used complete dentures for at least 2 years before examinations. Fifty‐three non‐denture users had never worn removable prostheses. Chi‐square analysis (p<0.05) was used to establish the possible relations between the linear values and the size indexes of the ridges and arches and the two examined parameters: age and denture wear. Results : Young old patients possessed edentulous structures that were not significantly larger than elderly old patients in both the maxilla and the mandible. Non‐denture users had significantly bigger arches and ridges in both edentulous jaws than denture users. Conclusions : Young old, non‐denture users tended to have bigger residual edentulous tissues compared to elderly old patients who used complete dentures.     

New facial measurement used in the determination of palatine index and thickness of the mandibular body index

Measurements of the height of the mandibular body and the length of the palate rest on the assumption that the alveolar parts of the mandible and maxilla are not altered. Unfortunately, in the skeletal remains of the past population most of the molar teeth are often antemortem lost and this tooth loss is followed by resorption of the alveolar ridge. A new method of taking mandibular and palate measurements, which could be used in these cases is proposed in the study.     

Influence of psychological factors on the acceptance of complete dentures

Objectives: To assess the influence of psychological factors on the acceptance of complete dentures in a population wearing dentures judged to be clinically satisfactory. Design: Subjects were asked to complete personality profiles and also to rate their dentures using a denture satisfaction questionnaire. Setting: The survey was conducted in the prosthetics clinic of a teaching hospital. Subjects: Patients were selected from those who had new complete dentures constructed in the department within the previous two years. Intervention and main outcome measures : The personality inventory was a self‐administered questionnaire comprising 240 items covering the five domains of personality. Denture satisfaction was scored on a nine item scale with four Likert type responses to each. Results: A group of 16% consistently complained about their dentures. Statistical analysis showed that personality factors especially Neuroticism had a significant relationship with denture satisfaction. Conclusion: Psychological factors significantly influence denture satisfaction and profiles may provide useful in predicting potential difficult denture wearers.     

全口义齿修复后造成松软牙槽嵴和／或牙槽嵴粘膜增生的原因初探

目的:研究松软牙槽嵴和/或牙槽嵴粘膜增生形成的原因,探讨预防和治疗措施。方法:对180例戴用全口义齿一年以上的患者进行临床调查研究。研究内容包括缺牙原因,义齿戴用的时间,牙槽嵴粘膜情况,松软牙槽嵴和/或牙槽嵴粘膜增生发生的部位,人工牙的类型等。结果:①180例全口义齿病例中,有松软牙槽嵴者20例,占22％,男:女=6:4,其中下牙槽嵴占60％,上牙槽嵴占,20％,上下牙槽嵴均有者占20％。患牙槽嵴粘膜增生者共8例,占4.4％,最多发生在下舌侧,其次为下唇沟。同时患有松软牙槽嵴和牙槽嵴粘膜增生的有4例,占患牙槽嵴粘膜增生病例的一半。②在患松软牙槽嵴的病例中,人工牙为塑料牙和瓷牙各占50％。缺牙原因为牙周病者共12例,占60％,龋病2例,占10％,龋病-牙周病者8例,占30％。③在患松软牙槽嵴的病例中,下颌牙槽嵴条件均为差,上颌牙槽嵴条件均为中或差。在患增生的粘膜组织的病例中,75％病例义齿固位为中或差,25％义齿固位为较好。结论:发病原因与患者缺牙原因,牙槽嵴部位,牙槽嵴条件,人工牙类型等有关。因此可以认为,牙槽嵴粘膜松软是戴用全口义齿后出现的不可忽视的问题,而牙槽嵴粘膜松软和/或增生的粘膜组织是相辅相成的。所以一副全口义齿不是一劳永逸的,使用一定的时间后需要更换,特别对牙槽嵴条件较差的患者     

Two-dimensional finite element analysis of stresses developed in the supporting tissues under complete dentures using teeth with different cusp angulations

Statement of problem: The selection of appropriate teeth for complete denture occlusion is very important for long‐term success, and adequate maintenance of the residual alveolar ridge. Purpose: The purpose of this study was to determine the stress generated underneath the complete denture by altering the cuspal angulations of the denture teeth. Material and methods: A two‐dimensional finite element model of a coronal section of maxillary and mandibular complete dentures, mucosa and alveolar bone in the first molar region was designed. The occlusal aspect of the denture teeth was altered to make 33°, 20°, 0° cuspal angulation. All the nodes at the bases of maxillary and mandibular alveolar bone of finite element analysis models were restrained in all directions. A functional occlusal load of 50 N was applied through the mandibular model base. To design these models and to analyse them, EMRC’s NISA II finite element analysis computer software was used. In these models, the elements were selected (a, b, c, d, e, f) in the region where it was necessary to determine the stresses generated in both the maxillary and mandibular portions. Results: The results were interpreted as Von Mises stresses and were observed in pre‐defined areas. The stress patterns observed within model with each type of posterior occlusion, showed unique variations as well as some similarities. Conclusion: Stresses of greater magnitude were observed in cuspal teeth, 33° and 20° respectively, where as 0° teeth showed a slightly less magnitude of stress generated.     

