good afternoon

Biomechanics of edentulous state

Guided byDr P.N. Sharma

Presented bydr.indrani das p.g. 1st year student

Outline-

Introduction Causes of patients becoming edentulous Mechanism of tooth support Mechanisms of Complete denture Support DIFFERENCES between persons with natural teeth and persons wearing CD RR changes following teeth loss Occlusion Distribution of Stress Morphologic Changes in the face associated with the edentulous state Individual behavioural responses Adaptive & psychological responses

Introduction
The edentulous patient represents a compromise in the integrity of the masticatory system that is

frequently accompanied by
adverse functional and cosmetic sequelae, which are varyingly perceived by edentulous patient.

Perceptions of the edentulous state may vary from feelings of inconvienience to feelings of handicap.

This seminar provides an understanding of the effects of edentulous condition and its clinical management.

Causes of patients becoming edentulous

Caries Periodontal disease Non disease factors Attitude Behavior Dental attendance Characteristics of health system Low occupational levels

Mechanism of tooth support

The masticatory system is made up of following components morphologic Functional Behavioral
When natural teeth are replaced by artificial teeth ,interaction among these are affected

Teeth function properly only if adequately supported --Periodontium(PDM)

Hard tissues (cementum & bone) Soft tissues (periodontal ligament & lamina propria of gingiva) PDM attaches teeth to bone (resilient suspensory apparatus resistant to functional forces) Teeth adjust their position under stress Principal function Support & positional adjustment Secondary and dependent function is Sensory perception

 Occlusal forces exerted are controlled by neuromuscular mechanisms of masticatory system Reflex mechanisms with receptors in muscles, tendons, joints & periodontal structures --- regulate mandibular movements Greatest force produced mastication & deglutition, short & vertical in direction Tongue & circumoral musculature longer duration & horizontal in direction

Calculation of forces applied on PDM-:

CHEWING Actual chewing time per meal Four meals per day 450 1800 0.3 sec sec sec

One chewing stroke per sec

Duration of each stroke Total chewing forces per day

1800 strokes
540 sec (9 min)

SWALLOWING
Meals Duration of one deglutition During chewing, 3 deglutition per min, 1/3 rd with occlusal force BETWEEN MEALS Daytime 25 / hr (16 hr) Sleep : 10 / hr (8 hr) 400 sec (6.6 min) 80 sec (1.3 min) 1 Sec 30 Sec (0.5 min)

TOTAL

1050 sec = 17.5 min

Mechanisms of Complete denture Support

Masticatory loads: The basic problem in the treatment of edentulous pt. lies in to the difference between the ways natural teeth and the artificial teeth are attached to the supporting bone. In natural dentition,pdl bear the functional load, With complete dentures,mucous membrane is forced to serve the same function. Masticatory load (conscious effort) 44 lb (20 kg) Maximum forces with CD - 13-16 lb (6 to 8 kg) Mucosa support: Approximate area of PDL support 45 cm2

Mucosa support - denture bearing area Maxilla 22.96 cm2 Mandible 12.25 cm2

DIFFERENCES BETWEEN PERSONS WITH NATURAL TEETH AND PERSONS WEARING CD1.Mucosal mechanism of support as opposed to support by periodontium. 2.movement of denture bases during mastication. 3.progressive changes in maxillomandibular relation and eventual migration of denture bases 4.different physical stimuli to the sensorimotor system. 5.Alveolar bone supporting natural teeth receives tensile load through pdl 6.Edentulous RAR receives vertical,diagonal,horizontal loads applied by a denture with a surface area much smaller than the total area of pdl of all natural teeth that had been present

Residual ridges

A variety of changes occur in

the residual ridges after extraction and wearing of CDFunction modifies the internal structure of bone Pressure causes resorption Tension in some situation causes deposition denture bearing area becomes progresssively smaller as residual ridges resorb. RRR MAY BE FURTHER ACCELERATED BY systemic diseases anaemia, hypertension, diabetes, nutritional deficiencies.

Occlusion
Primary components of dental occlusion 1. Dentition 2. Neuromuscular system 3. Craniofacial structures
FORCE GENERATED
DIRECTION Mastication Parafunction Mainly Vertical Frequently Horizontal as well as Vertical DURATION & MAGNITUDE Intermittent & light Diurnal only Prolonged, possibly excessive Both diurnal & nocturnal

CD ARE SO DESIGNED THAT THEIR OCCLUSAL SURFACES PERMIT BOTH FUNCTIONAL AND PARAFUNCTIONAL MOVEMENTS OF MANDIBLE.
Orofacial and tongue muscles play an important role in retaining and stabilizing CD. This is accomplished by arrangement of teeth in neutral zone where there is functional balance of orofacial and tongue musculature.

Muscular factors can be used to increase retention and stability of dentures. Key muscles of this activity arebuccinator Orbicularis oris Intrinsic and extrinsic muscles of tongue

Parafunction The initial discomfort associated with new denture is known to evoke unusual pattern of behaviour in the surrounding musculature. Habit of thrusting tongue against-sore tongue EMG-strong response of lower lip and mentalis in long term denture wearers with impaired retention and stability of lower denture.

Function & parafunction generate

Pressure

Force

Time

Controlled by

Controlled partially by

Tissue damaged by occluding local circulation

1. Correct clinical technique 2. Use of permanent soft liner

Nocturnal tissue rest

Distribution of Stress
Denture supporting tissues-viscoelastic. On application of loadInitially elastic compression of tissues Delayed elastic deformation of tissue {slow and continues to diminish in rate as duration of load is extended} On removal of loadElastic decompression Continuing delayed elastic recovery 4 hours to recover after moderate loading of 10 minutes. Longer period for recovery of displaced mucosa is required in elderly people[68-70 yrs] than in young[21-27 yrs]

Mucosal health can be promoted Hygienic measures Therapeutic measures Tissue-conditioning techniques OCCLUSAL LOAD can be reduced by Maximum extension Reduction of area of occlusal table Frequent rest periods (8 hours)

Factors affecting retention that are under control of

dentist: Maximal extension of denture base Maximal area of contact between mucous membrane and denture base intimate contact of denture base & its basal seat ALMOST ALL PRINCIPLES OF CD CONSTRUCTION HAVE BEEN FORMULATED TO MINIMIZE THE FORCES TRANSMITTED TO SUPPORTING STRUCTURES OR TO DECREASE THE MOVEMENT OF THE PROSTHESIS IN RELATION TO THEM.
.

Morphplogic Changes in the face associated with the edentulous stateCOSMETIC CHANGES 1. Deepening of Nasolabial groove 2. Loss of Labiodental angle 3. Decrease in horizontal labial angle 4. Narrowing of lips 5. Increase in columellaphiltral angle 6. Prognathic appearance

Individual behavioural responses Early communication about a patients cosmetic expectations should be established to avoid later misunderstanding Photographs of their predentulous appearance Careful explanation of prosthodontic objectives and methods is the basis for good communication with pt.

Adaptive & psychological responses

CD requires adaptation of learning, muscular skill & motivation Patients ability & willingness to accept & learn to use dentures ---- success Also Habituation gradual diminution of responses to continued or repeated stimuli In old age Memory & Storage is difficult, so adaptation to CD becomes difficult
(as progressive atrophy of elements in cerebral cortex & consequent loss in facility of coordination occurs)

So Dentists role is to MOTIVATE the patients & make understand their NEEDS has proven to be of greatest clinical value

Adaptation problems that may be encountered by PT

previously wearing CD opposing a few natural anterior mandibular teeth: MAY FIND CD Difficult to adapt,altered size and orientation of tongue. insertion of new denture-new environment for the tongue, intrinsic muscle reorganizes shape of tongue to conform to altered space available. Retraining of tongue posterior RR are now exposed to new sensation from overlying denture

ConclusionThe success of prosthodontic treatment is predicated not only on manual dexterity but also on ability of dentist to relate to patient and to understand their needs.

Indexprosthodontic treatment of edentulous patient,boucher Complete dentures,hugh delvin

Thank you