Linear vertical jaw resorption potential in elderly complete denture wearers: a five-year follow-up study

Human bones decrease in quality and increase in porosity beginning at about the third decade of life. The aim of this study was to establish an equation to predict the maxillary and mandibular linear vertical resorption potential for elderly edentulous patients on the basis of the analysis of the cervical vertebrae in a single cephalometric radiograph. The morphology of the bodies of the third and fourth cervical vertebrae and measurements of linear vertical resorption in the frontal region of the jaws were analyzed in two consecutive cephalometric observations of 26 elderly edentulous patients over the five-year period of wearing complete dentures. An equation was determined to obtain maxillary and mandibular linear vertical resorption on the basis of measurements in the third and fourth cervical vertebral bodies and the average errors between the predicted and the actual values were 0.14 mm. The cervical vertebrae exhibited significant decrease in the height and width, and residual alveolar ridges exhibited significant decrease in the height over the 5-year period of wearing dentures (p < 0.01). These results suggest that using cervical vertebral measurements might allow predicting the maxillary and mandibular resorption for edentulous elderly patients wearing complete dentures.     

Predictive factors for alveolar fenestration and dehiscence

The purpose of this study was to evaluate the distribution and incidence of two forms of alveolar bone resorption known as fenestration and dehiscence across time and space. To accomplish this a Medieval French population was studied and the results were compared with other studies to examine incidence and distribution of alveolar bone resorption. Thus, 1175 teeth were analysed for 81 individuals, from an agropastoral Medieval (12th–14th century) archaeological site of Vilarnau located in the South of France. Tooth presence and absence as well as dental alveolar resorption were recorded. A new standardised methodological approach to record alveolar resorption is presented and can be used for any skeletonised series. Measurements of dehiscence were made in the midline on each root in relation to the cemento-enamel junction and fenestration was considered as resorption restricted to alveolar bone. Through analyses of the distribution and incidence of alveolar bone resorption over-time in a Medieval French population, along with nine other studies, we present a list of predictive factors for alveolar bone resorption. Among these factors tooth position and function were the most important; anterior teeth were more commonly affected, bone resorption was more common on the labial/buccal versus palatal/lingual surfaces, fenestration was also more common on the maxilla and dehiscence on the mandible (p ≤ 0.001). These patterns do not vary through time or space, and therefore, provide predictive factors for health practitioners in oral therapy to improve patient recovery and post oral treatment success.     

Cephalometric evaluation of the changes in mandibular symphysis after 7 years of denture wearing

Objective: To evaluate changes in mandibular symphysis during 7 years of complete denture wearing following extraction of natural anterior teeth. Design: Comparison among measurements taken at four different occasions in a prospective cephalometric study. Setting: The study was conducted at the Dental School of Athens University. Subjects: 10 complete denture wearers (5 women, 5 men) with average age of 53.2 years, at the beginning of the study. Measures: Linear and area measurements of the mandibular symphysis. Results: The overall reduction in the anterior mandibular height was 7.87 mm and in the mandibular symphysis area 54.8 mm² (p<0.05). Females presented higher total average reduction in both variables tested, and more rapid bone loss during the first two years of denture wear, compared to men. Superimposition of the tracings revealed considerable individual variation in mandibular symphysis changes. Conclusion: Results are in line with the findings of other authors indicating continuous reduction and dramatic inter-subject variation in the mandibular alveolar bone, following extraction of natural teeth and wearing of complete dentures.     

Main patterns and individual differences in baboon skull split-lines and theories of causes of split-line orientation in bone

Split-line patterns are reported in skulls of five adult male baboons. While variations in pattern occur in all parts of the skull, these variations are relatively minor in the following regions: supraorbital, lateral orbital, medial orbital, nasal bones, zygomatico-alveolar crest, nasal opening, alveolar process of maxilla and mandible. Wide differences in pattern occur in these regions: infraorbital, zygomatic bone, body of maxilla, and frontal bone posterior to the supraorbital area. The major variability in split-line orientation indicates that oversimplified interpretations of the patterns in terms of (1) conformity to gross structure, or (2) direction of bone growth, are untenable. The variations do not contradict a functional interpretation in which mechanical forces and skull form interact to different degrees in different individuals, however. Skulls of a variety of primates are useful for functional analysis, because they have similar structural plans, but the differences are well outside the normal range of variation for a single species.     

下颌起排法全口排牙临床效果研究

目的:研究通过比较不同的排牙方式制作的全口义齿对咀嚼次数、咀嚼效率以及患者的主观感受的影响。方法:78例无牙颌患者按照牙槽嵴高度分为正常组和低平组,正常组有患者32例,低平组有患者46例,每组分别戴用上颌起排法和下颌起排法制作的全口义齿,比较咀嚼次数、咀嚼效率和满意度的差别。结果:在戴用上颌起排法制作的全口义齿时,正常组的咀嚼次数高于低平组,差异具有统计学意义(t=3.60,P0.05);戴用下颌起排法制作的全口义齿后,低平组的咀嚼次数高于采用上颌起排法的全口义齿,差异具有统计学意义(t=4.41,P0.05);在戴用上颌起排法制作的全口义齿中,正常组的咀嚼效率高于低平组,差异具有统计学意义(t=5.72,P0.05);而在戴用下颌起排法制作的全口义齿后,低平组的咀嚼效率高于采用上颌起排法的全口义齿,差异具有统计学意义(t=7.16,P0.05)。正常组认为使用下颌起排法制作全口义齿咀嚼能力、稳固感好于上颌起排法,差异均具有统计学意义(P0.05);低平组认为使用下颌起排法制作全口义齿咀嚼能力、稳固感和舒适感好于上颌起排法,差异均具有统计学意义(P0.05)。结论:对于牙槽嵴低平无牙颌患者使用下颌起排法制作的全口义齿,能够有效地增强咀嚼效率,提高义齿的稳定性。     

Maximum bite force after the replacement of complete dentures

Objective: The aim of the present study was to investigate whether the maximum bite force ( MBF ) can be improved by the replacement of complete dentures for elderly people. Design: Nine edentulous volunteers, mean age 74.2 (± 5.5) years and average denture experience 19.4 ± 19.5 years (1 to 50 years) had replacement dentures made. After a rehearsal session, MBF was recorded with the old dentures, and with the new dentures immediately at insertion, at 3, 8 days, 2–3 weeks, 1, 2, 3 and 6–10 months post insertion ( p‐i. ). MBF was recorded with the central bearing point method using a full‐bridge strain gauge load cell. Data were analysed off‐line using the mean of two peak readings per patient per session. Results: The results indicate that MBF tended to be impaired when replacement dentures were first fitted (n.s.). However, this trend reversed during the first month p‐i. for patients with a “moderate” lower ridge resorption of Atwood grade 3 or 4 (n = 5). Patients with more severe lower ridge resorption Atwood grade 5 or 6 (n = 4) showed a significantly lower MBF over the entire observation period (p0.05) and took longer to regain bite strength. Only patients with moderate bone resorption exceeded their pre‐insertion level of MBF within the observation period of 6–10 months p‐i. Conclusion: The present pilot study suggests that, at least for elderly patients with severe bone resorption, delayed improvement of MBF should be expected with replacement complete dentures.     

3-D model analysis of the maxilla of infants with lip-jaw-palate clefts]

For the investigation of three-dimensional morphological changes in the maxilla of children with cleft lip and palate, the use of two-dimensional test analysis is inadequate. Since no standardised three-dimensional method has so far been available, a three-dimensional digital, computer-aided procedure was developed to visualize and metrically analyse the growth of the edentulous maxilla of infants with cleft lip and palate. Chronologically consecutive casts of the maxillas (obtained at the ages of one week, and three, six and twelve months) of five children with complete unilateral CLP were measured optically with the instrument Micromeasure 70. Following digitation, the casts were reconstructed in the computer, aligned and superimposed using the Orthosurf program. The distances between the surfaces were then measured; in addition, the surfaces were segmented perpendicular to the alveolar crest at reference points C1, C1', C2, C2' and I. The volumes of the resulting segments were determined and compare with one another. Specially designed software automated the following steps: 1. identification of reference points; 2. alignment of the cloud of points in a system of coordinates, and 3. identification of the alveolar crest. Our initial results show that (1) the new method enables visualization of the extent and direction of morphological changes of the mucosal surface, and (2) reproducible quantification of these changes via the determination of changes in the volume of defined alveolar segments. The three-dimensional analysis presented here permits a comprehensive three-dimensional measurement of the models of the edentulous maxilla of infants with cleft lip and palate.     

3D Mapping of Safe and Danger Zones in the Maxilla and Mandible for the Placement of Intermaxillary Fixation Screws

Intermaxillary (IMF) screws feature several advantages over other devices used for intermaxillary fixation, but using cone beam computed tomography (CBCT) scans to determine the safe and danger zones to place these devices for all patients can be expensive. This study aimed to determine the optimal interradicular and buccopalatal/buccolingual spaces for IMF screw placement in the maxilla and mandible. The CBCT volumetric data of 193 patients was used to generate transaxial slices between the second molar on the right to the second molar on the left in both arches. The mean interradicular and buccopalatal/buccolingual distances and standard deviation values were obtained at heights of 2, 5, 8 and 11 mm from the alveolar bone crest. An IMF screw with a diameter of 1.0 mm and length of 7 mm can be placed distal to the canines (2 - 11 mm from the alveolar crest) and less than 8 mm between the molars in the maxilla. In the mandible, the safest position is distal to the first premolar (more than 5 mm) and distal to the second premolar (more than 2 mm). There was a significant difference (p<0.05) between the right and left quadrants. The colour coding 3D template showed the safe and danger zones based on the mesiodistal, buccopalatal and buccolingual distances in the maxilla and mandible.The safest sites for IMF screw insertion in the maxilla were between the canines and first premolars and between the first and second molars. In the mandible, the safest sites were between the first and second premolars and between the second premolar and first molar. However, the IMF screw should not exceed 1.0 mm in diameter and 7 mm in length.